Podcasts about Aan

In the August episode of the President's Spotlight, Dr. Jason Crowell and Dr. Natalia Rost highlight how the AAN's growing representation within the AMA strengthens the voice of neurology.  Stay informed by watching the President's Spotlight video.  

Wat heeft een laag libido eigenlijk écht te vertellen? In deze aflevering ontdek je waarom libido veel meer is dan alleen zin in seks. We duiken in de fysiologie achter levenslust en bespreken hoe hormonen, leptine, voeding, stress en je zenuwstelsel samen bepalen hoeveel energie en verlangen je lichaam ervaart.Je leert waarom een laag libido vaak niet op zichzelf staat, maar een signaal is dat je lichaam onvoldoende ruimte voelt om te herstellen, te verbinden en te genieten. Een aflevering die je helpt om niet alleen anders naar seksualiteit te kijken, maar vooral naar de manier waarop jij jouw lichaam, energie en leven voedt.

"Als je zijn moeder niet wil zijn, wees dan zijn vrouw." Relatiecoach Helen en Jaimie over wat mannen en vrouwen écht nodig hebben.In deze aflevering gaat Jaimie in gesprek met Helen, relatiecoach voor vrouwen (Sterk in Liefde). Twee coaches, twee invalshoeken (man en vrouw), maar exact dezelfde kernboodschap: stop met wijzen naar de ander en neem de regie terug over je eigen leven.Aan bod komen onder andere:Helens eigen verhaal: van pleasen en aanpassen naar staan in haar waarheidWaarom "ik ben je moeder niet" een man juist wegduwt, in plaats van uitnodigtHet verschil tussen masculiene en feminiene energie, en waarom die botsing zoveel relaties vastzetWaarom een vrouw soms "prikt" en wat daar écht achter zitVerwachten versus verlangen: het verschil dat alles verandertWaarom elke coach, therapeut of opsteller werkt vanuit zijn eigen perceptie, en waarom dat juist de kracht isEen openhartig gesprek tussen twee coaches die vanuit eigen ervaring spreken, niet vanuit een boekje.In september start een nieuwe ronde van Rise, het programma voor mannen. Maximaal 15 plekken.. plan een gratis kennismaking of stap meteen in!https://www.jaimiepeeters.nl/rise-programmaVond je deze aflevering waardevol? Geef hem 5 sterren dat helpt anderen deze podcast te vinden.

Deze zomer reconstrueert Het is maar politiek een aantal grote politieke schandalen en verhalen uit het verleden. Deze week: de vervalste F-16-mails, waarmee de socialistische voorzitter John Crombez dacht een minister ten val te kunnen brengen. Tot bleek dat zijn bewijs vals was. Aan tafel: Bart Eeckhout, Stavros Kelepouris & Joline MaenhoutProductie: Laurens Bervoets (hoorstroom) & Dries VermeulenEindredactie: Sam Feys Wil je reageren? Mail naar podcasts@demorgen.beSee omnystudio.com/listener for privacy information.

In deze aflevering van De Nieuwe Wereld bespreken Rogier van Bemmel, Jasper van Dijk en Michel Portier de botsende waarden in onze huidige samenleving.Aan de hand van de geschiedenis van de DDR en de Stasi trekken ze verontrustende parallellen met de moderne, digitale surveillance van vandaag. Daarnaast analyseren ze de recente aanslag op een Pride-evenement in Berlijn en de complexe 'tolerantieparadox': hoe verdedigen we onze vrijheid tegen intolerantie, zonder onszelf te verliezen in een identiteitscrisis?Ook duiken de sprekers in het vastgelopen publieke debat met behulp van de psychologische 'dramadriehoek', die verklaart waarom we in maatschappelijke discussies zo vaak vastlopen in de rollen van dader, slachtoffer of redder. Tot slot bespreken ze het falen van de rechtsstaat en de explosieve migratiecrisis in de Spaanse enclave Ceuta, waar geopolitieke spanningen zomaar het einde van de vrije Europese Schengenzone zouden kunnen inluiden.Steun DNWMaak het geluid van de Nieuwe Wereld mogelijk. Zonder uw steun geen DNW! Word lid of doneer:

Uur 1 1.         Fool that I am – Etta James 2.         Naar buiten – Gerard Cox 3.         Amore malox - Bungaro  4.         Flower of the universe - Sade 5.         Into temptation – Crowded House 6.         Unforgettable – George Benson & Wynton Marsalis 7.         On s'habitue à tout – Renan Luce 8.         Open arms – Lucy Thomas 9.         Wat voor weer zou het zijn in Den Haag – Conny Stuart 10.       Aan een klein meisje – Henny Vrienten & Holland Sinfonia 11.       Weltuntergang – Annett Louisan 12.       Nothing's impossible – Solomon Burke 13.       Black pearl – Margriet Eshuijs   Uur 2 1.         Falling slowly – Glen Hansard & Markéta Irglová 2.         Les amoureux des bancs publics – Georges Brassens 3.         Echo zonder naam – Roxeanne Hazes 4.         Morning dew – Long John Baldry 5.         That man – Caro Emerald 6.         Yasaman - Ladaniva 7.         Hemingway – Blof & Eliades Ochoa 8.         In your shoes – Girl Named Tom 9.         Goodmorning starshine – Beverly d'Angelo 10.       Era de aquario/deixa o sol entrar - MARO 11.       Hand it over – Keb'Mo'  & Soweto Gospel Choir  12.       De Peel in brand – Rowwen Heze 13.       Parlez-vous – Ocobar & Fay Lovsky 14.       Too high – Stevie Wonder

Omdat politiek Den Haag met reces is, maken we deze zomer op vrijdagen geen De kamer van Klok, maar brengen we onze andere podcasts onder de aandacht. Vandaag is dat Schaduwoorlog waarin onderzoeksjournalisten Annieke Kranenberg en Huib Modderkolk de wereld van spionage en sabotage analyseren Via psychologische campagnes en fysieke provocaties probeert Rusland de westerse samenleving te ontwrichten. Aan de hand van een omvangrijk datalek van een Russische pr-bureau wordt stap voor stap blootgelegd hoe desinformatiecampagnes (zoals het nepverhaal over een miljoenenappartement van de moeder van Oekraïense president Zelensky) worden opgezet en gefinancierd onder direct toezicht van het Kremlin.Naast digitale ‘cognitieve aanvallen’ komen in deze aflevering ook de fysieke operaties op Europees grondgebied aan bod. Huib en Annieke bespreken hoe westerse media ongewild worden ingezet om Russische sabotageacties, zoals het bekladden van Franse synagogen en het achterlaten van varkenskoppen bij moskeeën, te vergroten. Wat is het achterliggende doel van deze geraffineerde false flag-operaties, en hoe kunnen we als media en kritische burgers voorkomen dat we worden meegesleept in deze tactiek van doelbewuste polarisatie? Presentatie: Annieke Kranenberg en Huib ModderkolkMontage en redactie: Tiemen HagemanEindredactie: Corinne van Duin en Jasper VeenstraArtwork: Matteo BalSee omnystudio.com/listener for privacy information.

Hoe komt het dat een hele generatie schoolverlaters vastloopt bij hun eerste stappen op de arbeidsmarkt? In deze aflevering van De Nieuwe Wereld spreekt Ad Verbrugge met assessment psycholoog Daphne Pieterson en Leen van Ochten (werkzaam in het sociaal domein) over de groeiende kloof tussen ons onderwijssysteem en het bedrijfsleven.Starters kampen steeds vaker met een gebrek aan basisvaardigheden (zoals doorvragen en probleemanalyse), vallen snel uit met spanningsklachten, of hebben onrealistische verwachtingen over salaris en succes. Aan tafel wordt de diagnose scherp gesteld: van dertig jaar competentiegericht onderwijs en het desastreuze besluit om de LTS af te schaffen, tot de 'medaille-generatie' die geen kritiek meer kan verdragen. Waarom hebben we de Meester-Gezel structuur losgelaten, en hoe herstellen we de waardering voor écht vakmanschap en discipline?--------------Steun DNWMaak het geluid van de Nieuwe Wereld mogelijk. Zonder uw steun geen DNW! Word lid of doneer:

In de Spaanse exclave Ceuta, grenzend aan Marokko, zijn naar schatting tienduizenden migranten binnengedrongen in de afgelopen 24 uur. Ook zijn er mensen om het leven gekomen. Verder is er nog veel onduidelijk over de situatie. "Het is moeilijk voor journalisten om te zeggen dat je ergens bent en iets ziet gebeuren, maar dat heel veel dingen nog niet duidelijk zijn en dat je dat gaat uitzoeken", zegt journalist Frénk van der Linden. En zolang we geen totaaloverzicht hebben van de situatie, moet je als journalist voorzichtig zijn met cijfers, schetst Niki van der Naald, adjunct-hoofdredacteur van De Gelderlander. "Je moet echt duidelijk maken dat het in de chaos om honderden, maar ook om duizenden mensen kan gaan." Aan tafel zitten Niki van der Naald, Frénk van der Linden en Spraakmaker Hans Spekman. 

Hoe haal je écht meer uit Microsoft Copilot? In deze aflevering van Studio Beeckestijn gaat Bart in gesprek met AI-expert Ruben Mellaart over de kansen, valkuilen en ontwikkelingen rondom Copilot. Aan de hand van drie prikkelende stellingen ontdek je praktische tips, scherpe inzichten en do's & don'ts om Copilot slimmer en effectiever in te zetten.

In deze aflevering duiken we in een onderwerp waar ontzettend veel mensen mee worstelen: een zenuwstelsel dat altijd 'aan' lijkt te staan. Waarom lukt het soms niet om écht te ontspannen, zelfs niet als je mediteert, yoga doet of een vrije dag hebt? Je ontdekt waarom innerlijke veiligheid de echte basis is voor herstel en hoe jouw buik, ruggengraat en dagelijkse keuzes daarin een veel grotere rol spelen dan je misschien denkt.Je leert hoe chronische stress je hormonen, spijsvertering, slaap en energie beïnvloedt, waarom je lichaam voortdurend de vraag stelt "Ben ik veilig?" en hoe je stap voor stap weer kunt thuiskomen in jezelf. Een aflevering vol praktische inzichten én een uitnodiging om met meer rust, stevigheid en vertrouwen samen te werken met je lichaam.

Het OM heeft drie arrestaties gedaan naar aanleiding van een onderzoek naar terrorisme. In Alkmaar, Eindhoven en Rotterdam zijn drie jonge terreurverdachten van hun bed gelicht. Er wordt daarmee gelijk een link gelegd met de Pride in Amsterdam, wat aanstaande zaterdag plaatsvindt, en de aanslag in Berlijn van een paar dagen geleden. "Is er een connectie? Daar probeer je duiding aan te geven", stelt Bas van Sluis, onderzoeksjournalist bij Dagblad van het Noorden. Tot nu toe gaat het om speculatie, aangezien er nog niet genoeg bekend is over de zaken in Nederland. "Het OM geeft nu aan dat die twee dingen niet met elkaar te linken zijn, maar het is een opvallend moment." Volgens schrijver Haroon Ali is er een "behoefte" om het aan elkaar te linken, maar moeten we daar "waakzaam" voor zijn. "Er is al veel stigma en angst rondom de Islam. In de volksgeest gaat het al snel een eigen leven leiden, juist door dat stigma dat ze allemaal in hetzelfde complot zitten tegen het Westen." Aan tafel zitten Bas van Sluis, Sara Berkeljon en Spraakmaker Haroon Ali. 

Unruptured intracranial aneurysms and arteriovenous malformations are frequently discovered incidentally on neuroimaging, presenting complex decisions around monitoring, referral, and treatment. This episode highlights key risk factors for rupture, the role of imaging in evaluation, and practical approaches to triage and management, including when specialist intervention is warranted. In this episode, Gordon Smith, MD, FAAN, speaks with Edgar Samaniego, MD, FAAN, authors of the article "Unruptured Intracranial Aneurysms and Arteriovenous Malformations" in the Continuum® June 2026 Cerebrovascular Disease 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. Samaniego is a professor of neurology, neurosurgery, and radiology and the director of the vascular neurology fellowship at the University of Iowa in Iowa City, Iowa. Additional Resources Read the article: Unruptured Intracranial Aneurysms and Arteriovenous Malformations 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 Guest: @esamaniego Full episode transcript available here Dr Smith: Have you ever ordered an MRI of the brain and found a coincidental unruptured aneurysm or perhaps an arteriovenous malformation? If so, are you up to speed on how to manage this common situation, how to monitor, when to refer, and how to counsel your patients? If your answers to these two questions are yes and or no, then please keep listening.  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: This is Dr. Gordon Smith. Today, I'm interviewing Dr. Edgar Samaniego about his article on unruptured intracranial aneurysms and arteriovenous malformations. This article appears in the June two thousand twenty-six Continuum issue on cerebrovascular disease. Edgar, welcome to the podcast, and maybe you can briefly introduce yourself to our listeners.  Dr Samaniego: Yeah. Thank you, Gordon. So, I'm an interventional neurologist. I'm practicing at the University of Iowa. I've been in Iowa for the last ten years. I'm originally from Ecuador. Did my residency in Wisconsin, and then I went to Stanford for neuro critical care and stroke. And then I did my neurointerventional fellowship at the Baptist Cardiac and Vascular Institute in Miami.  Dr Smith: You're a triple threat in the world of vascular and critical care, which I want to get to later. But your article's really great. I'll admit one of the first things I do when I read an article for Continuum Audio is I see how long it is. I saw yours was as long as the rest, and I was a little surprised because this sounded like a simple topic. But having read it, it's anything but simple. This is really important and complex stuff. I wonder if maybe you can orient our listeners to the importance of this. We frequently find unruptured aneurysms or vascular malformations on brain imaging that we order for something else. I mean, how common is that, and why do you think our listeners need to be particularly attentive to our conversation today?  Dr Samaniego: It's pretty frequent that we see patients with unruptured brain aneurysms. A lot of times, you know, we do imaging like CT angiograms, or magnetic, resonance angiography. Patients come to the ER with headaches, and we find an unruptured aneurysm. And you know, the question always comes, "What should we do with this aneurysm that we found?" We know that a lot of these aneurysms will not rupture, but the caveat is that when they rupture, like fifty percent of these patients may die or have bad outcomes. So, it's always a puzzling question, you know. What should we do with the aneurysm?  Dr Smith: Well, thanks, Edgar. I mean, this is certainly something that I come across. I'm glad to hear that other people struggle with this as well. What actually is the prevalence of aneurysms in the general population? How common is this?  Dr Samaniego: It's more common than what we think, you know. The, the estimates talk about like one in every fifty people have a brain aneurysm, and about every eighteen minutes an aneurysm will rupture. In the United States, there's approximately thirty thousand ruptures per year. So, there's a significant number of, of patients affected by brain aneurysms. And, and the key thing is that affects usually younger patients who are in the most productive years of their lives. So that's why it shouldn't be ignored, and once we find an aneurysm, we have to have all the information for triaging and deciding on treatment of these aneurysms.  Dr Smith: Well, it's a great way to begin our conversation. I mean, this is not a rare problem. It's a common problem, and there's actually a really great section of the article I'll refer people to about medical malpractice and the importance of recognizing and dealing with this thoughtfully. It's an empowering section, not a scary one, but this is important for our listeners to know about. Pretty high-stakes stuff. Maybe you can orient listeners like me or maybe simple neuromuscular people. What different types of aneurysms are there?  Dr Samaniego: That's the interesting question because there's multiple types of aneurysms, and there is a whole spectrum of aneurysm. When we say aneurysm, you can be talking about a fusiform versus a saccular aneurysm. We tend to classify them based on shape, also location. But the two main classifications for brain aneurysms will be saccular, which, you know, has a sac kind of morphology shape, and then you have the fusiform aneurysms. Those are the main morphological classifications. Then on top of that, you have two other subtypes that you see quite often. The one that we see is mycotic aneurysms that is like a misnomer because it's not a fungal aneurysm. It's just an infectious aneurysm that most of the time we see on the setting of endocarditis. These behave a little bit different than the typical saccular or fusiform aneurysms. And then also you have other more rare types of aneurysms like blister aneurysms that are sometimes located in the anterior wall of the carotid artery. So, you know, within this spectrum, we have those main aneurysms. The typical aneurysms, which can be fusiform or saccular, and also the more atypical, which can be mycotic and also blister-like aneurysms.  Dr Smith: I wonder if you might comment a little bit on the relevance of the type of aneurysm, fusiform, saccular, blister, and then location on rupture risk or prognosis.You have a really great figure about anatomic classification in the article actually that I encourage everyone to check out when they hopefully read it. But what do these characteristics imply for risk?  Dr Samaniego: Yeah. This is very complex question because, you know, entails different characteristics of aneurysms such as shape, the location, morphology. So, we know that some locations, for example, the anterior communicating artery has a high risk of rupturing as opposed to patients such as the part of ophthalmic aneurysm, which are usually located at the origin of the ophthalmic artery in the internal carotid artery. So, by risk of rupturing, the highest risk is usually the anterior communicating. Then you have posterior communicating artery aneurysms, which are usually located in the internal carotid artery, but because of their proximity to the origin of the posterior communicating artery, they're called posterior communicating artery aneurysms. Then you have the posterior circulation aneurysms on top of risk of rupturing is the top of the basilar artery location. Those three are the highest risk for rupturing: ACOM, PCOM, and top of the basilar. In terms of morphology, I always tell my patients, you know, if it's like a nice-looking aneurysm that has this rounded shape is a benign morphology. If you have the aneurysm that's having these Mickey Mouse ears that has these blebs or daughter sacs, those are aneurysms that usually scare us because those are the ones that usually rupture. So that's another criteria, morphology. And then the other criteria would be size. There is this magnificent study called ISUIA, which was published several years ago, and basically what it demonstrated was that aneurysms that are seven millimeters or larger are more likely to rupture versus smaller aneurysms. So those are the three criteria that I'm looking into when talking to patients about morphology, location, size, and the, the shape or morphology of the aneurysm.  Dr Smith: So, let's say a general neurologist or comprehensive neurologist practicing in a community setting in a rural area orders a, let's just say a CT or CTA for a patient with a TIA and finds what looks like an aneurysm. What's the next step in terms of imaging? What's the best next step? I mean, there are a bunch of different imaging modalities. Do you get an MRA? Is it time-of-flight, contrasted? You know, when do you get a DSA and so forth?  Dr Samaniego: Yeah. The first thing to do is to better characterize the aneurysm. Order of more accurate imaging that we can obtain without being invasive with a diagnostic cerebral angiogram. The rest will be a magnetic resonance angiography with contrast that, you know, gives you really good detailed information about the aneurysm. Similar in terms of quality and precision will be a CT angiography. The caveat there is with CT angiography is that, you know, you use radiation, and the patient has to get iodine. And then under those two, you will have a time-of-flight magnetic resonance angiography, which doesn't use any contrast, but then you lose a little bit of quality in terms of the imaging and some morphological features you might miss. So usually what we do in my practice, I don't wanna do a diagnostic cerebral angiogram, and somebody has to refer an unruptured aneurysm. I try to do CT angiogram as a baseline, see how the aneurysm looks, and then for follow-up, I usually do magnetic resonance an- angiograms with with contrast. If there is a concern that the aneurysm has some dangerous features like it's irregular in shape, it's, it's larger, it's in one of these high-risk locations, might be better just to refer the, the patient to a specialist for a diagnostic cerebral angiography.  Dr Smith: So, you know, there are these scales that you talk about in the article. There's phases in the UIATS that are used to predict rupture risk and guide decision-making. Are these scales that general neurologists or non-vascular neurologists can use to guide care? I'm thinking of like Chad-Baskin, ASBAD, which, you know, all our residents know about. Should we all be familiar with these scores?  Dr Samaniego: I think they're very helpful in the sense that it will give us some guidance. Some of the characteristics of the scale might be up- outdated. For example, like ancestry. Although it's been described more in Japanese and Finnish populations, and North American, not as much as these two other populations. We do see a lot of aneurysms in people from North America and other backgrounds. For example, one of the biggest critiques for the phases is that doesn't take into account smoking history. Smoking that we know is a risk factor. And the other critiques for phases is that, for example, if you are older than seventy years old, you will score one point, which will increase your risk of aneurysm rupturing. Having said that, we do see like tons of aneurysms on younger patients, actually the most productive years of their lives that they rupture. So, it gives you some parameters like the presence of hypertension, the size, as I said, seven or larger, previous history of subarachnoid hemorrhage, and the location of the aneurysm. But it doesn't take into account other factors like smoking or morphological features of the aneurysm. Dr Smith: Now, you mentioned size. I'd like to maybe go back and talk about a case from your article, which I found really impactful. For our listeners, this is a sixty-four-year-old woman who had a five-millimeter ACOM aneurysm. She was imaged serially, didn't change over the time period, and then two years later ruptured with devastating consequence, right? And so that's a small aneurysm. Most aneurysms, I guess, are small aneurysms. I just wonder, when you see a patient like that, how do you handle the discussion regarding risk? And how do you decide when to refer them for an intervention?  Dr Samaniego: Yeah. It's always puzzling when we see these smaller aneurysms. And this example is a typical example of a patient that doesn't follow the rule of seven or larger aneurysm size for rupturing. We see that quite often on aneurysms located in the anterior communicating artery. Just this last week, I treated two patients with similar characteristics, with smaller aneurysms, like average size between four and five, that rupture, and both were located in the anterior communicating artery. So, we know that there is definitely a linear relationship between size and risk and rupture, but we do see a lot of patients that have smaller aneurysms, like three, four, five millimeters that rupture, and we don't really understand very well the, biology of these aneurysms. So, when we see these aneurysms, we try to maximize the characterization of the aneurysm with better imaging, try to see the morphology. And usually when an aneurysm is discovered, what we do for follow-up is a six-month follow-up with some type of imaging, CTA, MRA with contrast, and see if there's has been any change in, on the aneurysm.  Dr Smith: So, is it fair to say that a knowledgeable non-vascular neurologist can safely manage these patients, follow them over time using what they learned from reviewing your article, identify patients who have higher risk aneurysms based on the characteristics you summarize, and refer them to a tertiary center? When I get these, it's easy for me to have our vascular neurosurgeon see them or a vascular neurologist, right? But in a community where you may not have ready access to that subspecialist, is it still important to get all of these patients to a tertiary center? Are there select instances where a community-based general neurologist can follow them and then refer if there's change in size, for instance?  Dr Samaniego: Yeah. I think that everything else that we do in neurology, it's important to do some type of triage in referring some of these patients for further studying and  expert opinion. I think age and size of the aneurysm, age of the patient and size of the aneurysm are huge factors. For example, if we have an older patient in their nineties and has incidentally found two-millimeter aneurysm in a low-risk location like the parathalmic, that patient probably needs to be seen locally. I don't think merits a full workup. As opposed to a younger patient with a three-millimeter aneurysm located in the ACOM. I think that type of patient probably needs to be referred to a tertiary s-stroke center for workup. I mean, most of the time what's gonna happen is that if it's a small aneurysm with benign characteristics, you know, it's gonna be seen by the specialist and they're gonna determine some type of follow-up, which can be done locally.  Dr Smith: So maybe we can pivot a little bit and talk about AVMs, if that's okay. What's your approach to a coincidentally discovered AVM, right? I mean, presumably, we need to think about symptomatic AVMs a little differently, I would think. So maybe we can start with the same scenario we've been talking about. You get an imaging study for something else, and, well, we find an AVM. What's the approach to that situation?  Dr Samaniego: Yeah. AVMs are fascinating vascular lesions because they're very complex, they're very heterogeneous. If we're talking about the morphological features with aneurysms, this, in the case of AVMs, is way more complex in terms of location size. The complexity added to AVMs is that you have a feeding artery, you have a nidus, and then you have draining veins. So, all of these can be very heterogeneous. In case of AVMs, I think those definitely need to be referred to a tertiary center because the management of AVMs is multidisciplinary, even in the tertiary centers. You know, we don't have a magic wand that will say, you know, all these AVMs need to be treated this way. Sometimes they don't even need to be treated because we know from some studies that just watching them will be good enough.  Dr Smith: You raised management of AVMs. Maybe we can go back and talk a little bit about what's the latest in management of aneurysms. You manage aneurysms from soup to nuts and as an endovascular interventional neurologist. What's the latest in management of aneurysms?  Dr Samaniego: The latest is that, which falls within management, is that we have tools that they have not really been validated a hundred percent because we're still understanding the biology of some of these aneurysms. But high-resolution MRI will help us to define if there is some enhancement of the aneurysm. There is the thought that if there is enhancement after the administration of contrast, might be more of an inflammatory process. So that can be used for management, triage, and follow-up of some of these aneurysms. In terms of endovascular treatment, it has been really a revolution of how we treat these lesions. You know, we have a lot of new devices, better catheters to access the aneurysms.There is devices that you can place inside the aneurysm sac and it'll completely shut down flow into the aneurysm. There is other special stents called flow diverters that can take the flow away from the aneurysm and bypassing the aneurysm. So, all of these things have really revolutionized how we treat them. Having said that, you know, there's always a risk with any of these procedures, and that's why we gotta be mindful when we decide to treat these patients with unruptured incidentally found aneurysm.  Dr Smith: I've got just one more question, Edgar, which I kind of led with. You've got training as a vascular neurologist, a neurointensivist, and an interventional neurologist. And you know, Ralph Sacco, as you probably know, used to like to talk about the neurologist, and part of the neurologist was interventional. I wonder what wisdom you have to trainees that are listening to us right now who might be interested in pursuing a career as a neuroendovascular neurologist. What wisdom do you have for them about how to go about doing that?  Dr Samaniego: It has been really rewarding to be part of this process and evolution of treating a stroke and aneurysms and AVMs because I remember when I was a resident at the University of Wisconsin, we only had, like, thrombolysis and only one device for, retrieving some of these clots. But now we have, like, 10 different devices. We have two different indications or two, two different thrombolytics. So, my best advice for trainees that want to pursue neuroendovascular is to get engaged early on, understand very well the biology and the thought process because it's not only a technical field. You have to have really good judgment on when to do and when not to do the procedure, and try to find mentorship. You know, there is a lot of neurointerventional neurologists out there right now. Having a good mentor will really facilitate your career choices and getting into training.  Dr Smith: Well, Edgar, thanks so much. What an exciting conversation. It's just another great example of how exciting neurology is these days. Many exciting advances and innovations, and we just scratched the surface. I encourage all of our listeners to read the article. It's actually really, really informative. So, thank you very much.  Dr Samaniego: Thank you so much, Gordon.  Dr Smith: Again, today I've been interviewing Dr. Edgar Samaniego about his article on unruptured intracranial aneurysms and AVMs. This article appears in the June 2026 issue of Continuum on Cerebrovascular Disease. Be sure to check out other Continuum Audio episodes from this and other issues, and thanks to you, 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.

In '50 jaar Margreet Dolman' blikt Paul Haenen terug op het eigenzinnige personage dat al decennialang een vaste plek inneemt in de Nederlandse cultuur. Het boek schetst een portret van Margreet Dolman als scherpzinnige observator, trooster en provocateur, die met humor en emotie reageert op de wereld om haar heen. Aan de hand van markante momenten laat Haenen zien hoe Dolman steeds opnieuw grenzen verkent en tegelijk het menselijke centraal stelt. Paul Haenen is ook bekend als cabaretier en theatermaker, van zijn alter ego dominee Gremdaat en als stem van Bert en Grover in Sesamstraat. Presentatie: Carine van Santen

Sony schrapt het schijfje, Xbox schrapt banen en een nieuwe console kan richting duizend euro gaan. Wie kan gaming straks nog betalen? Games maken wordt duurder, consoles worden niet goedkoper en spelers blijven hangen op een prijsgrens van ongeveer 80 euro. Tweakers-redacteur Daan van Monsjou legt uit waarom die rekensom steeds minder goed uitkomt. Sony stopt vanaf januari 2028 met schijfjes voor nieuwe PlayStation-games en stuurt kopers richting digitale licenties, terwijl fysieke spellen volgens Daans prijsvergelijking meestal goedkoper zijn. Een korting in de PlayStation Store kan bovendien verdwijnen, waarna zelfs een jarenoude game weer 80 euro kost. Aan de andere kant snijdt Xbox na een kostbare overnamegolf in studio’s en personeel, terwijl aan tafel de vraag opkomt of Game Pass die investeringen ooit kan terugverdienen. Met Randal, Jurian en Ruurd bespreekt Daan wie de rekening betaalt, of de EU moet ingrijpen en waarom kleinere games juist ruimte krijgen tussen het miljoenengeweld. Over Daan van Monsjou Daan van Monsjou is nieuwsredacteur bij Tweakers, waar hij sinds 2019 nieuws- en achtergrondverhalen schrijft. Zijn voorliefde ligt bij computerhardware en de chipsector; eerder onderzocht hij de chipambities van de EU en interviewde hij ASML-cto Martin van den Brink. Voor deze aflevering dook hij in Sony’s afscheid van fysieke games en vergeleek hij de prijzen van digitale en fysieke PlayStation-games. LinkedIn: Daan van Monsjou Website: daanvanmonsjou.nl In deze aflevering 0:00:00 Cold open: schijfjes verdwijnen en consoles laten op zich wachten0:00:23 Intro: Daan is terug en Tech45 kreeg een verbouwing0:05:45 Waarom de game-industrie op haar grondvesten schudt0:10:41 Sony stopt in 2028 met nieuwe games op schijf0:14:52 Van winkelmarge naar Sony’s 30 procent0:20:05 Waarom games tegelijk te duur en te goedkoop zijn0:32:27 De volgende generatie: Sony op de troon, Xbox in de knel0:46:51 Miljoenenproducties, indiegames en de verdwenen middenklasse0:53:10 Luistervraag van Joris: wat betekent de Chinese invloed van Tencent?1:01:32 Luistervraag van Joost: werken bij Tweakers en pijnlijke kritiek Genoemd in deze aflevering GTA VI was het begin van het einde, Daan over Sony’s afscheid van fysieke games Prijsdata van fysieke en digitale PlayStation-games, fysieke spellen zijn vaak goedkoper PlayStation stopt met fysieke schijfproductie, Sony’s officiële aankondiging voor januari 2028 Project Helix, officiële toelichting op de volgende Xbox-console Digital Markets Act, Europese regels voor digitale poortwachters Steam-terugbetalingen, voorwaarden voor geld terug bij Steam Tech45, wekelijkse techpodcast met Ruurd Sanders Tips van de tafel Daan van Monsjou: Vergelijk de PlayStation Store met fysieke webwinkels; schijfjes zijn voorlopig meestal goedkoper en je kunt ze later doorverkopen. Ruurd Sanders: Test een Steam-game direct na aankoop; binnen veertien dagen en met minder dan twee uur speeltijd kun je meestal geld terugvragen. Randal Peelen: Loop gerust een consolegeneratie achter; oudere grote spellen zijn in een uitverkoop goedkoop en draaien prima op een Steam Deck.See omnystudio.com/listener for privacy information.

Het is inmiddels vijf dagen sinds de aanslag bij de Pride in Berlijn. De Duitse politiek en media zijn volop bezig met achterhalen hoe deze tragedie heeft kunnen voorkomen. Daarbij wordt de focus vooral gelegd op het falende systeem van de veiligheidsdiensten in het land. Volgens Sander Heijne, hoofdredacteur van Vrij Nederland, moet het vooral gaan over het feit dat de maatschappij minder homovriendelijk is geworden. "We moeten in de breedte kijken naar acceptatie en die is in de hele breedte aan het afnemen", zegt Heijne. Ook in Nederland is dat aan de hand. "We hebben leiders van regeringspartijen die zich uitspreken tegen de week van de lentekriebels, die regenboogzebrapaden vergelijken met hakenkruizen. Het debat wordt steeds LHBTI-onvriendelijker." Margriet Brandsma, oud-correspondent in Duitsland, "begrijpt" waarom het in de Duitse media gaat over hoe dit "alweer" heeft kunnen gebeuren, en dat daarbij vooral gekeken wordt naar de veiligheidsdiensten. "Hij was bekend, maar kon toch zijn gang gaan. Ik begrijp wel dat dat wordt uitgelegd", zegt Brandsma over de dader.  Aan tafel zitten Margriet Brandsma, Sander Heijne en Spraakmaker Tatjana Almulli. 

Het Witte Huis presenteerde afgelopen week een aangescherpte versie van de Clarity Act, de Amerikaanse wet die moet vastleggen wie in de Verenigde Staten de baas is over crypto: toezichthouder SEC voor effecten, of de CFTC voor grondstoffen en derivaten. Nieuw is een ethiekhoofdstuk van zes artikelen dat de president, de vicepresident, Congresleden, federale rechters en hun echtgenoten verbiedt om tijdens hun ambtstermijn tegen betaling tokens uit te geven of te sponsoren. Bestaande cryptobelangen moeten binnen een jaar worden verkocht of naar een blind trust verhuizen, en beurzen mogen tokens die onder dat verbod vallen niet listen. Toch zit er ruimte in de tekst. Het verbod gaat over uitgeven en sponsoren, niet over bezitten, en een clausule staat uitgevers toe de gelijkenis van een politicus te blijven gebruiken als de token al vóór het aantreden bestond. De TRUMP-coin verscheen drie dagen voor de beëdiging. Kinderen van politici vallen er evenmin onder, terwijl Donald Trump Jr. en Eric Trump betrokken zijn bij World Liberty Financial. Bovendien vervalt het hele pakket op 20 januari 2029, en daarna kunnen ook oudere overtredingen niet meer worden vervolgd. Dat verklaart waarom zeven Democratische senatoren het concept alsnog te mager vinden op ethiek, illegale geldstromen en belangenverstrengeling. Onder hen Angela Alsobrooks en Ruben Gallego, precies de twee die in mei in de commissie vóór stemden. Meerderheidsleider John Thune verwacht niet dat de wet vóór het zomerreces van 10 augustus af is, terwijl minister van Financiën Scott Bessent en cryptoadviseur Patrick Witt de eerste week van augustus nog kansrijk noemen. Handelaren op Polymarket schatten de kans op ondertekening dit jaar op ongeveer 43 procent. Tim Stolte, portfoliomanager bij Amdax en host van de podcast Een Nieuwe Koers, kijkt naar een markt die er in de zomervakantie stabiel bij ligt en steeds een beetje hoger kruipt. Deze week staat ook het rentebesluit van de Amerikaanse centrale bank op het programma. Banken en bedrijven trekken ondertussen miljoenen uit om bitcoin te beschermen tegen quantumcomputers. Bitcoin bewijst eigendom met cryptografie op basis van elliptische curves, en een voldoende krachtige quantumcomputer kan die stap omdraaien: van publieke sleutel terug naar geheime sleutel. Project Eleven schat dat zo'n 6,9 miljoen bitcoin in adressen zit waarvan de publieke sleutel al zichtbaar op de blockchain staat. Over de urgentie lopen de schattingen ver uiteen, van drie tot vijf jaar voorbereidingstijd in een rapport van Bernstein tot twintig tot veertig jaar volgens Adam Back van Blockstream. Aan oplossingen wordt gewerkt. BIP-360 introduceerde in februari een adrestype dat het kwetsbare onderdeel weghaalt, en BIP-361 gaat verder: kwetsbare munten migreren en na vijf jaar bevriezen, waaronder naar schatting 1,7 miljoen bitcoin in oeroude adressen waarvan zo'n miljoen vermoedelijk van Satoshi Nakamoto is. Galaxy stelt tot vijf miljoen dollar beschikbaar voor quantumbestendige handtekeningen, migratietools en audits. Negen partijen zetten daarnaast vijftien miljoen dollar over drie jaar in via het Bitcoin Security Consortium, gecoördineerd door Mike Schmidt van Brink, dat expliciet vastlegt zich niet met het protocol te bemoeien. Co-host is Raoul Esseboom. Over de podcast Cryptocurrency are here to stay. In deze wekelijkse podcast gidst Daniël Mol je door het belangrijkste cryptonieuws, langs hypes en trends, voor- en tegenstanders en winst en verlies. In het A-deel bespreken we het laatste nieuws en in het B-deel gaan we in gesprek met een gast. Van cypherpunkpioneers tot grootbanken die aan de haal gaan met stablecoins, van Bitcoin tot Ethereum tot CBDC's. Alles passeert de revue.Reageren? Stuur dan een mail naar cryptocast@bnr.nl Gasten Raoul Esseboom is contentspecialist bij BLOX en oprichter van Cryptotakkies. Tim Stolte is portfoliomanager bij Amdax en host van de podcast Een Nieuwe Koers. Links Clarity Act krijgt ethiekpakket dat politici verbiedt crypto uit te geven Amerikaanse Clarity Act dreigt opnieuw vertraging op te lopen Thune verwacht dat de Clarity Act zijn deadline voor het zomerreces mist Democraten verzetten zich tegen de ethiektekst in de Clarity Act Galaxy kondigt vijf miljoen dollar aan voor quantumbeveiliging van bitcoin Experts noemen crypto de kanarie in de kolenmijn voor de quantumdreiging Hoe reëel is het dat een quantumcomputer bitcoin naar nul schiet Host Daniël Mol is presentator en redacteur van de Cryptocast. Hij is sinds 2017 met Bitcoin bezig en kwam in 2021 bij het team van de Cryptocast. Redactie Daniël Mol Donner Bakker See omnystudio.com/listener for privacy information.

Rouw en verlies, van dichtbij. In deze aflevering van Omvatten spreekt Daniëlle van Sundert, therapeut en opleider bij Praktijk HB, open over haar rouw door haar echtscheiding van vorig jaar en het recente overlijden eind april 2026 van haar moeder. Aan de hand van het werk van klinisch psycholoog Manu Keirse ontrafelt ze waarom rouw geen probleem is dat je oplost, maar iets wat je overleeft. Ze neemt je mee in wat missen echt betekent, wat rouw met je brein en lichaam doet en hoe je er voor iemand die rouwt kunt zijn. Een aflevering over verlies en over liefde die blijft bestaan. Aan te bevelen boeken van Manu Keirse zijn:-Helpen bij verlies en verdriet-Rouwen is liefde-Van het leven geleerd-Als ik er niet meer ben-Vingerafdruk van verdriet

In deze aflevering neem ik je mee in een principe dat mijn kijk op verandering veranderde. Aan de hand van iets kleins, zoals die zak chips 's avonds bij tv, en iets groters, zoals jezelf tonen als expert, leg ik uit waarom je brein je soms actief tegenwerkt.Je hebt vast wel eens gehoord: gewoon meer discipline, dan lukt het wel. Maar naar mijn mening, en volgens het Immunity to Change principe, is dat niet het enige wat er nodig is. Klaar om nieuwe paden in je brein te leggen?

Het Brabantse dorp Engelen heeft te maken gekregen met bekladdingen op huizen. Mensen die een poster van VluchtelingenWerk achter hun raam hadden zitten, hebben nu teksten op de voorkant van hun huis. Anti-azc-demonstranten zitten achter de bekladdingen en richten zich op vrouwen, met leuzen en teksten als 'stinkteef', 'hoer' en 'slet.' Clara van de Wiel, adjunct-hoofdredacteur van NRC, noemt het "ironie ten top" dat demonstranten de veiligheid van vrouwen en meisjes opwerpen als argument tegen azc's, maar nu zelf vrouwen en meisjes aanvallen met hun bekladdingen. "Het is een nieuwe vorm van protest. Eerst ging het op de azc's zelf, nu op de eigen gemeenschap." Hasna el Maroudi, hoofdredacteur Journalistiek bij Omroep ZWART, stelt dat het dus ook niet het "doel" is van anti-azc-protesten om vrouwen te beschermen. "We zien dit keer op keer terug. Als we hier als maatschappij niet vaker over spreken en er goed over doorpraten, blijft dit gebeuren." Aan tafel zitten Clara van de Wiel, Hasna el Maroudi en Spraakmaker Melanie During. 

Het is volop zomer en normaal betekent dat een pauze voor de Ecosofie Podcast. Maar deze zomer deel ik met veel enthousiasme, een inspirerende podcastreeks met jullie die ik afgelopen maanden maakte in opdracht van het College van Rijksadviseurs, namelijk Ruimte voor de Economie van de Toekomst.In deze reeks onderzoek ik samen met verschillende denkers en experts hoe onze economie eruit kan zien als we mens, natuur en brede welvaart centraal stellen. Welke aannames mogen we loslaten? Welke nieuwe perspectieven dienen zich aan? En wat betekenen die voor de toekomst van Nederland?Ik wens je veel luisterplezier en ben benieuwd welke inzichten jij meeneemt uit deze aflevering. Fijne zomer!Wil je nu al de hele serie luisteren? Dat kan via het College van Rijksadviseurs!Aflevering 2 met Barbara Baarsma, over onze economie en de planetaire grenzenAflevering 3 met Najah Aouaki:, over een economie van brede waardecreatieAflevering 4 met Paul Schenderling, over een economie voorbij groei~In dit gesprek met historicus Bas van Bavel kijken Rijksadviseur Thijs van Spaandonk en host Marnix Kluiters terug in de geschiedenis om de mechanismen achter de huidige economie te begrijpen. Hoe zijn de spelregels ontstaan die onze economie vandaag vormgeven? En waarom lijken ze steeds minder goed te werken? Volgens Van Bavel creëren markten kansen, maar ook concentraties van macht, bezit en invloed. Vooral grond en kapitaal spelen daarin een cruciale rol. Tegelijk laat de geschiedenis zien dat alternatieven mogelijk zijn. Een gesprek over eigendom, ongelijkheid en de kracht van gemeenschappen, coöperaties en andere vormen van zelforganisatie. Welke spelregels hebben we nodig voor een economie waarin meer mensen kunnen meedoen?

Jurist, oud-hoogleraar strafrecht en oud-rechter Ybo Buruma is een van de bekendste juridische stemmen van ons land. Naast zijn werk als jurist, is Buruma samen met journalist Annette van Soest te horen in de HUMAN-podcast Goliath, die nu terug is met een tweede seizoen. Hierin onderzoeken zij wekelijks hoe eerlijk de Nederlandse rechtsstaat is. Aan de hand van zaken waarin burgers tegenover grote organisaties staan, vragen zij zich af of iedereen gelijk is voor de wet. Ook is Buruma redacteur bij het Nederlandse Juristenblad. Vorig jaar verscheen zijn boek 'De onvoltooide rechtsstaat'. Presentatie: Jannekee Kuijper Fotografie: Lowiegraphy

"Ik dacht: hoe kan het dat ik zoveel geef, en toch altijd verlies?" Remco deelt zijn eerlijke verhaal na een ronde Rise.In deze aflevering gaat Jaimie in gesprek met Remco, oud-deelnemer van Rise, over wat er écht gebeurt in het programma. Remco vertelt open over het patroon dat hem in relatie na relatie achtervolgde: eindeloos aanpassen, anticiperen, geven, en toch nooit genoeg zijn. En over het moment waarop hij besefte dat hij zelf de constante factor was.Aan bod komen onder andere:Hoe "alles goed doen" toch kan voelen als continu tekortschietenWaarom Remco naar zichzelf ging kijken in plaats van naar zijn partnerDe kracht van een mannengroep: spiegels krijgen zonder dat het over jou hoeft te gaan"Durf alles te verliezen, maar nooit meer jezelf": wat dat credo in de praktijk betekentHoe het patroon in een relatie ook terug te vinden is op je werk en in andere delen van je levenWaar Remco nu staat, en wat hij andere mannen zou willen meegevenDit is een eerlijk kijkje in wat Rise met een man doet, verteld door iemand die het zelf heeft doorgemaakt.In september start een nieuwe ronde van Rise, maximaal 15 plekken. Pre-sale korting van € 350 geldt tot 1 augustus. Wil je weten of het iets voor jou is? Plan een gratis kennismaking via deze link: https://calendly.com/lichterlevencoach/30-min-gratis-kennismaking-riseVond je deze aflevering waardevol? Geef deze podcast 5 sterren, dat helpt anderen deze podcast te vinden.

Wat maakt iemand een leider? En is leiderschap aangeboren, of ontwikkel je het?   In deze aflevering van **Talentgesprekken** spreekt Jan Prins met **Ray Klaassens**: oud-commando, voormalig officier, ondernemer, bestsellerauteur en voor miljoenen kijkers het gezicht van *Kamp van Koningsbrugge*.   Wie Ray kent van televisie ziet de man die onder extreme omstandigheden mensen test op karakter. Maar achter die onverzettelijke instructeur blijkt een verrassend open en reflectieve denker schuil te gaan.   Aan de hand van zijn TMA Talentenanalyse wordt al snel duidelijk welk talent als een rode draad door zijn leven loopt: **Verantwoordelijkheid & Leidinggeven**. Ray behoort tot de kleine groep mensen die van nature het voortouw neemt zodra het spannend wordt. Niet omdat hij de baas wil zijn, maar omdat hij voelt dat iemand moet opstaan.   Dat talent kwam niet meteen tot bloei. Op de KMA worstelde Ray juist met onzekerheid en probeerde hij zich aan te passen aan de omgeving. Pas toen hij zichzelf durfde te zijn, ontdekte hij dat leidinggeven hem natuurlijk afging. Een prachtig voorbeeld dat talent pas zichtbaar wordt als de omgeving daarvoor ruimte biedt.   Die ontdekking vormt meteen een van de belangrijkste inzichten uit deze aflevering: geboren leiders bestaan misschien niet, maar natuurlijke leiderschapstalenten wel. Talent is het vertrekpunt. Leiderschap is de vaardigheid die je vervolgens ontwikkelt.   Een talentgesprek over de essentie van leiderschap. Niet macht of hiërarchie staan centraal, maar **voorbeeldgedrag**. Volgens Ray ontstaat een sterke cultuur wanneer leiders zelf doen wat ze van anderen verwachten. Dat zie je terug in Defensie, maar net zo goed in het bedrijfsleven.   Ook deelt hij verrassende inzichten over het creëren van urgentie, het belang van het uitleggen van het *waarom*, de valkuil van onrealistische doelen en waarom mensen vaak veel meer kunnen dan ze zelf denken.   Natuurlijk komt ook *Kamp van Koningsbrugge* uitgebreid aan bod. Hoe ziet Ray vaak al op de eerste dag wie het gaat redden? Waarom vallen juist de meest zelfverzekerde deelnemers regelmatig af? En waarom blijken rustige, dienstbare mensen vaak de echte uitblinkers?   Zijn antwoord is verrassend. Niet fysieke kracht bepaalt de uitkomst, maar het vermogen om controle los te laten. Wie accepteert dat onzekerheid erbij hoort, blijkt vaak veel verder te kunnen gaan dan hij of zij ooit voor mogelijk hield.   Maar misschien wel het mooiste moment van het gesprek ontstaat wanneer Ray zichzelf onder de loep neemt.   Hij vertelt openhartig hoe zijn enorme verantwoordelijkheidsgevoel hem veel heeft gebracht, maar ook een prijs heeft gekost. Achteraf had hij soms een andere vader, partner en vriend willen zijn. De drive die hem succesvol maakte, kwam deels voort uit onzekerheid. Nu die onzekerheid langzaam is verdwenen, ervaart hij ook meer rust. Hetzelfde talent dat hem jarenlang vooruit heeft geduwd, heeft hij leren doseren.   Juist daardoor krijgt zijn verhaal extra geloofwaardigheid. Ray praat niet alleen over leiderschap; hij laat zien dat echte leiders ook bereid zijn kritisch naar zichzelf te kijken.   Zoals altijd sluit het talentgesprek af met de vraag in hoeverre de TMA-analyse klopt. Veel blijkt herkenbaar: verantwoordelijkheid nemen, het voortouw pakken en moeilijke beslissingen niet uit de weg gaan. Maar Ray laat ook zien dat ieder talent een keerzijde heeft – en juist daarin zit de ontwikkeling.   Een inspirerend gesprek over leiderschap, karakter en de vraag waarom sommige mensen vanzelf opstaan als anderen blijven zitten.   ±±±±±±±±±±±±±±±±±±±±±±±   Over Talentgesprekken: Jan Prins in gesprek met een gedreven gast, op zoek naar het talent achter de prestatie. In ieder gesprek staat een ander talent centraal, een talent dat sterk richtinggevend is geweest voor de keuzes in loopbaan en carrière. Voorafgaand aan elk gesprek doet de gast een TMA TalentenAnalyse die inzicht geeft in het kerntalent.   Hoofdstukken: 0:00 Ray in drie quotes 1:11 Introductie 1:31 TMA 1:45 Je bent wat je doet. 26:40 Een deadline is geen tijdlijn 39:45 "Geboren leiders bestaan niet" 50:20 "Goede leiders maken leiders" 1:11:36 De twijfel die je niet ziet   Meer Talentgesprekken: https://www.talentgesprekken.com Meer over de TMA Methode: https://www.tma.nl Meer over Ray Klaassens: https://rayklaassens.com   Abonneer voor nieuwe talentgesprekken.   #Talentgesprekken #RayKlaassens #Leiderschap #TMA #Talent #KampVanKoningsbrugge #PersoonlijkLeiderschap

Dries Van Langenhove leek een tijdje het boegbeeld van uiterst rechts. De student politiek kreeg veel aanzien als leider van jongerenbeweging Schild & Vrienden. Zijn directe communicatie sloeg aan. Het doel van Schild & Vrienden, het Vlaams nationalisme doen opleven, werd stilaan werkelijkheid. Tot een Pano-reportage alles veranderde en de prille politieke carrière van Van Langenhove op zijn kop werd gezet. Aan tafel: Bart Eeckhout, Stavros Kelepouris & Joline MaenhoutProductie: Laurens Bervoets (hoorstroom) & Dries VermeulenEindredactie: Sam Feys Wil je reageren? Mail naar podcasts@demorgen.beSee omnystudio.com/listener for privacy information.

In de nieuwste aflevering van de F1 VANDAAG keert Thierry Bakker eenmalig terug als presentator van de podcast als vervanger van de afwezige Geoffrey. Aan de bar schuiven Gandor Bronkhorst en Tim Kraaij weer aan om uitgebreid na te beschouwen op de Grand Prix van Hongarije.Er is uitgebreid aandacht voor Max Verstappen. De Nederlander verraste ook zichzelf door uiteindelijk naar de tweede plek te rijden, maar hoe kwam dit uiteindelijk tot stand en aan wie was dat vooral te danken? Er is ook veel aandacht voor alle andere teams. Is McLaren met Lando Norris na de zege nu een titelfavoriet, wat ging er mis tussen Oscar Piastri en Carlos Sainz en is Kimi Antonelli onderweg naar zijn eerste wereldtitel? Dat en nog veel meer in de nieuwste aflevering van de F1 podcast van GPblog.com.

Tijdens het slotfeest van Pride in Berlijn reed er een man in op de menigte, waarna hij de auto uitsprong en met een mes het publiek in ging. De schrik zit er goed in, ook hier in Nederland, waar de Pride-evenementen ook van start zijn gegaan. Volgens Hans van Soest, politiek verslaggever bij het AD, benadrukt dit waarom hier veel aandacht voor nodig is. "Het geweld tegen de LHBTI-gemeenschap neemt toe." Onderzoeksjournalist Sofyan el Bouchtili omschrijft het als een "heftige en verschrikkelijke" gebeurtenis. In de media wordt de aanslag als islamistisch aangeduid, wat niet hetzelfde is als islamitisch. "Islamistisch is een verzamelnaam voor conservatieve ideologieën die een vorm van Islam willen zien. Dat dat verschil zo wordt geduid, en zo uitgebreid, is een goede zaak", zegt El Bouchtili.  Aan tafel zitten Hans van Soest, Sofyan el Bouchtili en Spraakmaker Pieter Slaman. 

De aanleg van nieuwe natuur in Nederland gaat niet snel genoeg. Aan de hand van het noodlottige verhaal van boer Derk Kloppers (85), en wat na diens dood met zijn grond in beschermd natuurgebied gebeurde, regio-correspondent Pieter Hotse Smit zien waarom het stokt. Dit verhaal verscheen eerder in de Volkskrant. Voorgelezen door: Pieter Hotse SmitMontage en sounddesign: Pleuntje ValkhoffEindredactie: Corinne van Duin & Jasper VeenstraFoto: Pauline NiksSee omnystudio.com/listener for privacy information.

Waarom raken sommige teksten ons diep, terwijl andere vooral informatie overdragen? En waarom lijken oude spirituele geschriften soms pas werkelijk tot leven te komen wanneer we ze hardop lezen, ruimte laten voor stilte en luisteren naar wat ze in ons oproepen?In deze podcast neem ik je mee in onze zoektocht naar Ademend Lezen en Schrijven. Wat begon als een poging om lezen minder inspannend te maken, groeide uit tot een verrassende ontdekkingstocht. We onderzochten hoe kortere zinnen, witregels, ademritme en muzikale elementen een tekst toegankelijker kunnen maken. Maar onderweg ontdekten we iets wat we niet hadden verwacht.Tijdens het lezen van de Bhagavad Gita, de Katha Upanishad en de Ashtavakra Samhita werden mensen niet alleen geraakt door de betekenis van de woorden, maar ook door wat de teksten in hen opriepen: ontroering, warmte, stilte, soms zelfs een diep gevoel van heimwee. Zou het kunnen dat geschreven woorden méér overdragen dan alleen kennis?Aan de hand van een nieuwe vertaling van de Bhagavad Gita laat ik zien hoe ook ritme, herhaling en muzikale beweging een tekst kunnen dragen. Het lijkt erop dat sommige spirituele geschriften niet alleen bedoeld zijn om gelezen te worden, maar ook om te klinken, te resoneren en samen onderzocht te worden.Niet alleen de betekenis van een tekst verandert ons, maar ook de manier waarop wij haar lezen.Deze podcast is een uitnodiging om mee te denken, mee te voelen en mee te onderzoeken. Want misschien staat de geschiedenis van de geschreven taal nog helemaal niet aan haar einde.

Tijdens de zomereditie van het De Nieuwe Wereld Festival staat de toenemende 'Honger naar Religie' centraal. Hoe gaan we om met zingeving in een sterk geseculariseerde samenleving?Aan de hand van indringende persoonlijke ervaringen met het transcendente, bespreekt het panel de grenzen van ons westerse en puur materiële wereldbeeld. Ervaren we een fundamentele leegte nu religieuze kaders grotendeels zijn verdwenen? En hoe vinden we in deze tijd de moed en het innerlijke kompas om te blijven staan voor wat juist is? Gabriël van den Brink, Dennis Spaanstra, Govert Buijs en Christiaan Alting von Geusau spreken samen over de menselijke oerbehoefte aan spiritualiteit en de herontdekking van de Ziel.------------Steun DNWMaak het geluid van de Nieuwe Wereld mogelijk. Zonder uw steun geen DNW! Word lid of doneer:

Nog één laatste keer wil uw verslaggever het hebben over sekseverschillen en carrièreambities. Aan tafel zitten hoogleraar ondernemerschap prof. dr. Erik Stam en psychiater dr. Esther van Fenema voor de derde ronde. Want is het waar dat vrouwen niet voor het grote geld gaan? En zo ja, waar heeft dat dan mee te maken?

The period immediately after hospital discharge is a critical yet often overlooked phase in stroke recovery, marked by both heightened vulnerability and opportunities for rapid brain repair. This episode explores the concept of transitional stroke care, emphasizing early specialist follow up, coordinated multidisciplinary support, and targeted interventions to improve outcomes and reduce complications. In this episode, Katie Grouse, MD, FAAN, speaks with Mona N. Bahouth, MD, PhD, FAAN, author of the article "Transitional Stroke Care and the Road to Recovery" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California, San Francisco in San Francisco, California. Dr. Bahouth is the medical director of the Brain Rescue Unit and an associate professor of neurology at Johns Hopkins School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Transitional Stroke Care and the Road to Recovery 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 Guest: @MonaBahouth Full episode transcript available here Dr Grouse: A lot of attention has been paid to what happens within hours to days of a stroke, but are we missing an equally crucial time in our patient's recovery after their discharge? Today, I have the opportunity to interview Dr. Mona Bahouth about the latest issue of Continuum on cerebrovascular disease.  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 Grouse: This is Dr. Katie Grouse. Today, I'm interviewing Dr. Mona Bahouth about her article on transitional stroke care and the road to recovery. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast, and please introduce yourself to our audience.  Dr Bahouth: Thank you for having me. I'm Mona Bahouth. I'm a stroke neurologist in Baltimore, Maryland, and I'm the medical director of our brain rescue unit at the Johns Hopkins Hospital. Great to be with you.  Dr Grouse: Thank you so much. This was a very interesting article. I have to confess going into it, I really didn't know a lot about transitional stroke care and the growing sort of recognition of its importance for stroke recovery and improved outcomes. Can you tell me what the key message from this article is that you really hope that readers will take away after reading it and hopefully integrate into their own patient practices?  Dr Bahouth: Yeah. I would say if there's one overarching message, it is that stroke care has come so far over the last couple of decades. We do so much wonderful life-saving work in the first couple of hours and days after stroke, but we haven't really paid as much attention to what happens once a patient leaves the hospital with this devastating acute disease. And I would just like to say that this article allows us to shine a light on providing a little bit more of a system of care, a more structured system of care that could benefit the patient for the long term, then that will benefit a large population of patients who otherwise may have complications that could cause disability longer in life.  Dr Grouse: Now, Mona, could you tell us in a nutshell, what is transitional stroke care, and why are we needing to focus more of our attention on this to improve patient recovery?  Dr Bahouth: Yeah. Over the last few years, we've really done a wonderful job of reducing the time that a patient spends in a hospital after stroke care. But in parallel, we have not really changed anything about what we do in the outpatient setting. So, a patient tells us that they come to the hospital with this acute and very scary and disabling disease. They feel that they're the center of the universe at our stroke centers, where we're hustling around them in groups and in interprofessional teams. But then on the day of discharge, they feel that they leave the hospital, and in some of our focus groups, that they kind of go home to a, a dark bedroom where they have to process all of this sort of on their own. It's quite a transition for both patients and their care partners. And here we've been very systematic about how we structure our care in the hospital for stroke patients, but once they leave the hospital, it's been a sort of free-for-all, or the Wild West, as some of my colleagues say. So transitional stroke care is really a way to extend the care that we deliver in the stroke unit to the patient's home or to their next phase of care. We know that stroke patients have 11 handoffs from beginning to end, in average, that they experience through the course of their acute stroke. And so, what we're really trying to do is extend the, the stroke unit to the patient's home or to their next phase of care so that they feel a bit more extension of that specialty care that they were receiving in the hospital. So, it's really a structure, a system.  Dr Grouse: Now, it seems that when we're thinking about the transitional care period, that it really hinges on this idea of sort of the sensitive period of stroke recovery. What is that, and why is that so important, and why do we really need to focus on that specific time?  Dr Bahouth: There are really two reasons that this is a critical period for patients. One is that we know from work in animal models as well as other sort of human early studies that the brain really has its optimal period of efficient brain repair in the first few weeks after stroke, meaning that it's recovering after this injury and figuring out how to reroute some really important brain functions. I would say it's also a critical period because the time period after stroke is a period that all the comorbid conditions that sort of conspired to cause a stroke are sometimes destabilized. And we know that sort of just putting people back on standard regimens for their hypertension, their diabetes, their heart failure doesn't always equate to sort of long-term improved outcomes at a time that the brain itself is going through changes. So, for example, we know that blood flow is critical to the brain. That's what all the hustle is about in the hyperacute period. And for the next couple of weeks after a stroke, autoregulation remains disrupted, so typical treatments of hypertension could have negative consequences for a subpopulation of patients. This management of hypertension needs to continue for a couple of days and weeks after stroke, and therefore, if a patient is discharged from the hospital, really requires a bit more specialty input. We also know that as the brain is trying to repair during the sensitive period, this high period of efficiency, we really want to inject high-intensity, high-quality activities that really improve their recovery. But in our current system in the United States, our transition to the period of rehabilitation is really quite clunky and disrupted and doesn't often happen in a seamless way. So, a true transitional stroke care program really attempts to manage the stroke itself. The comorbid conditions that conspire to cause the stroke, and the expedition of, of rehabilitation that could really jumpstart the recovery period in a more meaningful way.  Dr Grouse: Now, you mentioned hypertension as being sort of a critical factor that can affect the patients during this transitional period or this sensitive period. What are some other factors that can really play a huge part in their long-term outcomes in this really sensitive time?  Dr Bahouth: In our transitional stroke program, in our interprofessional group, we often talk about all of the changes that a patient is required to make at the time of stroke. Typically, they stay in the hospital several days. The patient and their care partner will receive a bolus of instructions about what their new healthier life should look like, and then they're sort of sent off to sort of self-manage without really accepting that that wasn't the perfect time to teach these things. So really, it's all about sort of lifestyle improvement. How do we get into a system of medication adherence when medications are a central portion of a patient's care? It is about managing the cognitive changes that happen after stroke, whether we acknowledge them in the hospital as a main deficit or something that people realize once they get back into the groove of their usual life, and the emotional consequences of stroke for both the patient and their care partner, who are both adjusting to this very scary moment that resulted in a brain injury. So, I think that the things that are focused on are both medical in terms of, you know, what are we doing with the diabetes? Is our glucose at a target range? Have we started wearing our sleep apnea paraphernalia? Are we managing our smoking cessation as much as we should? How have we done with our low-fat diet? Are we taking our medications as prescribed, or was there some cognitive blip that caused a mistake? But also sort of the emotional support that sometimes paralyze patients into sort of saying they cannot handle this transition into a new healthier way of brain recovery.  Dr Grouse: Yes, and it sounds like when patients sort of hit that wall, they almost just give up, right? There's just so many things they have to manage. They're emotionally trying to cope, and then they may eventually get to their neurologist at some point for a follow-up, and not much has happened.  Dr Bahouth: That's a really well-put statement. Like I mentioned earlier, we had several focus groups to say, "How's our stroke center doing? How is our comprehensive stroke center doing?" And we realized that we were very comprehensive while the patient was with us, but then the experience of the patient going home was really opposite of receiving comprehensive care. You know, the patient in the hospital said they felt well-supported, surrounded, quite busy all the time, but then they did go home, and this sort of set in that they've had a stroke. And many patients told us, "I just laid in bed because I couldn't quite kind of get through the thought that this has happened to me." And so, in our prior state of our comprehensive stroke system where patients weren't seen for a couple of months after their discharge, patients would tell me, "Well, I'm fine now.  But those first couple of months, I sure wasn't. You know, I was laying in bed. I was crying. I wasn't taking my medicines. I had a lot of despair and fear." Care partners would say, "I wasn't sleeping myself. I was watching to see if another stroke was gonna happen every minute." So, there are a lot of elements that are going on in those first two weeks that really require a specialist to say, "This is normal. This requires more attention," and to really help people get through a lot of the changes that come with stroke and brain injury.  Dr Grouse: Now, your article gave a really great, I think, example, where you had a juxtaposition of a hypothetical patient with a stroke and two very different post-discharge courses, one where they really kind of fell into that vacuum, that post-discharge vacuum, where they didn't get support and had some very disappointing outcomes versus a patient who did have a transitional care program with a lot of support post-discharge, and a lot of obstacles were overcome and problems solved such that the patient could do a lot better. And I encourage our listeners to take a look at it. If you could design and run it, how would your ideal transitional post-stroke program be structured? Like, how would you design it so that it would optimally support these patients?  Dr Bahouth: Yeah, you know, we, um, tangle with this every day in our current transitional stroke program that we call the JSTEP program. We've had several chapters of what we think is ideal for a patient, and thank you for sort of acknowledging that, like, the way those cases were written were really to underscore that we can have a lot of influence for patients. And while they were sort of hypothetical juxtapositions of one another, these are things we literally see every single day for our stroke patients. And people say, "Oh, if only we had done this, we would've caught that, and we would've prevented such-and-so." Some of the indicators of success have been we've really reduced our readmission rates to the hospital. We have decreased our length of stay because the confidence people feel to go home because they're well supported. So there have been indicators of success. But if I could take our program even next level, I would probably include a few other things. So currently, some of the strengths of the program are that a stroke specialist sees a patient within days of their discharge from the hospital, a time where some of those questions are sort of raising for the patient. Maybe a complication is starting to pop up that we can address before it, uh, gets out of hand and requires a readmission. We can tackle some of the fears that patients are having to say, "I wonder if this is normal or not. I better just go to the hospital." So, some of that early touch point by a true stroke specialist is really critical. And that visit only happens because the seed is planted in the hospital, so there really has to be some initiation of the program at the time the patient is in the hospital to say, "This is what you can expect when you leave here. You have someone who's walking this with you. They're a stroke specialist. They're gonna know how to help you navigate." The second part of our program that is a success is our rapid connection to specialties. So, we know that stroke patients are gonna need connection to rehabilitation specialists, physiatrists, the therapists. We know they're gonna need connection to cardiology when atrial fibrillation or heart failure or something is really at an extreme.We know endocrinology might be a part of the patient's story going forward. And so, I think the second success of our program is really alliance with key stakeholders in a stroke patient's life and quick access to having the patient be connected to what it is they need in the moment that we realize that there is a situation at home. The third thing that I think has been really a success of our program is this interprofessional education that we schedule patients for at the time of their discharge, just as any other important healthcare visit. During this interprofessional education session, the patients get to meet dietician, pharmacist, nurse, therapist, where key discussions about healthy behaviors, avoidance of complications after stroke really happen in a group session where there can be a lot of interaction. You know, currently our education happens in a time where the brain is injured, the patient is not sleeping well in the hospital. We have a lot of stress and fear. It's not the perfect time for anyone to receive such important education. So, I think the third really most important thing has been this formalized interprofessional education to really bolster the education that started at the hospital. If I were to really take our program next level, and every day we're considering it, I really think we haven't done a couple of key things. One is we have not really found a way for the care partner to be supported, that the care partner is usually the brave one sitting there with a tight lip and nodding and very, you know, concerned about what's happening and taking close notes. But we really haven't done well to just manage the care partner's needs sort of independently of the patient themselves, sort of help them with the experience of going through this. I think that could benefit both the care partner and the patient by sort of bolstering their sort of emotional consequences of this. And they are really our key partner in the patient's success in the outpatient setting, getting the patient motivated, helping them get to appointments, helping them to adhere with medications. So, I think if we can focus a bit more on the care partner, that might really bolster the long-term effect for patients. And I think finally, behavior change is very complex. Sometimes we're taking a group of patients who may have never exercised and said, "You know, we really... You need to walk several minutes a day. You need to increase your aerobic capacity. We need you to stop smoking." And these are not behavior changes that can just happen with sort of a one-time visit. So, I think we really need to incorporate a lot more of exercise therapy and concepts of people who can sort of coach along the continuum for some of these behavior changes so that we can really promote wellness and a return to health. And I think one final thing that could be additive from a transitional stroke program is really a better way to truly measure recovery for stroke patients, some of those in between the line measures that we're not really getting by a three-month modified Rankin score. I think a transitional stroke care model would really allow us to both insert research and potential other therapies along this time period, but also measure the success of those in a more granular way.  Dr Grouse: Thank you so much for that, and also it was really helpful to get a good overview of, like, what the transitional care program really means, right? Like, what is the structure? What is happening with the patient? So, I think all of that's really helpful. But I can't help but think, listening to all of that, that sounds like while certainly in an ideal state, and I don't think anyone can argue with how helpful that sounds, is it always something that's practical? Can we implement things like this, especially where access is limited, resources are dwindling as far as what patients can get and what evaluations patients can get? Do you think that this is something that can actually be implemented in programs throughout the country? And what are strategies we can consider to try to improve getting some of these resources for our patients?  Dr Bahouth: I think this is such a critical topic. I think that we have, in the medical system, tried to force our healthcare practices into old models of care instead of sort of adopting new ones. And so, I think that, you know, while everyone says, "Wow, that sounds like a very resource-rich program," I would have to stop and push back and say, well, a very resource-rich situation is when a stroke patient, sometimes fifteen to twenty percent of the time, are readmitted to the hospital at a time where hospital beds are at a premium. Maybe we need to turn those dollars of savings of sort of these readmissions and extra length of stay into dollars that we put into sort of this transitional period where we help promote success. So, I think it really becomes more of a value proposition when you talk about it. But that said, of course, we have to make sure that we're a high-value, high-productivity system. So, our current transitional care program uses a telemedicine structure. We know that stroke patients cannot drive in most states after their stroke. We know that their care partners are trying to return to work and normalize. It is very difficult for patients with paralysis, cognitive changes to come back and forth to multiple appointments. In the past, we have tried to make this transitional care program an in-hospital program. I think using the technologies that we have available for telemedicine are critical, especially for this population who have barriers to getting to their appointments. So, I think with a very low resource investment, a transitional care program can be created once you really develop the skills of the, the stroke team to really reach beyond the hospital with the tools that we already have in the hospital and just extend that to the next chapter. It is an investment, most certainly, but I think it's one well worth the investment for the patient's success, their quality of life, as well as some of the value metrics that we judge our hospitals by.  Dr Grouse: Are some of the transitional care codes that CMS has put out in recent years helpful to get some reimbursement for these types of visits?  Dr Bahouth: Absolutely. So, I think that's been a really wonderful policy change that has happened, recognizing the importance of these transitional care models. There are billing codes that allow you to have higher billing than a usual neurology appointment when a patient is within a certain window, meeting certain criteria for their eligibility for such a visit.There are codes that have now been developed and are being more and more utilized to have visits with care partners and realize that the care partner is an important member of the equation of this patient's success. So, there are definitely codes that can be used. I think we're very good in healthcare of delivering a lot of free care, but that's not the nature of the beast these days. We have to really be very aware of our dollars and cents, and so utilizing some of these important codes that I hope only continue to expand to recognize the importance of the transitional period for patients.  Dr Grouse: Now, Mona, I wanted to ask, was there anything that you wish you could have included in this article that didn't make it in?  Dr Bahouth: You know, obviously, um, word limitations are always challenging. I think that the article, I think, does a good job going sort of from beginning to end. I think a deeper section, certainly we have commented on the sort of sociodemographic challenges of a program like this that also relies on a technology like telemedicine in many cases. But there are so many nuances to that conversation that I think that section could have definitely gone on for a much longer period of time to talk about some of the strategies, the strategic ways that we work hard to make sure that these type of transitional care programs are accessible to all, especially the vulnerable who may have challenges with accessing technology. But I will say it is possible. You know, we are in a urban city. We see a lot of patients with various insurance status and access to technologies, and we've had a very high show rate in our post-hospital transitional program, so it can be done with a thought and, uh, care to those vulnerable populations who may need more attention across the transition.  Dr Grouse: Well, I really appreciate all the work you've done in this area, and it sounds like it's an area that will continue to grow as we learn more and hopefully improve. And I really appreciate you taking the time out of your day to talk with us about your article.  Dr Bahouth: Well, thank you for having me, and it's a topic that's near and dear to us, so thanks again for highlighting its importance.  Dr Grouse: Again, today I've been interviewing Dr. Mona Bahouth about her article on transitional stroke care and the road to recovery. This article appears in the June 2026 Continuum issue on cerebrovascular disease. 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.

Aan voormalig gevangenisbewaarder Ela dringt zich, na jaren van vertellen over andermans leven achter tralies, een persoonlijker verhaal op. Uitgegeven door Uitgeverij G.A. Van Oorschot B.V. Spreker: Hanne Arendzen

In the July episode of the President's Spotlight, Dr. Jason Crowell and Dr. Natalia Rost provide a mid-year review of the AAN's progress, highlighting advocacy successes and the growing momentum for brain health worldwide.  Stay informed by watching the President's Spotlight video.  

Dit weekend voerde Rusland een van de grootste raketaanvallen uit op Kiev sinds het begin van de oorlog, en steeds vaker worden daarbij burgerdoelen geraakt. Toch wordt er al werk gemaakt van de wederopbouw van Oekraïne, onder welke omstandigheden gebeurt dat? Aan de andere kant van de oceaan waait er al even een behoorlijk rechtse wind; vorige maand werd er opnieuw een extreemrechtse president gekozen in Latijns-Amerika. Is Brazilië binnenkort de volgende, nu er na de zomer presidentsverkiezingen zijn in het land? In Bureau Buitenland Zomertafel schuiven vandaag stedenbouwkundige Fulco Treffers en hoogleraar Brazilië-studies Kees Koonings aan. Presentatie: Nadia Moussaid

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Heeft u een vaste plek thuis? Aan de eettafel of in bed? Is er een plaats in huis die enkel uw geur en afdruk draagt? Of bent u eerder het losgeslagen type dat eender waar neerploft en verwacht dat anderen die onvoorspelbare stoelendans van je dan maar gaan meedansen? Dit is een studie naar onze voorkeur voor een vertrouwde plaats in de wereld. Luisteren doe je gelukkig, nog steeds, gewoon hier.

In this week's episode of the Brain & Life Podcast, Drs. Daniel Correa and Katy Peters are joined by mother-son duo Genein and Shawn Letford. Genein, the founder of Brainolicious, a nonprofit dedicated to promoting brain health in a way that's fun, accessible, and lifelong, reveals how integrating arts and early childhood education can build resilience, prevent dementia, and even shape future leaders. Her 8-year-old son Shawn then shows us how kids can become brain advocates—speak before city councils, petition for World Brain Day, and spread awareness with confidence.   Additional Resources Brainolicious Steps to Building a Stronger Brain: Brain Health After Brain Injury Webinar Why Bike Helmets Are Essential for Kids Become a Brain Health Advocate   Brain & Life Podcast Episodes on Similar Topics Neurology Advocacy Out Loud: Live from the AAN's Annual Meeting Embracing Inclusion and Empowerment with Isabelle and Eliza Woloson   We want to hear from you! Have a question or want to hear a topic featured on the Brain & Life Podcast? ·       Record a voicemail at 612-928-6206 ·       Email us at BLpodcast@brainandlife.org   Social Media Guests: Genein Letford @brainoliciousadventures Hosts: Dr. Daniel Correa @neurodrcorrea; Dr. Katy Peters @KatyPetersMDPhD

Ben jij zo geniaal om Italië te zien als een hoge laars met naaldhak en kleine schoenmaat? Dan zie je in Sicilië vast ook de voetbal die Italië wegschiet in de hoop om zich weer eens te kwalificeren voor een WK. Maar eerlijk is eerlijk, daarmee maken we Sicilië te groot. We moeten niet doen alsof Sicilië de onmisbare schakel is tussen Italië en een glorieuze toekomst. Sicilië is wat de voetbalmetafoor insinueert: een verschoppeling. Een bal die al eeuwen rondgespeeld wordt, over het hele Europese speelveld, voordat hij weer terugkeert aan de voet van een Italiaan die er door zorgvuldig hooghouden voor zorgt dat de bal in bezit blijft. Waar moeten we nu op wachten? Op een tegenstander die de Siciliaanse bal verovert? Of op het moment dat de bal in de sloot verdwijnt en Italië Sicilië voorgoed kwijt is? Laten we inzetten op het gunstige scenario: een fluwelen balbehandeling waarin ze samen de show stelen. Een laars en zijn bal. Aan een touwtje. Klik hier voor meer informatie over het Nederland Dal vrij Abonnement Adverteren in deze podcast, een op maat gemaakte pubquiz als werkuitje of zoek je een andere samenwerking? Mail dan naar info@grotepodcastlas.nl.

Intracerebral hemorrhage carries high morbidity and mortality, but growing evidence highlights meaningful opportunities for prevention, risk reduction, and long-term recovery. This episode covers key strategies, including blood pressure management, interpretation of neuroimaging markers, and individualized decisions around antithrombotic therapy. It also emphasizes the prolonged recovery timeline and the importance of a holistic, patient-centered approach to improving outcomes. In this episode, Casey S. Albin, MD, FAAN, speaks with Wendy C. Ziai, MD, and Vishank A. Shah, MD, coauthors of the article "Intracerebral Hemorrhage" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Ziai is a professor of neurology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland. Dr. Shah is an assistant professor of neurology and critical care medicine at Johns Hopkins University School of Medicine in Baltimore, Maryland. Additional Resources Read the article: Intracerebral Hemorrhage 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: @caseyalbin Guest: @VishankShah3 Full episode transcript available here Dr Albin: A patient has suffered an intracerebral hemorrhage. They're taken to the neuro ICU, and they fortunately survive. But the journey does not end there. In fact, in some ways, the journey has just begun. Join us today as we unpack holistic care for ICH patients.  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 Albin: Hello to our audience. This is Dr. Casey Albin. Today, I'm interviewing Dr. Wendy Ziai and Dr. Vishank Shah about their article on intracerebral hemorrhage. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast. I am so delighted that both of you are joining. To begin, let's just do a brief introduction of who you are and, and a little bit of how you got interested in the topic.  Dr Ziai: Hi, I'm Wendy Ziai. Thank you for having me on this podcast. I am a professor of neurology at Johns Hopkins. I am a neurointensivist, and I think I got primarily interested in this topic through clinical trials that I have been a part of since my fellowship days.  Dr Shah: Hi, everyone. I'm, uh, Vishank Shah. I am also, uh, very thankful for being invited to be a part of this podcast. I'm also a neurointensivist at Hopkins and the fellowship program director here for neurocritical care, and I'm interested in recovery after ICH, and that's why I'm a part of this work.  Dr Albin: Welcome to you both. It is such a treat for me to get to interview fellow neurointensivist, particularly those who have such a wealth of experience. So, I am delighted to dive into this. All right. So, to set the stage for our audience, intracerebral hemorrhage has long been approached with pessimism. But your article really highlights that there are meaningful advantages in prevention and risk stratification and long-term recovery for these patients. Though you both are neurointensivist, this article really emphasizes primary prevention and the holistic long-term care for the survivors. And so, to begin, Dr. Shah, can you just lay out a little bit for our listeners the scope of intracerebral hemorrhage and its community impact?  Dr Shah: Yeah. So, you know, ICH is the second most common type of stroke. There are more than three million new cases of ICH globally each year, and it accounts for thirty percent of all stroke types, but it is the one that has the highest mortality, with more than forty to fifty percent of the patients dying in the first thirty days, and then continued long-term impact on both functional as well as outcomes, as well as survivorship after the early period. And it also disproportionately impacts lower socioeconomic, and then minority races like Blacks, Asians, as well as Hispanic ethnicity. And so, there's a lot of work that needs to be done to reduce the burden of this disease.  Dr Albin: Absolutely. I mean, these can really be devastating for families, and I really am appreciative of your highlighting that there's a lot of disparities, and there's a lot of work to be done to really increase equity to these patients. I think a lot of this goes into really the AAN's focus on brain health and trying to improve some of what we're doing to maintain brain health. And I really wanted to kind of drill down on this because for ICH, there's a lot that can be done upfront as we think about how do we counsel patients who may walk into the office about strategies to prevent ever becoming an intracerebral hemorrhage patient. So, Dr. Shah, can you walk us through a little bit about what neurologists in the community need to be doing to make sure that no one ends up with us in the neurointensive care unit?  Dr Shah: Yeah, sure. So, I think, you know, one of the most important risk factors is, of course, hypertension and long-standing uncontrolled hypertension. And so really recognizing the need for early onset screening with regular blood pressure monitoring at a very early age, particularly in the races that I discussed earlier. And then I think another big part, obesity, metabolic syndrome, and type two diabetes. And I think there's a lot of interesting new work that with the GLP-1 agonist, you know, in a large multicenter cohort studies showing that patients receiving these had a significantly lower reduction risk of ICH. And so, this might be a really important part that, you know, clinicians need to start increasingly recognizing and using in their practice. And then, of course, other risk factors that are common include smoking, diet high in sodium, exposure to air pollution, both indoor as well as outdoor. And so, mitigating all of these risk factors can also reduce the burden of ICH.  Dr Albin: Absolutely. And I really want to highlight that hypertension plays such an important role and that we as neurointensivist, as community neurologists, really need to be creative about ways that we can help people meet those blood pressure target and meeting people in the community where they are, making sure that they're not suffering from side effects from their medication that would prevent them from sticking with it long term. Dr. Ziai, anything else to add about what we can do in the community?  Dr Ziai: So, we really want to emphasize, even in the acute phase, that patients moving forward need to have targeted interventions to reduce blood pressure, smoking, enhance their physical activity, have a diet that is high in fruits and vegetables and low in alcohol and salt, and then promoting weight loss, of course.  Dr Albin: And Dr. Ziai, I'm gonna ask you a little bit about one of the things that maybe not all of our listeners have heard about is this APOE2, APOE4 genetic risk for intracerebral hemorrhage. What's going on there and, and should clinicians be testing for that? Dr Ziai: That's a great question, and it is not one that we currently test people for at least acute ICH presentation. APOE2 and A4- E4 alleles, these give patients a two to three times higher risk of ICH by increasing cerebral amyloid deposition. And if you happen to have APOE2 carrier ship status, then along with other risk factors like white matter disease and vascular risk factors, these predict the onset of new microbleeds even during very short follow-up periods of about two years. And as we know, having cerebral microbleeds are associated with an increased risk of all strokes, ischemic and ICH, but they are one of many MRI markers of small vessel disease, which along with cortical superficial siderosis, does significantly increase future ICH risk. And so even in people who've never had an ICH, if they happen to have an MRI, it may be reasonable to look at the MRI and incorporate this burden of small vessel disease, and especially these hemorrhagic markers into, uh, decision-making about interventions.  Dr Albin: That's a really excellent point. And so, I think that your article did a really beautiful job of thinking holistically about the patient, incorporating clinical markers of their risk for having ICH, but also those radiographic markers. I'm just gonna ask you to summarize those again one more time because not everyone will be familiar with these. So, when you're looking at an MRI, what are the things that you're particularly clued in on that would increase the patient's risk of future ICH?  Dr Ziai: In the past, what we're looking for really is markers of cerebral amyloid angiopathy, which significantly increase a person's risk for lobar hemorrhage in particular. And so, we have a set of criteria called the Boston Criteria, and there's a new version of these, version 2.0. And these, um, incorporate a number of imaging markers that provide a very high sensitivity and specificity to diagnose CAA after an ICH. But even if someone's never had an ICH, and they evaluate that risk-benefit ratio for different cardiovascular prevention strategies. And so, the markers that we're specifically interested in are, of course, microbleeds. But not just having microbleeds, but are they lobar or are they deep? Lobar having a higher risk for lobar ICH. How many microbleeds are there? Is it greater than five, or is it just one or two? Also, cortical superficial siderosis is a marker, a hemorrhagic marker, that does portend a significant increased risk of recurrent ICH, along with having a lobar ICH. And now we have these new markers, which are the white matter hyperintensity multi spot pattern, which requires these hyperintensities on flare imaging in the subcortical area, having greater than at least ten of these multi spots, and also having enlarged perivascular spaces in the centrum semiovale, and having at least twenty of those. And finally, white matter hyperintensities, which can be measured with the physica score or just by visualizing them. We can look at white matter hyperintensities as well as being a measure of small vessel disease.  Dr Albin: Got it. And so just to summarize, we're looking for small vessel disease markers because that puts our patients at higher risk of ongoing future bleeds. And then we're also looking for markers of particularly small vessel disease that's caused by cerebral amyloid angiopathy, which again, because it's having that protein deposition, that puts the patient at risk of those leptomeningeal very small vessels, putting the patient at risk of lobar ICH. Just confirming I've summarized this all correctly.  Dr Ziai: Yes. That was perfect.  Dr Albin: Amazing. Dr. Shah, I'm gonna go back to you. Let's say we have a patient. Let's say this is a sixty-five-year-old man who comes in and they want follow-up and they're... And you're trying to think about they've had an ICH in the past, and they are also at risk for ischemic disease. Let's say they, they have hypertension, they've had a smoking history. They have some risk for ischemic events. And you're trying to think about how do you balance those. Let's say the patient needs to be on aspirin but does have some of those high-risk features on their MRI. Is there any guidance on how we think through preventing them from having a recurrent bleed if they're a high-risk patient, also preventing them from having an ischemic event, which they might be at high risk for as well?  Dr Shah: Yes. So, I think, you know, the first step is of course trying to understand what was the type of bleed. I think that has a very important role, like you mentioned. If it's a lobar hemorrhage versus a deep hemorrhage, the risk of recurrent ICH and ischemic events is very variable. So lobar hemorrhages, there's obviously a higher risk of recurrent hemorrhage events, whereas deep hemorrhage is actually at or behaves sort of like small vessel ischemic strokes and have a higher risk of recurrent arterial ischemic events. So that distinction in itself can help you gauge which patients would be safe and would benefit from these therapies. To begin, and of course, looking for some of these markers on MRI that were mentioned by Dr. Ziai for recurrence of hemorrhage risk. In terms of antiplatelet, the, there is a lot more data now to guide treatment, and we have the RESTART as well as the ESTART trial that showed that starting an, a single antiplatelet after intracerebral hemorrhage did not increase the risk of hemorrhage recurrence. They were very variable in the timing when aspirin was started, and so that remains still a question about what is the safest time point to start aspirin. For example, in the ESTART trial, they started them very early, within the first three days, whereas in  the RESTART it was all the way up to two months after the hemorrhage. And so... But in general, the risk of recurrent ICH was very low with a single antiplatelet agent. And so, if it's needed for ischemic prevention, it's relatively safe broadly across all types of hemorrhages.  Dr Ziai: Yeah. I would just mention that there was also a subgroup analysis of the RESTART trial using MRI. And so, this more than likely included patients with CAA, since 40% of the hemorrhages were lobar in that study, and therefore seeing that there was no increased risk of recurrent ICH in RESTART, it is thought that putting patients back on their antiplatelet therapy is safe.  Dr Albin: That's a really huge takeaway pearl for our listeners, that regardless of whether it's a lobar bleed or a deep bleed, if there is a strong indication, you know, this is not just, oh, because someone gave them aspirin 81, but truly that there is a reason that they need to be on a single antiplatelet agent, it probably benefits them to be on that agent, and there's good data that there's not a huge increase in risk. Summarizing all of that?  Dr Ziai: Great.  Dr Albin: Now, things are gonna get a little bit tricky here, because what if the patient, what if they need to be on dual antiplatelet therapy? Or what if they need to be on anticoagulation? Dr. Ziai, I'll, I'll throw that to you. How do you tackle that patient population?  Dr Ziai: Yeah, the safety of dual antiplatelet therapy hasn't really been studied in patients who've had a prior ICH. Although, in people who've had previous strokes, putting them on dual antiplatelets doesn't seem to increase the risk of ICH, but it does increase extracranial hemorrhage. And so there may be other reasons not to put patients on dual antiplatelet agents. Patients who have cancer and also cardiovascular or cerebrovascular disease, putting them on dual antiplatelet therapy does seem to increase the risk for intracranial hemorrhage. So, I think there is enough of a bias against DAPT therapy in patients who have had an ICH that we would not recommend DAPT for patients with a prior ICH.  Dr Albin: Absolutely. And, and then what about, let's say they have atrial fibrillation, and you know that they have a high CHA2DS2-VASc score, and they are at very high risk of ischemic events, but they've also had a prior intracerebral hemorrhage. Walk us through a little bit, how should we approach that patient? Dr. Ziai, I'm gonna start with you again.  Dr Ziai: Sure. So again, looking at the MRI, which all patients with ICH should have nowadays. If patients do have these hemorrhagic findings, a lobar ICH, evidence of CSS, cortical superficial siderosis, especially if it's disseminated, and also lobar microbleeds, especially if there are greater than five, if they're multiple, then anticoagulation should really be avoided in those patients.  Dr Albin: Absolutely. So, I'm really hearing that when we have a patient with ICH, it is just critically important that we understand is this a hypertensive bleed or is this a lobar bleed that is probably related to cerebral amyloid angiopathy? And getting to that distinction is going to play a major role in our deciding whether or not the patient can be on DAPT or can be on anticoagulation. And then what are some of the strategies for patients that you're referring them to if they really cannot tolerate being on anticoagulation, but they have atrial fibrillation, and they do need some sort of ischemic stroke prevention?  Dr Shah: There's still a lot of controversy, even in non-lobar hemorrhages, about resuming anticoagulation and when that would be safe. HAF trial, there was a reduction in ischemic stroke recurrence, uh, but a significantly higher increase in hemorrhage recurrences. I think that trial included both deep and lobar hemorrhages. So, we still need more data, and I think the ASPIRE trial and maybe a meta-analysis would answer that eventually. But in the meantime, if a, specifically for lobar hemorrhages, which are, uh, thought to be CAA related, if they, uh, and the patient has AFib, you know, where anticoagulation would be contraindicated, a watchman device or, you know, AFib ablation may be some of the other strategies that can be looked into for those patients specifically.  Dr Albin: Right. I think that's a really important point to emphasize, that we don't just don't give up and say, "Oh, you're not a candidate for anticoagulation," but we really reach out to our cardiovascular friends and say, "Hey, what other procedures can you offer that will minimize the risk of recurrence?" You know, we don't want them to have an ischemic event, but we also know long-term that there would be a real risk of anticoagulation. Just reminder to our listeners that there are new procedures, and our cardiology colleagues are always doing new trials and new devices, and so we should really leverage their expertise here. I am in the final minutes gonna just switch gears a little bit from talking about sort of the nitty-gritty of secondary ischemic prevention and secondary hemorrhagic stroke prevention and thinking about there has been this degree of pessimism around ICH patients, and that, you know, they have a much more severe outcome than our patients with ischemic strokes. I think that that is probably a myth that we need to do some debunking around, and I think maybe we need to reframe in terms of thinking about just the trajectory. So, Dr. Shah, walk us through a little bit about what we can expect about the recovery trajectory in ICH compared to those patients who have an ischemic stroke. Dr Shah: Yes. From some newer data and studies, it is becoming clear that recovery after ICH is much slower than we expect. In general, for ischemic stroke, recovery is measured within the first few weeks to up to 90 days. But in ICH, we now know that patients can keep recovering all the way up to six months and even beyond. In general, from just a, a study of heart recovery that occurs after ischemic stroke, there's a steep recovery in the first seven days, and then sort of after that, patients still continue to recover, but it, it starts plateauing where up to 90 days. Whereas with ICH, there is not much recovery in the first 7 to 30 days, but after that, there is a recovery that occurs significantly between day 30 and day 180, and then some patients continue to recover all the way up to one year. The more severe the hemorrhage, the slower the recovery, but there's still some evidence to suggest that even severe hemorrhage patients can recover all the way up to one year out and beyond. This is, of course, in terms of functional recovery.  Dr Albin: I think that's a really important point for our audience. Many of the listeners are residents, they're fellows, they're seeing these patients in the hospital, and they may not see a whole lot of improvement over even 30 days. But to keep in mind that just because the patient has not had a dramatic recovery within that first month that they may be in the ICU and then on the floor does not mean that that patient will never have recovery, and that we reset our expectations that recovery is possible, it's just gonna be slower. And I think that that's not only important for the healthcare team to take in mind, but also for patients and their families to know there is hope here. It's just gonna be slower. Dr. Ziai, looking ahead, what developments in this are you most excited about that you think will move the needle for care for the long-term outcomes and the prevention for these patients? What's ahead in, in ICH?  Dr Ziai: Yeah, I think the research that's going on is very exciting at the moment. We just saw the presentation at the World Stroke Organization conference in the fall of the TRIDENT trial, Triple therapy prevention of Recurrent intracerebral Disease events, meaning strokes. And these investigators found that a single pill, a fixed dose of three blood pressure-lowering agents actually was successful in significantly reducing the risk of recurrent stroke in patients who have had a history of ICH and have just normal or low-grade hypertension. So rather than having patients on multiple antihypertensive agents, it may be possible to have them on a single pill, and may dramatically reduce their stroke risk. So that's exciting. There is also a trial ongoing, ASPIRING, testing whether antiplatelet monotherapy after 24 hours only can reduce the risk of all serious vascular events in ICH survivors. So very early antiplatelets. The SATURN trial, we didn't talk about statins yet, but it is comparing continuation versus discontinuation of statin therapy in ICH patients. And then we have ongoing epidemiological studies that are really needed to understand this interaction between the cardiovascular prevention strategies, the antithrombotic use, the blood pressure targets, and these high-risk neuroimaging markers for ICH. And I think that's gonna be key, personalizing the interventions for these patients.  Dr Albin: So, I love that. And what I'm hearing is that it's really important to think about the personalized approach as well as how do we simplify things. We know that blood pressure control is critically important to the primary and secondary prevention of ICH, but we have to make it easy for patients to do so. Dr. Shah, I want to end with kind of understanding, you know, this was an unusual topic for neurointensivists to talk about. This was really about prevention. It was about long-term survivorship. It was about not what's happening in the neuro ICU. How did you guys get interested in sort of that aspect of care?  Dr Shah: Yeah, so that's a great question. Dr. Ziai has been my mentor since I was in fellowship, so now about eight years that I've been working with her, and this was a project that I started in fellowship with under her mentorship, looking at long-term recovery in ICH patients, and specifically severe patients. Happy that work has received a lot of recognition. It was published in JAMA Neurology. We looked at patients with severe intracerebral and intraventricular hemorrhage, those that survived with an mRS of four and five at day 30, and what happened to them over the course of the year. There was really not much data on recovery after ICH. And we were very surprised to see that up to 40% of patients that were an mRS of four and five, so really, really severely disabled at day 30, recovered to an mRS of zero to three by one year. About one-third of that group that recovered actually achieved functional independence with an mRS of zero to two, which was very surprising, really breaking the myths around the pessimism with ICH. We found that a lot of the baseline comorbidities like diabetes, white matter disease, as well as what happens to them during the acute hospitalization, were adding all of that information to the severity of the hemorrhage significantly improved our ability to predict long-term recovery after ICH. And so that's kind of how we got interested in this work, looking at how factors in the care that we provide in the ICU, as well as what the patients come in with, how all of that could be modified to promote recovery in these patients that are often been forgotten.  Dr Albin: I think that there's one takeaway to our listeners is that this is really a place where there's a lot of hope for recovery, and that the nihilism that has really surrounded ICH is a thing of the past, and we have to move forward with thinking about how do we proactively impact the recovery and counsel the patients and give them hope. Because just as your research shows, there really is the ability that they can attain that functional independence, which is absolutely astounding. It's really amazing. Again, today I've been interviewing Dr. Wendy Ziai and Dr. Vishank Shah about their article on intracerebral hemorrhage. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Please be sure to check out Continuum Audio episodes from this and other issues. Please go and check out. They have a wonderful article with lots of tables and figures, so much data. And again, thank you to our listeners for joining us today. Thank you, Dr. Ziai and Dr. Shah.  Dr Ziai: Thanks very much.  Dr Shah: Thank you.   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.

ASML heeft een extreem goed kwartaal achter de rug. De omzet steeg met 21 procent, de winst ging met 26 procent omhoog. Beide veel beter dan gedacht. Maar belangrijker, voor de tweede keer dit jaar gaat de omzetverwachting omhoog. Ook die verhoging was niet verwacht. Met al dat goede nieuws zou je denken: het aandeel gaat door het dak. Aanvankelijk leek het erop. Aan het begin van de beurshandel stond het aandeel zo'n 7 procent hoger, maar de koers zakte als een oude onderbroek. Deze aflevering kijken we waar dat pessimisme vandaan komt. Ook lopen we uitgebreid door de cijfers en de verwachtingen heen. Je hoort meer over het opschalen van de productie, over de orders en over de mogelijke aandelensplitsing. Gaat het ook over Stripe, de betaalverwerker. Dat is een Amerikaanse concurrent van Adyen die groeit door overnames. Nu willen ze de grootste overname uit hun geschiedenis doen: voor ruim 50 miljard het kwakkelende PayPal opkopen. Het lijkt een bedreiging voor Adyen, maar toch gaat dat aandeel opvallend goed op het nieuws. De Zuid-Koreaanse beurs komt ook langs. De beurs doet het dit jaar erg goed, maar heeft ook wat manische periodes. De koers schommelt nogal. Het gaat zo hard dat zelfs de president van het land ingrijpt! Te gast: Jordy Beuving van De Aandeelhouder BNR Beurs is een journalistiek onafhankelijke productie, mede mogelijk gemaakt door Saxo. Over de makers: Jelle Maasbach is presentator van BNR Beurs en freelance financieel journalist. Zijn favoriete aandeel om over te praten is Disney, maar daar lijkt hij de enige in te zijn. Sinds de eerste uitzending van BNR Beurs is 'ie er bij. Maxim van Mil is presentator van BNR Beurs en journalist bij BNR, waar hij zich focust op de financiële markten en ontwikkelingen in de tech-wereld. Je krijgt hem het meest enthousiast als hij kan praten over ASML, of oer-Hollandse bedrijven zoals Ahold of ABN Amro. Jorik Simonides is presentator van BNR Beurs, economieredacteur en verslaggever bij BNR. Hij wordt er vooral blij van als het een keer níet over AI gaat. Je hoort hem ook in de BNR-podcast Moerdijk: dorp van de rekening. Milou Brand is presentator van BNR Beurs, freelance podcastmaker en columnist bij het Financieele Dagblad. Jochem Visser is presentator van BNR Beurs, maakt Beursnerd XL en is redacteur bij de podcast Onder Curatoren. Vraag hem naar obscure zaken op financiële markten en hij vertelt je waarom het eigenlijk nóg leuker is dan je al dacht. Over de podcast: Met BNR Beurs ga je altijd voorbereid de nieuwe beursdag in. We praten je in een kleine 25 minuten bij over alle laatste ontwikkelingen op de handelsvloer. We blijven niet alleen bij de AEX of Wall Street, maar vertellen je ook waar nog meer kansen liggen. En we houden het niet bij de cijfers, maar zoeken ook iedere dag voor je naar duiding van scherpe gasten en experts. Of je nu een ervaren belegger bent of net begint met je eerste stappen op de beurs, de podcast biedt waardevolle inzichten voor je beleggingsstrategie. Door de focus op zowel de korte termijn als de lange termijn, helpt BNR Beurs luisteraars om de ruis van de markt te scheiden van de essentie.See omnystudio.com/listener for privacy information.

Aan de top van de meest rendabele influencers in Vlaanderen staan opvallend veel vrouwen. Dat blijkt uit een financieel-economische analyse van Trends. Ongenaakbaar op nummer één staat Céline Dept, die wereldwijd doorbrak met haar voetbalvideo's. Hoofdredacteur Stijn Fockedey en adjunct-hoofdredacteur Jan De Meulemeester duiken in de cijfers achter een beroep dat voor veel jongeren vandaag geldt als de ultieme droomjob. Trends is een podcastkanaal van de redactie van Trends. --- --- Hosted by Simplecast, an AdsWizz company. See https://pcm.adswizz.com for information about our collection and use of personal data for advertising.

Send us Fan MailLydia Daniël wordt regelmatig uitgemaakt voor 'TERF' (Trans-Exclusionary Radical Feminist), een term die zij inmiddels als geuzennaam heeft omarmd. In gesprek met Ancilla van de Leest vertelt zij over haar persoonlijke wake-upcall en waarom zij zich is gaan uitspreken over genderideologie, vrouwenrechten en de volgens haar belangen achter de snel groeiende transbeweging.Aan bod komen onder meer het omstreden 'Dutch Protocol', de toename van medische transities, de vraag waarom steeds meer mensen – en ook minderjarigen – in transitie gaan, en welke rol volgens Daniël economische en maatschappelijke belangen daarbij spelen. Ook bespreekt zij de positie van vrouwen, mannen in vrouwengevangenissen, de bedreigingen waarmee critici te maken krijgen en de invloed van woke taal- en wetswijzigingen. Een uitgebreid gesprek over een onderwerp dat wereldwijd tot felle discussies leidt.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 - ...

De Verenigde Staten voeren urenlange luchtaanvallen uit op doelen in Iran om de Iraanse controle over de Straat van Hormuz te verzwakken. Iran reageert met drone-aanvallen op Amerikaanse bases in de regio en zegt de belangrijke zeestraat te hebben gesloten, terwijl de VS dat ontkent maar rederijen en verzekeraars de route feitelijk al mijden. Midden-Oosten-correspondent Tara Kenkhuis schetst hoe beide partijen blijven bombarderen en de kans op de-escalatie verder afneemt. Ondertussen houdt de Nederlandse MKB-ondernemer de hand op de knip, blijkt uit het rapport Branche Inzicht 2026 van brancheorganisatie SRA. De omzet stijgt met ruim 6%, maar de winst blijft achter met 3,4% doordat inkoop- en personeelskosten oplopen, waardoor er minder ruimte is om te investeren. Bestuurslid en accountant Pieter van der Kwaak wijst op onzekerheden rond stikstof, netcongestie en regeldruk, en benadrukt dat voorspelbaar beleid nodig is om ondernemers weer tot investeren te bewegen. Het WK Voetbal is de laatste week ingegaan. Inmiddels zitten er nog maar vier ploegen in het toernooi. Volgende week wordt duidelijk of Frankrijk, Spanje, Argentinië of Engeland wereldkampioen wordt. Aan kop van de topscorers-lijst staan spelers Mbappé en Messi. BNR's sportverslaggever Jaap de Groot vertelt wat dit doet met hun transferwaarde. Deze omschrijving is met AI gemaakt en gecontroleerd door een BNR-redacteur. Over deze podcast BNR Nieuws Vandaag is de podcast met daarin BNR Ochtendnieuws en BNR Avondnieuws. Je krijgt ’s ochtends vroeg en aan het einde van de werkdag in 20 minuten het belangrijkste nieuws van de dag. Abonneer je via bnr.nl/podcast/bnrnieuwsvandaag, de BNR-app, Spotify en Apple Podcasts. Of luister elke dag live via bnr.nl/live.See omnystudio.com/listener for privacy information.

De theorie uit, de praktijk in: tijd voor een diepgaande analyse! Deze aflevering op de snijtafel: Toast (TOST). Een Amerikaans techbedrijf dat verticale software maakt voor restaurants. Een beetje de Shopify van de horeca. Zó verticaal geïntegreerd zag je een bedrijf nog nooit! We duiken in het verdienmodel, het management, de cultuur en wat Toast allemaal doet voor restaurants. Met een waardering als toetje. Kortom, een fundamentele analyse, met twee totale Toast-autodidacten: Pim en vriend van de show Frenkel Tel. Aan tafel! ► Uitgebreide show notes en achtergrondinformatie: https://jongbeleggendepodcast.nl/223-deep-dive-toast-tost ► Word Vriend: https://portfoliodividendtracker.com ► Updates via Instagram: https://www.instagram.com/jongbeleggen ► Mijn volledige portfolio: https://app.portfoliodividendtracker.com/p/jongbeleggen 1) We maken gebruik van programmatic advertising, wat inhoudt dat we geen invloed hebben op de spots die in de podcast worden afgespeeld. Dit is vergelijkbaar met tv, YouTube, radio en de krant, uiteraard met uitzondering van de advertenties die we zelf hebben ingesproken. 2) Deze podcast is 100% expertise-vrij en alleen geschikt voor amusementsdoeleinden. De inhoud mag niet worden beschouwd als financieel advies. ► Ben je van plan om dit jaar je huis te verkopen? Ga dan naar krib.nl. Als je laat weten dat je via Jong Beleggen komt, dan krijg je gratis extra begeleiding van het team van Krib.See omnystudio.com/listener for privacy information.

In this episode, Dr. Jonathan Crowe reviews the Capitol Hill Report from June 22nd, discussing milestones related to the Improving Seniors' Timely Access to Care Act.  Stay updated with what's happening on the hill by visiting aan.com/chr.  Learn how you can get involved with AAN advocacy. 

Stroke in children and younger adults differs significantly from adult stroke, with varied presentations and a broader range of underlying causes such as congenital heart disease and arteriopathies. This episode highlights key diagnostic considerations and evolving approaches to treatment in these younger populations. In this episode, Aaron L. Berkowitz, MD, PhD, FAAN, speaks with Thalia S. Field, MD, FRCPC, MHSc, coauthor of the article "Stroke in Children and Younger Adults" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Berkowitz is a Continuum® Audio interviewer and a professor of neurology in the Department of Neurology at the University of California, San Francisco, in San Francisco, California. Dr. Field is a professor at the University of British Columbia and the Sauder Family Heart and Stroke Professor of Stroke Research, and a stroke neurologist at the Vancouver Stroke Program, Vancouver Coastal Health in Vancouver, British Columbia, Canada. Additional Resources Read the article: Stroke in Children and Younger Adults 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: @AaronLBerkowitz Full episode transcript available here Dr Berkowitz: Most neurologists are used to evaluating and treating adults with stroke since it's one of the most common neurologic conditions. But stroke can also occur in children, in infants, and even in utero. Today, I have the privilege of interviewing Dr. Thalia Field to talk about pediatric stroke.  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 Berkowitz: This is Dr. Aaron Berkowitz, and today I'm interviewing Dr. Thalia Field about her article on stroke in children and younger adults. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast, Dr. Field, and could you please introduce yourself to our audience?  Dr Field: Well, thanks so much. It's a pleasure to, uh, be speaking to you. I'm a stroke neurologist, and I treat adults generally. My wonderful colleague, Thivya Selvanathan, who's a neonatal neurologist, co-wrote the chapter with me. We do, unfortunately, have to treat some children with stroke collaboratively and I do advise on those cases. My practice is about one-quarter clinical, so I treat patients with acute stroke, look after them on the wards, see patients in stroke prevention clinic, and the rest of my time is mainly research and some administrative work and teaching. I run the clinical trials program for the Vancouver Stroke Program, and I do research of my own, mainly focused on stroke in younger adults. We previously did a trial and registry on cerebral venous thrombosis, and more recently, I've been running a national study looking at brain health in adults and children with congenital heart disease.  Dr Berkowitz: Fantastic. Wow, that is a lot that you do, and we'll look forward to the results of some of those studies. So, when adults suffer a stroke, they typically present with sudden onset focal neurologic deficits, very common scenario we're consulted on.  And one thing you and your colleague talk about in the article is that strokes can present differently in infants and in young children. Can you talk a little bit about the differing clinical presentations of stroke in the youngest young as compared to our usual experience treating the older adults?  Dr Field: Sure. So, you know, speaking about this as someone who doesn't see the children directly but has had the opportunity to discuss these patients with my colleagues and, like we all do, learn about it during our training, I think one of the distinctions, especially with neonates, is that it's generally not a presentation with focal neurologic deficits. Often these babies will have seizures or encephalopathy as their main presentation, and sometimes we're only finding out after the fact if they're presenting with developmental delay or early preference for handedness and hypotonia, things like that. So, in very young children, that's a distinction. And in older children, there can be sudden onset deficits and, and unfortunately, sometimes these are mistaken for other conditions that are more common in children, like seizures. But sometimes you can have a more indolent course, say, with something like a focal cerebral arteriopathy or something like that. So, it depends on the scenario, but the big difference primarily is in neonates, as far as I understand.  Dr Berkowitz: Perfect. That's very helpful. So as an adult neurologist, when I think about causes of stroke or teach sort of the categories of causes of stroke to our residents and students, when we think about the evaluation of stroke, I divide them broadly into causes related to the heart, causes related to the blood vessels, and causes related to the blood with, in the adult world, the most common things, of course, being atrial fibrillation for the heart, atherosclerosis for the blood vessels, and then risk factors for atherosclerosis in the blood, diabetes, hyperlipidemia, very rarely picking up a hypercoagulable disorder in the blood column. And reading your article, it seems that, correct me if I'm wrong, stroke in young adults, stroke in the pediatric population can basically be organized into those same broad categories, heart, blood vessels, and blood, just that there's many more conditions on the differential diagnosis that you would consider in young adults to begin with and then children and then neonates as we get into the younger and younger population. So, I'd like to talk about each of these sort of buckets of etiology in turn and ask you about some of the causes we would consider in young adults and children in each of these, and then as they come up, probably ask you more questions about how frequently we find these sorts of things, how frequently they're the cause of stroke treatment, et cetera. So, let's start with the heart. As I said, in adults, we're mostly looking for rhythm disorders, right, atrial fibrillation. Sometimes we'll pick up a patent foramen ovale or PFO or other structural abnormalities, but mostly we're thinking about atrial fibrillation. But reading your paper, I was struck by the huge variety of conditions that you might be looking for in the heart in children or infants with stroke. So, can you tell us a little more about cardiac etiologies of stroke in the young?  Dr Field: Yeah. So, I'd say unlike in older adults, where it tends more often to be a rhythm disorder, in children and adults who are younger, it's primarily a structural cause, and congenital heart disease being the most common. And it changes a little bit from younger adults shifting downwards in age to younger children in terms of the fact that often if we're seeing an adult with stroke related to congenital heart disease, it can be a paradoxical embolism from a previously undiagnosed PFO. Not in all cases, but fortunately this is improving over time. You know, generally people with diagnoses of more severe congenital heart disease are followed up from childhood and people are aware of the diagnosis, and hopefully they're being managed and watched for things like premature arrhythmias or depressed heart function or other things that can develop and require their own distinct antithrombotic management, for example. In young children, however, more severe causes of congenital heart disease tend to more frequently be associated with stroke. And in many cases, those strokes can be early on in life or associated, say, with perioperative complications or other iatrogenic-related causes in, in that way. Again, congenital heart disease can be associated with stroke at, at any point in the life course. But as adult neurologists, most frequently we're seeing very simple lesions like PFO with large shunts, and in children, it tends to be the more complex causes of congenital heart disease.  Dr Berkowitz: Got it. So, let's move on to the blood vessels. Again, in adults, we're usually thinking about atherosclerotic disease, be that of the cervical arteries or of the intracranial arteries. But in your paper, a lot of discussion about the various vasculopathies, arteriopathies that can be cause of stroke in younger adults and in children. Could you talk a little bit more about some of the vasculopathies and vascular conditions that are causes of stroke in the younger population?  Dr Field: Sure. Before I do that, I will say that especially in older younger adults, particularly over the age of thirty-five, and you know, kind of makes me shudder that that's an older younger adult. But, um, in, in any case, certainly conventional vascular risk factors are more common in this population with stroke, especially in those who don't have PFO-associated stroke. Like conventional atherosclerosis, you know, certainly is a cause of stroke in younger adults. But that being said, certainly other vascular causes and vasculopathy in particular is a much more common cause of stroke in younger adults and, and children than it is in older adults. In particular, dissection is an extremely common cause of stroke in younger adults. Generally cervical artery dissection from non-inflammatory vasculopathy, usually on, sometimes on the FMD fibromuscular dysplasia spectrum and, and sometimes, you know, provoked by minor trauma or something post-infectious that may make the vessels a little bit more susceptible. And in younger children, this inflammatory focal cerebral arteriopathy is a distinct cause that is a common cause of stroke in, in young children. There are other causes that can affect the blood vessels, you know, rarer things like vasculitis and vasculopathies that can develop in the context, say, of sickle cell anemia. But in general, as a bucket, vessels are still very important, but the pathology tends to shift.  Dr Berkowitz: Got it. And you, um, alluded to a point that I wanted to ask you about. You mentioned the sort of, there's stroke in the young, and then where do you draw the line at young? Less than sixty, less than thirty-five, and then we've also talked about strokes as young as before the age of birth. Yeah, I'm remembering, is it the Helsinki study, one of the early large series of stroke in younger individuals? I think that, was it eighteen to forty-nine in that or fifty-nine? I don't remember the exact age, but being struck reading that paper as a resident and thinking about the workup for exotic causes we do, right, and when a young patient has a stroke. And correct me if I'm wrong, the most common etiologies of stroke in that series, and I'm curious the other large series yourself have been involved with, have still been vascular risk factors and arrhythmias and things that we, even common, quote unquote, common things in the young, such as dissection or hypercoagulable states. Uh, the things that we sort of tend to think about first are actually less common. But acknowledging that that paper has folks up to the late forties when the vascular risk factors may be, um, unfortunately kicking in earlier, uh, and earlier due to dietary and lifestyle factors. So is that true, or do you have sort of an age cutoff when it's, we say stroke in the young, people sort of think, "Oh, they'd work someone up differently if they're less than sixty, and they have no vascular risk factors or few vascular risk factors." When do we start getting into the kind of younger population where atherosclerosis and cardiac arrhythmias are not number one and two?  Dr Field: I'd say first of all, you and I must have trained around the same time because I was also in my training, really struck by the results of the Helsinki study going, "Wow, I, I really didn't know how much of a role these conventional vascular risk factors still play." And I think we're seeing that information reiterated, unfortunately, like even with higher prevalences and more attributable risk in some of the newer series. There are newer European series looking at stroke in younger adults, and more recently, there's been one that we mentioned in the article from the Florida Stroke Registry. And it's true that generally the burden is in the older younger adults. But what I would say overall in terms of kind of how things guide the workup, you need to look at the patient and consider things. I mean, obviously you don't want to miss things that can be treated differently and identified by tests easily. You know, things like ruling out syphilis or antiphospholipid antibody disease in, in younger patients. You really want to make sure that that's not something that, that you'd miss because, you know, obviously your treatment is going to change. However, certainly we start with the basics for stroke workup in any patient that's coming in. At my center, CT angiography. Some centers it may be MR angiography and echocardiography. We take a careful history. We look at the blood work. We look at the vascular risk factor burden. We find out if there's kind of any worrisome personal history, family history, look at their general health context. I think that really helps to guide how far we go in a particular workup, and it also helps to direct the other investigations and types of follow-up we need to do. For example, if a patient has a fairly suspicious story for dissection, let's say they're getting over a cold, and they went to the gym, and, you know, there was a sudden movement that they did that really produced headache and neck pain, and there's an obvious cervical artery dissection. I'm not going to go too far down testing them for rare infections and doing advanced cardiac imaging unless something shows up on their initial echo, for example. But I will make an effort to do more detailed vascular imaging of the rest of their body, find out careful family history. If there's additional manifestations of a non-inflammatory vasculopathy elsewhere, say consider sending them to medical genetics, or obviously, if this is, you know, a second event, your flags raise even more. So, it really depends on the patient. If I find out that there's, you know, a family history of premature cardiac disease and things like that, you know, obviously we're gonna be keeping a close eye on their cholesterol, making sure that we're not identifying, for example, familial hypercholesterolemia, which is, you know, something that comes up not infrequently where we'll see an LDL in an untreated patient of more than five. I apologize, you're gonna have to do the conversion to American units on that. But there are things we identify and, you know, again, you don't want to fall solely on heuristics and your preconceived notion of, of the patient. You do have to consider the results of the investigations that you do order. But I think you can certainly be mindful in terms of how you direct your workup and in turn, how you direct your follow-up.  Dr Berkowitz: That's great to hear your approach. Yeah, as you said, our approach always begins with the same, coming back to these three categories, right? Doing some type of structural imaging of the heart, rhythm monitoring for the heart, and then vascular imaging of the head and neck. And then I was going to ask you, and you sort of began to answer this question. Yeah. What's next and how far do you go? I think most people think the expanded stroke workup in the young is at a minimum, a TEE if there's been no signal thus far on the original workup. I just mentioned and you spoke about, and then probably hypercoagulable testing and only sending arterial side if there's no shunt and venous and arterial side if there's a shunt. Is that your second pass approach or did I miss anything, or are there other nuances there that are helpful to discuss?  Dr Field: No, I think that's generally in keeping with what I do. I think with TEE being very important. I mean, the first pass are arterial stuff. Really, it's antiphospholipid antibodies and, and making sure there's no cancer. Like you said, only if there's a shunt do I pursue other venous hypercoagulability testing. Again, you [chuckles] kind of reiterate, go through with the history, make sure there's kind of no red flags. And sometimes, obviously, you do your best reasonable job with the first pass workup, and you will find out when someone presents with a second event that it's something very unexpected. Maybe first manifestation, someone with no obvious history and very initially normal-looking imaging, say with, with CATASL or something like Fabry's disease or something where you would consider it if there was kind of a more classical picture. But it wouldn't be something you would do kind of on your first or even second pass workup in the absence of any sort of clinical suspicion, family history, or something along those lines.  Dr Berkowitz: I'm curious just as far as rough percentage. I feel like many of these patients we see it's a patient who's young and who's had a stroke, and the initial first pass has been unremarkable, and we do our TEE, and we do our hypercoagulable workup. Again, antiphospholipid antibodies only if it's-- there's no shunt. And if there's a shunt, adding on some of the venous hypercoagulability protein C, protein S, factor five, Leiden, et cetera. A lot of the times I feel like we don't find anything. What's your sort of general gestalt? Again, as a general neurologist who does a lot of inpatient neurology, I feel like when these cases come up, it's not that common that you say, "Oh, I actually diagnosed protein S deficiency." Or every once in a while, diagnose an antiphospholipid antibody, or you'll find a PFO on TEE. You didn't find on TT. I've maybe found one fibroelastoma in many years. How often do you find something? How often is it just as an adult a cryptogenic stroke in a young adult or child?  Dr Field: So much of what we see is PFO-related, dissection-related, conventional vascular risk factor-related. We do send referrals to medical genetics. Sometimes we'll do testing for rare things like Fabry's or consider other diagnoses. But I mean, those tend to be the exceptions. About one in four to one in five young adults with stroke end up with this cryptogenic label. I like to keep them on my radar for a few reasons. I think, one, it produces tremendous anxiety for them to not have a cause of stroke identified and just to kind of have a generic approach to secondary prevention. So, I think just to kind of keep an eye on them, manage their anxieties each year, make sure there's kind of no updates in, in terms of general secondary preventionAnd sometimes just things dawn on you later or there are new conditions, say things like, you know, DADA2, this, you know, adenosine deaminase deficiency. You know, there are new diagnoses that, that come on the radar. And sometimes treatments change. You know, for example, when I was starting my early career, the evidence hadn't yet been in place for PFO closure, and then all of a sudden, the paradigm completely changed. And you want to make sure that you can get in touch with those patients to reconsider your approach at the time. So I realize that not everybody has the luxury of extended follow-up with their patients, but I think often you can kind of encourage them or their healthcare team or just, you know, patient themselves to keep in touch periodically just to make sure that there haven't been any changes in treatment paradigms or just with your own awareness of particular, you know, diagnoses or, or just kind of readdressing the situation, uh, a year after and seeing if there's anything that may have occurred to you in the interim.  Dr Berkowitz: Perfect. Really illuminating to hear your approach to these challenging cases. And as you said here and then a couple of times, I think, in this interview is in many of these cases it's your first pass, maybe even your second pass, you haven't found anything. And the key is, unfortunately, as distressing as it may be for the patient as well as for us to not have an answer, to just keep following these patients. And sometimes you really can't sort it out until something else happens, either neurologically or systemically, where you say, "Oh, that's what this was." But there would've been no way to know it from the first presentation. So, we've talked a lot about the diagnosis of causes of stroke in younger adults and children. And in the last minute or two here, I just wanted to talk a little bit about treatment. You mentioned early on that you're involved in thrombectomy cases in children. What's the state of evidence or at least state of practice in terms of offering therapies like thrombolysis and thrombectomy in our patient population? I guess it would be under 18, right, who is not studied in the major trials. Do we have evidence and, or in the absence of evidence, what's sort of the, the expert guidance on treating young adults under 18 and children with some of these acute therapies?  Dr Field: So, trying to keep up with the literature on this. You know, certainly the evidence has been more established in a small trial and pediatric registries for use of tPA, tissue plasminogen activator, in children just because, you know, it's been around much longer. In terms of tenecteplase, which I, I really think signifies a, a practice shift in adult stroke because of its, you know, non-inferior efficacy and ease of use and potentially better rates of recanalization over time. In children, to my knowledge, that evidence base is, is limited to case series and anecdotal shifts in availability of drug and, and different practices. So, the evidence base is not particularly strong for tenecteplase in children who are identified within a reasonable amount of time who are still otherwise candidates for thrombolysis, you know, thrombolysis in children. Children who are a little bit older, I think, can't remember the exact age, but generally very young, like neonates, children who are under the age of two, I believe. I would want to double-check that thrombolysis is less commonly used and just because the safety has not really been that well-established. And for thrombectomy, it's now recommended to use thrombectomy in otherwise eligible children in the newest AHA guidelines. It gets a little bit more controversial in very young children. Under the age of six, there's less of an evidence base and, and often it will depend on people's level of comfort in terms of the size of the arteries. It's my understanding that once you get to about age six, the artery diameter is similar to that in fully grown people. But in younger children, I think just because of the catheters, there can be risk of, of injury. So, it's more of a case-by-case conversation with your interventionalist for younger children. And again, the evidence to intervene is not there for very, very young babies, for example.  Dr Berkowitz: That's very helpful to hear the current state of the evidence and the current state of practice, acknowledging, of course, there's not that much evidence, and these are relatively uncommon occurrences, fortunately, for children, but making it challenging for practitioners and practices may, um, vary based on different institutional protocols. So again, today I've been interviewing Dr. Thalia Field about her article on stroke in children and younger adults. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues. And thank you 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.

Aan de vooravond van 11 juli lijkt er weinig reden tot vieren voor Vlaanderen. De Vlaamse regering begeestert niet, onderling zit de klad erin en nu komt er ook kritiek uit de eigen administratie. Is de ploeg van minister-president Matthias Diependaele (N-VA) in staat om zichzelf heruit te vinden? ­ In de afscheidsinterviews van Hans Bonte (Vooruit) vielen al harde woorden over de Vlaamse regering – bijvoorbeeld dat ze “dringend moet bezinnen” - en ook de administratie is niet onverdeeld gelukkig met de gang van zaken in Vlaanderen, zo blijkt. Collega Simon Andries van de Wetstraatredactie interviewde topambtenaar Koen Algoed, hij schetst een sfeer van wantrouwen van politici ten opzichte van ambtenaren. En dat is problematisch... ­ Is het ook symptomatisch, voor de werking van de Vlaamse regering dan? “Feit is dat we de laatste zes maanden niets anders zien dan ministers die elkaar vliegen afvangen en de duvel aandoen”, aldus collega Dario Van Fleteren, die het Vlaamse niveau volgt. Zo rollen N-VA-ministers Zuhal Demir en Annick De Ridder steeds openlijker ruziënd over de straatstenen. ­ De begroting is hét stokpaardje van de N-VA, die met Matthias Diependaele de minister-president levert, maar ook daar zit er zand in de machine. Diependaele wil de centen op orde, maar over het te volgen pad bestaat nog veel onduidelijkheid en onenigheid. Allicht valt er vóór het zomerreces geen beslissing meer over de begroting, zeggen Simon en Dario. Hoe moet het verder met de weinig begeesterende Vlaamse regering? Wat kan en zal ze nog voor elkaar krijgen? ­ Journalisten Simon Andries en Dario Van Fleteren | Presentatie Marjan Justaert | Redactie Sofie Steenhaut en Tara Van Eycken | Eindredactie Tara Van Eycken | Audioproductie en muziek Brecht PlasschaertSee omnystudio.com/listener for privacy information.

Rapid advances in acute ischemic stroke care have expanded treatment windows and improved patient outcomes through thrombolysis, mechanical thrombectomy, and optimized antithrombotic strategies. This episode highlights evolving approaches to patient selection, the growing role of tenecteplase, and the importance of team-based systems of care in delivering timely, effective treatment. In this episode, Casey S. Albin, MD, FAAN, speaks with Christopher R. Leon Guerrero, MD, author of the article "Thrombolysis, Thrombectomy, and Antithrombotic Therapy for Acute Ischemic Stroke" in the Continuum® June 2026 Cerebrovascular Disease issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Leon Guerrero is an associate professor of neurology and the adult neurology residency program director at Atrium Health Carolinas Medical Center in Charlotte, North Carolina, where he also serves as outpatient stroke director. Additional Resources Read the article: Thrombolysis, Thrombectomy, and Antithrombotic Therapy for Acute Ischemic Stroke 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: @caseyalbin Full episode transcript available here Dr Albin: In stroke care, every minute kills nearly two million neurons. But today, we're going to unpack all the details about the latest treatments that can give those neurons back.  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 Albin: Hello and welcome. This is Dr. Casey Albin. Today, I'm interviewing Dr. Christopher Leon-Guerrero about his article on Thrombolysis, Thrombectomy, and Antithrombotic Therapy for Acute Ischemic Stroke. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast. I always like to start by just having you introduce yourself so our listeners know a little bit about you.  Dr Leon-Guerrero: Thanks for the introduction, Dr. Albin. Really glad to be here today. My name is Chris Leon-Guerrero. I'm a vascular neurologist at Atrium Health in Charlotte, North Carolina, at Carolinas Medical Center. I'm an associate professor in the Department of Neurology. I serve as our Neurology Residency Program Director, and I also wear the hat of an outpatient stroke director in our clinics.  Dr Albin: So, you are wearing a lot of hats and balancing a lot of things, and it's a really exciting time to be talking about this. For our listeners, we are recording this right after the launch of the American Heart Association, American Stroke Association just released their new guidelines on acute ischemic care. So, no better time to kind of dive into some of this. And really, when I think about acute ischemic stroke care, it's dramatically transformed in the last two to three decades. I mean, from lengthening time windows for IV thrombolysis to expanded thrombectomy eligibility, this is really, I think, some of the most exciting stuff in neurology. And your article did a fantastic job of distilling those rapid advancements and clarifying some of the evidence behind some of these new evolving treatment selections and imaging modalities, and it's exciting. So, let's just start with thrombolysis. Where are we now with IV thrombolytics and the time windows there?  Dr Leon-Guerrero: So, a lot has changed in the last decade, since that initial trial with NINDS, nearly thirty years ago. We're still giving intravenous thrombolysis in the traditional time window up to 4.5 hours, and really emphasizing we should be selecting patients for treatment early and quickly as possible. In most of those cases, a non-con head CT is sufficient to rule out bleeding and initiate treatment as quickly as possible. Where things have gotten really exciting is using advanced neuroimaging to help select patients beyond that traditional 4.5 hour window, and we're able to treat patients even up to twenty-four hours from symptom onset.  Dr Albin: Which is really exciting. It has really totally shifted the paradigm here. You know, I think most listeners are going to be pretty familiar with three to four and a half hours. Like, that's sort of our standard. What can you tell us about some of the advanced imaging we're using for that later selection period?  Dr Leon-Guerrero: It's around the principle of you want to be able to, uh, rescue significant salvageable tissue without a lot of core. So, this large profusion deficit and small core is really how you're trying to select out these patients. And two types of modalities are used. One is going to be MRI, and a lot of those imaging protocols, you know, are outlined in the WAKE UP trial and basically are looking for patients with DWI hyperintense lesions and FLAIR negative lesions to suggest that patients in an early time window that's treatable for thrombolysis. And then in the other category, we'll be using profusion imaging, whether that's CT profusion or MR profusion, to look for patients with large salvageable tissue.  Dr Albin: Yeah. And I think that this has been one of the things that, to me, has been really impactful is I think when WAKE UP came out, it was exciting. It was fun to sort of think about, "Hey, we're going to be able to use MRI." But MRI can be very challenging to get acutely, especially in community centers where they don't have the capabilities to get someone from the emergency department into an MRI rapidly enough to make thrombolysis decisions. So, to see some of that expand to CT profusion has been really exciting. How are you going about sort of counseling patients or thinking about their risk when you're using some of those, like, advanced imaging techniques?  Dr Leon-Guerrero: Yeah. I think it's similar to the conversations we've had with patients even within the traditional 4.5 hour window. The risk for intravenous thrombolysis is hemorrhage, and counseling patients on the, you know, the risk and benefits of hemorrhage and the potential clinical benefit of receiving thrombolytics is important. And then providing patients with that information to make an informed decision, so that they can make the best decision for their own care.  Dr Albin: Totally. And it's, again, time sensitive, but trying to give families enough information and enough time to sort of process those, especially when it's a little bit beyond the standard that we're so used to consenting for. The other big area that's really changed is that tenecteplase has become the star of the show. It's really gained momentum, so what should clinicians understand about this?  Dr Leon-Guerrero: Yeah. There's been an explosion of data over the last decade on tenecteplase supporting its use for clinical practice. You know, there was recent updates even from the neurology journal with a large meta-analysis with all of the data showing good clinical outcomes and perhaps even lower risk of bleeding. And so, I think you're seeing a lot of centers across the country switching from alteplase to tenecteplase. There's some practical advantages. So tenecteplase is a one-time bolus dose. And then biologically, it seems to have better fibrin specificity, longer half-life, which may ultimately make it a more attractive drug and may make it even more effective. But I think the practical aspects of tenecteplase are not to be understated. I think there's a lot of advantages for speed and efficiency and for centers to make that switch.  Dr Albin: Yeah. I remember when our health system made the pivot from alteplase to tenecteplase. Like any changes, that obviously created some adjustments with the new workflow. But, the fact that this could be given just as a one-time dose and not with the "we got to calculate the bolus, and now we got to get the infusion on board," like really simplified workflow. So, I think that's been pragmatically one of the nicest things we've done in stroke care. Really exciting.  Dr Leon-Guerrero: Yeah. And, you know, it's a doable thing. I think you have to be, very deliberate about it at whatever center you're at to make sure that all stakeholders are aware of that change. I think that's helpful to get everybody involved and have a lot of planning to avoid wrong dosing errors or inadvertently dosing as alteplase versus tenecteplase. But it's certainly doable, and I think in the long term, centers that have switched have been pretty satisfied with tenecteplase.  Dr Albin: And you know, initially when this came out, there really was sort of a debate about, is it gonna be 0.25? Was it gonna be 0.4? Where have we landed with that debate?  Dr Leon-Guerrero: So, I think we found the correct dose is 0.25 milligrams per kilogram is the recommended dose with a max out of 25 milligrams. There's some within the American Heart Association guidelines that were just published. They mentioned even tier dosing based on 10 kilograms, so intervals. So, that may be an easier way for centers to do it. But that cap out dose of 25 milligrams at 0.25 milligrams per kilogram, I think, is the sweet spot.  Dr Albin: Yeah. That's great, and I think that that has helped, you know, say, "This is what we're doing. There's not a debate that's happening anymore." And that really just got codified in the new ASA guidelines, so really exciting there. So, there is a lot of guidance for these patients, but I think one of the things that your article really tackled is the fact that there are some special populations, where we really still don't have a lot of guidance. And so, I think just to kind of distill those for the listeners, thinking about our pregnant patients, thinking about children, how are we approaching thrombolysis decisions in these special populations?  Dr Leon-Guerrero: These are always tough cases. For example, for pregnant women, they've often been excluded in the thrombolytic trials. But there's still evidence. You know, there's some inference based on the evidence we do have, and there's a lot of registry and case reports suggesting potential safe treatment for pregnant women. And I think when you're approaching those cases, again, it's gonna be patient-centered and really should be multidisciplinary. These are the types of cases you really need to lean on your maternal fetal medicine colleagues, your high-risk OBGYNs, your obstetricians to help with that decision-making. And I think, a multidisciplinary approach is the way to go for these cases. It's the same thing with the pediatric population. We had some data. There was one trial, randomized control trial, called TIPS trial that looked at using intravenous alteplase for acute ischemic stroke in patients under the age of 18. It had difficulty with enrollment. But I think most experts would argue that patients with pediatric stroke should be considered for intravenous thrombolysis if appropriate. Again, same thing. You want to make it a multidisciplinary approach, really getting your pediatric neurologists, your pediatricians involved early to make the best decision for the patient.  Dr Albin: Yeah. That's just really an important takeaway, just thinking about this as a multidisciplinary decision, because there are going to be other stakeholders to the patient's care who may have some different information than what we as neurologists are bringing to the approach. And obviously, our perspective really matters. But trying to work in everyone's unique vantage point of the patient really helps to make the most effective decision. When we talk about acute ischemic stroke care, I really don't think that you could do justice to the topic without pivoting to mechanical thrombectomy, which, you know, as we think about how the medical field as a whole, not just neurology, how the medical field has evolved. I mean, there's probably no bigger impact than mechanical thrombectomy has made in terms of reducing not just morbidity, but mortality from stroke. I mean both. So, thrombectomy has been around for a while, but just walk our listeners through what's the core that we for sure know that these are the patients that this works for?  Dr Leon-Guerrero: The types of patients we should be selecting for intervention are patients with large vessel occlusions. And those initial trials that were published in 2015 really demonstrated that this is a quite an effective treatment for patients with large vessel occlusion ischemic strokes in the anterior circulation. When that smattering of publications occurred in 2015, the general consensus, we should be treating all patients up to six hours from symptom onset if they do have a large vessel occlusion. And then, Dr. Albin, as you know, the, the windows continue to expand. So, we were using advanced neuroimaging with MR selection and perfusion selection based on DAWN and DEFUSE 3 trial protocols to select patients all the way out to the 24 window, and it's even expanded beyond that over the last few years.  Dr Albin: I think that when we think about trials that really, totally, changed the game, when we think about DAWN and DEFUSE 3, and we switched from that time-based window to more of that, like we talked about for thrombolysis, that tissue-based clock and, like, looking at what is salvageable and where can we make an impact on salvageable tissue, truly moved the needle in terms of just bringing this therapy for people who, you know, it's hard to get in within six hours. When we moved the needle to 24, it made a huge difference. But people were still coming in with a lot of ischemic damage already done, and they would have traditionally been excluded from being enrolled in thrombectomy trials. But that's changing too. So where are we there?  Dr Leon-Guerrero: Yeah. I think there were lessons learned from DEFUSE and DAWN that we were probably over-selecting. Perhaps too stringent. You know, we had number needed to treat in the range of two to three for good outcome based on those trials. And so, I think those were lessons learned to move forward, and we, and, and people started looking at large core infarctions. And in the last few years, we've seen a multitude of randomized control trials examining large core infarctions. These are patients with ASPECT scores all the way down to zeros. A lot of the trials relied on three to six as their score, but there was at least one large core study that looked at ASPECT scores down to zero to two, and all of these studies showing benefit.  Dr Albin: Yeah. And we've really moved into if there's some tissue to spare there, probably getting clot out really makes a big difference in impact. You know, it was really surprising to me as a neurointensivist looking at these trials, that the trials had such low rates of hemorrhage, and pretty low rates of dramatic cerebral edema after thrombectomy. I don't know that we've seen all of that in sort of real world applications, but again, we are still seeing some of these patients come in, that really would've been devastated having some amount of functional recovery regained, which is incredible. In terms of another patient population that I think gives a lot of people pause or stickiness, is those basilar artery occlusions, right? Another large vessel, but one that we've had a little bit harder of a time enrolling in trials and having well-selected trials. Where are we now on whether or not basilar artery occlusion should go to mechanical thrombectomy?  Dr Leon-Guerrero: So, a lot of excitement in this area, too. There's at least two studies that were published in the last five years that were showing benefit in doing thrombectomy for patients with basilar artery occlusion up to 24 hours, and these were patients with moderate to severe deficits with NIH Stroke Scale scores greater than 10. And then making sure that they don't have large core, so using a newer scoring algorithm on the CAT scan called PC ASPECT, so basically a posterior circulation ASPECT score, to kind of make sure that patients don't have large core infarctions that are being considered for thrombectomy. All of those things collectively in those two recent studies, the ATTENTION trial and the BAOCHI trial, I think is what ended up making those studies positive, is that we were selecting the right types of patients, uh, without large core, early core, and patients with moderate to severe deficits that made the difference from previous trials.  Dr Albin: Yeah. I think that that's so important. Those trials to me, and like how long it took to get those enrolled, really emphasized to me that there really was a selection bias. Like, we believed this worked, which made it hard to then do a trial. But I'm so glad to hear that we have the data now to support moving forward in a more rigorous way.  Dr Leon-Guerrero: You're absolutely right. I think that was some of the challenges with the initial trials. In fact, the authors had commented on that. There's a lot of difficulties with lack of clinical equipoise, or experts wanting to take these patients anyways out of clinical trial and treat them, and so that's always been an issue. And then, you know, we all remember basilar artery occlusion cases. They can be severe, devastating cases in our career, but the reality is they're not that common. So, if you look at large vessel occlusions, they only account for about 10%, and if you look at all stroke patients presenting to most centers, they represent about 1% of cases. So really hard clinical trials to do just because there's thankfully not a lot of patients walking around with basilar artery occlusions, but certainly makes for challenges when you're trying to conduct randomized controlled trials on this subset of patients.  Dr Albin: Absolutely. But we did it, and I think that, like, really if, if the listeners take nothing else, it's that the field of vascular neurology is really moving forward with evidence-based, doing very rigorously controlled clinical trials, which is, I think, is what makes this field so exciting. Finally, closing out, cause we could talk all day, but we don't have all day. You know, it seems to me that more and more we are just using dual antiplatelet therapy all the time. And maybe that is, uh, a little bit of a hyperbole, cause I don't think it's all the time, but let's walk through— when is there good evidence for dual antiplatelet therapy?  Dr Leon-Guerrero: Yeah. So, there's strong evidence for early initiation of dual antiplatelet therapy or DAPT in patients with minor stroke or high-risk TIAs, and it's been studied using both clopidogrel as an add-on to aspirin and ticagrelor. Both seem like they're viable options in patients. I think one of the key things is the duration of therapy. So, in these cases with minor stroke and high-risk TIAs, we really should be confining the treatment of early DAPT for 21 days. The risk profile changes, so the risk of recurrent stroke starts to decline with time, and that risk of hemorrhage complications increases with time. And so that sweet spot of 21 days, or even some centers will do 30 days for just practical purposes, you know, really is what we should be doing in most of those cases. Other instances where DAPT can be considered, is in patients with intracranial atherosclerosis that's symptomatic, extrapolating from the SAMMPRIS trial that in the, in the medical management arm alone, used dual antiplatelet therapy with aspirin and clopidogrel for up to 90 days. So, you'll see that as well in clinical practice. Some people will opt for a 90-day duration for those patients with symptomatic intracranial atherosclerosis and stroke.  Dr Albin: Just so I emphasize, this is not set it and forget it. You can stay on DAPT forever. It is you're going to have a definitive time course, 21 days, 90 days. We have directed instructions where we're doing more benefit than harm because of that risk of hemorrhage.  Dr Leon-Guerrero: That's correct. In most cases, we really should be confining the duration of DAPT either to 21 days or 90 days. This is a challenging clinical practice. Centers really have been making an emphasis on stroke follow-up, so making sure these patients get appropriate and timely stroke follow-up to address these issues and to make sure that DAPT is discontinued if appropriate.  Dr Albin: Yeah. I love that, and I want to pull on that a little bit because you as someone who is helping direct a stroke center– A lot of this really does rely on systems of care. When we think about early lysis decisions or mechanical thrombectomy, it's how do we get the patient to one of those capable centers as quickly as possible? And then on the back end, when you're discharging a patient, how do you make sure that they are getting follow-up, making sure that they're getting their Holter monitor if they need it? You know, all the stuff that goes into kind of figuring out, why did the stroke happen? What are some of the things that you, in your role, are really excited about, that will move the needle over the next five or 10 years?  Dr Leon-Guerrero: Yeah. I think a lot of centers are doing it just like we're doing it. It really has to be a team-based approach, and you really want to reach the patient where they are in terms of the continuum of care. And so making sure if it's the in the field that you've reached out to your EMS and first responders to make sure they understand triage protocols to get patients where they need to be, to get the acute treatments that they need for the type of stroke that they're presenting with, to the actual centers that you work at, making sure your whole team, nurses, emergency physicians, APPs that are involved in care are all aware of the stroke protocols and how we're selecting these patients, making sure that your imaging protocols are up to date, and so that it's seamless when patients come in, that we're not adding on perfusion if we should have gotten that up front– We already know, have made decisions before that patient gets there. And then thinking about the patient after that hospital stay, I think, is critical. We really want to reduce their risk of recurrence, making sure that we're leveraging transitions of care, getting those patients seen in our stroke clinics for follow-up, and then make sure we're passing that baton to the long term. All of their long-term comorbidities that may be increasing their risk of stroke are managed and reduced as best as possible.  Dr Albin: From the Continuum journal to the continuum of stroke care.  Dr Leon-Guerrero: That's right.  Dr Albin: I mean, we have it all. I think that that really is so important. I'll just close with what's one thing that is your favorite part about being a vascular neurologist?  Dr Leon-Guerrero: I think it's what attracted to me to this field. As a medical student at that time, all we had was intravenous thrombolysis, and there was so much promise. There was so much promise that there was going to be widespread advancements in acute stroke, and here we are. There's been a tremendous amount of advancements and improvements for patients. I'm really excited to see what unfolds in the next few years, and I'm really excited that we've been able to increase the number of patients we're able to treat with acute ischemic stroke. I hope that we continue to expand the time window, the inclusion criteria, all of those things that we can treat more stroke patients effectively.  Dr Albin: It is really a very exciting time to be a vascular neurologist. Again, today, I've been interviewing Dr. Christopher Leon-Guerrero about his article on Thrombolysis, Thrombectomy, and Antithrombotic Therapy for Acute Ischemic Stroke. This article appears in the April 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues, and thank you again, Dr. Leon Guerrero and our listeners for joining today.  Dr Leon-Guerrero: 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.