Podcasts about Aan

In the January episode of the President's Spotlight, Dr. Jason Crowell and Dr. Natalia Rost discuss AAN's plans for 2026, including a general neurology boot camp, Autoimmune Conference, and new resources for members.    Stay informed by watching the President's Spotlight video.     

Careful assessment and individualized care, provided by a skilled multidisciplinary care team, are emphasized in the holistic approach to neuropalliative care, which considers physical, psychological, social, spiritual, and existential aspects for people with neuromuscular diseases. In this episode, Gordon Smith, MD, FAAN, speaks with David J. Oliver, PhD, FRCP, FRCGP, FEAN, author of the article "Neuropalliative Care in Neuromuscular Disorders" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Smith is a Continuum® Audio interviewer and a professor and chair of neurology at Kenneth and Dianne Wright Distinguished Chair in Clinical and Translational Research at Virginia Commonwealth University in Richmond, Virginia. Dr. Oliver is an honorary professor of Tizard Centre at the University of Kent in Canterbury, United Kingdom. Additional Resources Read the article: Neuropalliative Care in Neuromuscular Disorders Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Smith: Hello, this is Dr Gordon Smith. Today I've got the great pleasure of interviewing Dr David Oliver about his article on neuropalliative care and neuromuscular disorders, which appears in the December 2025 Continuum issue on neuropalliative care. David, welcome to the Continuum podcast, and please introduce yourself to our audience. Dr Oliver: Thank you. It's a pleasure and a privilege to be here. I'm a retired consultant in palliative medicine in the UK. I worked at the Wisdom Hospice in Rochester for over thirty years, and I'm also an honorary professor at the University of Kent in Canterbury in the UK. I've had a long interest in palliative care in neurological diseases. Hopefully we can talk about a bit later. Dr Smith: I really look forward to learning a little bit more about your path and experiences. But I wonder if, before we get into the meat of neuropalliative care with a focus on neuromuscular, if maybe you can kind of set the stage by just defining palliative care. I mean, my experience is that people think of this in different ways, and a lot of folks think- hear palliative care, and they immediately go to end-of-life care or comfort care. So, what- how should we think about maybe the discipline of palliative care or neuropalliative care? Dr Oliver: I see palliative care as very much responding to people's needs, whether that's physical needs, psychological needs, social or spiritual or existential. So, it can be much earlier in the disease progression. And I think particularly for neurological diseases, early involvement may be very important. Dr Smith: That was actually going to be my first substantive question, really, was when to begin the conversation and what does that look like and how does it evolve over time. You have a really great figure in the article that kind of emphasizes the various stages within a patient's journey that, you know, palliative care can become involved. But I wonder if you could use ALS as a good example and describe what that looks like from when a patient is first diagnosed with ALS through their course? Dr Oliver: I think particularly in ALS at the beginning, soon after diagnosis, someone may have a lot of distress and a lot of questions that they need answering. This is a disease they've not had any contact with before. And they don't understand what's going on, they don't understand the disease. So, there may be a great need to have the opportunity to talk about the disease, what may happen, what is happening, how it's going to affect them and their family. As think time goes on, there may be later they develop swallowing problems, and that will need to be talking about a feeding tube and gastrostomy. And again, there may be a lot of issues for the person and their family. As they deteriorate, they may have respiratory problems and need to have discussion about ventilatory support, either by PAP, noninvasive ventilation, or even tracheostomy. And again, I think that's a big issue that needs wide discussion. And then it may be at the final few months of the disease, where they are deteriorating, that they may have increased needs, and their families may have those needs after the death. And I think often families bereaved from someone with a neurological disease such as ALS need a great deal of support, having many mixed emotions. There may be a feeling of relief that they're not involved in that caring, but then a feeling of guilt that they shouldn't be having those feelings. So, I think that can happen over a period of… what with ALS it may be two, three, four years, but it may be similar changes over time with any patient with a neurological disease. It may be ten or fifteen years with Parkinson's or five to ten years with a progressive supranuclear palsy, but there'll be this similar need to look at palliative care during their disease progression. Dr Smith: So, I'm curious at the time of diagnosis of ALS, how far out in the future do you provide information? So a specific question would be, do you talk about end-of-life management? In my experience, ALS patients are sometimes interested in knowing about that. Or do you really focus on what's in front of you in the next three to six months, for instance? Dr Oliver: I think it's both. Obviously, we need to talk about the next three to six months, but often giving patients the opportunity to talk about what's going to happen in the future, what may happen at the end of life, I think is important. And I think a disease like ALS, if they look it up on the Internet, they may have a lot of very distressing entries there. There's a lot about how distressing dying with ALS is. And actually confront those and discuss those issues early is really important. Dr Smith: So of course, the other thing that comes up immediately with an ALS diagnosis---or, for that matter, with any other neurodegenerative problem---is prognosis. Do you have guidance and how our listeners who are giving a diagnosis of ALS or similar disorder should approach the prognostication discussion? Dr Oliver: It's often very difficult. Certainly in the UK, people may have- be a year into their disease from their first symptoms before they're diagnosed, and I've seen figures, that's similar across the world. So, people may be actually quite way through their disease progression, but I do think we have to remember that the figures show that at five years, 25% of people are still alive, and 5 to 10% are still alive at ten years. We mustn't say you are going to die in the next two or three years, because that may not be so. And I think to have the vagueness but also the opportunity to talk, that we are talking of a deterioration over time and we don't know how that will be for you. I always stress how individual I think ALS is for patients. Dr Smith: One of the other concepts that is familiar with anyone who does ALS and clearly comes through in your article---which is really outstanding, by the way. So, thank you and congratulations for that---is the importance of multidisciplinary teams. Can you talk a little bit about how neuropalliative care sits within a multidisciplinary care model? Dr Oliver: I think the care should be multidisciplinary. Certainly in the UK, we recommended multidisciplinary team care for ALS in particular, from the time of diagnosis. And I think palliative care should be part of that multidisciplinary team. It may be a member of the team who has that palliative care experience or someone with specialist experience. Because I think the important thing is that everyone caring for someone with ALS or other neuromuscular diseases should be providing palliative care to some extent: listening to people, discussing their goals, managing their symptoms. And a specialist may only be needed if those are more complicated or particularly difficult. So, I think it is that the team needs to work together to support people and their families. So, looking at the physical aspects where the physiotherapist or occupational therapist may be very important, the psychologicals are a counsellor or psychologist. The social aspects, most of our patients are part of wider families, and we need to be looking at supporting their carers and within their family as well as the person. And so that may involve social work and other professionals. And the spiritual, the why me, their fears about the future, may involve a spiritual counsellor or a chaplain or, if appropriate, a religious leader appropriate to that- for that person. So, I think it is that wider care provided by the team. Dr Smith: I'm just reflecting on, again, your earlier answers about the Continuum of neuropalliative care. Knowing your patient is super valuable here. So, having come to know someone through their disease course must pay dividends as you get to some of these harder questions that come up later during the disease progression. Dr Oliver: I think that's the very important use of palliative care from early on in the diagnosis. It's much easier to talk about, perhaps, the existential fears of someone while they can still talk openly. To do that through a communication aid can be very difficult. To talk about someone's fear of death through a communication aid is really very, very difficult. The multidisciplinary team, I think, works well if all the members are talking together. So that perhaps the speech therapist has been to see someone and has noticed their breathing is more difficult, comes back and talks to the doctor and the physiotherapist. The social worker notices the speech is more difficult and comes back and speaks to the speech therapist. So, I think that sort of team where people are working very closely together can really optimize the care. And as you said, knowing the person, and for them to know you and to trust you, I think that's important. Those first times that people meet is so important in establishing trust. And if you only meet people when they're very disabled and perhaps not able to communicate very easily, that's really difficult. Dr Smith: I think you're reading my mind, actually, because I was really interested in talking about communication. And you mentioned a few times in your article about voice banking, which is likely to be a new concept for many of our listeners. And I would imagine the spectrum of tools that are becoming available for augmented communication for patients who have ALS or other disorders that impair speech must be impressive. I wonder if you could give us an update on what the state of the art is in terms of approaching communication. Dr Oliver: Well, I think we all remember Stephen Hawking, the professor from Cambridge, who had a very robotic voice which wasn't his. Now people may have their own voice on a communication aid. I think the use of whether it's a mobile phone or iPad, other computer systems, can actually turn what someone types into their own voice. And voice banking is much easier than it used to be. Only a few years ago, someone would have to read for an hour or two hours so the computer could pick up all the different aspects of their voice. Now it's a few minutes. And it has been even- I've known that people have taken their answer phone off a telephone and used that to produce a voice that is very, very near to the person. So that when someone does type out, the voice that comes out will be very similar to their own. I remember one video of someone who'd done this and they called their dog, and the dog just jumped into the air when he suddenly heard his master's voice for the first time in several months. So, I think it's very dramatic and very helpful for the person, who no longer feels a robot, but also for their family that can recognize their father, their husband, their wife's speech again. Dr Smith: Very humanizing, isn't it? Dr Oliver: There is a stigma of having the robotic voice. And if we can remove that stigma and someone can feel more normal, that would be our aim. Dr Smith: As you've alluded to, and for the large majority---really all of our ALS patients, barring something unexpected---we end up in preparing for death and preparing for end of life. I wonder what advice you have in that process, managing fear of death and working with our patients as they approach the end of their journey. Dr Oliver: I think the most important thing is listening and trying to find what their particular concerns are. And as I said earlier, they may have understood from what they've read in books or the Internet that the death from ALS is very distressing. However, I think we can say there are several studies now from various countries where people have looked at what happens at the end of life for people with ALS. Choking to death, being very distressed, are very, very rare if the symptoms are managed effectively beforehand, preparations are made so that perhaps medication can be given quickly if someone does develop some distress so that it doesn't become a distressing crisis. So, I think we can say that distress at the end of life with ALS is unusual, and probably no different to any other disease group. It's important to make sure that people realize that with good symptom control, with good palliative care, there is a very small risk of choking or of great distress at the end of life. Dr Smith: Now, I would imagine many patients have multiple different types of fear of death; one, process, what's the pain and experience going to be like? But there's also being dead, you know, fear of the end of life. And then this gets into comments you made earlier about spirituality and psychology. How do you- what's your experience in handling that? Because that's a harder problem, it seems, to really provide concrete advice about. Dr Oliver: Yeah. And so, I think it's always important to know when someone says they're frightened of the future, to check whether it is the dying process or after death. I've got no answer for what's going to happen afterwards, but I can listen to what someone may have in their past, their concerns, their experience. You know, is their experience of someone dying their memories of someone screaming in pain in an upstairs bedroom while they were a child? Was their grandfather died? Trying to find out what particular things may be really a problem to them and that we can try and address. But others, we can't answer what's going to happen after death. If someone is particularly wanting to look at that, I think that may be involving a spiritual advisor or their local spiritual/religious leader. But often I think it's just listening and understanding where they are. Dr Smith: So, you brought up bereavement earlier and you discussed it in the article. In my experience is that oftentimes the families are very, very impacted by the journey of ALS. And while ALS patients are remarkably resilient, it's a huge burden on family, loved ones, and their community. Can you talk a bit about the role of palliative care in the bereavement process, maybe preparing for bereavement and then after the loss of their loved one? Dr Oliver: Throughout the disease progression, we need to be supporting the carers as much as we are the patient. They are very much involved. As you said, the burden of care may be quite profound and very difficult for them. So, it's listening, supporting them, finding out what their particular concerns are. Are they frightened about what's going to happen at the end of life as well? Are they concerned of how they're going to cope or how the person's going to cope? And then after the death, it's allowing them to talk about what's happened and how they are feeling now, cause I think having had that enormous input in care, then suddenly everything stops. And also, the support systems they've had for perhaps months of the carers coming in, the doctor, the nurse, the physiotherapist, everyone coming in, they all stop coming. So, their whole social system suddenly stops and becomes much reduced. And I'm afraid certainly in the UK if someone is bereaved, they may not have the contact with their friends and family because they're afraid to come and see them. So, they may become quite isolated and reduced in what they can do. So, I think it's allowing them to discuss what has happened. And I think that's as important sometimes for members of the multidisciplinary team, because we as doctors, nurses and the wider team will also have some aspects of bereavement as we face not seeing that person who we've looked after for many years and perhaps in quite an intensive way. So, we need to be looking at how we support ourselves. And I think that's another important role of the multidisciplinary team. I always remember in our team, sometimes I would say, I find this person really difficult to cope with. And the rest of the people around the team would go have a sigh of relief because they felt the same, but they didn't like to say. And once we could talk about it, we could support each other and work out what we could do to help us help the patient in the most effective way. Dr Smith: Well, David, I think that's a great point to end on. I think you've done a really great job of capturing why someone would want to be a palliative care specialist or be involved in palliative care, because one of the themes throughout this conversation is the very significant personal and care impact that you have on patients and families. So, I really appreciate your sharing your wisdom. I really encourage all of our listeners to check out the article, it's really outstanding. I wonder if maybe you might just briefly tell us a little bit about how you got into this space? It's obviously one for which you have a great deal of passion and wisdom. How did you end up where you are? Dr Oliver: I became interested in palliative care as a medical student, and actually I trained as a family doctor, but I went to Saint Christopher's Hospice following that. I had actually had contact with them while I was a medical student, so I worked Saint Christopher's Hospice in South London when Dame Cecily Saunders was still working there. And at that time Christopher's had sixty-two beds, and at least eight of those beds were reserved for people with ALS or other neurological diseases. And I became very involved in one or two patients and their care. And Dame Sicily Saunders asked me to write something on ALS for their bookshelf that they had on the education area. So, I wrote, I think, four drafts. I went from sort of C minus to just about passable on the fourth draft. And that became my big interest in particularly ALS, and as time went on, in other neurological diseases. When I went to the Wisdom Hospice as a consultant, I was very keen to carry on looking after people with ALS, and we involved ourselves with other neurological patients. That's how I got started. Having that interest, listening to patients, documenting what we did became important as a way of showing how palliative care could have a big role in neurological disease. And over the years, I've been pressing again and again for the early involvement of palliative care in neurological diseases. And I think that is so important so that there can be a proper holistic assessment of people, that they can build up the trust in their carers and in the multidisciplinary team so that they can live as positively as possible. And as a result of that, that their death will be without distress and with their family with them. Dr Smith: Well, David, you've convinced and inspired me, and I'm confident you have our listeners as well. Thank you so much for a really informative, enjoyable, inspiring conversation. Dr Oliver: Thank you for inviting me. Dr Smith: Again, today I've been interviewing Dr David Oliver about his article on neuropalliative care and neuromuscular disorders, which appears in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues, and thanks to our listeners for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Jasper van Dijk gaat in gesprek met Kemal Rijken, auteur van Verbind en heers, over de toenemende polarisatie en de bestuurlijke stilstand in Nederland. Hoe is het politieke debat zo vastgelopen, en wat is er nodig om weer tot samenwerking te komen?Aan de hand van voorbeelden uit Rotterdam, Zweden, Zwitserland en Denemarken bespreken zij mogelijke nieuwe coalitie- en samenwerkingsvormen, met speciale aandacht voor migratie, democratisch vertrouwen, burgerschap en de rol van media en talkshows. Het gesprek is een pleidooi voor minder loopgraven en meer bestuurlijke verantwoordelijkheid, zonder politieke verschillen te ontkennen.

Make Europe Great Again en BNR Beurs slaan de handen ineen. Met Michal van der Toorn kijken we naar het bizarre jaar dat Europa had. Aan de hand van vijf speeches vertelt Michal hoe de Amerikanen in stappen afscheid namen van Europa. Je hoort wanneer de eerste barstjes zichtbaar waren en hoe de relatie ten einde komt. Ook gaat het over de enorme defensie-uitgaven die Europa moet doen. Een kans voor de Europese economie, maar worden landen niet elkaars grote concurrenten? Mario Draghi komt ook voorbij. Michal denkt dat zijn veelbesproken rapport eindelijk wordt uitgevoerd. Waardoor we dus flinke investeringen gaan zien.See omnystudio.com/listener for privacy information.

In de laatste aflevering van het jaar blikken we traditiegetrouw terug op 2025. Wederom een mooi LEGO®-jaar! Aan de hand van onze befaamde categorieën bespreken we de vele geweldige sets die afgelopen jaar uitgekomen zijn. En we kunnen het uiteraard niet laten om toch nog even de allerstomste sets te benoemen. Bedankt voor weer een jaar lang luisteren naar onze blokjes en op naar een geweldig 2026 vol met LEGO®-blokjes!Besproken sets en andere shownotes kun je vinden op steengoed.show. Hosted on Acast. See acast.com/privacy for more information.

Twintig jaar geleden maakte Joost Luisten zijn debuut op de Europese Tour. Aan de tas had hij toen een 'hardloper' en niet een tourcaddie: Eric Brommert. Eerder dit seizoen hoorde je al de verhalen van beide mannen afzonderlijk. In deze laatste kerstspecial of liever eindejaarsshows van de Seve Podcast blikken ze samen terug op die maanden samen. Van series kijken op de hotelkamer tot omgaan met elkaar nukken.De Seve Podcast is er iedere vrijdag. Jacob (golfpro), Rick (golfer) en Etienne (golfer) bespreken van alles over de golfsport. Niet te serieus, met een glimlach en ze ontvangen geregeld gasten die ook golfen (natuurlijk!).

Make Europe Great Again en BNR Beurs slaan de handen ineen. Met Michal van der Toorn kijken we naar het bizarre jaar dat Europa had. Aan de hand van vijf speeches vertelt Michal hoe de Amerikanen in stappen afscheid namen van Europa. Je hoort wanneer de eerste barstjes zichtbaar waren en hoe de relatie ten einde komt. Ook gaat het over de enorme defensie-uitgaven die Europa moet doen. Een kans voor de Europese economie, maar worden landen niet elkaars grote concurrenten? Mario Draghi komt ook voorbij. Michal denkt dat zijn veelbesproken rapport eindelijk wordt uitgevoerd. Waardoor we dus flinke investeringen gaan zien.See omnystudio.com/listener for privacy information.

De laatste politieke prijzen van 2025 worden uitgereikt. Zo kronen Joline, Bart en Stavros de verliezer van het jaar. En gaan ze op zoek naar het probleem dat eigenlijk geen probleem hoefde te zijn. Maar we onthullen ook van welk thema de meeste luisteraars wakker liggen, en welke partij momenteel jouw stem verdient. Aan tafel: Bart Eeckhout, Stavros Kelepouris, Joline MaenhoutProductie: Laurens Bervoets (hoorstroom) & Dries VermeulenEindredactie: Sam Feys & Rik Boey Wil je reageren? Mail naar podcasts@demorgen.beSee omnystudio.com/listener for privacy information.

In haar leven maakte Brigitte Bardot (91) op vele manieren impact. Want naast gevierd actrice en model was ze ook een omstreden figuur door haar radicaal-rechtse opvattingen. Hoe ga je daar als media na haar overlijden mee om? "Ze keerde zich tegen de islam en was tegen homoseksualiteit. Dat zijn opvattingen die we in culturele kringen niet zo herkennen. Dat maakte haar toch bijzonder", aldus Rennie Rijpma (AD-hoofdredacteur). Journalist en AI-expert Laurens Vreekamp benadrukt hoe in Bardot's leven ook de tijdsgeest veranderde. "Ze heeft op verschillende manieren impact gehad. Toen ze als filmster begon, had ze niet de impact waar we nu naar kijken. Als ze 60 was geworden, had ze een hele andere biografie gehad."  Aan tafel zitten Rennie Rijpma, Laurens Vreekamp en Spraakmaker Lotte Dunselman.

Aan het eind van het jaar blikken de H&W Podcastmakers terug op de H&W Podcasts van 2025. Wat zijn hun belangrijkste leerpunten en wat zijn ze naar aanleiding van deze podcasts in hun dagelijkse praktijk anders gaan doen? Tessa Dijksman, Femke Veldman, Marco Krukerink en Sjoerd Bruggink, allen huisarts, blikken terug. Van endometriose tot fractuurpreventie en van kinderen met koorts tot klinisch redeneren met AI.  

2025 was een geweldig jaar voor de Africast, waarbij we mooie nieuwe verhalen hebben mogen maken, de 100ste aflevering hebben gevierd met een live uitzending en aanwezig waren op de Afrikadag. Aan het einde van dit jaar willen we graag de aflevering nogmaals delen die we allemaal het beste vonden van het afgelopen jaar.In deze aflevering duiken we in het verhaal van Abdulaal Hussein uit Soedan. Over zijn jeugd in dit prachtige land, het verzet tegen de Soedanese tiran, genaamd Al-Bashir, en de gevaarlijke vlucht op een rubberen bootje over de Middellandse zee. Ook spreken we hem over de oorlog die in 2023 in Sudan uitbrak en hoe hij zich vandaag de dag blijft inzetten vanuit Nederland om de crisis in zijn geboorteland onder de aandacht te brengen. Abdulaal is theatermaker, jongerenwerker, deed mee aan het Vrijheidscollege, was winnaar van de Young Impact Award en reisde het hele land rond voor het programma ‘Ask Me Anything' om onwetendheid en desinformatie over vluchtelingen te verminderen.Volg onze LinkedIn: https://www.linkedin.com/showcase/africastpodcast?originalSubdomain=nlVoor mooie beelden, quizjes en 'behind the scenes', volg onze Instagram: https://www.instagram.com/africast_podcast/Link met Jos of Joeri via LinkedIn: https://www.linkedin.com/in/jos-hummelen/ & https://www.linkedin.com/in/joerinortier/

In Nerd Culture #239 kijken Koos, Huey en Jelle uitgebreid terug op 2025: een jaar vol grote releases, verrassingen en verhitte discussies. Wat waren dé films die het jaar hebben gemaakt? Welke series bleven hangen, vielen juist tegen of verrasten onverwacht? Van blockbusters tot kleinere parels en van streaminghits tot bioscoopervaringen: de mannen zetten hun persoonlijke favorieten op een rij, vergelijken lijstjes en blikken terug op de trends die 2025 hebben gevormd. Een aflevering vol meningen, nostalgie en het onvermijdelijke meningsverschil.Ryan Coogler verrast met SinnersWe staan stil bij Ryan Coogler's onverwachte succes met Sinners. De film wist vrijwel uit het niets uit te groeien tot een van de meest besproken titels van het jaar, dankzij Cooglers sterke regie, thematische durf en een toon die duidelijk afweek van wat het grote publiek van hem gewend was. In deze aflevering bespreken we waarom Sinners zo goed werkte, hoe de film zich verhoudt tot Cooglers eerdere werk en waarom dit project voor velen hét bewijs was dat originele, persoonlijke cinema ook in 2025 nog keihard kan raken.One Battle After AnotherOok bespreken we One Battle After Another, een film die dit jaar flink stof deed opwaaien door zijn thematiek en aanpak. De film combineert persoonlijke conflicten met grotere maatschappelijke spanningen en weet die twee verrassend effectief met elkaar te verweven. De boys gaan in op wat de film wil zeggen, hoe de structuur werkt en waarom One Battle After Another voor sommigen een instant favoriet werd, terwijl anderen er juist moeite mee hadden. Is dit een film die vooral blijft hangen door zijn boodschap, of juist door de manier waarop die wordt verteld?Blockbuster Helden: Largo WinchOok hebben we aandacht voor de Blockbuster Helden van Standaard Uitgeverij, en dit keer staat Largo Winch centraal. Terwijl Largo geniet van wat rust op zijn geheime eiland Sarjevane, wordt die abrupt verstoord door de komst van een onbekend jacht. Aan boord bevindt zich Obi Martins, een drone-ontwerper met humanitaire idealen, die echter wordt vermoord nog vóór hij voet aan wal zet. Wat de dader niet weet, is dat Obi's dochter Hope eveneens aan boord was. Largo neemt haar onder zijn hoede en raakt samen met haar verwikkeld in een internationaal complot rond de schimmige dronebusiness. Het duo reist de wereld over om een technologische én humanitaire ramp te voorkomen. Een typisch Largo Winch-avontuur: groots, actueel en vol spanning, zoals je mag verwachten van een echte blockbuster op papier.

Uur 1 1.         Stay as sweet as you are – Nat King Cole 2.         Heel even klein – Tess Merlot 3.         My valentine – Barbra Streisand & Paul McCartney 4.         Brothers in arms – Joan Baez 5.         Os argonautos – Carminho & Caetano Veloso 6.         Slaapliedje – Gerard van Maasakkers 7.         Can't find my way home – Tony Davis 8.         I belong to your heart – Sam Cooke 9.         Aan de Schelde – Joost Prinsen 10.       Ma France – Jean Ferrat 11.       Chambermaid – Suzanne Vega 12.       Strawberries – Robert Forster & Karin Bäumler 13.       Het leven moet een wals zijn – Stef Bos 14.       Bossa antigua – Paul Desmond   Uur 2 1.         Un jour comme un autre – Brigitte Bardot 2.         Schoen calypso – Donald Jones 3.         Room on the porch – Keb'Mo' & Taj Mahal 4.         Diaraby – Sara Baya 5.         Requiem – Eliza Gilkyson 6.         It don't mean a thing…. – Eva Cassidy 7.         Als de liefde niet bestond (Si l'amour n'existais pas) – Katell & Bert Visscher 8.         Peace somehow – Avi Kaplan  9.         Aua atu ra – Marlon Williams 10.       Leaving on a jetplane – Peter, Paul & Mary 11.       Englishman in NY – Sting 12.       Superlover – Allison Russell & Annie Lennox 13.       Gisteren blijft vandaag – Philippe Robrecht 14.       Seul ici – Boulevard des Airs 15.       Grazing in the grass – Hugh Masekela

Denk jij wel eens dat we collectief naar de ratsmodee gaan? Aan het einde van het jaar blikt godsdienstfilosoof Rik Peels terug én vooruit in De verwondering podcast. Samen met Annemiek Schrijver bespreek hij de vraag: hoe gaat het met ons? En waar ziet hij hoop voor 2026?  In De verwondering podcast neemt Annemiek Schrijver haar gasten mee om met hen, weg van de waan van de dag, toevlucht te zoeken bij inspirerende woorden en met hen te praten over hun inspiratie en alledaagse spiritualiteit. 

Drs. Mahinda Yogarajah, Benjamin Tolchin, and Jon Stone discuss recommendations for clinicians, patients, and other stakeholders on the management of functional seizures.  Show citation: Tolchin B, Goldstein LH, Reuber M, et al. Management of Functional Seizures Practice Guideline Executive Summary: Report of the AAN Guidelines Subcommittee. Neurology. 2026;106(1):e214466. doi:10.1212/WNL.0000000000214466  Show transcript:  Dr. Mahinda Yogarajah: Welcome to this edition of Neurology Minute. I'm your host for this. My name's Mahinda Yogarajah. I've just finished interviewing Dr. Ben Tolchin and Jon Stone for this week's Neurology® Podcast. For today's Neurology Minute, I'm hoping Ben can tell us the main points of the podcast and the paper discussed in that podcast. Dr. Ben Tolchin: We discussed the AAN guideline on the Management of Functional Seizures. This is the first American Academy of Neurology evidence-based guideline on functional neurologic disorder. It includes a systematic review of the randomized controlled trials relating to the treatment of this disorder, which found that psychological interventions are possibly effective in improving the chance of achieving freedom from functional seizures, in reducing the frequency of functional seizures, in improving quality of life, and in improving anxiety. In addition to the systematic review, there are clinical recommendations based on the systematic review and on related evidence. The recommendations deal with all stages of the diagnosis, management, and treatment of functional seizures and are particularly relevant to neurologists caring for patients with functional seizures. In addition, there are recommendations for future research relating to the diagnosis and management of functional seizures. Dr. Mahinda Yogarajah: Thank you, Ben. For more information, I'd recommend go to the main podcast or go and have a read of the article that's been published in Neurology® on the Management of Functional Seizures Practice Guidelines.

We hebben iets te vieren, want we hebben duizend Jortcasts gemaakt en jullie, luisteraars hebben ook geluisterd. Bedankt! Om dat te celebreren hebben we onze vier favoriete gasten uitgenodigd (en publiek) om een quiz te spelen en tussendoor vragen te stellen over de wetenschap; kun je gelovig zijn als wetenschapper? En mag of moet je fouten maken als onderzoeker? Aan deze heresengymnastiek spelen mee prof. dr. Marcel Levi (UvA en NWO), prof. dr. Iris Sommer (RuG), prof. dr. Ronald van Raak (Erasmus) en dr. Jelle van Baardewijk (Nyenrode). 

Dit keer is Narrentief geland op inspirerende plek verstopt in de dichte bossen in de buurt van Leersum. Na anderhalve kilometer door het bos, denk je dat je er bent. Dan volgt er nog een lange zandweg. Aan het einde, als je niet meer verder kunt, ligt het boshuis De Ginkel. Buiten het geluid van de ruisende bossen, binnen mooie gesprekken met gasten met een verhaal. Informatieve verhalen, maar ook persoonlijke. Ontspannen, open. Gesprekken met passie. Met: Bert Weteringe, Maria Mazarakis, Amy van Son en Jonathan Krispijn.

Dit keer is Narrentief geland op inspirerende plek verstopt in de dichte bossen in de buurt van Leersum. Na anderhalve kilometer door het bos, denk je dat je er bent. Dan volgt er nog een lange zandweg. Aan het einde, als je niet meer verder kunt, ligt het boshuis De Ginkel. Buiten het geluid van de ruisende bossen, binnen mooie gesprekken met gasten met een verhaal. Informatieve verhalen, maar ook persoonlijke. Ontspannen, open. Gesprekken met passie. Met: Bert Weteringe, Maria Mazarakis, Amy van Son en Jonathan Krispijn.

In deze aflevering neem ik je mee in een helder en verdiepend gesprek over het pijnlichaam.Over dat deel in ons dat geactiveerd wordt wanneer oude pijn wordt aangeraakt en hoe dat zich niet alleen laat zien in gedachten, maar vooral in je lichaam, emoties en gedrag.Je ontdekt:​ wat het pijnlichaam precies is​ waarom je er steeds opnieuw in terechtkomt​ hoe het zich laat zien in relaties, spanning en ontregeling​ en waarom inzicht alleen vaak niet genoeg is om patronen te doorbrekenDeze podcast is bedoeld als bewustzijnsverdieping.Zodat je jezelf niet langer veroordeelt, maar leert herkennen:dit is geen zwakte, dit is een oud beschermingsmechanisme dat gezien wil worden.Aan het einde van de aflevering nodig ik je uit om, als je verder wilt verdiepen, kennis te maken met mijn lichaamsgerichte training Reset & Release voor wie wil leren reguleren, loslaten en veilig aanwezig blijven in zichzelf en in verbinding.Wil je verder verdiepen?Met de code VERBINDING ontvang je €20,- korting op deze waardevolle training.https://wwwleveninwaarheidnl.plugandpay.com/checkout/reset-en-release Je hoeft het niet alleen te doen.Je mag leren verbinden, zonder jezelf kwijt te raken.Heb je vragen of wil je iets delen. Stuur me gerust een bericht via:

Severe acute brain injury presents acute and longitudinal challenges. Addressing total pain involves managing physical symptoms and providing emotional, social, and spiritual support to enhance quality of life for patients and their families. In this episode, Kait Nevel, MD, speaks with Claire J. Creutzfeldt, MD, author of the article "Neuropalliative Care in Severe Acute Brain Injury and Stroke" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Liewluck is a professor in the department of neurology at the University of Washington in Seattle, Washington. Additional Resources Read the article: Neuropalliative Care in Severe Acute Brain Injury and Stroke With Dr. Claire Creutzfeldt Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Guest: @cj_creutzfeldt Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kait Nevel. Today I'm interviewing Dr Claire Creutzfeldt about her article on neuropalliative care in severe acute brain injury and stroke, which appears in the December 2025 Continuum issue on neuropalliative care. Claire, welcome to the podcast, and please introduce yourself to the audience. Dr Creutzfeldt: Thanks, thanks for having me. Yeah, I'm an associate professor of neurology at the University of Washington. I'm a stroke neurologist and palliative care researcher and really have focused my career on how we can best integrate palliative care principles into the care of patients with severe stroke and other neurocritical illness. Dr Nevel: Wonderful. Well, I'm looking forward to talking to you today about your excellent article that I really enjoyed reading. To get us started, can you tell us what you feel is the most important takeaway from your article for the practicing neurologist? Dr Creutzfeldt: Yeah. You know, I think one is always a little biased by what one is working on currently. And I think what I'm most excited about or feel more strongly about is this idea that stroke and severe acute brain injury are not an event, but really a chronic illness that people are left with usually for the rest of their lives, that change their life radically. And I think that education, research funding, also the clinical setting, current healthcare models aren't set up for that. And this idea that severe acute brain injury, you know, should be viewed as a lifelong condition that requires support across all ranges of goals of care. So curative, restorative, palliative and end-of-life care. Dr Nevel: Yeah, I love that part of your article, how you really highlighted that concept. And I think obviously that's something that we see in neurology and learn, especially as we transition out of our residency stages. But I think especially for the trainees listening, can sometimes be hospital inpatient-heavy, if you will, that kind of you can lose sight of that, that these acute strokes, severe acute brain injury, it turns into a chronic illness or condition that patients are dealing with lifelong. Dr Creutzfeldt: Often what we do in a very acute setting is like, is really cool and sexy and like, we can cure people from their stroke if they come, you know, at the right time with the right kind of stroke to the right hospital. And often the symptoms that people come in with much later on are harder to treat and address, partly because the focus in education, clinical and research just hasn't been as much on that time. Dr Nevel: Yeah, absolutely. So, can you talk to us about this concept of total pain? What does it mean, and how do we incorporate this concept into the way that we view our approach, our patient care? Dr Creutzfeldt: Total pain is a very old word, but it's sort of coming back into fashion in the palliative care world because it really describes all those sources of suffering or sources of distress, like, beyond what we sort of really think of as sort of the physical symptoms in recovery of stroke. As many of you know, palliative care often thinks in this multidimensional way of the physical distress, physical pain, but also psychological, emotional, social and spiritual, existential. And both- we sort of created sort of a figure that incorporates all of them and also includes both patients and their family members. They share some of these sources of distress, but they also have distinct ones that need to be addressed. And at the core of that total pain is what we need to provide, is sort of optimal communication and goals-of-care prognosis. Dr Nevel: Yeah, I'm thinking about all of those aspects and not just focusing on one. How does the disease trajectory of severe acute brain injury and stroke play a role in the palliative care approach? And how should we kind of going back to that original point of this idea of severe acute brain injury being an acute event and then oftentimes turning into kind of a chronic condition? How does that play a role in how we address palliative care with our patients, or kind of the stages of palliative care with our patients? Dr Creutzfeldt: Yeah, I think several things, especially for neurologists, is the more traditional palliative care illnesses, like cancer or congestive heart failure, illnesses where people are diagnosed when they're still functioning at a relatively high level and tend to have time to consider their prognosis and their goals of care in the end of life wishes and to meet with palliative care and to consider their personhood. Who am I? What's most important for me? And stroke, people with stroke, they not only present at their worst, they meet us at their worst, at a time when the patient themselves usually can't speak for themselves, when their personhood has been stripped from them. And then as providers, we, you know, we often really just get that one opportunity to get the conversation right and to guide people towards, you know, what we would call optimal and goal-concordant care. So, the challenges are many. I do think that the burden of these early conversations is on neurologists and really requires the neurologists to show compassion, to learn communication skills, think really hard about how you want to communicate prognosis and goals of care early on, because it's going to color people's experiences and decisions longitudinally. You asked about, sort of, this trajectory. And I do think it's important to think about, you know, what really happens even after the thrombectomy or even after we discharge people, especially from the ICU. Because for us, often after sort of day five or six, you know, we're sort of done. We're thinking about secondary stroke prevention. And, you know, how do I get the patient to rehab or out of the hospital? For the patients and families, this is when it really all just starts. You know, this is when they- when they're first memories are usually, you know, they hardly remember that acute setting. And so, when they are medically stable, we're done with the acute blood pressure treatment where we've removed the Foley, we've made a decision about nutrition. For us that tends to be a time where we let go a little; for patients and families that tends to actually be the time when they have to think about how am I going to live with this and what are the next several months or years going to look like? And so being there for them is important. Dr Nevel: That's such a, I think, important point, that when we have our plan in place, we know medically what the plan is for that patient and we're starting to step back, think about rehab or discharge. That's when oftentimes more quote-unquote "reality" steps in for patients and families about what their future is going to look like. Dr Creutzfeldt: And medical stability is not even close to neurological stability. And so, they are still in the middle of real prognostic uncertainty, and often waxing and waning symptoms or new symptoms coming up for them. Like pain, you know, post thalamic pain syndrome, just as an example, tends to be something that doesn't develop until later. Dr Nevel: Right, right. Absolutely. And since you touched on this concept of prognostic uncertainty, and, you know, that's something that's so challenging in severe acute brain injury, especially the early days when you talk about this, you know, that things tend to become a little bit more certain as more time passes. But these are really hard conversations because a lot of times feel like big decisions that need to be made early on, you know? Dr Creutzfeldt: Huge! Dr Nevel: Sometimes things like trach and PEG and things like that. How do you approach that conversation? I know you talk about that a little bit in your article. You touch on that, some of the, kind of, strategies or concepts that we use in palliative care to approach this prognostic uncertainty with patients. Dr Creutzfeldt: Yeah, I think the challenge is to balance this acknowledging uncertainty with still being able to guide the families and allow them to trust you. So, there are a few things that I have said in the past, and I have taught in the past, and I don't use anymore. They include sentences like I don't have a crystal ball, for example. Nobody was asking you for one. The other one that I want us to avoid, I think, is the sentence we are terrible at prognosticating. Because what I have seen is that that sentence carries on for families. And families at nine months are still saying, well, you guys are terrible at prognosticating. That's what you told me. First of all, it's all relative, and relative to non-neural providers---even at this time using Google and AI, we're actually quite good at prognosticating. It's just that a wide range early on. So that's how I would change that sentence is, early on after stroke, the range of possible outcomes is still very wide. And so, you've communicated uncertainty without saying I have no idea what I'm doing, which is not true. That is in order to help families be able to trust you and also to trust the person who comes after you, because we all know that a week or two after admission, we do know a lot more. And if we told them on day one that we're terrible at prognosticating, it's hard to sort of build that trust again later. You also asked about, you know, communication strategies. And I think it's this range of possible outcomes that I think is a good guideline for us to work on. And that range, sort of like a confidence interval, is still very wide early on. And as we collect more information over time, both about the clinical scenario that is evolving in front of us and about the patient who we are learning more about over time, this confidence interval becomes smaller. And that's where this idea of the best case/worst case scenario sort of conversation, for example, comes from: that range of possible outcomes. Dr Nevel: So, what to you is most challenging about palliative care for patients with severe acute brain injury and stroke? Dr Creutzfeldt: I think the biggest challenge in stroke care is balancing restorative and curative care with palliative and end-of-life. And that is especially early on when sort of everything is possible, when patients and families want to hear the good news and, I think, are also quite willing to hear the bad news, and probably should. So, I think that that communication is hard when, you know, really we want to provide goal-concordant care. We want to make sure that people get that care that is most important to them and can meet the outcomes that are most important to them. Dr Nevel: Yeah, agree. What is most rewarding? Dr Creutzfeldt: I think these patients and families have enormous needs and are extremely grateful if they can find someone that they can trust and who can guide them and who will stick with them. And when I say someone, I think that can be a team. That always depends on how we communicate. In the ideal world, it would be the same person following someone over time, the patient and the family over time. But in our current healthcare system, we're usually moving on from one place to another and being able to communicate with the people that come after you. Telling the family that you're a team and supporting them through that, I think, is really important. Dr Nevel: Yeah. And like you touched upon, patients and families, I think oftentimes they're looking for, you mentioned, you know, the sharing and communication and they're looking for information. Dr Creutzfeldt: You know, what's really rewarding is working with a team. And health care has really excelled at that. And I think we have a lot done from them is that it's not always the MD that family needs. And we have a lot of people at our side, and I think we need more of them. Chaplains, social workers; psychologists, actually, I think; and nurses or- in an ideal world, would really work together to support these multidisciplinary, multidimensional symptoms. Dr Nevel: Yeah. I think it benefits both the patient and the care team, too. Dr Creutzfeldt: Absolutely! Dr Nevel: It's helpful to be part of a team. You know, there's camaraderie in that and, like, a shared goal, and I think the thought is rewarding, too. Dr Creutzfeldt: If we really try and think about severe stroke as a chronic illness or severe acute brain injury as a chronic illness not unlike cancer, then if you think about the systems that have been built for cancer where an entire team of providers follows the patient and their family member over time, I think we need that, too. Dr Nevel: Yeah, I agree. That point, every member of the team has overlapping things, but has a slightly individual role to a degree too, which is also helpful to the patient and the family. You talked about this a little bit in your article, and I want to hear more from you about what we know about healthcare disparities in this area of medicine and in providing palliative care for patients with severe acute brain injury and stroke. Dr Creutzfeldt: Yeah, I think actually a lot of the huge decisions that we make, especially early on, are highly variable. And can identify people by various things, whether it's their race or ethnicity or sex or age, or even where they live in the United States. But decisions tend to be made differently. And so, just as an example, we know that I think people who identify as black, for sure, are less likely to receive the acute, often life-saving interventions like TNK or thrombectomy and more likely to undergo longer-term, life-prolonging treatment like PEG and trach. That seems true, after adjusting for clinical severity and things like that. And so disparities like that may be based on cultural preferences or well-informed decisions, and then we can support them. But of course, unfortunately there's a clear idea when we see, often, unexplained variability that a lot is due to uninformed decisions and poor communication and possibly racism in certain parts. And that is, of course, something that has to be addressed. Dr Nevel: Yeah, absolutely. What are future areas of research in this area? I know you do a lot of research in this area and I'd love to hear about some of it and what you think is exciting or kind of new and going to change the way we think about things, perhaps. Dr Creutzfeldt: I think every aspect of stroke continues to be exciting and just, you know, our focus of today and my research is on palliative care. I mean, obviously, the things we can do in rehab these days have to be embraced, and the acute stuff. But I think this longitudinal support, an ideally longitudinal multidisciplinary support for patients and families, requires more research. I think it will help us with prognosis. It will help us with communicating things early on and learning more about sort of multidimensional symptoms of these patients over time. That requires more research. And then, how can we change the healthcare system---in a sustainable way, obviously---to maximize quality of life for the survivors and their families? Dr Nevel: Going back to that total pain again, making sure that we're incorporating that longitudinally. Dr Creutzfeldt: I think there are currently 94 million people worldwide living with the aftermath of a stroke. I joined a stroke survivor support group recently. People are supporting each other that have that had their stroke, like, 14 years ago and are still in that just to show that this is not one and done. People are still struggling with symptoms afterwards and want support. Dr Nevel: Before we close out, is there anything else that you'd like to add? Dr Creutzfeldt: Your questions have all been great, and I think one observation is that we've talked a lot about, sort of, new ideas of the need for longitudinal care for patients after severe stroke. There's still a ton for all of us to do to optimize the care we provide in the very acute setting, to optimize the way we communicate in the very acute setting. To make sure we are, for example, providing the same message as our team members and providing truly compassionate goal-concordant care from the time they hit the emergency room throughout. Including time-limited trials, for example. Dr Nevel: Well, thank you so much for chatting with me today about your article on this really important topic. Again, today I've been interviewing Dr Claire Creutzfeldt about her article on neuropalliative care in severe acute brain injury and stroke, which appears in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues. And as always, to our listeners, please check out the article. It's great, highly recommend. And thank you to our listeners for joining us today. And thank you so much, Claire, for sharing your expertise with us today. Dr Creutzfeldt: Thanks for having me. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Kerstmis staat voor de deur en de voetbalwereld komt op adem na een memorabel transferjaar. Alle reden om in een speciale #DoneDeal terug te blikken op 2025. Wie was het beste koopje, welke transfer pakte rampzalig uit en welke club voerde het slimste beleid? Aan tafel passeren onder meer Luciano Valente, Mo Ihattaren, Luuk de Jong, Carlos Forbs, PSV, Ajax, Feyenoord, NEC en Sunderland de revue, net als de transfers die nét niet doorgingen. En wat waren de beste internationale deal en de sterkste Eredivisie-transfer van het jaar? Check nu De Grote Kerstspecial van #DoneDeal.See omnystudio.com/listener for privacy information.

Episode 3 staat in het teken van de eerste wedstrijden van Congo, Senegal, Nigeria en Tunesië. Senegal laat tot nu toe de allerbeste indruk na op dit toernooi en bevestigt zijn status als topfavoriet.Congo pakt de overwinning tegen Benin, maar dat ging allesbehalve vlot. Tunesië verraste positief met een sterke en volwassen prestatie, terwijl Nigeria vooral het nodige deed om hun start goed af te ronden.Aan tafel deze aflevering: guest Scott, met scherpe analyses en vooruitblikken op wat nog komt in dit Afrika Cup-toernooi.

Hoe begin jij aan een nieuw jaar?Aan de vooravond van het nieuwe jaar heb ik Willem Pinksterboer gevraagd om samen met mij te kijken naar het fenomeen 'goede voornemens'.Waarom sneuvelen onze plannen zo vaak terwijl we vol goede moed beginnen? Zijn 'old school' goede voornemens gedoemd om te mislukken?Willem neemt ons mee in de flow van de seizoenen en 5 elementen.Wat zou er gebeuren als we deze 'lineaire ideeen' vervangen door dit cyclische geheel van intentie, acceptatie en kleine stappen? Met de Vijf Elementen als kompas wordt de Kunst van Veranderen lichter, menselijker en effectiever, zonder de kern uit het oog te verliezen.Het verschil tussen lineaire doelen en circulaire intentiesTerugblikken met metaal en landen in waterVerlangen van binnenuit leren voelenKaizen en mini-stappen die weerstand verlagenVieren als brandstof van vuur en verbindingFocus bewaren in een wereld vol prikkelsMaandelijkse hereiking als ritueel voor richtingDrie niveaus: voornemen, gevoel, grondhoudingWil je dit ritme samen met ons onderhouden? Dat kan bij ons in de praktijk door maandelijks bij ons langs te komen voor een sessie acupunctuur of Qi Counseling om je intentie te verversen en Qi af te stemmen.Wat vind je van deze aflevering? Laat het weten in de comments! Liefs, Nathalie

Send us a textRuilverkaveling, de wolf, stikstof, voedselvoorziening, windmolenklachten en het lied ‘15 miljoen Nederlanders'. In de donkere dagen rond Kerstmis en Nieuwjaar presenteert blckbx.tv een gloednieuwe programmaserie: Wintergasten. Ab Gietelink heeft voor deze serie zeven bekende opiniemakers uit de alternatieve wereld uitgenodigd voor boeiende en leerzame gesprekken, onderbouwd met nieuwsfragmenten uit de afgelopen jaren. De gasten in deze reeks zijn Kees van der Pijl, Willem Engel, Elze van Hamelen, Marcel van Silfhout, Marie-Thérèse ter Haar, Diedert de Wagt en Mordechai Krispijn. Vanavond is Elze van Hamelen te gast. Aan de hand van ‘Het Dorp' van Wim Sonneveld spreken Elze en Ab over de ruilverkaveling en de verbouwing van Nederland. Daarnaast komen onderwerpen aan bod als de wolf, stikstof, voedselvoorziening, de energietransitie, windmolenklachten en het lied ‘15 miljoen Nederlanders'. Support the showWaardeer je deze video('s)? Like deze video, abonneer je op ons kanaal en steun de onafhankelijke journalistiek van blckbx met een donatieWil je op de hoogte blijven?Telegram - https://t.me/blckbxtvTwitter - / blckbxnews Facebook - / blckbx.tv Instagram - ...

Aan tafel zitten Jan Slagter, Frénk van der Linden en Spraakmaker Abdullah Uysal. Sinds vrijdag publiceert het Amerikaanse ministerie van Justitie een deel van de onderzoeksdocumenten over de veroordeelde zedendelinquent Jeffrey Epstein. Opvallend is de hoeveelheid zwartgelakte informatie, foto's die verdwijnen en weer online komen en een haperende zoekfunctie. Interessante bevindingen "vallen tot nu toe heel erg" tegen, ziet Kamran Ullah, hoofdredacteur bij De Telegraaf. "Trump komt er helemaal niet zoveel in voor, vooral Clinton." Ullah denkt daarom dat de verwachting van deze documenten "misschien ook te hoog was." Het betreurt Carmen Fernald, hoofdredacteur Levensbeschouwing en Caribisch Netwerk bij NTR, vooral dat het in de berichtgeving niet veel over de slachtoffers gaat. "Het is een politiek spel geworden terwijl er iets afschuwelijks is gebeurd waar mensen in hoge kringen betrokken bij zijn geweest. Iets meer erkenning voor de slachtoffers zou op zijn plaats zijn."

In deze eindejaarsspecial delen Joline, Bart en Stavros jouw politieke prijzen uit. Wie is de politicus van het jaar? Wat was het meest verrassende politieke moment van 2025? En valt ook Bouchez in de prijzen? Je ontdekt het in dit eerste deel van de Het is maar politiek awards 2025. Aan tafel: Bart Eeckhout, Stavros Kelepouris, Joline MaenhoutProductie: Laurens Bervoets (hoorstroom) & Dries VermeulenEindredactie: Sam Feys & Rik Boey Wil je reageren? Mail naar podcasts@demorgen.beSee omnystudio.com/listener for privacy information.

In episode 2 duiken we in het attractieve spel van **Zuid-Afrika onder Hugo Broos**, dat tegen **Angola** niet alleen plezier bracht, maar ook perfect de bijzondere evolutie van het land als voetballand toont.**Egypte** kwam met de schrik vrij: dankzij **Mohamed Salah** en **Omar Marmoush** trokken ze de wedstrijd naar zich toe tegen **Zimbabwe**.Ook de **teleurstelling van Mali** komt aan bod, dat ondanks hoge verwachtingen niet verder raakte dan een **1-1 tegen Zambia**.Aan tafel deze aflevering: **guest Sherjill MacDonald**, met **Brian** als host en **Alex** als co-host. We sluiten af met een vooruitblik op **Congo** en Alex? Die is nu al helemaal **hyped!**

Aan tafel zitten Carmen Fernald, Kamran Ullah en Spraakmaker Martine Gosselink. Sinds vrijdag publiceert het Amerikaanse ministerie van Justitie een deel van de onderzoeksdocumenten over de veroordeelde zedendelinquent Jeffrey Epstein. Opvallend is de hoeveelheid zwartgelakte informatie, foto's die verdwijnen en weer online komen en een haperende zoekfunctie. Interessante bevindingen "vallen tot nu toe heel erg" tegen, ziet Kamran Ullah, hoofdredacteur bij De Telegraaf. "Trump komt er helemaal niet zoveel in voor, vooral Clinton." Ullah denkt daarom dat de verwachting van deze documenten "misschien ook te hoog was." Het betreurt Carmen Fernald, hoofdredacteur Levensbeschouwing en Caribisch Netwerk bij NTR, vooral dat het in de berichtgeving niet veel over de slachtoffers gaat. "Het is een politiek spel geworden terwijl er iets afschuwelijks is gebeurd waar mensen in hoge kringen betrokken bij zijn geweest. Iets meer erkenning voor de slachtoffers zou op zijn plaats zijn." 

FC Groningen sloot de eerste seizoenshelft af met een 1-1 tegen Go Ahead Eagles, maar bij Radio Milko blijft de toon opvallend positief. De ploeg van Dick Lukkien staat er beter voor dan vooraf werd verwacht, al blijft de afwerking een hardnekkig probleem. Aan tafel bespreken William Pomp, Piet van Dijk en Marnix Kolder hoe de wedstrijd in Deventer symbool stond voor het seizoen tot nu toe: goed veldspel, veel kansen, maar te weinig rendement. De binnenkant-paal van Taha en de grote kans van Schreuders worden genoemd als veelzeggende momenten. Toch overheerst waardering voor de stabiele organisatie en het herkenbare spel onder Lukkien. De contractverlenging van de trainer wordt gezien als een cruciale stap richting de tweede seizoenshelft. “Hij trekt iedereen erbij,” zegt Kolder, die benadrukt hoe helder Lukkien zijn visie overbrengt. Tegelijkertijd waarschuwen de heren voor een mogelijke uittocht komende zomer, met Resink, Van Bergen, Vaessen en Blokzijl als kandidaten voor een transfer. * Vragen voor in de podcast? Mail naar: william.pomp@dvhn.nl * FC Groningen op de voet volgen? Abonneer je hier op onze nieuwsbriefSee omnystudio.com/listener for privacy information.

Zondag 21 december Kerstuitzending Kerstmis (Long) Robert Long 4'06 Van de DVD Kerstconcert Eigen beheer Kerst (Veenstra) Harald Veenstra 2'51 Spotify Jubelzang (Polzer) Drs. P 1'57 Van de cd Drs. P compilé sur cd Polydor 847 920-2 Ik ben een kerstbal (Plafond, Haenen/Van Mechelen) Bert en Ernie 3'09 Van de cd Schippers in Plafondvaart CDJD 15 WTS Oh Lord, what a morning (De Corte) Jules de Corte 3'33 Eigen opname Kyrie Eleison (W. Vermandere) Herman van Veen 2'30 Van de cd Carré 2000 Polydor 549 653-2 Nepreportages (Kaandorp) Brigitte Kaandorp 4'30 Van de cd Badwater BIS 061 Praktische vrouwen (Rienstra) Yora Rienstra 2'55 Van de cd Aan jou heeft het niet gelegen Eigen beheer Kerst Pi-pa-pijpen (Polderman) Katinka Polderman 2'51 van de cd Kerstmis vier je niet alleen Eigen beheer Een beetje sneeuw (L. Vermeulen) Lotte Velvet 2'26 Van de cd Carrousel Eigen beheer Dit jaar wil ik sneeuw (Fosko/Raggende Manne) De raggende manne 1'45 Van de cd Het rottigste van de Raggende manne Eigen beheer Op deze avond (Degenhardt/Groot) Don Quishocking 3'29 Van de LP Trappen op Philips 6423 126 Hier in de stal (Verburg) Roel C. Verburg 3'00 Eigen opname Kerstmis (Finkers) Herman Finkers 3'02 Van de cd Als gezonde jongen zijnde Mercury 812 668-2 Zolang (Lohues) Jenny Arean 2'55 Van de cd Jenny Arean solo BIS 066 Rudolph the red-nosed reindeer (J. Marks) Tonny Eyk Quartet met Frans Poptie, viool Van de LP Christmas party Philips 6401 084

Aan tafel deze week: straatarts Michelle van Tongerloo, filosoof Daan Roovers, kunstenaar Tina Farifteh, schrijver Chloe Dalton. Presentatie: Maaike Schoon Wil je meer weten over de gasten in Buitenhof? Op onze website vind je meer informatie. Daar kan je deze aflevering ook terugkijken en je vindt er natuurlijk nog veel meer gesprekken: https://bit.ly/44DbLUi Michelle van Tongerloo is huis- en straatarts, en in de Rotterdamse Pauluskerk zet zij zich in voor de medische zorg van daklozen. Van Tongerloo ziet al jaren hoe het aantal daklozen toeneemt. Met de winter in aantocht is het de vraag hoe deze groeiende groep de kou moet overleven. ‘Onze democratie staat onder druk', zegt filosoof Daan Roovers in de Huizingalezing deze week. Aan de hand van het werk van historicus Johan Huizinga onderzoekt ze wat een gezonde politieke cultuur vraagt van politici, burgers en media. Daarbij stelt Roovers scherpe vragen: hoe voorkomen we dat kabinetten blijven vallen? En is onze politiek, zoals Huizinga al in de jaren dertig schreef, gevangen in een permanente puberteit? Het vluchtelingendebat bepaalt al jaren de politieke agenda in Den Haag en zorgt voor rumoer in de samenleving. Daarbij verdwijnt vaak de menselijke kant. Met de tentoonstelling In Your Face legt Tina Farifteh juist die onderbelichte kant vast in het Nationaal Archief van het Rijksmuseum met het verhaal van een vluchteling zelf. Ze was een workaholic en politiek adviseur voor het Britse parlement tot een pasgeboren haasje haar aandacht trok. In haar bestseller Een Haas in Huis, schrijft Chloe Dalton hoe deze ervaring haar leven en haar blik op de natuur totaal veranderde. Het boek won verschillende literaire prijzen en was een New York Times-bestseller.

In the hospital setting, neurologists may be responsible for managing common end-of-life symptoms. Comprehensive end-of-life care integrates knowledge of the biomedical aspects of disease with patients' values and preferences for care; psychosocial, cultural, and spiritual needs; and support for patients and their families. In this episode, Teshamae Monteith, MD, FAAN, speaks with Claudia Z. Chou, MD, author of the article "End-of-Life Care and Hospice" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Knox is an assistant professor of neurology and a consultant in the Division of Community Internal Medicine, Geriatrics and Palliative Care at Mayo Clinic in Rochester, Minnesota. Additional Resources Read the article: End-of-Life Care and Hospice Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: This is Dr Teshamae Monteith. Today I'm interviewing Dr Claudia Chou about her article on end-of-life care and hospice, which is found in the December 2025 Continuum issue on neuropalliative care. Welcome to our podcast. How are you? Dr Chou: I'm doing well. Thank you for having me. This is really exciting to be here. Dr Monteith: Absolutely. So, why don't you introduce yourself to our audience? Dr Chou: Sure. My name is Claudia Chou. I am a full time hospice and palliative medicine physician at Mayo Clinic in Rochester. I'm trained in neurology, movement disorders, and hospice and palliative medicine. I'm also passionate about education, and I'm the program director for the Hospice and Palliative Medicine fellowship here. Dr Monteith: Cool. So just learning about your training, I kind of have an idea of how you got into this work, but why don't you tell me what inspired you to get into this area? Dr Chou: It was chance, actually. And really just good luck, being in the right place at the right time. I was in my residency and felt like I was missing something in my training. I was seeing these patients who were suffering strokes and had acute decline in functional status. We were seeing patients with new diagnosis of glioblastoma and knowing what that future looked like for them. And while I went into neurology because of a love of neuroscience, localizing the lesion, all of those things that we all love about neurology, I still felt like I didn't have the skill set to serve patients where they perhaps needed me the most in those difficult times where they were dealing with serious illness and functional decline. And so, the serendipitous thing was that I saw a grand rounds presentation by someone who works in neurology and palliative care for people with Parkinson's disease. And truly, it's not an exaggeration to say that by the end of that lecture, I said, I need to do palliative care, I need to rotate in this, I need to learn more. I think this is what I've been missing. And I had plans to practice both movement disorders neurology and palliative care, but I finished training in 2020… and that was not a long time ago. We can think of all the things that were going on, all the different global forces that were influencing our day-to-day decisions. And the way things worked out, staying in palliative care was really what my family and I needed. Dr Monteith: Wow, so that's really interesting. Must have been a great lecturer. Dr Chou: Yes, like one of the best.  Dr Monteith: So why don't you tell me about the objectives of your article? Dr Chou: The objectives may be to fill in some of the gaps in knowledge that may be present for the general neurologist. We learn so much in neurology training, so much about how to diagnose and treat diseases, and I think I would argue that this really is part and parcel of all we should be doing. We are the experts in these diseases, and just because we're shifting to end-of-life or transitioning to a different type of care doesn't mean that we back out of someone's care entirely or transition over to a hospice or palliative care expert. It is part of our job to be there and guide patients and their care partners through this next phase. You know, I'm not saying we all need to be hospice and palliative care experts, but we need to be able to take those first steps with patients and their care partners. And so, I think objectives are really to focus in on, what are those core pieces of knowledge for end-of-life care and understanding hospice so we can take those first steps with patients and their care partners? Dr Monteith: So, why don't you give us some of those essential points in your article? Dr Chou: Yeah. In one section of the article, I talk about common symptoms that someone might experience at the end of life and how we might manage those. These days, a lot of hospitals have order sets that talk us through those symptoms. We can check things off of a drop-down menu. And yet I think there's a little bit more nuance to that. There may be situations in which we would choose one medication over another. There may be medications that we've never really thought of in terms of symptom management before. Something that I learned in my hospice and palliative medicine fellowship was that haloperidol can be helpful for nausea. I know that's usually not one of our go-tos in neurology for any number of reasons. So, I think that extra knowledge can take us pretty far when we're managing end of life symptoms, particularly in the hospital setting. And then I think the other component is the hospice component. A lot of us may have not had experience talking about hospice, talking about what hospice can provide, and again, knowing how to take those first steps with patients. We may be referring to social work or palliative medicine to start those conversations. But again, I think this is something that's definitely learnable and something that should be part of our skill set in neurology. Dr Monteith: Great. And so, when you speak about symptom management and being more comfortable with the tools that we have, how can we be more efficient and more effective at that? Dr Chou: Think about what the common symptoms are at end of life. We may know this kind of intuitively, but what we commonly see are things like pain, nausea, dyspnea, anxiety, delirium or agitation. And so, I think having a little bit of a checklist in mind can be helpful. You know, how can I systematically think through a differential, almost, for why my patient might be uncomfortable? Why they might be restless? Have I thought through these different symptoms? Can I try a medication from my tool kit? See if that works, and if it does, we can continue on. If not, what's the next thing that I can pivot to? So, I think these are common skills for a little bit of a differential diagnosis, if you will, and how to work through these problems just with the end-of-life lens on it. Dr Monteith: So, are there any, like, validated tools or checklists that are freely available? Dr Chou: I don't think there's been anything particularly validated for end-of-life care in neurologic disease. And so, a lot of our treatments and our approaches are empiric, but I don't think there's been anything validated, per se. Dr Monteith: Great. So, why don't we talk a little bit about the approach to discussions on hospice? We all, as you kind of alluded to, want to be effective neurologists, care for our patients, but we sometimes deal with very debilitating diseases. And so, when we think that or suspect that our patient is kind of terminally ill, how do we approach that to our patients? Of course, our patients come from different backgrounds, different experiences. So, what is your approach? Dr Chou: So, when we talk about hospice and when a patient may be appropriate for hospice, we have to acknowledge that we think that they may be in the last six months of their disease. We as the neurologist are the experts in their disease and the best ones to weigh in on that prognosis. The patient and their care partners then have to accept that the type of care that hospice provides is what makes sense for them. Hospice focuses on comfort and treating a patient's comfort as the primary goal. Hospice is not as interested in treating cancer, say, to prolong life. Hospice is not as interested in life-prolonging measures and treatments that are not focused at comfort and quality of life. And so, when we have that alignment between our understanding of a patient's disease and their prognosis and the patient care partner's goal is to focus on comfort and quality of life above all else, that's when we have a patient who might be appropriate for hospice and ready to hear more about what that actually entails. Dr Monteith: And what are some, maybe, myths that neurologist healthcare professionals may have about hospice that you really want us to kind of have some clarity on? Dr Chou: That's a great question. What we often tell patients is that hospice's goal is to help patients live as well as possible in the time that they have left. Again, our primary objective is not life prolongation, but quality of life. Hospice's goal is also not to speed up or slow down the natural dying process. Sometimes we do get questions about that: can't you make this go faster or we're ready for the end. But really, we are there to help patients along the natural journey that their body is taking them on. And I think hospice care can actually be complex. In the inpatient setting, in particular in neurology, we may be seeing patients who have suffered large strokes and have perhaps only days to a few weeks of life left. But in the outpatient setting and in the home hospice setting, patients can be on hospice for many months, and so they will have new care needs, new urinary tract infections, sometimes new rashes, the need to change their insulin regimens around to avoid extremes of hyperglycemia or hypoglycemia. So, there is a lot of complexity in that care and a lot that can be wrapped up under that quality-of-life and comfort umbrella. Dr Monteith: And to get someone to hospice requires a bit of prognostication, right? Six months of prediction in terms of a terminal illness. I know there's some nuances to that. So how can you make us feel more comfortable about making the recommendations for hospice? Dr Chou: I think this is a big challenge in the field. We're normally guided by Medicare guidelines that say when a patient might be hospice-appropriate. And so, for a neurologic disease, this really only encompasses four conditions: ALS, stroke, coma, and Alzheimer's dementia. And we can think of all the other diseases that are not encompassed in those four. And so, I think we say that we paint the picture of what it means to have a prognosis of six months or less. So, from the neurologic side, that can be, what do you know about this disease and what end-stage might look like? What is the pattern of the patient's functional decline? What are they needing more help with? Are there other factors at play such as heart failure or COPD that may in and of themselves not be a qualifying diagnosis for hospice, but when it's taken together in the whole clinical picture, you have a patient who's very ill and one that you're worried may die in the next six months or less? Dr Monteith: Then you also had some nice charts on kind of disease-specific guidelines. Can you take us a little bit through that? Dr Chou: The article does contain tables about specific criteria that may qualify someone for hospice with these neurologic conditions. And they are pretty dense. I know they're a checklist of a lot of different things. And so, how we practice is by trying to refer patients to hospice based on those guidelines as much as possible and then using our own clinical judgment as well, what we have seen through taking care of patients through the years. So, again, really going back to that decline. What is making you feel uncomfortable about this patient's prognosis? What is making you feel like, gosh, this patient could be well supported by hospice, and they could have six months or less? So, all of that should go into your decision as well. And all of that should go into your discussion with the patient and their care partners. Dr Monteith: Yeah. And reading your article, what stood out was all the services that patients can receive under hospice. So, I think sometimes people think, okay, this is terminal illness, let's get to hospice for whatever reasons, but not necessarily all the lists and lists and lists of benefits of hospice. So, I don't know that everyone's aware of all those benefits. So, can you talk to us a little bit about that? Dr Chou: Yeah, I like that you brought that up because that's also something that I often say to patients and their care partners when we're talking about hospice. When the time is right for a patient to enroll in hospice, they should not feel like they're giving anything up. There should be no more clinical trial that they're hoping to chase down, and so they should just feel like they're gaining all of those good supports: care that comes to their home, a team that knows them well, someone that's available twenty-four hours a day by phone and can actually even come into the home setting if needed to help with symptom management. Hospice comes as well with the psychosocial supports for just coping with what dying looks like. We know that's not easy to be thinking about dying for oneself, or for a family member or care partner to be losing their loved one. So, all of those supports are built into hospice. I did want to make a distinction, too, that hospice does not provide custodial care, which I explain to patients as care of the body, those daily needs for bathing, dressing, eating, etc. Sometimes patients are interested in hospice because they're needing more help at home, and I have to tell them that unfortunately, our healthcare system is not built for that. And if that's the sole reason that someone is interested in hospice, we have to think about a different approach, because that is not part of the hospice benefit.  Dr Monteith: Thank you for that. And then I learned about concurrent care. So why don't you tell us a little bit about that? That's a little bit of a nuance, right? Dr Chou: Yeah, that is a little bit of a nuance. And so, typically when patients are enrolling in hospice, they are transitioning from care the way that it's normally conducted in our healthcare system. So, outpatient visits to all of the specialists and to their primary care providers, the chance to go to the ER or the ICU for higher levels of care. And yet there are a subset of patients who can still have all of those cares alongside hospice care. That really applies to two specific populations: veterans who are receiving care through the Veterans Administration, and then younger patients, so twenty six years old and less, can receive that care through, essentially, a pediatric carve out. Dr Monteith: Great. Well, I mean, you gave so much information in your article, so our listeners are going to have to read it. I don't want you to spill everything, but if you can just kind of give me a sense what you want a neurologist to take away from your article, I think that would be helpful. Dr Chou: I think what I want neurologist to take away is that, again, this is something that is part of what we do as neurologists. This is part of our skill set, and this is part of what it means to take good care of patients. I think what we do in this transition period from kind of usual cares, diagnosis, full treatment to end of life, really can have impact on patients and their care partners. It's not uncommon for me to hear from family members who have had another loved one go through hospice about how that experience was positive or negative. And so, we can think about the influence for years to come, even, because of how well we can handle these transitions. That really can be more than the patient in front of us in their journey. That is really important, but it can also have wide-reaching implications beyond that. Dr Monteith: Excellent. And I know we were talking earlier a little bit about your excitement with the field and where it's going. So why don't you share some of that excitement? Dr Chou: Yeah. And so, I think there is a lot still to come in the field of neuropalliative care, particularly from an evidence base. I know we talked a lot about the soft skills, about presence and communication, but we are clinicians at heart, and we need to practice from an evidence base. I know that's been harder in palliative care, but we have some international work groups that really are trying to come together, see what our approaches look like, see where standardization may need to happen or where our differences are actually our strength. I think there can be a lot of variability in what palliative care looks like. So, my hope is that evidence base is coming through these collaborations. I know it's hard to have a conversation these days without talking about artificial intelligence, but that is certainly a hope. When you look at morbidity, when you look at patients with these complicated disease courses, what is pointing you in the direction of, again, a prognosis of six months or less or a patient who may do better with this disease versus not? And so, I think there's a lot to come from the artificial intelligence and big data realm. For the trainees listening out there, there is no better time to be excited about neuropalliative care and to be thinking about neuropalliative care. I said that I stumbled upon this field, and hopefully someone is inspired as well by listening to these podcasts and reading Continuum to know what this field is really about. And so, it's been exponential growth since I joined this field. We have medical students now who want to come into neuropalliative care as a profession. We have clinicians who are directors of neuropalliative care at their institutions. We have an international neuropalliative care society and neuropalliative care at AAN. And I think we are moving closer to that dream for all of us, which is that patients living with serious neurologic illness can be supported throughout that journey. High-quality, evidence-based palliative care. We're not there yet, but I think it is a possibility that we reach that in my lifetime. Dr Monteith: Well, excellent. I look forward to maybe another revision of this article with some of that work incorporated. And it's been wonderful to talk to you and to reflect on how better to approach patients that are towards the end of life and to help them with that decision-making process. Thank you so much.  Dr Chou: Yeah, thank you for having me. And we're very excited about this issue. Dr Monteith: Today. I've been interviewing Dr Claudia Chou about her article on end-of-life care and hospice, which is found in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Een absoluut noodzakelijk pleidooi van de onverschrokken VN-rapporteur. Aan de hand van 10 diepmenselijke verhalen toont Albanese het aangrijpende lot van de Palestijnen. Uitgegeven door Atlas Contact Spreker: Hasna El Maroudi

Agra Veilings Namibië het ‘n terugblik op die jaar gegee. Aan die begin van die jaar was daar verskeie onsekerhede in boerdery wat kop uitgesteek het. Knopvelsiekte en bek-en-klouseer wat in Suid Afrika uitgebreek het was kopsere, maar Namibië se boerderybedryf het kop bo water gehou. Kosmos 94.1 Nuus het met Paul Klein, uitvoerende bestuurder van Agra Veilings, gesels.

In de accountancy is kwaliteit niet onderhandelbaar. Tegelijkertijd weten we dat controlekwaliteit sterk samenhangt met teamdynamiek, cultuur en de mate waarin mensen zich durven uitspreken. Dat plaatst managers midden in een spanningsveld: hoe ben je scherp op inhoud en normen, zonder een klimaat te creëren waarin twijfel en fouten verborgen blijven of worden genegeerd?In deze aflevering van Vitamine A gaan we hierover in gesprek met drie gasten aan tafel: Martin Berghuis (Londen & Van Holland), Gert van Ginkel (Baker Tilly) en Claudia Koppen (Pure Colors). Vanuit verschillende perspectieven verkennen we hoe managers dagelijks invloed uitoefenen op cultuur en gedrag in controleteams. Daarbij maken we gebruik van inzichten uit onderzoek naar psychologische veiligheid, onder meer van Amy Edmondson, maar steeds verbonden aan herkenbare situaties uit de praktijk.Aan bod komen onder andere:wat psychologische veiligheid betekent in de controlepraktijkhoe managers ruimte creëren voor speak-up, ook onder tijdsdrukhet omgaan met feedback en spanning tussen controle en vertrouwende balans tussen professioneel en menselijk gedragwaarom cultuurverandering vaak begint met kleine, dagelijkse interventiesWe onderzoeken hoe leidinggevenden, vaak zonder het zelf te merken, bepalend zijn voor het (leer)klimaat en daarmee voor de kwaliteit van het werk.Een aflevering voor managers, partners en accountants die willen reflecteren op hun rol in teams.Links:Boek: The Fearless Organization: Creating Psychological Safety in the Workplace for Learning, Innovation, and Growth van Amy C. Edmondson. 

Aan tafel deze week: president Finland Alexander Stubb, demissionair minister van Defensie Ruben Brekelmans, Oekraïens-Nederlandse Vita Kovalenko, Pjotr Sauer en Ellen Verbeek. Presentatie: Twan Huys Wil je meer weten over de gasten in Buitenhof? Op onze website vind je meer informatie. Daar kan je deze aflevering ook terugkijken en je vindt er natuurlijk nog veel meer gesprekken: https://bit.ly/buitenhof-14-dec-25 De onderhandelingen over de toekomst van Oekraïne zijn op een cruciaal punt beland: voor het eerst heeft president Zelensky een vredesvoorstel gedaan waarin Oekraïne bereid is grondgebied op te geven. Tegelijkertijd waarschuwt NAVO-secretaris-generaal Rutte voor de Russische dreiging. Te gast hierover: demissionair minister van Defensie Ruben Brekelmans. Buitenhof had een exclusief interview met de Finse president Alexander Stubb. Tijdens zijn tweedaagse staatsbezoek liepen de spanningen rond Oekraïne hoog op en de Finse president speelt een sleutelrol in de contacten met president Trump. Hoe kijkt hij naar de nieuwe veiligheidsstrategie van de Amerikaanse regering? En is er nog kans op een rechtvaardige vrede in Oekraïne? Over het Amerikaanse vredesplan voor Oekraïne is Vita Kovalenko te gast. Ze heeft familie in Oekraïne. Hoe ervaart de bevolking, voor wie de oorlog al bijna vier jaar dagelijkse realiteit is, deze ontwikkelingen? 112 x Derk, zo heet de bundel met alle columns van journalist en uitgever Derk Sauer. Afgelopen zomer overleed hij onverwacht. Zijn vrouw Ellen Verbeek en zoon Pjotr Sauer vertellen over de liefde van Derk voor Rusland en waarom de bundel er komt.

Eva Hofman is journalist en schrijver. Ze debuteerde in 2024 met ‘Josephine', over navelstaren en esthetiek als culturele analyse. Daarnaast werkt ze als onderzoeksjournalist en technologieverslaggever bij de Groene Amsterdammer. In het blad publiceert ze artikelen, onderzoeken en essays over internetcultuur, feminisme en de macht van big tech. Nu komt ze met ‘Man neemt Vrouw: aantekeningen uit het patriarchaat'. In het boek onderzoekt Hofman de giftige tegenreactie van het patriarchaat op feminisme: luidruchtig, ziedend en viral. Aan de hand van essays over klassieke misogynie, rechtse feministen en de hedendaagse digitale backlash laat Hofman zien hoe vrouwenhaat zich telkens opnieuw uitvindt. Ellen Deckwitz gaat met Eva Hofman in gesprek.

This one is 'Uit de oude doos'! I found this audio in my files and, even though it's an old one, the content is still very relevant for when your working in a Dutch environment. You ready? Klaar voor?This is the vocab you'l learn: Veel te doen?Zet 'm op. Werk ze!Aan de slag!Bakkie (doen)? Ga je mee lunchen?De lunchwandelingHet overleg (kort)De afspraak (algemeen - general)De vergadering (met collega', of op een club) Liked this podcast? Please leave a review, or send me a comment :) Are you on my emaillist yet?https://dutchspeakingacademy.nl/nieuwsbrief/Follow me on Instagram here: https://www.instagram.com/dutchspeakingacademy/

De dochter van de vader des vaderlands van Myanmar werd in 1988 bekend toen ze in verzet kwam tegen de militaire junta die het land regeerde. Ze leefde - totdat ze in 2016 State Counselor werd - af en aan 15 jaar onder huisarrest en werd een beroemde politieke gevangene. In 1991 won ze voor haar strijd de Nobelprijs voor de Vrede. Na een periode van voorzichtige democratisering volgde in 2021 opnieuw een staatsgreep. Nu zit ze weer gevangen. Ze werd dit jaar tachtig en geldt daarmee als een van de oudste politieke gevangenen ter wereld. Intussen is er in Myanmar al tachtig jaar sprake van een volksopstand tegen het leger. Voor journaliste Minka Nijhuis is dit geen abstract verhaal. Aan het begin van haar carrière kreeg ze het advies om naar Myanmar te reizen. In 1995 sprak ze Aung San Suu Kyi voor het eerst, toen die nog onder huisarrest leefde. In de jaren daarna ontmoette ze haar vele malen en zag ze van nabij de veranderingen in Suu Kyi’s leven: van vrijlating tot regeringsdeelname, en alle obstakels die daarmee gepaard gingen. Deze week staat er een uitgebreid profiel van Suu Kyi in De Groene. Met de recente geschiedenis van Myanmar erdoorheen geweven. Want dat lijkt ook zo te zijn met het leven van Aung San Suu Kyi. Productie: Laura ten Hove, Kees van den Bosch en Matthijs Domen.See omnystudio.com/listener for privacy information.

Neurologists are privileged to act as guides for patients as they navigate the complex course of serious neurologic illnesses. Because of the impact on quality of life, personhood, and prognosis, neurologists must be able to conduct serious-illness conversations to improve rapport, reduce patient anxiety and depression, and increase the likelihood that treatment choices agree with patient goals and values. In this episode, Teshamae Monteith, MD, FAAN speaks with Jessica M. Besbris, MD, author of the article "The Approach to Serious-Illness Conversations" in the Continuum® December 2025 Neuropalliative Care issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Besbris is an assistant professor of neurology and internal medicine, and the director of the neuropalliative care, at Cedars-Sinai Medical Center in Los Angeles, California. Additional Resources Read the article: The Approach to Serious-Illness Conversations Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @JessBesbris Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: Hi, this is Dr Teshamae Monteith. Today I'm interviewing Dr Jessica Besbris about her article on the approach to serious illness conversation, which is found in the December 2025 Continuum issue on neuropalliative care. How are you? Dr Besbris: I'm doing great. Thank you so much for having me here today. Dr Monteith: Well, thank you for being on our podcast. Dr Besbris: My pleasure. Dr Monteith: Why don't we start off with you introducing yourself? Dr Besbris: Sure. So, my name is Jessica Besbris. I am a neurologist with fellowship training in palliative care, and I am currently at Cedars Sinai Medical Center in Los Angeles, where I am the director of our neuropalliative care program. Dr Monteith: Excellent. So, how did you get involved in that? Dr Besbris: Like, I think, many neurologists, I always knew I wanted to be a neurologist---or, I should say, from the moment I decided to be a doctor I knew that that was the type of doctor I wanted to be, a neurologist. So, I went into medical school with the aim of becoming a neurologist. And very quickly, when I started my clinical years, I was exposed to patients who were living with very serious illnesses. And I found myself really drawn to opportunities to help, opportunities to make people feel better, opportunities to improve quality of life in situations that on the face of it seemed really challenging, where maybe it seemed like our usual treatments were not necessarily the answer or were not the only answer. And so, I pretty quickly recognized that taking care of patients with serious illness was going to be a big part of my life as a neurologist and that palliative care was the way I wanted to help these patients and families. Dr Monteith: And you mentioned you're leading the group. So, how many colleagues do you have in the program? Dr Besbris: We have a very large palliative care group, but within neuropalliative care, it's myself and one other physician, a nurse practitioner, and a social worker. Dr Monteith: Okay, well, I know you guys are busy. Dr Besbris: Yes, we are very happy to be busy. Dr Monteith: Yes. So, let's talk about the objectives of your article. Dr Besbris: Sure. So, the goal of this article is to impress upon neurologists that it really is all of our jobs as neurologists to be having these conversations with our patients who are affected with serious illness. And then, in most areas of neurology, these conversations will come up. Whether it's giving a life changing diagnosis, or talking about treatment choices, or treatment not going the way that we had hoped, or even sometimes progression of disease or end-of-life care. These topics will come up for most of us in neurology, and really, we're hoping that this article not only makes the case that neurologists can and should be having these conversations, but that there are skills that we can teach in this article and with other resources to improve the skill level and sense of confidence that neurologists have when they enter into these conversations. Dr Monteith: Great. I read that there are some developments in the field, on organizational levels, about really making these skills part of standard of care in terms of education. So, can you speak to that? Dr Besbris: Yes. So, there have been a couple of really landmark papers and changes in the educational landscape that I think have really brought neuropalliative care in general, and serious illness conversation in particular, to the forefront. So, there were the position statements released by the American Academy of Neurology in 1996 and 2022, both of which really said, hey, all neurologists should be doing this and receive training on how to have these conversations and provide this care. And the ACGME, the Accreditation Council for Graduate Medical Education, also requires neurology residency programs to learn how to communicate with patients and families, assess goals, and talk about end-of-life care. So, there's a real structural imperative now for neurologists to learn early on how to have serious illness conversations with their patients. Dr Monteith: Great. If there's anything for our listeners to get out of this conversation, what are the essential points? Dr Besbris: If you only take away one or two things from this conversation, I hope that they're that this is an awesome responsibility to be in a moment with a patient going through something challenging, to meet them in that moment with thoughtful, honest, empathic conversations about who they are and what's important to them. And that, just like any other procedure, these are skills that can be taught so that you can feel really confident and comfortable being in these moments. Dr Monteith: Excellent. Wow. Okay, I feel your energy and your empathy already. And so, why don't we just talk about skills? What is the best way to deliver tough news? I read this wonderful chart on SPIKES protocol. Dr Besbris: Yeah, the SPIKES protocol is one really well-known way to deliver serious news. And what's nice about SPIKES is it gives a mnemonic. And as neurology learners, we all love a good mnemonic to help you really center yourself when you're entering into these conversations so that you have a structured format to follow, just like with any procedure. So, the SPIKES protocol stands for Setting: so, making sure you have the right environment; Perception, or assessing what your patient or surrogate decision maker knows already so that you know where to begin; receiving an Invitation to deliver serious news. And then K stands for Knowledge, delivering in a clear and concise way the information that you want to make sure the family or patient walk away with. E for exploring Emotion; and S for really Summarizing what's been discussed and Strategizing on next steps. I think that having these kinds of conversations, it's just like being expert in anything. When you first start learning, it's helpful to have a set of very concrete steps you can follow. And you might even think through the mnemonic as you get ready to walk into that room. And as you become more expert, the flow becomes more natural. And maybe what you do before walking in to prepare is just honing what is that headline? What is that concise statement that I'm really going to give? And the rest may start to feel more natural and less protocolized. Dr Monteith: And there are a few other mnemonics. There's the NURSE mnemonic, which I like. You know, there's a balance between saying things and sounding kind of… you know, sometimes they're like, well, how could you understand what I'm going through? Have you been through something like this? And people shy away, and they're afraid to kind of be a part of these conversations. So how do we approach that with this, a NURSE mnemonic in a way that's kind of sincere? Dr Besbris: Absolutely. So, the NURSE mnemonic, unlike SPIKES, is not a step-by-step protocol. So, NURSE is a mnemonic, but you don't go through each letter and sort of give a naming statement and then an understanding statement and then a respecting statement and so on. Nurse is really a toolkit of different types of statements that we can give in response to emotions so that when you find yourself in a situation where a patient or family member is tearful, is scared, is angry, is expressing feelings, you have some phrases ready that feel authentic to you and that you feel are going to meet the moment and allow you to empathically respond to those emotions. Because until we do that, we really can't move further in this conversation with our patients and families feeling heard and respected. So, that NURSE mnemonic, those Naming, Understanding, Respecting, Supporting and Exploring statements, are really examples of statements that we can use to meet that moment with empathy and understanding and without implying that we have walked in their shoes. We want to avoid being presumptuous and really focus on just being present and empathic. Dr Monteith: So, let's just kind of run through, I think it's really important. Let's run through some of these examples. Maybe if someone's crying hysterically, how would we respond to that? Dr Besbris: So, this is an opportunity for Naming. And I made this one, I think, in the chart, a little bit obvious, meaning that we recognize when someone is crying that they are feeling probably very sad. This is an opportunity for us to name and thus normalize that emotion. I just think something as simple as, I think anyone would be really sad hearing this. These responses are not intended to fix this emotion. I'm not trying to get someone to stop crying or to, you know, necessarily not feel sad. It's really just to say, yeah, it's normal that you're feeling sad. It's okay. I'm here with you while you're feeling sad. And I'm going to be with you no matter what you're bringing to the table. Dr Monteith: Yeah. Let's go through just a couple of others. I mean, these are really good. Dr Besbris: Sure. Maybe Respecting. Dr Monteith: Yeah. So, my Dad is a fighter. Only God, not doctors, can know the future. Dr Besbris: Yeah. So, I love giving these examples with our learners because these statements, things like my Dad is a fighter or God will bring me a miracle or you don't know the answer. Only God knows what's going to happen, I think that they give a lot of doctors a feeling of confrontation, a feeling of anxiety. And I think there are a few reasons for that. And I think one of the main ones is that they're statements that imply that we as doctors are not all-powerful and it's our patients or families sort of looking for a different locus of control, whether it's internal fortitude or a higher power. They're looking to something other than us, and maybe that makes us feel a little bit uncomfortable. And I think that sometimes physicians think that these statements imply that someone doesn't even understand what's going on. But maybe they're coming to this from a place of denial. And I would argue that when someone comes to you with a statement like my dad is a fighter or, you know, I'm looking to God to bring me a miracle or to show me the future. I think that what they're really saying is, wow, I'm really hearing that things are serious, so much so that I'm reaching for these other resources to give me strength and hope. I don't think anyone asks for a miracle if they think that a miracle is not needed, if the problem is easy to fix. And so, rather than come to these types of statements from a confrontational place of I'm the doctor and I know best, I think this is a great opportunity to show some respect and give some respecting statements. Your dad is a fighter. I don't think he could have come this far without being a fighter. Or, you know, I am so grateful that you have your faith to lean on during times like these to give you strength. These are also nice opportunities for exploring statements. For example, I'm so grateful to learn more about your dad. Can you tell me what it is that he has been fighting for all of this time? Dr Monteith: I love that. It's like a follow-up, and also validating. Dr Besbris: Yeah, it's validating. And it allows us to learn a little bit more about this person and to learn, well, is he fighting for a life that we can still achieve with our interventions to lead into the next part of a conversation? Or, is God is going to bring me a miracle? Well, tell me what a miracle looks like for you. I can't tell you how many times I thought someone was going to tell me that a miracle would be cure. And sometimes that is what comes up. But other times I hear, a miracle would be, you know, my loved one surviving long enough for the rest of the family to gather. And, you know, that is certainly something we can work towards together. Dr Monteith: So, why don't we talk a little bit about approach to goals of care discussions? They are tough, and let's just put it into perspective to the critical care team. It's time, the person's been in the ICU, the family wants everything thrown at medically. And it's to the point that the assessment is that would be medical futility. Dr Besbris: Lots to unpack there. Dr Monteith: I wanted to make it hard for you. Dr Besbris: No, no, this is good! I mean, this is something- I work in a, you know, almost one thousand-bed hospital with a massive critical care building. And so, these are not unusual circumstances at all. First of all, I would just say that goals of care conversations are not only about end-of-life care. And I make that point a few different times in the article because I think when people imagine goals of care, and one of the reasons that I think clinicians may sometimes shy away from goals of care discussions, is that they think they have to be sad, they have to be scary, they have to be about death and dying. And I would argue that, really, goals of care discussions are about understanding who a person is, how they live their life, what's most important to them. Most of these conversations should be about living. How are we going to together achieve a quality of life that is meaningful for you and treatments that are going to fit your needs and your preferences? But there is a little slice of that pie in the pie chart of goals of care discussions that is in the arena of end-of-life care. For example, ICU care with, really, the highest levels of intensity of care, and having to talk about whether that still is meeting the moment from the perspective of goals as well as the perspective of efficacy. So, from the goals standpoint, I approach these conversations just like any other goals of care conversation. Usually at this point, we're speaking to family members and not our patients because in a neurocritical care unit, if someone is that sick, they probably are incapacitated. And so, it's a moment to really sit down with family and say, please tell me about the human being lying in that bed. They can't introduce themselves. What would they tell me about themselves if they could speak right now? What kinds of things were important to them in the course of their treatment? What kind of a life did they want to live or do they want to live? So that then we can reflect on, well, can our treatment achieve that? And this process is called shared decision making. This is really where we take in data from the family, who are experts in the patient, and then our own expertise in the illness and what our treatments can achieve, and then bring all of that information together to make a recommendation that aligns with what we believe is right for a particular patient.  So, in the example that you gave, the extreme circumstance where someone is receiving maximal intensive care and we're starting to reach the point of futility, I think that we need to first really understand, well, what does futility mean for this particular patient? Is it that we as healthcare providers would not value living in the state this person is in? Or is it that the treatments truly cannot physiologically keep them alive or meet their stated goals? If it's the first one, that I wouldn't want to be on machines unconscious, you know, at the end of my life, well, I have to set that aside. It's really about what this patient wants. and if the family is telling you they valued every breath, every moment, and if we have care that can achieve that, we should continue to offer and recommend that care. And as healthcare providers, it is so important that we do explain when treatments are not going to be able to physiologically meet a patient's needs or achieve their goals. And that's where we can say, I'm going to continue to do everything I can, for example, to, you know, keep your loved one here for these meaningful moments. And we are at a point where performing CPR would no longer be able to restart his heart. And I just wanted to let you know that that's not something that we're going to do because I have an obligation not to provide painful medical treatments that will not work. So, my approach to futility is really different than my approach to shared decision-making because in the context of objective futility, it's not about necessarily- it's not about decision-making, it's not about shared decision-making as much as it is explaining why something is simply not going to work. Does that make sense? Dr Monteith: Absolutely. And what I love in your article is that, you know, you go beyond the skills, but also potential communication challenges---for example, patients' neurologic status, their ability to understand complex communication, or even cultural differences. So, can you speak about that briefly? Dr Besbris: Absolutely. In the world of neurological serious illness, it is incredibly common for our patients to face challenges in communication. That might be because they are aphasic, because they have a motor speech deficit, it might be because they're intubated, it might be because their capacity is diminished or absent. And so, there are a lot of challenges to keeping patients in these conversations. And in the article, I summarize what those challenges can look like and some strategies that we can use to continue to engage our patients in these conversations to the greatest extent possible and also turn to their surrogate decision makers where the patients themselves are no longer able to participate or participate fully. In terms of cultural considerations, I mean, there could be an entire article or an entire Continuum just on cultural considerations in neurology and in serious illness communication. And so, the key points that I really tried to focus on were exploring from a place of cultural humility what the beliefs and practices of a particular patient and family are in their cultural context, to ask questions to help you understand how those cultural differences may impact the way you approach these conversations. And being sensitive to folks with limited English proficiency, to ensure that we are using medical interpreters whenever possible. Dr Monteith: Excellent. Well, there's so much in the article. There's already so much that we just discussed, but our listeners are going to have to go to the article to get the rest of this. I do want to ask you to just kind of reflect on, you know, all the different cases and experiences that you have, and just, if you can give us a final remark? Dr Besbris: I can think of a number of cases that I've seen in my work as both an inpatient and outpatient neuropalliative provider where I've seen patients after strokes in the hospital with uncertain prognosis, whose families were struggling with a decision around feeding tubes. And where we have made a determination based on goals; for example, to pursue what's called a time-limited trial, to say let's place a feeding tube, let's meet again in the clinic in a few months after some rehab and let's just see, is this meeting this patient 's goals and expectations? I have been pleasantly surprised by the number of patients who have walked into my office after a period of rehabilitation who have regained the ability to eat, who are living an acceptable quality of life, and who have expressed gratitude for the work that I did in eliciting their goals, helping support their families. And some of whom have even come in and said, now that I'm doing better, I'd really like to do an advance directive to better guide my family in the future. People asking for more goals of care discussions, having seen how successful and helpful these conversations have been. Dr Monteith: Great. That's really life-altering for that patient, the family, so many people. Thank you so much for the work you do and for writing this great article and sharing all of this that we really need to learn more about. Dr Besbris: It's been a privilege. Thank you so much for talking with me today. Dr Monteith: Today I've been interviewing Dr Jessica Besbris about her article on the approach to serious illness conversation, which is found in the December 2025 Continuum issue on neuropalliative care. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Vandaag een jaar geleden viel het Assad-regime in Syrië. De omverwerping van de dictatuur, die meer dan 50 jaar duurde, gaf Syriërs vrijheid, maar ook zorgen. Toch overheerst een positief gevoel, want 'het had allemaal veel erger kunnen zijn'. Correspondent Daisy Mohr reisde vorig jaar december zo snel als ze kon naar het nieuwe, vrije Syrië. In totaal is ze er sindsdien zes keer geweest. Aan de hand van haar reizen en reportages probeert ze in deze podcast antwoord te geven op de vraag: hoe gaat het nu met Syrië, een jaar na de val van Assad? Reageren? Mail dedag@nos.nl Presentatie, montage, redactie: Elisabeth Steinz

Aan tafel deze week: oud-minister van Landbouw CDA Cees Veerman, oud-minister voor Grote Stedenbeleid D66 Roger van Boxtel, directeur Atlantische Commissie Anna van Zoest, hoogleraar virologie Erasmus MC Marion Koopmans, schrijver Haroon Ali Presentatie: Joost Vullings Wil je meer weten over de gasten in Buitenhof? Op onze website vind je meer informatie. Daar kan je deze aflevering ook terugkijken en je vindt er natuurlijk nog veel meer gesprekken: https://bit.ly/buitenhof-7-dec-25 Na een optimistische start zit de formatie sinds donderdagmiddag muurvast. In welke fase van de formatie zitten we eigenlijk nu? Aan tafel twee gelouterde bestuurders: Roger van Boxtel van D66 en Cees Veerman van het CDA. Na een optimistische start zit de formatie sinds donderdagmiddag muurvast. In welke fase van de formatie zitten we eigenlijk nu? Aan tafel twee gelouterde bestuurders: Roger van Boxtel van D66 en Cees Veerman van het CDA. Dode vogels, besmette runderen, zeeleeuwen, steenmarters en knaagdieren. We leken bijna gewend aan de aanwezigheid van de besmettelijke vogelgriep. Maar nu is ook een kitten bezweken aan deze ziekte. Waarom maken virologen zich zorgen om deze dierenziekte? En is er een oplossing in zicht? Marion Koopmans, hoogleraar virologie in Rotterdam, is bij ons te gast.  In het boek Het blijft toch je familie? ontleedt schrijver Haroon Ali de diepere lagen van gezinsbreuken. Met de feestdagen voor de deur moeten veel mensen dealen met families die niet meer compleet zijn door een conflict. Hoe ga je daarmee om? En kunnen we ook anders kijken naar de heilige bloedband? 

Een klein landje dat al eeuwenlang als speelbal fungeert voor ingewikkelde geo-politieke relaties: Libanon. En dat terwijl ook intern onrust en conflict aan de orde van de dag is. Aan de ene kant lijken vredesonderhandelingen tussen Hezbollah en Israel te stagneren. Aan de andere kant is er een politieke doorbraak nu politiek leiders van Israel en Libanon om tafel zijn gegaan. Maar wat is eigenlijk de oorsprong van deze conflicten en zijn er diplomatieke oplossingen? Jan spreekt met Universitair docent conflictstudies aan de Radboud Universiteit Nora Stel!

Deze talkshow wordt mede mogelijk gemaakt door MSI. Alle meningen in deze video zijn onze eigen. MSI heeft inhoudelijk geen inspraak op de content en zien de video net als jullie hier voor het eerst op de site.Ga maar even goed zitten voor het rotsvaste startschot van het weekend. Anderhalf uur aan knus gekwebbel over videogames kietelt binnen enkele seconden jouw trommelvliezen. Jelle, JJ en Koos zitten in de studio klaar. Ready om een nieuwe editie op te nemen van Einde van de Week Live. De talkshow waarin we elke week het belangrijkste game gerelateerde nieuws met jullie, de kijkers, doornemen. We hebben een fijn lijstje aan topics voor je klaarstaan. Zo discussiëren de drie over de teaser van Geoff Keighley, die toch minder makkelijk te herleiden bleek dan verwacht, de komst van Red Dead Redemption Remastered, het uitstel van Skyblivion en het grote aantal studio's wat aan Metroid Prime 4 werkte. Dit alles en meer ga je beleven in de Einde van de Week Live van vrijdag 5 december 2025.Red Dead Redemption eindelijk in 4K speelbaarAndere onderwerpen betreffen de winnaars van de Dutch Game Awards 2025, het onderzoek dat uitwijst dat games jouw hersens tien jaar jonger kunnen maken en de fan-made movie gebaseerd op de illustere game Manhunt van Rockstar.Pak honderden euro's korting op desktops en laptops met een NVIDIA RTX 50-series GPU tijdens de NVIDIA Holiday CampaignOp zoek naar een dikke videokaart, een nieuwe PC of een laptop? Zoek dan niet verder en check alle dikke deals tijdens de NVIDIA Holiday Campaign. Van videokaarten tot de desk- en laptops van Asus, MSI, Lenovo etc, met een RTX 50-series GPU aan boord, je kunt hier vele euro's korting krijgen. En dat is, denken wij, toch mooi meegenomen.Krijg 200 euro korting bij aankoop van de ‘nieuwe' Cyborg 15 gaming laptopDeze week zet MSI de ‘nieuwe' Cyborg 15 in het winterse zonnetje. Nieuw omdat de gaming laptop een fris design kent. Aan boord bevinden zich een Intel Core 7 processor, een NVIDIA GeForce RTX 5060 GPU, een 512GB SSD, een 4-zone RGB toetsenbord en genoeg USB aansluitingen voor al je randapparatuur. Bij de MediaMarkt kun je deze laptop nu hier met 200 euro korting verkrijgen. Timestamps:00:00:00 Einde van de Week Live van 5 december00:02:17 Huishoudelijke mededeling: MSI00:15:34 Metroid Prime 4 gemaakt door meer dan 20 studio's 00:19:36 Metroid Prime Amibo00:21:24 Prince of Persia niet op The Game Award00:23:48 PlayStation Mike Booth Left for Dead00:26:55 Netflix wint bieding voor Warner Bros 00:35:54 Red Dead Redemption remaster 00:37:55 BULLETTÎME: NVIDIA 00:45:46 SkyBlivion uitgesteld naar 2026 00:48:33 Monster Hunter baas over moeilijkheidsgraad 00:49:38 Dutch Game Awards00:52:16 Helldivers 2 movie00:56:37 PC Gamer Show00:59:54 Carmageddon Rogueshift 1997 01:01:42 BULLETTÎME: GAMEKINGS GIG GUIDE 01:07:30 Vier toppers aan tafel 01:09:55 Tepelbeleid Fortnite op de schop? 01:13:46 Manhunt (2003) movie, fan-made01:16:10 Rolls Royce auto 01:18:58 Zootopia met honden01:22:26 Cool of Serious Uncool?

Het wordt winter en de kachel mag weer aan. En wat is er dan beter dan thuis op de bank met een goed boek? Jeroen tipt drie heel verschillende culinaire romans en Jesse deelt twee comfortabele winterse recepten. Aan het einde van de herfst pakken we toch nog een stukje zomer mee, want dit is ook het moment waarop je kunt genieten van de nieuwe oogst olijfolie. Jonas belde met de experts en na een rondje proeven kunnen we concluderen: het is een goed jaar.KortingscodesOlives & More: WATSCHAFT10Atrevido: WatSchaftDePodcast10ShownotesBij elke aflevering maken we uitgebreide shownotes, met informatie uit de podcast en links naar recepten. De shownotes staan op: watschaftdepodcast.com.Word lid van de BrigadeAls lid van De Brigade krijg je een advertentievrije podcast met exclusieve content, toegang tot onze online kookclub, kortingen, winacties en steun je de podcast. Word lid via: petjeaf.com/watschaftdepodcast. Hosted on Acast. See acast.com/privacy for more information.

Transcriptie: https://www.eenbeetjenederlands.nl/podcast/volkshuisvestingSteun de podcast! https://petjeaf.com/eenbeetjenederlandsAflevering 81: VolkshuisvestingWonen is een grondrecht in Nederland, iedereen heeft recht op een dak boven zijn hoofd. Een goed dak, dat niet lekt en niet op beschimmelde muren staat. Het is de taak van de overheid om te zorgen dat er genoeg woningen zijn, die van goede kwaliteit zijn en in een buurt staan waar het fijn is om te wonen. Aan het begin van de twintigste eeuw was dat nog heel anders. We gaan deze aflevering kijken hoe de overheid is gaan zorgen voor goede huizen voor de bevolking. Zoals we dat in het Nederlands noemen: volkshuisvesting.Een Beetje NederlandsDe podcast voor iedereen die beter Nederlands wil leren luisteren! Voor mensen op niveau B1/B2. Afleveringen over allerlei onderwerpen in duidelijk en helder gesproken Nederlands. Iedere aflevering heeft een transcriptie om mee te lezen. Leer met deze podcast Een Beetje Nederlands!Learn Dutch with this podcast for intermediate learners (level B1/B2). This podcast lets you listen to a range of different subjects in clear and slowly spoken Dutch. Every episode comes with a free transcript on the website. Learn a little Dutch with Een Beetje Nederlands!

Aan tafel deze week: burgemeester Utrecht Sharon Dijksma, president van Signal Meredith Whittaker, Europarlementariër Bart Groothuis, journalist Michiel Driebergen. Presentatie: Maaike Schoon Wil je meer weten over de gasten in Buitenhof? Op onze website vind je meer informatie. Daar kan je deze aflevering ook terugkijken en je vindt er natuurlijk nog veel meer gesprekken: https://bit.ly/3K4zzcJ Het lokale bestuur staat onder een enorme druk. Afgelopen week stapte de burgemeester van Terneuzen op en werden bestuurders van de gemeente Venlo geïntimideerd. Welke gevolgen hebben deze ontwikkelingen voor de lokale democratie? Daarover Sharon Dijksma, voorzitter van de Vereniging van Nederlandse Gemeenten en burgemeester van Utrecht.    Meredith Whittaker is de baas van Signal en één van 's werelds meest invloedrijke stemmen op het gebied van digitale rechten en privacy. Na meer dan tien jaar bij Google te hebben gewerkt, besloot ze op te stappen omdat ze tegen ethische grenzen aanliep. In Buitenhof vertelt Whittaker over het belang van privacy en hoe de EU zich beter kan voorbereiden op een digitale toekomst.   Europa gold lange tijd als de hoeder van privacy en digitale rechten, maar die reputatie staat onder zware druk van Washington en Big Tech. Hoe kwetsbaar zijn we eigenlijk? En is Europa verworden tot een speelbal van de Verenigde Staten? Aan tafel: Europarlementariër Bart Groothuis (VVD).   En hoe geef je woorden aan een oorlog? Michiel Driebergen zag dat poëzie de woorden kan brengen. In zijn podcast Dichter aan het front spreekt hij met Oleksiy, de man die de doden bergt, met Yaryna, die haar drones op de Russen afstuurt, en hij laat Maksym aan het woord. Maksym leeft niet meer, maar zijn gedichten zijn er nog.  

Aan die einde van 2024 was die wêreld nader as ooit om Vigs as 'n openbare gesondheidsbedreiging teen 2030 te beëindig. Op daardie stadium was 31,6 miljoen van die 40,8 miljoen mense wat met MIV leef, op lewensreddende behandeling. MIV-voorkomings- en behandelingsdienste, en die fokus op die maatskaplike hindernisse wat mense 'n verhoogde risiko vir MIV plaas, het gelei tot 'n afname van 40 persent in die aantal nuwe infeksies en 'n afname van 54 persent in die aantal Vigs-verwante sterftes tussen 2010 en 2024. Na die afkondiging deur president Donald Trump dat USAid befondsing gestop sal word het verskeie programme gely daaronder. Dr. Jacques Kamangu van die gesondheidministerie sê die vasteland moet minder staatmaak op buitelandse hulp.

Dystrophinopathies are heritable muscle disorders caused by pathogenic variants in the DMD gene, leading to progressive muscle breakdown, proximal weakness, cardiomyopathy, and respiratory failure. Diagnosis and management are evolving areas of neuromuscular neurology. In this episode, Kait Nevel, MD, speaks with Divya Jayaraman, MD, PhD, an author of the article "Dystrophinopathies" in the Continuum® October 2025 Muscle and Neuromuscular Junction Disorders issue. Dr. Nevel is a Continuum® Audio interviewer and a neurologist and neuro-oncologist at Indiana University School of Medicine in Indianapolis, Indiana. Dr. Jayaraman is an assistant professor of neurology and pediatrics in the division of child neurology at the Columbia University Irving Medical Center in New York, New York. Additional Resources Read the article: Dystrophinopathies Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @IUneurodocmom Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Nevel: Hello, this is Dr Kate Nevel. Today I'm interviewing Dr Divya Jayaraman about her article on dystrophinopathies, which she wrote with Dr Partha Ghosh. This article appears in the October 2025 Continuum issue on muscle and neuromuscular junction disorders. Divya, welcome to the podcast, and please introduce yourself to the audience. Dr Jayaraman: Thank you so much, Dr Nevel. My name is Divya, and I am an assistant professor of Neurology and Pediatrics at Columbia University Irving Medical Center, and also an attending physician in the Pediatric Neuromuscular program there. In that capacity, I see patients with pediatric neuromuscular disorders and also some general pediatric neurology patients and also do research, primarily clinical research and clinical trials on pediatric neuromuscular disorders. Dr Nevel: Wonderful. Thank you for sharing that background with us. To set us on the same page for our discussion, before we get into some more details of the article, perhaps, could you start with some definitions? What comprises the dystrophinopathies? What are some of the core features? Dr Jayaraman: So, the dystrophinopathies, I like that term because it is a smaller subset from the muscular dystrophies. The dystrophinopathies are a spectrum of clinical phenotypes that are all associated with mutations in the DMD gene on chromosome X. So, that includes DMD---or, Duchenne muscular dystrophy---, Becker muscular dystrophy, intermediate muscular dystrophy (which falls in between the two), dilated cardiomyopathy, asymptomatic hyperCKemia, and manifesting female carriers. In terms of the core features of these conditions, so, there's some variability, weakness being prominent in Duchenne and also Becker. The asymptomatic hyperCKemia, on the other hand, may have minimal symptoms and might be found incidentally by just having a high CK on their labs. They all will have some degree of elevated CK. The dilated cardiomyopathy patients, and also the Becker patients to a lesser degree, will have cardiac involvement out of proportion to skeletal muscle involvement, and then the manifesting carriers likewise can have elevated CK and prominent cardiac involvement as well as some milder weakness. Dr Nevel: Now that we have some definitions, for the practicing neurologists out there, what do you think is the most important takeaway from your article about the dystrophinopathies? Dr Jayaraman: I like this question because it suggests that there's something that, really, any neurologist could do to help us pick up these patients sooner. And the big takeaway I want everyone to get from this is to check the CK, or creatine kinase, level. It's a simple, cheap, easy test that anyone can order, and it really helps us a lot in terms of setting the patient on the diagnostic odyssey. And in terms of whom you should be thinking about checking a CK in, obviously patients who present with some of the classic clinical features of Duchenne muscular dystrophy. This would include young boys who have toe walking, as they're presenting, sign; or motor delayed, delayed walking. They may have calf hypertrophy, which is what we say nowadays. You might have seen calf pseudohypertrophy in your neurology textbooks, but we just say calf hypertrophy now. Or patients can often have a Gowers sign or Gowers maneuver, which is named after a person called Gowers who described this phenomenon where the child will basically turn over and use their hands on the floor to stand up, usually with a wide-based gait, and then they'll sort of march their hands up their legs. That's the sort of classic Gowers maneuver. There are modified versions of that as well. So, if anyone presents with this classic presentation, for sure the best first step is to check a CK. But I would also think about checking a CK for some atypical cases. For example, any boy with any kind of motor or speech delay for whom you might not necessarily be thinking about a muscle disorder, it's always good practice to check a CK. Even a boy with autism for whom you may not get a good clinical exam. This patient might present to a general pediatric neurology clinic. I always check a CK in those patients, and you'll pick up a lot of cases that way. For the adult folks in particular, the adult neurologist, a female patient could show up in your clinic with asymptomatic hyperCKemia. And I think it's an important differential to think about for them because this could have implications not just for their own cardiac risks, but also for their family planning. Dr Nevel: So, tell us a little bit more about the timing of diagnosis. Biggest takeaway: check a CK if this is anywhere on your radar, even if somewhat of an atypical case. Why is it so important to get kiddos started on that diagnostic odyssey, as you called it, early? Dr Jayaraman: This is especially important for kids because if they especially get a Duchenne muscular dystrophy diagnosis, you might be making them eligible for treatments that we've had for some time, and also treatments that were not available earlier that hinge on making that diagnosis. So, for example, people may be skeptical about steroids, but there's population data to suggest that initiation and implementation of steroids could delay the onset of loss of ambulation as much as three years. So, you don't want to deprive patients of the chance to get that. And then all the newer emerging therapies---which we'll be talking about later, I'm sure---require a Duchenne muscular dystrophy diagnosis. So, that's why it's so important to check a CK, have this on your radar, and then get them to a good specialist. Dr Nevel: I know that you alluded already, or shared a few of the kind of exam paroles or findings among patients with dystrophinopathy. But could you share with us a little bit more how you approach these patients in the clinic who are presenting with muscle weakness, perhaps? And how do you approach this or think about this in terms of ways to potentially differentiate between a dystrophinopathy versus another cause of motor weakness or delay? Dr Jayaraman: It's helpful to think through the neuraxis and what kinds of disorders can present along that neuraxis. A major differential that I'm always thinking about when I'm seeing a child with proximal weakness is spinal muscular atrophy, which is a genetic anterior horn cell disorder that can also present in this age group. And some of the key differences there would be things like reflexes. So, you should have dropped reflexes in spinal muscular atrophy. In DMD, surprisingly, they might have preserved Achilles reflexes even if their patellar reflexes are lost. It may only be much later that they go on to lose their Achilles reflex. So, if you can get an Achilles reflex, that's quite reassuring, and if you cannot, then you need to be thinking about spinal muscular atrophy. They can both have low muscle tone and can present quite similarly, including with proximal weakness, and can even have neck flexion weakness. So, this is an important distinction to make. The reason for that is, obviously there are treatments for both conditions, but for spinal muscular atrophy, timing is very, very important. Time is motor neurons, so the sooner you make that diagnosis the better. Other considerations would be the congenital muscular dystrophies. So, for those that they tend to present a lot younger, like in infancy or very early on, and they can have much, much higher CKS in that age range than a comparable Duchenne or Becker muscular dystrophy patient. They can also have other involvement of the central nervous system that you wouldn't see in the dystrophinopathies, for example. My mnemonic for the congenital muscular dystrophies is muscle-eye-brain disease, which is one of the subtypes. So, you think about muscle involvement, eye involvement, and brain involvement. So, they need an ophthalmology valve. They can have brain malformations, which you typically don't see in the dystrophinopathies. I think those are some of the major considerations that I have. Obviously, it's always good to think about the rest of the neuraxis as well. Like, could this be a central nervous system process? Do they have upper motor neuron signs? But that's just using all of your exam tools as a neurologist. Dr Nevel: Yeah, absolutely. So, let's say you have a patient in clinic and you suspect they may have a dystrophinopathy. What is your next diagnostic step after your exam? Maybe you have an elevated CK and you've met with the patient. What comes next? Dr Jayaraman: Great question. So, after the CK, my next step is to go to genetics. And this is a bit of a change in practice over time. In the past we would go from the CK to the muscle biopsy before genetic testing was standard. And I think now, especially in kids, we want to try and spare them invasive procedures where possible. So, genetic testing would be the next step. There are a few no-charge, sponsored testing programs for the dystrophinopathies and also for some of the differential diagnosis that I mentioned. And I think we'll be including links to websites for all of these in the final version of the published article. So, those are a good starting point for a genetic workup. It's really important to know that, you know, deletions and duplications are a very common type of mutation in the DMD gene. And so, if you just do a very broad testing, like whole exome, you might miss some of those duplications and deletions. And it's important to include both checking for duplications and deletions, and also making sure that the DMD gene is sequenced. So always look at whatever genetic test you're ordering and making sure that it's actually going to do what you want it to do. After genetics, I think that the sort of natural question is, what if things are not clear after the genetics for some reason? We still use biopsy in this day and age, but we save it for those cases where it's not entirely clear or maybe the phenotype is a little bit discordant from the genotype. So, for mutations that disrupt the reading frame, those tend to cause Duchenne muscular dystrophy, whereas mutations that preserve the reading frame tend to cause Becker muscular dystrophy. There are some important exceptions to this, which is where muscle biopsy can be especially helpful in sorting it out. So, for example, there are some early mutations early in the DMD gene where, basically, they find an alternate start codon or an initiation codon to continue with transcription and translation. So, you end up forming a largely functional, somewhat truncated protein that gives you more of a milder Becker phenotype. On the other hand, you can have some non-frameshift or inframe mutations that preserve the reading frame, but because they disrupt a very key domain in the protein that's really crucial for its function, you can actually end up with a much more severe Duchennelike phenotype. So, for these sorts of cases, you might know a priori you're dealing with them, but might just be a child who is who you think has DMD has a mutation that's showed up on testing. There isn't enough in the literature to point you one way or another, but they look maybe a little milder than you would expect. That would be a good kid to do a biopsy in because there are treatment decisions that hinge on this. There are treatments that are only for Duchenne that someone with a milder phenotype would not be eligible for. Dr Nevel: So, that kind of stepwise approach, but maybe not all kids need a muscle biopsy is what I'm hearing from you. If it's a mutation that's been well-described in the literature to be fitting with Duchenne, for example. Dr Jayaraman: Absolutely. Dr Nevel: So, after you confirm the diagnosis through genetic testing---and let's say, you know, whether or not you do a muscle biopsy or not, after you know the diagnosis is a dystrophinopathy---how do you counsel the families and your patients? What are the most important points to relay to families, especially in that initial phase where the diagnosis is being made? Dr Jayaraman: This is a lot of what we do in pediatric neurology in general, right? So, I actually picked up this approach from the pediatric hematology oncology specialists at Boston Children's. They had this concept of a day-zero conversation, which is the day that you disclose the life-changing diagnosis or potentially, at some point, terminal diagnosis to a family. And some of the key components of that are a not beating around the bush, telling them what the diagnosis is, and then letting them have whatever emotional response they're going to have in the moment. And you may not get much further than that, but honestly, you want them to take away, this is what my child has. I did not do anything to cause this, nor could I have done anything to prevent this. Because often for these genetic conditions, there's a lot of guilt, a lot of parental guilt. So, you want to try and assuage that as much as possible. And then to know that they're not going to be alone on this journey; that, you know, they don't have to have it all figured out right then, but we can always come back and answer any questions they have. There's going to be a whole team of specialists. We're going to help the family and the kid manage this condition. Those are sort of my big takeaways that I want them to get. Dr Nevel: Right. And that segues into my next question, which is, who is part of that team? I know that these teams that help take care of people with dystrophinopathies and other muscle disorders can be very large teams that span multiple specialists. Can you talk a little bit more about that for this group of patients? Dr Jayaraman: Of course. So, the neuromuscular neurologist, really, our role is in coordinating the diagnosis, the initiation of any disease-specific treatments, and coordinating care with a whole group of specialists. So, we're sort of at the center of that, but everyone else is equally important. So, the other specialists include physical therapists; occupational therapists; rehab doctors or physiatrists; orthotists who help with all of the many braces and other devices that they might need, wheelchairs; pulmonology, of course, for managing the respiratory manifestations of this. It becomes increasingly important over time, and they are involved early on to help monitor for impending respiratory problems. Cardiac manifestations, this is huge and something that you should be thinking about even for your female carriers, the mother of the patient you're seeing in the clinic, or your patient who comes to adult clinic with asymptomatic hyperCKemia. if you end up making a diagnosis of DMD carrier for those patients, or if you make a Becker diagnosis, the cardiac surveillance is even more important because the cardiac involvement can be out of proportion to the skeletal muscle weakness. And of course, extremely important for the Duchenne patients as well. Endocrinologists are hugely important because in the course of treating patients with steroids, we end up giving them a lot of iatrogenic endocrinologic complications. Like they might have delayed puberty, they might have loss of growth, of height; and of course metabolic syndrome. So, endocrinology is hugely important. They're also important in managing things like fracture prevention, osteoporosis, prescribing bisphosphonates if necessary. Nutrition and GI are also important, not just later on when they might need assistance to take in nutrition, whether that's through tube feeds, but also earlier on when we're trying to manage the weight. Orthopedics, of course, for the various orthopedic complications that patients develop. And then finally, a word must be said for social work and behavioral and mental health specialists, because a lot of this patient population has a lot of mental health challenges as well. Dr Nevel: After you give the diagnosis, you've counseled the patient and families and you've had those kind of initial phase discussions, the day-zero discussion, when you start getting into discussions or thoughts about management, disease-specific medication. But what are the main categories of the treatment options, and maybe how do you kind of approach deciding between treatment options for your patients? Dr Jayaraman: So, there are two broad categories that I like to think about. So, one is the oral corticosteroids and oral histone deacetylase, or HDAC inhibitors, which share the common characteristic that they are non-mutation specific. And within corticosteroids, patients now have a choice between just Prednisone or Prednisolone, or Deflazacort or Vermilion. The oral HDAC inhibitors are newly FDA-approved as a nonsteroidal therapy in addition to corticosteroids in DMD patients above six years of age. I would say we're in the early phase of adoption of this in clinical practice. And then the other big category of treatment options would be the genetic therapies as a broad bucket, and this would include gene therapy or gene replacement therapy, of which the most famous is the microdystrophin gene therapy that was FDA-approved first on an accelerated approval basis for ages four to eight, and then a full approval in that age group as well as an accelerated approval for all comers, essentially, with DMD. This is obviously controversial. Different centers approach this a bit differently. I think our practice at our site has been to focus on the ambulatory population, just thinking about risk versus benefit, because the risks are not insignificant. So really this is something that should be done by experienced sites that have the bandwidth and the wherewithal to counsel patients through all of this and to manage complications as they arise with regular monitoring. And then another class that falls within this broader category would be the Exon-skipping therapies. So as the name suggests, they are oligonucleotides that cause an Exon to be skipped. The idea is, if there is a mutation in a particular Exon that causes a frame shift, and there's an adjacent Exon that you can force skipping of, then the resulting protein, when you splice the two ends together, will actually allow restoration of the reading frame. I think the picture I want to paint is that there's a wide range of options that we present to families, not all of which everyone will be eligible for. And they all have different risk profiles. And I really think the choice of a particular therapy has to be a risk-benefit decision and a shared decision-making process between the physician and the family. Dr Nevel: What is going on in research in this area? And what do you think will be the next big breakthrough? I know before we started the recording you had mentioned that there's a lot of things going on that are exciting. And so, I'm looking forward to hearing more. Dr Jayaraman: Of course. So, I'll be as quick as I can with this. But I mentioned that next-generation Exon skipping therapies, I think the hope is that they will be better at delivering the Exon skipping to the target tissue and cells and that they might be more efficacious. I'm also excited about next-generation gene therapies that might target muscle more specifically and hopefully reduce the off-target effects, or combination use of gene therapies with other immunosuppressive regimens to improve the safety profile and maybe someday allow redosing, which we cannot do currently. Or potentially targeting the satellite cells, which are the muscle stem cells, again, to improve the long term durability of these genetic therapies. Dr Nevel: That's great, thank you for sharing. Thank you so much for talking to me today about your article. I really enjoyed learning more about the dystrophinopathies. Today I've been interviewing Dr Divya Jayaraman about her article on the dystrophinopathies, which she wrote with Dr Partha Ghosh. This article appears in the October 2025 Continuum issue on muscle and neuromuscular junction disorders. Please be sure to check out the Continuum Audio episodes from this and other issues. Also, please read the Continuum articles for more details than what we were able to get to today during our discussion. Thank you, as always, so much to the listeners for joining us today, and thank you, Divya, for sharing all of your knowledge with us today. Dr Jayaraman: Thank you so much for having me on the podcast. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Sarah Janneh is te gast bij Gijs Groenteman in de archiefkast van de Volkskrant. Groenteman bezocht haar nieuwe – zeer goed ontvangen – voorstelling ‘Brabo Leone’. Voor deze voorstelling ging Janneh naar het thuisland van haar overleden vader Sierra Leone. In de kast spreken ze over haar band met haar vader (voor wie ze ook heeft moeten vluchten), hoe ze zover is gekomen, Brabant en haar verstoorde relatie met mannen.Aan het einde luisteren ze naar het nummer Stoplicht van Sarah Janneh. Bekijk dit gesprek ook als video. Presentatie: Gijs GroentemanRedactie: Julia van AlemMontage: Lisette SpiegelerEindredactie: Jasper VeenstraSee omnystudio.com/listener for privacy information.