Podcasts about Aan

Regina Nieuwhof - Ultimate Temple Podcast

Play Episode Listen Later Jun 18, 2025 21:08

Idiopathic intracranial hypertension (IIH) is characterized by symptoms and signs of unexplained elevated intracranial pressure (ICP) in an alert and awake patient. The condition has potentially devastating effects on vision, headache burden, increased cardiovascular disease risk, sleep disturbance, and depression. In this episode, Teshamae Monteith, MD, FAAN speaks with Aileen A. Antonio, MD, FAAN, author of the article “Clinical Features and Diagnosis of Idiopathic Intracranial Hypertension” in the Continuum® June 2025 Disorders of CSF Dynamics issue. Dr. Monteith is the associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Antonio is an associate program director of the Hauenstein Neurosciences Residency Program at Trinity Health Grand Rapids and an assistant clinical professor at the Michigan State University College of Osteopathic Medicine in Lansang, Michigan. Additional Resources Read the article: Clinical Features and Diagnosis of Idiopathic Intracranial Hypertension Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @headacheMD Guest: @aiee_antonio Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Monteith: Hi, this is Dr Teshamae Monteith. Today I'm interviewing Dr Aileen Antonio about her article on clinical features and diagnosis of idiopathic intracranial hypertension, which appears in the June 2025 Continuum issue on disorders of CSF dynamics. Hi, how are you? Dr Antonio: Hi, good afternoon. Dr Monteith: Thank you for being on the podcast. Dr Antonio: Thank you for inviting me, and it's such an honor to write for the Continuum. Dr Monteith: So why don't you start off with introducing yourself? Dr Antonio: So as mentioned, I'm Aileen Antonio. I am a neuro-ophthalmologist, dually trained in both ophthalmology and neurology. I'm practicing in Grand Rapids, Michigan Trinity Health, and I'm also the associate program director for our neurology residency program. Dr Monteith: So, it sounds like the residents get a lot of neuro-ophthalmology by chance in your curriculum. Dr Antonio: For sure. They do get fed that a lot. Dr Monteith: So why don't you tell me what the objective of your article was? Dr Antonio: Yes. So idiopathic intracranial hypertension, or IIH, is a condition where there's increased intracranial pressure, but without an obvious cause. And with this article, we want our readers---and our listeners right now---to recognize that the typical symptoms and learning about the IIH diagnostic criteria are key to avoiding errors, overdiagnosis, or sometimes even misdiagnosis or underdiagnosis. Thus, we help make the most of our healthcare resources. Early diagnosis and management are crucial to prevent disability from intractable headaches or even vision loss, and it's also important to know when to refer the patients to the appropriate specialists early on. Dr Monteith: So, it sounds like your central points are really getting that diagnosis early and managing the patients and knowing how to triage patients to reduce morbidity and complications. Is that correct? Dr Antonio: That is correct and very succinct, yes. Dr Monteith: And so, are there any more recent advances in the diagnosis of IIH? Dr Antonio: Yes. And one of the tools that we've been using is what we call the optical coherence tomography. A lot of people, neurologists, physicians, PCP, ER doctors; how many among those physicians are well-versed in doing an eye exam, looking at the optic disc? And this is a great tool because it is noninvasive, it is high resolution imaging technique that allows us to look at the optic nerve without even dilating the eye. And we can measure that retinal nerve fiber layer, or RNFL; and that helps us quantify the swelling that is visible or inherent in that optic nerve. And we can even follow that and monitor that over time. So, this gives us another way of looking at their vision and getting that insight as to how healthy is their vision still, along with the other formal visual tests that we do, including perimetry or visual field testing. And then all of these help in catching potentially early changes, early worsening, that may happen; and then we can intervene more easily. Dr Monteith: Great. So, it sounds like there's a lot of benefits to this newer technology for our patients. Dr Antonio: That is correct. Dr Monteith: So, I read in the article about the increased incidence of IIH, and I have to say that I completely agree with you because I'm seeing so much of it in my clinic, even as a headache specialist. And I had a talk with a colleague who said that the incidence of SIH and IIH are similar. And I was like, there's no way. Because I see, I can see several people with IIH just in one day. That's not uncommon. So, tell me what your thoughts are on the incidence, the rising incidence of IIH; and we understand that it's the condition associated with obesity, but it sounds like you have some other underlying drivers of this problem. Dr Antonio: Yes, that is correct. So, as you mentioned, IIH tends to affect women of childbearing age with obesity. And it's interesting because as you've seen that trend, we see more of these IIH cases recently, which seem to correlate with that rising rate of obesity. And the other thing, too, is that this trend can readily add to the burden of managing IIH, because not only are we dealing with the headaches or the potential loss of vision, but also it adds to the burden of healthcare costs because of the other potential comorbidities that may come with it, like cardiovascular risk factors, PCOS, and sleep apnea. Dr Monteith: So why don't we just talk about the diagnosis of IIH? Dr Antonio: IIH, idiopathic intracranial hypertension, is also called pseudotumor cerebri. It's essentially a condition where a person experiences increased intracranial pressure, but without any obvious cause. And the tricky part is that the patients, they're usually fully awake and alert. So, there's no obvious tumor, brain tumor or injury that causes the increased ICP. It's really, really important to rule out other conditions that might cause these similar symptoms; again, like brain tumors or even the cerebral venous sinus thrombosis. Many patients will have headaches or visual disturbances like transient visual obscurations---we call them TVOs---or double vision or diplopia. The diplopia is usually related to a sixth nerve palsy or an abducens palsy. Some may also experience some back pain or what we call pulsatile tinnitus, which is that pulse synchronous ringing in their ears. The biggest sign that we see in the clinic would be that papilledema; and papilledema is a term that we only use, specifically use, for those optic nerve edema changes that is only associated with increased intracranial pressure. So, performing of endoscopy and good eye exam is crucial in these patients. We usually use the modified Dandy criteria to diagnose IIH. And again, I cannot emphasize too much that it's really important to rule out other secondary causes to that increased intracranial pressure. So, after that thorough neurologic and eye evaluation with neuroimaging, we do a lumbar puncture to measure the opening pressure and to analyze the cerebrospinal fluid. Dr Monteith: One thing I learned from your article, really just kind of seeing all of the symptoms that you mentioned, the radicular pain, but also- and I think I've seen some papers on this, the cognitive dysfunction associated with IIH. So, it's a broader symptom complex I think than people realize. Dr Antonio: That is correct. Dr Monteith: So, you mentioned TVOs. Tell me, you know, if I was a patient, how would you try and elicit that from me? Dr Antonio: So, I would usually just ask the patient, while you're sitting down just watching TV---some of my patients are even driving as this happens---they would suddenly have these episodes of blacking out of vision, graying out of vision, vision loss, or blurred vision that would just happen, from seconds to less than a minute, usually. And they can happen in one eye or the other eye or both eyes, and even multiple times a day. I had a patient, it was happening 50 times a day for her. It's important to note that there is no pain associated with it most of the time. The other thing too is that it's different from the aura that patients with migraines would have, because those auras are usually scintillating and would have what we call the positive phenomena: the flashing lights, the iridescence, and even the fortification that they see in their vision. So definitely TVOs are not the migraine auras. Sometimes the TVOs can also be triggered by sudden changes in head positions or even a change in posture, like standing up quickly. The difference, though, between that and, like, the graying out of vision or the tunneling vision associated with orthostatic hypotension, is that the orthostatic hypotension would also have that feeling of lightheadedness and dizziness that would come with it. Dr Monteith: Great. So, if someone feels lightheaded, less likely to be a TVO if they're bending down and they have that grain of vision. Dr Antonio: That is correct. Dr Monteith: Definitely see patients like that in clinic. And if they have fluoride IIH, I'm like, I'll call it a TVO; if they don't, I'm like, it's probably more likely to be dizziness-related. And then we also have patient migraines that have blurriness that's nonspecific, not necessarily associated with aura. But I think in those patients, it's usually not seconds long, it's usually probably longer episodes of blurriness. Would you agree there, or…? Dr Antonio: I would agree there, and usually the visual aura would precede the headache that is very characteristic of their migraine, very stereotypical for their migraines. And then it would dissipate slowly over time as well. With TVOs, they're brisk and would not last, usually, more than a minute. Dr Monteith: So, why don't we talk about routine imaging? Obviously, ordering an MRI, and I read also getting an MRV is important. Dr Antonio: It is very important because, one: I would say IIH is also a diagnosis of exclusion. We need to make sure that the increased ICP is not because of a brain tumor or not because of cerebral venous sinus thrombosis. So, it's important to get the MRI of the brain as well as the MRV of the head. Dr Monteith: Do you do that for all patients' MRV, and how often do you add on an orbital study? Dr Antonio: I usually do not add on an orbital study because it's not really going to change my management at that point. I really get that MRI of the brain. Now the MRV, for most of my patients, I would order it already just because the population that I see, I don't want to lose them. And sometimes it's that follow-up, and that is the difficult part; and it's an easy add on to the study that I'm going to order. Again, it depends with the patient population that you have as well, and of course the other symptoms that may come with it. Dr Monteith: So, why don't we talk a little bit about CSF reading and how these set values, because we get people that have readings of 250 millimeters of water quite frequently and very nonspecific, questionable IIH. And so, talk to me about the set value. Dr Antonio: Right. So, the modified Dandy criteria has shown that, again, we consider intracranial pressure to be elevated for adults if it's above 250 millimeters water; and then for kids if it's above 280 millimeters of water. Knowing that these are taken in the left lateral decubitus position, and assuming also that the patients were awake and not sedated during the measurement of the CSF pressure. The important thing to know about that is, sometimes when we get LPs under fluoroscopy or under sedation, then these can cause false elevation because of the hypercapnia that elevated carbon dioxide, and then the hypoventilation that happens when a patient is under sedation. Dr Monteith: You know, sometimes you see people with opening pressures a little bit higher than 25 and they're asymptomatic. Well, the problem with these opening pressure values is that they can vary somewhat even across the day. People around 25, you can be normal, have no symptoms, and have opening pressure around 25- or 250; and so, I'm just asking about your approach to the CSF values. Dr Antonio: So again, at the end of the day, what's important is putting everything together. It's the gestalt of how we look at the patient. I actually had an attending tell me that there is no patient that read the medical textbook. So, the, the important thing, again, is putting everything together. And what I've also seen is that some patients would tell me, oh, I had an opening pressure of 50. Does that mean I'm in a dire situation? And they're so worried and they just attach to numbers. And for me, what's important would be, what are your symptoms? Is your headache, right, really bad, intractable? Number two: are you losing vision, or are you at that cusp where your optic nerve swelling or papilledema is so severe that it may soon lead to vision loss? So, putting all of these together and then getting the neuroimaging, getting the LP. I tell my residents it's like icing on the cake. We know already what we're dealing with, but then when we get that confirmation of that number… and sometimes it's borderline, but this is the art of neurology. This is the art of medicine and putting everything together and making sure that we care and manage it accordingly. Dr Monteith: Let's talk a little bit about IIH without papilledema. Dr Antonio: So, let's backtrack. So, when a patient will fit most of the modified Dandy criteria for IIH, but they don't have the papilledema or they don't have abducens palsy, the diagnosis then becomes tricky. And in these kinds of cases, Dr Friedman and her colleagues, when they did research on this, suggested that we might consider the diagnosis of IIH. And she calls this idiopathic intracranial hypertension without papilledema, IIHWOP. They say that if they meet the other criteria for modified Dandy but show at least three typical findings on MRI---so that flattening of the posterior globe, the tortuosity of the optic nerves, the empty sella or the partially empty sella, and even the narrowing of the transverse venous sinuses---so if you have three of these, then potentially you can call these cases as idiopathic intracranial hypertension without papilledema. Dr Monteith: Plus, the opening pressure elevation. I think that's key, right? Getting that as well. Dr Antonio: Yes. Sometimes IIHWOP may still be a gray area. It's a debate even among neuro-ophthalmologists, and I bet even among the headache specialists. Dr Monteith: Well, I know that I've had some of these conversations, and it's clear that people think this is very much overdiagnosed. So, that's why I wanted to plug in the LP with that as well. Dr Antonio: Right. And again, we have not seen yet whether is, this a spectrum, right? Of that same disease just manifesting differently, or are they just sharing a same pathway and then diverging? But what I want to emphasize also is that the treatment trials that we've had for IIH do not include IIHWOP patients. Dr Monteith: That is an important one. So why don't you wrap this up and tell our listeners what you want them to know? Now's the time. Dr Antonio: So, the- again, with IIH, with idiopathic intracranial hypertension, what is important is that we diagnose these patients early. And I think that some of the issues that come into play in dealing with these patients with IIH is that, one: we may have anchoring bias. Just because we see a female with obesity, of reproductive age, with intractable headaches, it does not always mean that what we're dealing with is IIH. The other thing, too, is that your tools are already available to you in your clinic in diagnosing IIH, short of the opening pressure when you get the lumbar puncture. And I need to emphasize the importance of doing your own fundoscopy and looking for that papilledema in these patients who present to you with intractable headaches or abducens palsy. What I want people to remember is that idiopathic intracranial hypertension is not optic nerve sheath distension. So, these are the stuff that you see on neuroimaging incidentally, not because you sent them, because they have papilledema, or because they have new headaches and other symptoms like that. And the important thing is doing your exam and looking at your patients. Dr Monteith: Today, I've been interviewing Dr Aileen Antonio about her article on clinical features and diagnosis of idiopathic intracranial hypertension, which appears in the most recent issue of Continuum on disorders of CSF dynamics. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today. Thank you again. Dr Antonio: 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.

tv university social media miami michigan er medicine md disorders diagnosis michigan state university clinical lp american academy pcos mri friedman grand rapids neurology aan continuum associate editor lps icp cme dandy pcp osteopathic medicine tvos faan csf tvo idiopathic miami miller school mrv monteith iih idiopathic intracranial hypertension sih clinical features rnfl teshamae monteith

Laut Berparuh Merah - M. Aan Mansyur

Ardi Kamal Karima

Play Episode Listen Later Jun 16, 2025 2:41

Sebuah PuisiLAUT BERPARUH MERAHDitulis Oleh M. Aan MansyurDisuarakan Oleh Ardi Kamal KarimaDalam Buku: Melihat Api BekerjaAku benci berada di antara orang-orang yang bahagia. Mereka bicara tentang segala sesuatu, tapi kata-kata mereka tidak mengatakan apa-apa. Mereka tertawa dan menipu diri sendiri menganggap hidup mereka baik-baik saja. Mereka berpesta dan membunuh anak kecil dalam diri mereka.Aku senang berada di antara orang-orang yang patah hati. Mereka tidak banyak bicara, jujur, dan berbahaya. Mereka tahu apa yang mereka cari. Mereka tahu dari diri mereka ada yang telah dicuri."Menikmati Akhir Pekan"(Mendengarkan Larik-larik Aan Masyur) Beberapa pilihan puisi M Aan Masyur dalam Melihat Api Bekerja Sajak buat Seseorang yang tak Punya Waktu Membaca Sajak Kata-kata bukan jembatan yang bisa membuat sepatumu tidak tersentuh lumpur. Kata-kata bukan kendaraan yang pandai melayang dan menghindarkanmu dari kemacetan. Kata-kata tak ingin jadi senjata untuk kau gunakan membunuh atasanmu. Kata-kata adalah awan yang mengamati jendela kamarmu menjelang matahari tenggelam. Pernahkah kau membayangkan bagaimana rasanya memiliki awan sebagai hewan peliharaan? Ia lebih setia dari kebiasaan buruk.“Aan adalah salah seorang dari dua atau tiga penyair kita yang berhasil memaksa kita dengan cermat mendengarkan demi penghayatan atas keindahan dongengnya.“ Sapardi Djoko Damono#ardikamal #literasi #penulis #monologue #jurnal #luka #perspektive #monolog #menjadimanusia #filsafat #sastra #ardikamal #puisi #poem #poet #penyair #penyair #kutipan #poetry #sajak #mentalhealth #syair #cinta #aanmansyur #melihatapibekerja

ia laut aan aku mereka seseorang pernahkah sapardi djoko damono aan mansyur

Hoe je met voeding afgestemd op je DNA écht blijvend resultaat behaalt

Play Episode Listen Later Jun 16, 2025 15:29

Je begint supergemotiveerd aan een dieet, valt wat kilo's af, maar na een tijdje lukt het gewoon niet meer. Je zit vast, raakt gefrustreerd en vraagt je af: ligt het aan mij? In deze aflevering vertel ik je waarom de meeste diëten niet blijvend werken en deel ik waarom eten volgens je DNA dé gamechanger is voor blijvend resultaat en een energiek, gezond lijf.Ik neem je mee in hoe je je eigen lichaam weer leert begrijpen en hoe je kunt samenwerken met je metabolisme. Weer lekker, veel en zonder schuldgevoel kunnen eten! Is dat niet wat we allemaal willen?Je ontdekt onder andere: Waarom veel diëten (zoals keto, koolhydraatarm en carnivoor) op de lange termijn niet werkenHet geheim achter een gezond én snel metabolismeHoe je lichaam omgaat met overvloed en schaarste, en waarom daar juist de kracht ligtWaarom voldoende dierlijke eiwitten essentieel zijn voor vetverbranding én spieropbouwWaarom eten volgens je DNA zorgt voor blijvende energie, een gezond gewicht en een fit gevoel Durf jij te kiezen voor blijvende gezondheid & energie, zonder strenge dieetregels? Luister nu en ontdek hoe het ook voor jou mogelijk is! ---

dna dit waarom ik luister laat aan kijk weer volg vragen klik vond abonneer klaar durf voeding resultaat dagelijkse

16 juni - De vier lessen van de stromende olie

Play Episode Listen Later Jun 16, 2025 6:22

Aan de slag!Welke van de vier lessen van de stromende olie gaat je makkelijk af, en welke vind je moeilijk? Ga er biddend mee aan de slag.Deze overdenking is geschreven door schrijfster Emmely Post-Spreeuwenberg.

ga deze wil vier welke aan lees meld lessen waarheid olie bijbel

Waarom 5 procent voor defensie absurd is

Lopende zaken

Play Episode Listen Later Jun 16, 2025 38:16

De NAVO heeft beslist dat elk land 5 procent van het bruto binnenlands product moet investeren aan defensie. Die nieuwe norm lijkt, zeker voor ons land, onhaalbaar. Theo Francken is nochtans fan, al drukken andere politici zich sceptisch uit. En wat is er aan de hand tussen minister Frank Vandenbroucke en artsen? Is de hervorming die hij wil doorvoeren dan zo onaanvaardbaar? Aan tafel: Bart Eeckhout, Stavros Kelepouris, Joline MaenhoutProductie: Laurens Bervoets (hoorstroom) & Dries VermeulenEindredactie: Sam Feys & Rik Boey Wil je reageren? Mail naar podcasts@demorgen.beSee omnystudio.com/listener for privacy information.

mail voor waarom absurd aan procent defensie de navo theo francken

Ruben Brekelmans, Eelco Heinen, Ralph Dekkers, Koert Debeuf, Paul van Hooft

Play Episode Listen Later Jun 15, 2025 62:10

Aan tafel deze week: Demissionair minister van Defensie Ruben Brekelmans, demissionair minister van Financiën Eelco Heinen, hoogleraar Internationale Politiek Koert Debeuf, onderzoeksleider veiligheid en defensie RAND Europe Paul van Hooft en M-O correspondent Ralph Dekkers Presentatie: Twan Huys Wil je meer weten over de gasten in Buitenhof? Op onze website vind je meer informatie. Daar kan je deze aflevering ook terugkijken en je vindt er natuurlijk nog veel meer gesprekken: https://bit.ly/buitenhof-15-juni-25 Met operatie ‘Rising Lion' begon Israël vrijdag met aanvallen op nucleaire installaties van Iran. Met grote schade als gevolg, meerdere hooggeplaatste generaals en commandanten die zijn gedood en een escalatie voor een regionale oorlog dreigt. Demissionair premier Schoof 'betreurt' de Israëlische aanval op Iran en heeft 'grote zorgen over de escalatie'. In deze Buitenhof, geheel in het teken van de laatste ontwikkelingen in het Midden-Oosten: Demissionair minister van Defensie Ruben Brekelmans. Deze week werd ook bekend dat demissionair kabinet Schoof heeft de nieuwe voorgestelde NAVO-norm omarmt. Er gaan de komende jaren miljarden extra naar Defensie. Hoe gaat dat besteed worden? En hoe gaan de voorbereidingen van de NAVO-top volgende week in Den Haag? Welke gevaren liggen er op de loer wat onze economie betreft nu de geopolitieke situatie met de dag ingewikkelder lijkt te worden? Hierover Eelco Heinen, demissionair minister van Financien. Waar haalt hij al het geld vandaag dat nodig is om die nieuwe NAVO-norm te halen? Hoe staan de geopolitieke machtsblokken in het conflict tussen Israël en Iran en hoe groot is het risico op verdere escalatie? Een analyse met hoogleraar internationale politiek Koert Debeuf, onderzoeksleider veiligheid en defensie RAND Europe Paul van Hooft en vanuit Tel Aviv Midden-Oosten correspondent voor de Telegraaf Ralph Dekkers.

er iran deze waar welke daar isra aan financi den haag navo paul van defensie heinen eelco hooft dekkers koert demissionair buitenhof financien ruben brekelmans

Ruben Brekelmans, Eelco Heinen, Ralph Dekkers, Koert Debeuf, Paul van Hooft

Play Episode Listen Later Jun 15, 2025 62:10

er iran deze waar welke daar isra aan financi den haag navo paul van defensie heinen eelco hooft dekkers koert demissionair buitenhof financien ruben brekelmans

15 juni - Falende vaders

Play Episode Listen Later Jun 15, 2025 4:54

Aan de slag!Dank God voor de positieve vaderfiguren in je aardse leven. Dank God voor wie Hij is. Bid voor de mensen die op een dag als vandaag meer van Gods vaderlijke liefde kunnen gebruiken. Of stuur ze een bemoedigende Bijbeltekst via WhatsApp of een kaart!Deze overdenking is geschreven door schrijfster Eline Verhaar.

gods whatsapp deze hij wil aan lees bid meld waarheid bijbel vaders bijbeltekst

14 juni - Liefde in drievoud - deel 2: je naaste en jezelf liefhebben

nederlandse aan tafel pim steff bellen morning person bestel oostenrijk van diemen overmars diemen ironman cairns

Play Episode Listen Later Jun 14, 2025 7:49

Aan de slag!Alles wat je aandacht geeft, groeit – dus ook de liefde!Deze overdenking is geschreven door schrijfster Joanne van de Vendel.

alles deel deze wil aan lees liefde jezelf meld waarheid bijbel vendel

5 jaar RTM XL Podcast

RTM XL Podcast

Play Episode Listen Later Jun 13, 2025 54:24

Onze podcast is jarig en alweer vijf jaar oud! Een goede reden om eens in ons archief te duiken. Deze maand bespreken Tim, Jurian en Arjan daarom de onderwerpen die zijn gepasseerd. En we kijken terug op bijzondere gasten en verhalen.We begonnen in coronatijd, met alle beperkingen, uitgestorven steden en onzekerheden die daarbij kwamen kijken. Hoe was dat? En over welke onderwerpen hebben we het nu, vijf jaar later helemaal niet meer? Aan de hand van fragmenten nemen we je mee terug in de tijd, en veel afleveringen zijn nog steeds de moeite van het beluisteren waard. Dus wellicht een mooie inspiratiebron voor de zomermaanden, want na deze aflevering heeft de podcast een zomerstop. In september verschijnt de volgende.We groeiden van enkele honderden luisteraars in het begin naar gemiddeld zo'n 1000 luisteraars per maand nu. Dus op naar de volgende vijf jaar RTM XL Podcast want we zijn er nog niet klaar mee! Hosted on Acast. See acast.com/privacy for more information.

acast deze onze aan jaar dus arjan jurian

#178 - Aan tafel met Steff Overmars en we bellen Pim van Diemen

Triathlon Inside

Play Episode Listen Later Jun 13, 2025 71:09

Aan de vooravond van een weekend met een hoop Nederlandse inbreng bij verschillende triathlons. O.a. T100 Vancouver, IRONMAN Cairns en IRONMAN Klagenfurt. We bellen met Pim van Diemen over zijn kansen in Oostenrijk en bespreken alle nieuwtjes en uitslagen van de afgelopen week. Probeer AG1 nu en bestel de AG1 Welcome Kit, krijg daar een ‘Morning Person' pet bij, 5 travel packs en Vitamin D3+K2 flesjes, dit met een waarde van €87. Het Welcome Kit krijg je gratis bij je abonnement op AG1: https://drinkag1.com/triathloninside! Alle details over de voordelen kan je lezen via de link. Met 30 dagen geld terug garantie zit er geen risico aan. Bestel nu!

13 juni - Liefde in drievoud – deel 1: jouw God liefhebben

365 Dagen Succesvol Podcast

Play Episode Listen Later Jun 13, 2025 6:53

Aan de slag!Wees je vandaag bewust van jouw manier om je liefde aan God te uiten. Kies een liefdestaal uit en spreek jouw liefde op die manier uit naar God.Deze overdenking is geschreven door schrijfster Joanne van de Vendel.

god deel deze wil aan lees liefde jouw meld wees kies waarheid bijbel vendel

Leven met onvervulde verlangens. Zo ga je daar liefdevol mee om.

Play Episode Listen Later Jun 12, 2025 33:25

Wat als je leven niet is geworden wat je hoopte? Je kreeg geen kinderen. Je relatie staat op losse schroeven. Je bent vijftig en voelt het gemis van wat had kunnen zijn. In deze aflevering beantwoorden David en Arjan een ontroerende luisteraarsvraag van Jan over levende rouw: het verdriet om onvervulde verlangens, het verlies van toekomstbeelden, en de angst om opnieuw te beginnen. Hij vraagt: Hebben jullie advies voor iemand die rouwt om onvervulde verlangens, bang is voor verlies en zoekt naar een nieuw begin in zichzelf?Hoe blijf je overeind als je droom uit elkaar valt? Hoe laat je los wat nooit werkelijkheid werd, en vind je toch richting in jezelf?Aan de hand van inzichten uit Een Cursus in Wonderen en het werk van Viktor Frankl verkennen David en Arjan:Waarom je pijn voelt om wat nooit was en hoe je daar liefdevol mee omgaat.Hoe je het verleden kunt herzien zonder jezelf te verliezen.Wat het verschil is tussen pijn en lijden en hoe je daar zelf invloed op hebt.Hoe schoonheid, waardigheid en aanwezigheid je kunnen helpen betekenis te hervinden.Luister ook en laat weten wat jou raakte.Shownotes:Leuk als je reageert op de podcast onder deze aflevering, via youtube, via onze socials, of onze Academy.❓ Stuur jouw vraag in!Onze programma's:✨ Miracle Roadmap (met speciale aanbieding voor podcast luisteraars)

12 juni - Levend gemis kwam in mijn leven – hoe kan ik nu verder?

Play Episode Listen Later Jun 12, 2025 7:05

Aan de slag!Is er iets moeilijks wat jij nu in je leven meemaakt of hebt meegemaakt, en wat ervoor gezorgd heeft dat er iets tussen God en jou tot stilstand is gekomen? Daag jezelf dan uit en pak dat weer op! Voor mij was dat zingen. Het duurde best even voordat ik hier doorheen kon breken, maar ook jij bent met God meer dan overwinnaar! Ja, ik zing van de goedheid van God.Deze overdenking is geschreven door gastschrijfster Mienke Elisabeth.

god voor deze wil mijn verder aan leven lees meld kwam waarheid bijbel daag

Radiographic Evaluation of Spontaneous Intracranial Hypotension With Dr. Ajay Madhavan

Play Episode Listen Later Jun 11, 2025 20:00

Recently, sophisticated myelographic techniques to precisely subtype and localize CSF leaks have been developed and refined. These techniques improve the detection of various types of CSF leaks thereby enabling targeted therapies. In this episode, Katie Grouse, MD, FAAN, speaks with Ajay A. Madhavan, MD, author of the article “Radiographic Evaluation of Spontaneous Intracranial Hypotension” in the Continuum® June 2025 Disorders of CSF Dynamics 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. Madhavan is assistant professor of radiology at the Mayo Clinic in Rochester, Minnesota. Additional Resources Read the article: Radiographic Evaluation of Spontaneous Intracranial Hypotension 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 Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Ajay Madhavan about his article on Radiographic Evaluation of Spontaneous Intracranial Hypotension, which he wrote with Dr Levi Chazen. This article appears in the June 2025 Continuum issue on disorders of CSF dynamics. Welcome to the podcast, and please introduce yourself to our audience. Dr Madhavan: Hi, thanks a lot, Katie. Yeah, so I'm Ajay Madhaven. I'm a neuroradiologist at the Mayo Clinic in Rochester, Minnesota. I did all my training here, so, I've been here for a long time. And I have a lot of interest in spinal CSF leaks, and I do a lot of that work. And so I'm really excited to be talking about this article with you. Dr Grouse: I'm really excited too. And in fact, it's such a pleasure to have you here talking today on this topic. I know a lot's changed in this field, and I'm sure many of our listeners are really interested in learning about the developments and imaging techniques to improve detection and treatment of CSF leaks, especially since maybe we've learned about this in training. I want to start by asking you what you think is the most important takeaway from your article. Dr Madhavan: Yeah, that's a great question. I think---and you kind of already alluded to it---I think the main thing is, I hope people recognize that this field has really changed a lot in the last five to ten years, through a lot of multi-institutional collaboration and also collaboration between different specialties. We've learned a lot about different types of spinal CSF leaks, how we can recognize the disease, particularly the types of myelography that we need to be using to accurately localize and treat these leaks. Those are the things that have really evolved in the last five to ten years, and they've really helped us improve these patients' lives. Dr Grouse: Can you remind us of the different common types of spinal leaks that can cause spontaneous intracranial hypotension? Dr Madhavan: Yeah, so there are a number of different spinal CSF leaks, types, and I would say the three most common ones that really most people should try to be aware of and cognizant of are: first, ventral dural tears. So those are, like, just physical holes in the dura. And they're usually caused by little bone spurs that come from the vertebral columns. So, they're often patients who have some degenerative changes in their spine. And those are really very common. Another type of spinal CSF leak that we commonly see is a lateral dural tear. So that's like the same thing in a slightly different location. So instead of being in the front, it's off to the side of the dura laterally. And so, it's also just a hole in the dura. And then the third and most recently discovered type of spinal CSF leak is a CSF-venous fistula. So those are direct connections between the subarachnoid space and little paraspinal vein. And it took us a long time to even realize that this was a real pathology. But now that it's been recognized, we've found that this is actually quite common. So those three types of leaks are probably the three most common that we see. And there's certainly others out there, but I would say over 90% of them fall into one of those three categories. Dr Grouse: That's a great review, thank you. Just as another quick review, as we talk more about this topic, can you remind us of some of the most common or typical brain imaging findings that you'll see in cases of spontaneous intracranial hypotension? Dr Madhavan: Yeah, absolutely. So, when you do a brain MRI in a patient who has spontaneous intracranial hypotension, you will usually, though not always, see typical brain MRI abnormalities. And I kind of think of those as falling into three different categories. So, the first one I think of is dural enhancement or thickening. So that's enlargement or engorgement of the dura, the pachymeninges, and enhancement on postgadolinium imaging. So, that's kind of the first category. The second is that, when you lose spinal fluid volume, other things often expand to take up the space. So, for example, you can get distension or enlargement of the dural venous sinuses, and sometimes you can also get subdural food collections or hematomas. They can arise spontaneously. And I kind of think of those as, you know, you, you've lost the cerebrospinal fluid volume and something else is kind of filling up the space. And then the third category is called brain sagging. And that's a constellation of findings where the posterior fossa structures and the pituitary gland in the cell have become abnormal because you've lost the fluid that normally cushions those structures and causes them to float up. For example, the brain stem will sag down, the distance between the mammillary body and the ponds may become reduced. The suprasellar cistern space may be reduced such that the optic chiasm becomes very close to the pituitary gland, and the prepontine cistern may also become reduced in size. And there are various measurements that can be used to determine whether something is subtly abnormal. But just generally speaking, those are really the three categories of brain MRI abnormalities you'll see. Dr Grouse: That was a great review. And of course, I think in many times when we are thinking about or suspecting this diagnosis, we may be lucky to find those imaging findings to reinforce a diagnosis. Because as it turns out, after reading your article, I was really surprised to find out that in as many as 19% of cases we actually see normal brain imaging, which really was a surprise to me, I have to say. And I think that this really encompasses why spontaneous intercranial hypotension is such a difficult diagnosis to make. I think a lot of us struggle with how far to take the workup when, you know, spontaneous intercranial hypotension is clinically suspected, but multiple imaging studies are normal. Do you have any guidance on how to approach these more difficult cases? Dr Madhavan: So, that's a really good question. And you know, it's- as you can imagine, that's a topic that comes up in most meetings where people discuss this, and it's been a continued challenge. And so, like you said, about 19 or 20% of patients who have this disease can have a, a normal brain MRI. And we've tried to do some work to figure out why that is and how we can identify patients who still have the disease. And I can just provide, I guess, some tips that have helped me in my clinical practice. One thing is, if I ever see a patient with a normal brain MRI where this disease is clinically suspected---for example, maybe they have orthostatic headaches or other very typical symptoms and we don't know why, but their brain MRI is normal---the first thing I do is I try to look back at their old imaging. So many times, these patients who present to us at Mayo, who, when we do their MRI scan here, their brain MRI looks normal… if you really look back at imaging that they've had done elsewhere---maybe even two to three years prior---at the time their symptoms started, they actually had some abnormalities. So, I might see that a patient, two years ago, had dural enhancement that spontaneously resolved; but now they still have symptoms of SIH and they may still have a CSF leak that we can find and treat, but their brain MRI has, for whatever reason, normalized. So, I always start by looking back at old imaging, and I found that to be very helpful. The other thing is, if you see a patient with a normal brain MRI, it's also important to look at their spine MRI because that can provide clues that might suggest that they could still have a spinal CSF leak. And the two things I look for on the spine MRI: one, if there's any extradural CSF. So, spinal fluid outside of where it's supposed to be within the confines of the subarachnoid space. And you know, really, if you see extradural CSF, you know they probably have a spinal fluid leak somewhere. Even if their brain MRI is normal, that just gives you the information that there is a dural tear probably somewhere. And so, in those patients we'll definitely still proceed to myelography or other testing, even if they have a normal brain MRI. And then the last thing I look for is whether or not they have prominent meningeal diverticula. Patients with CSF venous fistulas almost always have one or more prominent diverticula on their spine along the nerve root sleeves. And that's probably because most of these fistulas come from nerve root sleeve diverticula. We don't completely understand the pathogenesis of CSF venous fistulas, but they're clearly associated with meningeal diverticula. So, if I see a patient who has a normal brain MRI, but I see on their spine MRI that they have many meningeal diverticula that are relatively prominent, that makes me more inclined to be a little bit more aggressive in doing myelography to find a CSF leak. And then I look at other demographic features, too. So, for example, elevated BMI and older age are associated with CSF venous fistulas. So, that can help you determine whether or not it's warranted to go on to more advanced imaging, too. So those are all just a variety of different things that we've used to help us. Dr Grouse: Thank you for sharing that. I wanted to go on to say that, you know, reading your article, of course, as you mentioned, you alluded to the fact there's lots of new imaging modalities out there. It was very illuminating and just an excellent resource for the options that exist and when they're useful. You did a great job summarizing it. And I encourage our readers to check out your article, to refresh themselves, update themselves on what's happened in this space. And of course, we can't summarize them all today, but I was wondering if you could possibly walk us through a hypothetical case of a patient who comes in with a history very suspicious for SIH? How would you approach this patient? Say you have gotten imaging that suggested that there is a spinal fluid leak and now you have to figure out where it is. Dr Madhavan: Yeah. So, you know, I think the most typical scenario it'll be a patient who has been seen by one of my excellent neurology colleagues and they've done a brain MRI and they've made the diagnosis through a combination of clinical information and brain MRI finding. And then the next thing we'll do always is, we'll obtain a spine MRI. So, I think of the purpose of the spine MRI as to determine what type of spinal fluid leak they have. On the spine MRI, if you see extradural CSF, those patients essentially always will have a dural tear. And it may be a ventral dural tear or a lateral dural tear. But if you see extradural CSF, that is pretty much what they have. And conversely, if you don't see extradural CSF---if you just see, for example, many meningeal diverticula, but you don't see anything else particularly abnormal---most of those patients have a CSF venous fistula, just common things being common. So I use the spine MRI to determine what type of leak they have. And then the next thing I think about is, okay, I'm going to do a myelogram on this patient. How do I want to position them? Because it turns out that positioning is probably the most important factor for finding these spinal fluid leaks. You have to have the patient positioned correctly to find the leak that you're trying to localize. And so, if I suspect they have a ventral dural tear, I will always position those patients prone for their myelogram. And I might do one of many different types of myelograms. And, you know, the article talks about things like digital subtraction myelography and dynamic CT myelography. And you can find any of these leaks with any of those techniques, but you just have to have the patient positioned correctly. So, if I think I have a ventral dural tear, I'll put them prone for the myelogram. If I think they have a lateral dural tear, I'll put them in the cubitus position for the myelogram. And also, if they- if I think they have a CSF-venous fistula, I'll also put them in the decubitus position. Obviously if you're putting them in the decubitus position, you have to decide whether it's going to be left or right side down. So that may require a two-day exam. Sometimes you don't have to; in many cases, we're able to just do everything in one day. But those are all the different factors I think about when I'm trying to determine how I'm going to work those patients up further. So, I really use the spine MRI chiefly to think about what type of leak they're going to have and how I'm going to plan the myelogram. Dr Grouse: That's really great. And it's, I think, really nice to emphasize how much the positioning matters in all this, which I think is not something we've been classically taught as far as the diagnosis of spinal leaks. Another thing I'm really interested in your opinion on is, you talked a lot about how to optimize and what can make you successful at diagnosis. I'm curious what you think one of the easiest mistakes to make or, you know, that we should hopefully avoid when treating patients with this disease. Dr Madhavan: Yeah. And I think, you know, one other thing that's been discussed a lot in this topic… you know, we've talked about the patients with a normal brain MRI. Another barrier or challenge particularly with CSF-venous fistulas is, sometimes they can be very subtle on imaging. So, it's not always you see it very definitive CSF-venous fistula where you can say, like, there's no question, that's a fistula. There are many times where we do a good-quality myelogram and we see something that looks, like, possible for a CSF venous fistula, or probable. If I had to put a number on it, maybe there's a 50 to 70% chance of real. So, in those cases, we end up wondering, like, should we treat this suspected leak? And I think one common mistake or one thing that needs to be looked at further is, how do we handle these patients where we don't know whether the fistula is real or not? That's usually something where I will have a discussion with the patient, and I'm usually just very upfront with him about my interpretation of the imaging. I'll just tell them, we did a good-quality myelogram. You did a great job. We got good images. I don't see anything definitive, but I see this thing that I think has maybe a 60% chance of being real. And then I'll confer with one of my neurology colleagues and we'll decide whether it's worth treating that or not. And we'll just be very upfront with a patient about whether- about the likelihood of its success and what their long-term prognosis is. And oftentimes we let them make the decision. But I think that remains to be one of the big challenges is, how do we treat these patients who have suspected leaks that are not definitive on imaging. Dr Grouse: That sounds absolutely like an important area where there can be problems, so I appreciate that insight. I'm interested what you think in your article would come as the biggest surprise to our listeners who may not have kept up as much with all of the changes that have happened in recent years? Dr Madhavan: One of the things that was certainly, at least, a surprise to me as I was going through my training and learning about this topic is how diverse myelography has really become. You know, when I was a radiology resident, I learned about myelography as this thing that we've been doing for 30 to 40 years. And historically we've used myelograms just to look for degenerative changes: disc bulges, you know, disc herniations and things like that. Now that MRI is more prevalent, we don't use it as much, but it has turned out that it has a very big role in patients with spinal fluid leaks. Furthermore, something that I've learned is just how diverse these different types of myelograms have become. It used to kind of be just that a myelogram is a myelogram is a myelogram, but now we have different types of positioning, different types of equipment that we use. We vary the timing between contrast injection and imaging to optimize success for finding spinal fluid leaks. So, I think many times I talk to people who may not be as familiar with this field and they're surprised at just how diverse that has become and how sophisticated some of the various myelographic techniques have become and how much that really makes a difference in being able to accurately diagnose these patients. Dr Grouse: Well, I can say it was a surprise to me. Even as someone who does treat quite a few patients with this condition, I was surprised to see the breadth of different options that have become available. And then kind of a follow-up to that, what do you think the current area of controversy is in this area of diagnosis and treatment? Dr Madhavan: The biggest ones are ones you've sort of already alluded to. So, one big one is, how far do we go in patients who have a normal brain MRI who still have a clinical suspicion of the disease? And sometimes it's really hard, because sometimes you will find patients who clinically have a very strong case for having spontaneous intracranial hypotension. You look at them, they have very acute-onset orthostatic headaches. There's no better explanation for their symptoms that we know of. And it's hard to know what to do with those patients, because some of them want to continue to undergo diagnostic workup, but you can only do so many myelograms and you can only do so much with this diagnostic workup that requires some radiation dose before it becomes very challenging. That's a major point of just, I guess, ongoing research as to what can we do better for that subset of patients. Fortunately, it's not all of them, it's a subset of them, but I think we could help those patients better in the future as we learn more about the disease. So that's one. And the other one is treating these equivocal findings, like I discussed. And where should our threshold be to treat a patient, and what type of treatment should we do in patients where we don't know whether a leak is real? Should we just do a very noninvasive- relatively noninvasive blood patch? Do we do an embolization where we're leaving a foreign body there? Is it worth sending those patients to surgery? Those are all unanswered questions and things that continue to spark ongoing debate. Dr Grouse: Do you think that there's going to be any new big breakthroughs, or even, do you know of any big developments on the horizon that we should be keeping our eyes out for? Dr Madhavan: You know, I think for me the biggest thing is, imaging is dramatically improving. We talked a little bit about photon counting detector CT in our article, and that's one of the newest and best techniques for imaging these patients because it has very, very high resolution, it has a lower radiation dose, it has allowed us to find leaks that we were not able to find before. And there are other high-resolution modalities that are emerging and becoming more accessible to things like cone beam CT which we do in addition to digital subtraction myelography. And on top of that, we've started to use AI-based tools to make images look a lot better. So, there are various AI algorithms that have come out that allow us to remove artifacts from imaging. They help us image patients with a bigger body habitus better without running into a lot of imaging artifacts. They help us reduce noise in imaging. They can just give us better-quality images and aid us in the diagnosis. For me as a radiologist, those are some of the most exciting things. We're finding less invasive ways with less radiation to better diagnose these patients with just better-quality imaging. Dr Grouse: Well, that is definitely something to be excited about. So, I just want to thank you so much for talking with us today. It's been such an interesting, informative discussion and a real privilege to talk with you about this important topic. Dr Madhavan: Yeah, thanks so much. I really appreciate the time to talk with you, and I look forward to seeing the article out there and hopefully getting some interesting questions. Dr Grouse: Again, today I've been interviewing Dr Ajay Madhavan about his article on Radiographic Evaluation of Spontaneous Intracranial Hypotension, which he wrote with Dr Levi Chasen. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. 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.

Flevoparkbad - Parel van Oost

Geluiden uit Oost

Play Episode Listen Later Jun 11, 2025 11:30

Begin jaren '60 ijverde wethouder Harry Verheij om de bevolking van Amsterdam-Oost van een modern zwembad te voorzien. Enrico Hartsuyker kreeg opdracht een ontwerp te maken. De eerste paal wordt geslagen in 1964 en in 1967 vond de opening plaats.In 1973 had het Flevoparkbad 263.500 bezoekers en was na het de Mirandabad drukst bezochte zwembad van Amsterdam. Vanaf 1975 liep het bezoek echter terug. Toe te schrijven aan verschillende oorzaken: door toegenomen welvaart hadden mensen meer keuzes om hun vakantie of vrije tijd door te brengen. Veel Amsterdammers verhuisden naar eengezinswoningen in plaatsen als Hoorn, Purmerend, Lelystad en Almere. Het bevolkingsaantal van Amsterdam daalde met 200.000 inwoners minder. In 1998 wordt het Flevoparkbad gerenoveerd. Er komt een nieuwe duurzame verwarming voor het zwembad. Een aantal kleedruimtes wordt gesloopt. De tegelvloer van het bad wordt vernieuwd evenals extra speelvoorzieningen. De kosten (6 miljoen gulden) worden in 15 jaar afgeschreven. Aan deze lening van de centrale stad zat de voorwaarde dat het Flevoparkbad in gebruik moest blijven tot het eind van de periode 2013 en niet verkocht mocht worden. Het zou zelfs een monumentenstatus kunnen krijgen. In 2023 is door het college van Amsterdam 32,6 miljoen euro opzij gezet voor een flinke uitbreiding van het Flevoparkbad; twee extra baden, waarvan één binnenbad. Vrijwilligers en vaste bezoekers zijn blij en hopen dat de gemeente oog heeft voor hun wensen. We wachten af.Interviews: Lucy BuddelmeijerSamenstelling: Leon PaquayFoto's: Lucy BuddelmeijerMuziek: Antimatter / Blue dot sessions

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Telanjang Di Depan Cermin - M. Aan Mansyur

Ardi Kamal Karima

Play Episode Listen Later Jun 11, 2025 2:58

Sebuah Puisi TELANJANG DI DEPAN CERMINDitulis Oleh M. Aan MansyurDisuarakan Oleh Ardi Kamal KarimaDalam Buku: Melihat Api BekerjaAku benci berada di antara orang-orang yang bahagia. Mereka bicara tentang segala sesuatu, tapi kata-kata mereka tidak mengatakan apa-apa. Mereka tertawa dan menipu diri sendiri menganggap hidup mereka baik-baik saja. Mereka berpesta dan membunuh anak kecil dalam diri mereka.Aku senang berada di antara orang-orang yang patah hati. Mereka tidak banyak bicara, jujur, dan berbahaya. Mereka tahu apa yang mereka cari. Mereka tahu dari diri mereka ada yang telah dicuri. "Menikmati Akhir Pekan"“Aan adalah salah seorang dari dua atau tiga penyair kita yang berhasil memaksa kita dengan cermat mendengarkan demi penghayatan atas keindahan dongengnya.“ -Sapardi Djoko Damono-#ardikamal #literasi #penulis #monologue #jurnal #luka #perspektive #monolog #menjadimanusia #filsafat #sastra #ardikamal #puisi #poem #poet #penyair #penyair #kutipan #poetry #sajak #mentalhealth #syair #cinta #aanmansyur #melihatapibekerja

aan aku mereka sapardi djoko damono aan mansyur

11 juni - Zwoegen is zinloos!

Play Episode Listen Later Jun 11, 2025 6:36

Aan de slag!Houd je agenda bij de hand: welke taken en afspraken van deze week kun je in Zijn handen leggen? Welke taken en afspraken zijn zinloos, tenzij Hij ze zegent?Deze overdenking is geschreven door schrijfster Marianne de Bart-van der Lee.

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Huidige behandelopties voor patiënten met CLL

Oncologie Up-to-date

Play Episode Listen Later Jun 10, 2025 27:30

In deze podcast, mede mogelijk gemaakt door AstraZeneca en Beigene, spreekt wetenschapsjournalist Judith Cohen met prof. dr. Stephan Stilgenbauer (Universiteit Ulm, Duitsland) over de huidige eerstelijnsbehandelopties voor patiënten met CLL. Aan bod komen de belangrijkste punten van de meest recente richtlijnupdates en zijn ervaring met de behandeling van CLL-patiënten.Disclosures Prof. dr. Stephan Stilgenbauer: AbbVie, Amgen, AstraZeneca, BeiGene, BMS, Galapagos, Gilead, GSK, Hoffmann-La Roche, Johnson&Johnson, Lilly, Novartis, Sunesis.

prof voor astrazeneca aan gilead novartis pati galapagos duitsland gsk amgen disclosures bms nten cll judith cohen

MYN Netwerk Café over uitdagingen binnen het MKB - MYN Netwerk Café 10 juni 2025

New Business Radio

Play Episode Listen Later Jun 10, 2025 29:00

(00:00) Opening (01:30) Herbert Denk (MYN) (06:30) Walter Vendel (fit20) (15:27) Peter Hoitinga (BrandMR) (21:23) Mark Reinders (MYN) (26:52) Tips Presentator Roelof Meijer ontving diverse gasten voor een boeiend gesprek over uitdagingen binnen het mkb. Aan tafel schoven aan Walter Vendel van fit20 en Peter Hoitinga van BrandMR. Daarnaast waren Mark Reinders en Herbert Denk van MYN te gast. MYN Netwerk Café maakt onderdeel uit van het zakelijke netwerk MYN. Het netwerk brengt ondernemers op een aangename en effectieve manier met elkaar in contact met als doel bij te dragen aan elkaars succes. Belangrijk uitgangspunt is dat je elkaar beter leert kennen, zodat je het vanzelfsprekend vindt om elkaar te inspireren, te helpen en aan te bevelen. Elke tweede dinsdag van de maand is MYN Netwerk Café tussen 16:00 en 17:00 uur te beluisteren op New Business Radio. Na de uitzending is het programma terug te luisteren als podcast via newbusinessradio.nl en alle bekende podcastplatforms (onder meer Spotify en Apple Podcasts).

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10 juni - Samen bidden: klein beginnen en volhouden!

Play Episode Listen Later Jun 10, 2025 5:07

Aan de slag!Met wie ga jij de komende tijd samen bidden? Maak vandaag een plannetje. Bespreek het met hem of haar. Welk moment is geschikt? Heb je al een notitieboekje? En dan… volhouden! God zegent jou, lieve vrouw, en de Heilige Geest wil je helpen!Deze overdenking is geschreven door schrijfster Marieke van der Maaten.

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9 juni - De Heilige Geest laat zien wie Christus is in mij

Regina Nieuwhof - Ultimate Temple Podcast

Play Episode Listen Later Jun 9, 2025 7:03

Aan de slag!Luister Opwekking 488 – Heer ik kom tot UDeze overdenking is geschreven door schrijfster Linda Aalbers.

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8 oorzaken waardoor je in overlevingsmodus zit

Play Episode Listen Later Jun 9, 2025 35:00

Heb jij het gevoel dat je continu moe bent, last hebt van vage klachten of lukt het niet om af te vallen, wat je ook probeert? Je bent niet de enige! In deze aflevering neem ik je mee in de 8 belangrijkste oorzaken waardoor jouw lichaam in de overlevingsmodus schiet én wat je daaraan kunt doen. We kijken samen naar de 'wortels' en de 'stam' van de boom, oftewel: niet alleen wat je aan de buitenkant merkt, maar vooral ook wat er onder de oppervlakte speelt. Ik deel wat jij nu al kunt veranderen om uit deze vicieuze cirkel te komen.In deze aflevering hoor je:Waarom ondervoeding (ook als je genoeg eet!) vaak voorkomtWat de impact is van teveel koolhydraten en te vaak etenHoe water- én mineralentekort je energielevel beïnvloedenWaarom chronische stress je lijf op slot zetHoe laaggradige ontstekingen en een disbalans in vetten kunnen sluimerenWat pathogenen en een trage schildklier met jouw klachten te maken hebbenEn… waarom emotionele ballast vaak de échte gamechanger isIk geef je praktische handvatten, voorbeelden én mijn eerlijke mening zodat je zelf kunt herkennen waar jouw grootste disbalans zit. Laat je inspireren, ontdek wat jouw lijf je probeert te vertellen en neem vandaag nog de eerste stap richting meer energie en balans!

dit heb waarom ik laat aan kijk volg vragen vond abonneer klaar waardoor isik dagelijkse oorzaken

Sophie Hermans, Ingrid Coenradie, Jeroen Dijsselbloem, Jesse Klaver, David van Reybrouck

daar aan denker hermans justitie jesse klaver david van reybrouck demissionair jeroen dijsselbloem buitenhof

Play Episode Listen Later Jun 8, 2025 64:17

Aan tafel deze week: Demissionair vicepremier Sophie Hermans, oud-staatssecretaris Justitie en Veiligheid Ingrid Coenradie, burgemeester van Eindhoven Jeroen Dijsselbloem, GroenLinks-Kamerlid Jesse Klaver, Denker der Nederlanden David Van Reybrouck Presentatie: Maaike Schoon Wil je meer weten over de gasten in Buitenhof? Op onze website vind je meer informatie. Daar kan je deze aflevering ook terugkijken en je vindt er natuurlijk nog veel meer gesprekken: https://bit.ly/buitenhof-8-juni-25

Compleetdenkers #89 Tartarië het begin van de geschiedvervalsing? I Hans Scheffers

Compleetdenkers

Play Episode Listen Later Jun 8, 2025 91:20

Send us a textMet jullie maandelijkse steun maken wij jullie wereldbeeld completer!https://www.buzzsprout.com/1956185/supportGroot Tartarië. Nooit heb je daarover iets geleerd in de geschiedenislessen op school, nooit heb je er iets over gelezen in encyclopedieën van na 1940 en nooit heb je erover gelezen in de literatuur. Dit wereldimperium heeft echter wel degelijk bestaan, het was vanaf 1200 zelfs een van de machtigste en grootste rijken aller tijden. Hoe kan dit? Het opzettelijk achterhouden en wissen van de historie wordt ook wel 'geschiedvervalsing' genoemd. "De geschiedenis wordt", zoals Winston Churchill al zei, "door de overwinnaars geschreven”...Hans Scheffers deed jarenlang onderzoek naar Tartarië en andere belangrijke thema's. Aan de hand van overleveringen, verslagen, originele manuscripten, kaarten, afbeeldingen en foto's, kwam hij tot de conclusie dat de geschiedvervalsing van Tartarië slechts het topje van de ijsberg is. Na het verhaal van de Reuzen Bomen, neemt Hans ons voor een tweede maal mee op een fascinerende reis, ditmaal via Tartarië, naar onze ware geschiedenis.Veel luisterplezier!Bekijk zeker de opkomende events van het Beam Health Centerhttps://www.beamhealthcenter.com/Steun ons zodat we content kunnen blijven maken: http://steunactie.be/actie/steun-podcast-compleetdenkers-1/-25295Of koop ons een ☕️ https://www.buymeacoffee.com/compleetdenkersInterviewer: Kristien Van BaelⓢGastspreker: Hans ScheffersCamera: anja coenenⓢ & Finn FransenMontage: Finn Fransen & anja coenenⓢSoundmixer: Finn FransenMuziek Compleetdenkers: Finn FransenDatum opname: 16 mei 2025#compleetdenkers #podcast #hildeaudenaert #kristienvanbael #steveaernouts #cocoenenfilms #finnfransen #anjacoenen #cocoenen #hansscheffers #tartaria #tartariëSupport the show

hans dit winston churchill veel aan nooit bekijk steun

Van bromance tot botsing | Postma in Amerika

Amerika Podcast | BNR

Play Episode Listen Later Jun 7, 2025 5:50

Elon Musk blijft zich kritisch uitlaten over de ‘Big Beautiful Bill’. Een reactie van president Donald Trump was er tijdens deze opname nog niet. Maar inmiddels is de ruzie tussen Musk en Trump op X losgebarsten. Ook binnen de Republikeinse Partij groeit de onrust over het wetsvoorstel van Trump. Aan de ene kant wil men geen ruzie met Musk, aan de andere kant is botsen met de president misschien nog wel riskanter.See omnystudio.com/listener for privacy information.

donald trump elon musk amerika maar aan bromance postma

#354 - Ravijn

Zin van de Dag

Play Episode Listen Later Jun 5, 2025 2:29

"Aan de rand van het ravijn bloeien de mooiste bloemen." - Stine deelt een bekende spreuk van filosoof Erasmus.

aan erasmus stine

'Oekraïne zet Rusland keer op keer voor joker'

De Wereld | BNR

Play Episode Listen Later Jun 5, 2025 44:59

Met ‘operatie Spinnenweb’ heeft Oekraïne Rusland een pijnlijke tik gegeven. Poetin gaat terugslaan, vertelde hij Donald Trump in een telefoongesprek. Te gast is onze Rusland-correspondent Joost Bosman. Hij vraagt zich af wat Poetin nog echt kan doen om wraak te nemen. Want hoeveel erger kan het nog worden voor Oekraïne? Lees ook | Veldkamp: ‘Gesprek Trump en Poetin kan eerste stap zijn naar vrede, maar Poetin blijft tegenwerken’ Europaverslaggever Geert Jan Hahn sprak met Eurocommissaris van defensie Andrius Kubilius en Commandant der Strijdkrachten Onno Eichelsheim over 'operatie Spinnenweb'. Zij zijn vol bewondering over de Oekraïense aanval. Maar maken zich toch ook zorgen, want zijn Nederland en Europa wel voorbereid op dit soort droneaanvallen? Luister ook | Spinnenweb en de nitwits Zuid Korea heeft nu echt een nieuwe president Na het uitroepen van de staat van beleg, het afzetten van president Yoon en benoeming van meerdere interim-presidenten heeft Zuid Korea nu eindelijk echt een nieuwe president. De centrum-linkse liberaal Lee Jae-myung moet nu de als president de politieke chaos gaan herstellen. Te gast is hoogleraar Koreastudies, Remco Breuker. Hij maakt zich zorgen over de plannen van Lee om de banden aan te halen met Noord-Korea. Van bromance tot botsing | Postma in Amerika Elon Musk blijft zich kritisch uitlaten over de ‘Big Beautiful Bill’. Een reactie van president Donald Trump blijft voorlopig uit, maar de irritatie lijkt toe te nemen – Musk heeft immers een enorm bereik. Ook binnen de Republikeinse Partij groeit de onrust over het wetsvoorstel. Aan de ene kant wil men geen ruzie met Musk, aan de andere kant is botsen met de president misschien nog wel riskanter. Luister ook | Amerika Podcast See omnystudio.com/listener for privacy information.

donald trump elon musk europa joker maar voor nederland hij luister zij aan lees rusland yoon oekra commandant keer poetin postma zuid korea noord korea remco breuker koreastudies andrius kubilius joost bosman europaverslaggever geert jan hahn

Clinical Features and Diagnosis of Spontaneous Intracranial Hypotension With Dr. Jill Rau

Play Episode Listen Later Jun 4, 2025 23:58

Spontaneous intracranial hypotension reflects a disruption of the normal continuous production, circulation, and reabsorption of CSF. Diagnosis requires the recognition of common and uncommon presentations, careful selection and scrutiny of brain and spine imaging, and, frequently, referral to specialist centers. In this episode, Gordon Smith, MD, FAAN speaks with Jill C. Rau, MD, PhD, author of the article “Clinical Features and Diagnosis of Spontaneous Intracranial Hypotension” in the Continuum® June 2025 Disorders of CSF Dynamics 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. Rau is an assistant professor of clinical neurology at the University of Arizona, School of Medicine-Phoenix in Phoenix, Arizona. Additional Resources Read the article: continuumjournal.com Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @gordonsmithMD Full episode transcript available here Interview with Jill Rau, MD 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 Jill Rau about her article on clinical features and diagnosis of spontaneous intracranial hypotension, which she wrote with Dr Jeremy Cutsworth-Gregory from the Mayo Clinic. This article appears in the 2025 Continuum issue on disorders of CSF dynamics. I'm really excited to welcome you to the Continuum podcast. Maybe you can start by just telling our listeners a little bit about yourself? Dr Rau: Hi, thanks for having me. I'm really honored to be here, and I really enjoyed writing the paper with Dr Cutsforth-Gregory. I hope you guys enjoy it. I am the director of headache medicine at the Baba Bay Neuroscience Institute at Honor Health in Scottsdale, Arizona. I'm also currently the chair of the special interest group in CSF Dynamics at the American Headache Society, and I've had a special interest in this field since I first watched Dr Linda Gray speak at a conference where she talked about spinal CSF leaks and their different presentations. And they were so different than what I had been taught in residency. They're not just the post-LP headache. They have such a wide variety of presentations and how devastating they can be, and how much impact there is on someone's life when you find it and fix it. And I've been super interested in the field and involved in research since that time. And, yeah. Love it. Dr Smith: Well, thanks for sharing your story. And as I reflected on our conversation ahead of time and have been thinking about this issue… this is a cool topic, and every time I read one of these manuscripts and have the opportunity to speak with one of the authors, I learn a ton, because this was something that wasn't even on the radar when I trained back in the 1800's. So, really looking forward to the conversation. I wonder if you could really briefly just summarize or remind for everyone the normal physiology about CSF dynamics, you know, production, absorption, and so forth? Dr Rau: So, the CSF is the fluid that surrounds the brain and the spinal cord, and it's contained by the dura, which is like a canvas or a sac that covers that whole brain and spinal cord. And within the ventricles of the brain, the choroid plexus produce CSF. It's constantly producing and then being reabsorbed by the arachnoid granulations and pushed into the venous space, the cerebral sinuses, venous sinuses. And also some absorption and push into the lymphatics that we've just learned about in the past year. This is kind of new data coming out, so always learning more and more about CSF, but we know that it bathes the brain and the spinal cord, helps keep some buoyancy of the brain as well as pushing nutrients in and pulling out metabolic waste. And it sort of keeps the brain in the state of homeostasis that's happy. And so, when there's a disruption of that flow and the amount of fluid there, that disrupts that, that can cause lots of different symptoms and problems for people. Dr Smith: One of the many new things I learned is that even the name of this---spontaneous intracranial hypotension---is misleading. And I think this is clinically relevant, as we'll probably get to in a moment, but can you talk a little bit about this? Is this really like a pressure disorder or a volume disorder? Dr Rau: Yeah. It's almost certainly a volume disorder. We do see in some people that they have low pressure, and it's still part of the diagnostic criteria. But it's there because if you have a low pressure, if you measure an opening pressure and it's below six, if you're measuring it in the spine in the right place, then you have indication that there's low volume. But there's over 50% of people's opening pressure who have a spinal CSF leak, have all the symptoms and can be fixed. So, they have normal pressure in 50% of the people. So, it is an inaccurate term, hypotension, but it was originally discovered because of the thought that it was a low-pressure situation. Some of the findings would suggest low pressure, but ultimately, we are pretty sure it's a low-volume condition. Dr Smith: Another new thing that I learned that really blew me away is how bad this can be. I did a podcast with Mark Burish about cluster, and I was reminded many cluster patients are pushed to the point of suicidal ideation or committing suicide by the severity of pain. And this sounds like for many patients it's equally severe. Can you maybe paint a picture for our listeners why this is so clinically important? Dr Rau: A large number of people, even people who are known to have leaks because they've had them before or they've releaked, they have a lot of brain fog and cognitive impairment. They often have severe headaches when they're upright. So, orthostatic headache is probably the number one most common symptom, and those headaches are one of the worst headaches out there. When people stand up, their fluid is not supporting the brain and there's an intense amount of pain. And so, they spend a large portion of their lives horizontal. And there's associated symptoms with that, it's not just headache pain and brain fog. There's neck pain. There's often subsequent disorders that accompany this, like partial orthostatic tachycardia syndrome. We don't know if that's because of deconditioning or an actual sequela of the disease, but it's a frequent comorbidity. We have patients that have extreme dizziness with their symptoms, but many patients are limited to hours, if that, upright per day, combined, total. And so they live their lives, often, just in the dark, lots of photophobia, sensitive to the light, really unable to function. It's also very hard to find and so underrecognized that a lot of patients, especially if they don't have that really clinical symptom of orthostatic headache. So, it's often missed. So, they're just debilitated. You know, treatments don't work because it's not a migraine and it's not a typical headache. It's a mechanical issue as well as a metabolic issue and not found, not a lot helps it. Dr Smith: So, you know, I have always thought about this as really primarily an orthostatic symptom. I wonder if you can talk about the complexity of this; in particular, kind of how this evolves over time, because it's not quite that simple. And maybe in doing so, you can give our listeners some pearls on when they should be thinking about this disorder? Dr Rau: A large portion of people do have headache with spinal CSF leak, in particular, spontaneous intracranial hypertension- hypotension, excuse me. And that's something to be thought about, is that there are spontaneous conditions where people have either rupture of the dural sac, or an erosion of the dural sac, or a development of a connection between the dura and the venous system. And that is taking away or allowing CSF to escape. In these instances that patients have spontaneous, there may be a different presentation than if they have, like, a postdural puncture or a chronic traumatic or iatrogenic leak. And we're not sure of that yet, but we're looking into that. Still, the largest presentation is headache, and orthostatic headache is very dominant in the headache realm. But over time, patients' brains can compensate for that lack of CSF and start overproducing---or at least we think that's probably what's happening. And you may see a reduction in the orthostatic symptoms over time, and you may see an improvement in the radiographic findings. So, there are some interesting papers that have been published that look at these changes over time, and we do see that sometimes within that first three to four months; this is the most common time to see that change. Other patients may worsen. You may actually see someone going from looking sort of normal radiographically to developing more of a SIH-type of picture on the brain. And so it's not predictable which patients have gone from orthostatic to improvement or the other way around, both radiographically and clinically. So, it can be quite difficult to tell. So, for me, if I have a patient that comes to me and they're struggling with headache… if it's orthostatic, very clearly orthostatic: I lay down, I get considerably better or my headache completely goes away. And then when I stand up, it comes on relatively quickly, within an hour. And sometimes it's a worsening-throughout-the-day type of thing, it's lowest in the morning and it worsens throughout the day. These are the times that it's most obvious to think about CSF leak. Especially if that headache onset relatively suddenly, if it onset after a small trauma. Like I've had patients that say, you know, I was doing yoga and I did some twists and I felt kind of a pop. And then I've had this headache that is horrible when I'm upright but is better when I lay down ever since, you know, since that time. That's kind of a very classic presentation of spinal CSF leak or spontaneous intracranial hypotension. Maybe a less common presentation would be someone who comes to you, they've had a persistent headache for a couple years, they kind of remember it started in March of a couple years ago, but they don't know. Maybe it's, you know, it's a little better when they lay down. It may be a little worse when they're up moving around, but so is migraine, and it's a migrainous headache. But they've tried every migraine drug you can think of. Nothing is responding, nothing helps. I'm always looking at patients who are new daily, persistent headaches and patients who aren't responding to meds even if it's not new daily, but they have just barely any response. I will always go back and examine their brain imaging and get full spine to make sure I'm not missing. And you can never be 100% sure, but it's always good to consider those patients to the best of your ability, if that- have that in the back of your mind. Dr Smith: So obviously, goes without saying, this is something people need to have on their radar and think about. And then we'll talk more about diagnostic tools here in a second. But how common is this? If you're a headache doc, you see a lot of patients who have intractable headaches. And how often do you see this in your headache practice? Now you're- this is your thing, so probably a little more than others, but, you know, how common will someone who sees a lot of headache encounter these patients? Dr Rau: If you see a lot of headache, I mean, currently the thought is it's about 5 in 100,000. That was from a study before we were finding CSF venous fistulas. I think a lot of us think it's more common than that, but it's not super common. We don't have good estimates, but I would guess between 5 and 10 for 100,000 persons, not “persons who come to a tertiary headache clinic with intractable headaches”. So, it's hard to gauge how frequent it is, but I would say it's considerably more frequent than we currently think it is. There's still a group of people with orthostatic headaches that we can't find leaks on; that, once you treat other things that can cause or look for other things that can cause orthostatic headaches. So, there may be even still a pathophysiology out there that is still a leak type. Before 2014, we didn't even know about CSF venous fistulas. And now here we are; like, 50% of them are CSF venous fistulas. So, you know, we're still in a huge learning curve right now. Dr Smith: So, I definitely want to talk about the fistulas in a second. But before moving on, one of the things that I found really interesting is the wide spectrum of clinical phenotype. And we obviously don't have a lot of time to get into all of these different ones, but the one that I was hoping you might talk about---and there's a really great case, and you're on bunch of great case, a great case of this---is brain sagging dementia, not a term I've used before. Can you really briefly just tell our listeners about that, because that's a really interesting story and a great case in your article? Dr Rau: Yeah. So, brain sag dementia is a… almost like an extreme version of a spontaneous intracranial hypotension. Where there is clear brain sag in the imaging---so that's helpful---but the patients present kind of like a frontotemporal dementia. And when this was first started to being determined, you could turn the patient into Trendelenburg, and sometimes they would improve. There are some practitioners that have introduced fluid into the thecal sac and had temporary improvement. Patching has improvement, then they leak again, sometimes not. But the clinical changes with this have been pretty tremendous to be able to identify that that's a real thing. And in some cases, out of Cedars Sinai, you know, who does a lot of the best research in this, they've had lots of cases where they can't find the leak, but there's clear brain sag that fits with our clinical picture of CSF leaks. So, we're on a learning curve. But yeah, this- they really present. They have disinhibition and cognitive impairment that is very similar to frontotemporal dementia. Dr Smith: Well, so let's talk about what causes this. You mentioned CSF venous fistulas. I mean, that was reported now just over a decade ago, it's pretty amazing. That accounts for about half of cases, if I understand correctly. What are the other causes? And then we'll talk more about therapy in a minute, but what causes this? Dr Rau: So, within the realm of spontaneous, you know, we say it's spontaneous. But the spontaneous cases we account for, they can be tears in the dura, which are usually sort of lateral tears in the dura. They can be little places that rubbed a hole, often on an osteophyte from the spine. They can come from these spinal diverticuli. So, I always describe it to my patients like those balls that have mesh and squishy, and you squeeze them in the- through the mesh, there's the extra little bubbling out. If you think of like the dura bubbling, out in some cases, through the framing of the spine, right where the spinal nerve roots come out, they should poke out like wires from the dura. But in many cases they poke out with this extra dura surrounding them, and we call that spinal diverticuli. And if you imagine like the weakening of where you squeeze that, you know, balloon through your fingers, in those locations, that's a very common place to find a CSF leak, and you can imagine that the integrity of the dura there may be less than it would be if it were not being expanded in that direction. And that's often the most common place we see these CSF venous fistulas. So, you can get minor traumas; like I said, it can be spontaneous, like someone just develops a leak one day. It can be rubbed off, and it can be a development of a connection between the dura and the venous system. There are also iatrogenic causes, but we don't consider them spontaneous. But when you're considering your patients for spontaneous cases, you should consider if they've ever had chronic---even long, long time ago---had any spinal implementation, procedures near the spine, spinal injections, LPs in the past, and especially women who've had epidurals in pregnancy. Dr Smith: All right, so we see a patient, positional severe headache, who meets the clinical criteria. Next step, MRI scan? Dr Rau: Yeah. So, the first thing is always to get the brain MRI with and without contrast. Most places will have a SIH or a spinal CSF leak protocol, but you should get contrast because one of the most pathognomonic findings on brain MRI is that smooth diffuse dural enhancement. And that's a really fantastic thing when you find it, because it's kind of a slam dunk. If you find it, then you will see other findings. It almost never exists alone. But if you see that, it's pretty much a spinal CSF leak. But you're also looking for subdural collections, any indication of brain sag. We do have these new algorithms that have come out in the past couple of years that are helpful. They're not exclusionary---you can have negative findings on the brain and still have spinal CSF leak---but the brain MRI is extremely helpful. If it's positive for the findings, it really does help you nudge you in the direction of further investigations and treatments. Dr Smith: And what about those further investigations and treatments, right? So, you see that there's findings consistent with low pressure, and I guess I should say low intracranial CSF volume. Be that as it may, what's the next step after that? Dr Rau: Depends on where you are and what you can do. I almost always will get a full spine MRI: so, C spine, T spine, and L spine separately. Not, you know, we don't want it all in one picture, because we want to get the full view. And you want to get that with at least T2 highly- heavily T2 weighted with fat saturation in at least the sagittal and axial planes. It's really helpful if you can get it in the coronal planes, but we have to have- often have good talks with your radiologist to get the coronal plane. I spoke about the spinal diverticuli earlier, and I want to clarify a little bit of something. The coronal image will show those really nicely. It's interesting, but 44% of people have those. So just having the spinal diverticuli does not indicate that you have a leak. But if you have a lot of those, there may be more likelihood of having leak than if you don't have any of those. So, I will get all of those and I will look at them myself, but I've been looking at them myself for a long time. But a lot of radiologists in community hospitals, especially not- nonneuroradiologists, but even neuroradiologists, this isn't something that's that everybody's been educated about, and we've been learning so much about it so rapidly in the past ten years. It's not easy to do and it's often missed. And if it's not protocoled properly, the fat saturation's not there, it's very hard to see… you can have a leak and not see it. Even the best people, like- it's not always something that's visible. And these CSF venous fistulas that we talked about are never visible on normal MRI imaging. Nonetheless, I will run those because if I can find a leak---and 90% of the ones that are found on MRI imaging are in the thoracic spine. So that's where I spend the most of my time looking. But if you find it, that's another thing to take to your team to say, hey, look, here it is, let's try and do this, or, let's try and do that, or, I've got more evidence. And there are other findings on the spine; not just the leak, but other findings, sometimes, you can see on spine that maybe help you push you towards, yes, this is probably a leak versus not. Dr Smith: So, your article has a lot of great examples and detail about kind of advanced imaging to, like, find the fistula and what not. I guess I'm thinking most of our listeners are probably practicing in a location where they don't have a team that really focuses on that. So, let's say we do the imaging of the spine and you don't find a clear cause. Is the next step to just do a blood patch? Do you send them to someone like you? What's the practical next step? Dr Rau: Yeah, if your- regardless of whether you find a leak or not, if your clinical acumen is such that you think this patient has a leak or I've treated them for everything else and it's not working and I have at least a high enough suspicion that I think the risk of getting a patch is lower than the benefit that if they got a patch and it worked, I do send my patients for non-directed blood patches, because it currently does take a long time to get them to a center that can do CT myelograms or any kind of advanced imaging to look for sort of a CSF venous fistula or to get treated outside of a nondirected patch. You know, sometimes nondirected patches are beneficial for patients, and there's some good papers out there that sort of explain the low risks of doing these if done properly versus the extreme benefit for patients when it works. And, I mean, I can't tell you how many people come in and tell me how their lives are changed because they finally got a blood patch. And sometimes it works. And it's life-changing for those people. You know, they go back to work. They can interact with their kids again. Before, they didn't know what was wrong, just had this headache that started. So it's worth doing if you have a strong clinical suspicion. Dr Smith: Yeah. I mean, that was great. And, you know, to go back to where we began, this is severe. It's something like 60% of patients with this problem have thought about suicide, right? And you take this patient and cure the problem. I feel really empowered having read the article and talked to you today. And so, I'm ready to go out and look for this. Thank you so much for a really engaging conversation. This has been terrific. Dr Rau: Thank you. I appreciate it. I enjoyed being here. Dr Smith: Again, today I've been interviewing Dr Jill Rau about her article on clinical features and diagnosis of spontaneous intracranial hypotension---which I guess I should say hypovolemia after having talked to you---which she wrote with Dr Jeremy Cutsworth-Gregory. This article appears in the most recent issue of Continuum on disorders of CSF dynamics. Please be sure to check out Continuum Audio episodes from this really interesting issue and other interesting issues. And thank you, our listeners, again for listening to 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.

Hoe schoon (of vies!) is Bitcoin nu echt? | 380 B

Cryptocast | BNR

Play Episode Listen Later Jun 3, 2025 62:43

Zo'n 2 jaar geleden spraken we voor het eerst over de verduurzaming van Bitcoin met Danny Oosterveer, oprichter van ondermeer De Groene Nerds en Groene Zaken. Sindsdien zijn er grote stappen gezet, maar ook kritische noten blijven klinken. In de eerste aflevering van juni 2023 bespraken we vooral theoretische mogelijkheden: methaan afvangen met mining, gebruik van duurzame energie en profiteren van negatieve energieprijzen. Eind januari 2024 volgde een vervolg, met meer concrete voorbeelden. Inmiddels is het tijd voor een nieuwe tussenstand. Het Cambridge Digital Mining Industry Report stelt dat 52,4% van de Bitcoin-hashrate afkomstig is van duurzame energiebronnen. Dat is een stijging van 15 procentpunten ten opzichte van 2022. Toch is die sprong niet zonder kanttekeningen: Cambridge veranderde tussen de onderzoeken door hun methodologie, wat natuurlijk ook andere resultaten opleverde. Ook andere onderzoeken, zoals dat van Daniel Batten, suggereren een aandeel tot 57%. Ook zijn er meer cijfers over E-waste. Opvallend is ook dat de hashrate van Bitcoin onlangs de grens van 1 zettahash per seconde heeft overschreden. En ondanks de recente halving zijn er nauwelijks miners failliet gegaan. Dat roept vragen op over de veerkracht van de sector. Beursgenoteerde miners in Noord-Amerika blijven de dominante partijen, maar ook landen als Pakistan, Bhutan en verschillende staten in het Midden-Oosten tonen groeiende interesse. Pakistan kondigde recent een project van 2 gigawatt aan voor Bitcoinmining en AI, maar wat daar nu concreet van terecht zal komen is voorlopig nog onduidelijk. De concentratie van miners in beursgenoteerde bedrijven heeft wel grote gevolgen. Aan de ene kant wordt er vaak efficiënter en schoner gewerkt, met inzet van restwarmte en deelname aan balanceringsmechanismen op het stroomnet. Aan de andere kant leidt centralisatie tot nieuwe zorgen, zoals de mogelijkheid van een 51%-aanval of het ontstaan van monopolies. Sommige partijen zoals Marathon Digital (MARA) nemen inmiddels een rol als treasurybedrijf aan, waarbij Bitcoinreserves centraal staan. Ook hanteren vrijwel alle miners een groeistrategie, waarbij geleend geld wordt ingezet voor de aanschaf van nieuwe machines. In Europa blijven initiatieven grotendeels uit. Beleidsmatig zijn er wel stappen, zoals in Duitsland, waar men kijkt naar gebruik van overschotten in het elektriciteitsnet. In Nederland wordt het speelveld gevormd door een overgang van aanbod- naar vraaggestuurde energiemarkten, wat particuliere initiatieven mogelijk maakt, maar grootschalige projecten bemoeilijkt. Co-host is Bart Mol. Gasten Danny Oosterveer Bart Mol Links Het rapport van Cambridge Daniel Batten Groene Zaken, van Danny Oosterveer Host Daniël Mol Redactie Daniël MolSee omnystudio.com/listener for privacy information.

ai europa bitcoin cambridge pakistan zo echt toch aan bhutan vies eind inmiddels duitsland sommige bitcoin mining in nederland sindsdien midden oosten opvallend schoon noord amerika daniel batten bart mol

#1885 - Homo in Hongarije

De Dag

Play Episode Listen Later Jun 2, 2025 20:32

Krisztian Marton is 35, schrijver, homo en Hongaars. Zijn autobiografische roman werd onlangs uit de handel gehaald vanwege een nieuwe anti-homowet van de regering-Orban. Aan podcast De Dag vertelt hij hoe het is om gay te zijn in Hongarije en waarom hij zich ondanks mogelijke zware repercussies toch uitspreekt en opkomt voor homorechten in zijn land. Juni is pride-maand: op allerlei plekken in de wereld wordt aandacht besteed aan de positie, emancipatie en acceptatie van de regenboog-gemeenschap. De rechten van de LHBTQI-gemeenschap staan op steeds meer plekken onder druk. In Hongarije is dat al langer het geval, maar nieuwe wetten zijn reden tot grote zorg. Nederland leidt daarom in Europa ook nieuw verzet tegen de wetten in Hongarije en een meerderheid van de Tweede Kamer wil dat kabinetsleden naar de Pride in Boedapest gaan op 28 juni. Die wordt waarschijnlijk verboden. In de podcast hoor je ook de Nederlandse fotograaf Kris Oosting die enkele maanden in Boedapest is neergestreken en wekelijks bij demonstraties tegen de regering-Orban is. En Rémy Bonny is van Forbidden Colours, een ngo die lhbti-rechten onder de aandacht brengt. Hij probeert druk te zetten op de Europese Commissie om met tegenmaatregelen tegen Hongarije te komen. Reageren? Mail dedag@nos.nl Presentatie en montage: Elisabeth Steinz Redactie: Sid van der Linden

pride europa mail nederland zijn hij homo nederlandse aan linden orban tweede kamer enr de dag hongarije reageren europese commissie boedapest

Polen een nieuwe Europese dwarsligger? & De strijd om arbeidsmigranten

Bureau Buitenland

Play Episode Listen Later Jun 2, 2025 27:41

Terwijl de Polen naar de stembus trekken, kijkt Brussel gespannen toe. Welke koers slaat Polen in: een terugkeer naar de Europese waardengemeenschap, of een die verder afglijdt richting het kamp van dwarsliggers zoals Hongarije en Slowakije? En is de Europese Unie in staat deze interne dreiging het hoofd te bieden? EU-correspondent Kysia Hekster duidt de uitslag en de mogelijke gevolgen voor Europa. (16:53) De strijd om arbeidsmigranten Migratie blijft Europa verdelen, maar volgens socioloog Hein de Haas kijken we naar de verkeerde kaart. Terwijl politici elkaar verdringen met plannen om de asielinstroom te beperken, dreigt Europa juist het volgende grote gevecht te missen: de strijd om arbeidsmigranten. Aan onze kaarttafel neemt De Haas ons mee langs vijf eeuwen migratiegeschiedenis én tekent hij de migratiewereld van morgen. Presentatie: Tim de Wit

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Ehud Barak, Dilan Yeşilgöz, David van Weel, Giuliano da Empoli

daar isra aan giuliano vvd justitie weel ehud barak buitenhof dilan ye giuliano da empoli

Play Episode Listen Later Jun 1, 2025 53:35

Aan tafel deze week: VVD-fractievoorzitter Dilan Yeşilgöz, oud-premier Israël Ehud Barak, minister van Justitie en Veiligheid David van Weel, schrijver Giuliano da Empoli Presentatie: Twan Huys Wil je meer weten over de gasten in Buitenhof? Op onze website vind je meer informatie. Daar kan je deze aflevering ook terugkijken en je vindt er natuurlijk nog veel meer gesprekken: https://bit.ly/buitenhof-1-juni-25

#12 - Propaganda I'm not falling for (S10)

De Lesbische Liga Podcast

Play Episode Listen Later May 31, 2025 52:20

Wat is de propaganda waar we NIET voor vallen? ¯_(ツ)_/¯ Aan de vooravond van Pride Month maken we de balans op van alle shit waar we als queer personen mee moeten dealen. De tongen worden geroerd over ‘lekker gekke meiden' en het dragen van jorts. Verder is er een cover van Blondshell die nergens te vinden (maar wel te verslavend) is en verklaren we de bad butch summer voor geopend! Post voor de Liga? NTR t.a.v. Lesbische Liga Podcast Wim T. Schippersplein 5 1217 WD Hilversum

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508 – De NAVO-top in Den Haag moet de onvoorspelbare Trump vooral niet gaan vervelen

Betrouwbare Bronnen

Play Episode Listen Later May 27, 2025 86:10

Over een maand komen de 32 regeringsleiders van de NAVO bijeen in Den Haag voor de NAVO-top. Dat gebeurt in een geopolitiek gevaarlijke tijd. Met oorlog in Oekraïne, niet-aflatende dreiging vanuit Rusland, een robuust China en onzekerheid over langdurige betrokkenheid van de sterkste bondgenoot, de Verenigde Staten.Wat gaat er die twee dagen - 24 en 25 juni - gebeuren, voor het eerst onder leiding van de nieuwe secretaris-generaal Mark Rutte? Waar moeten we op letten en op wie? Wanneer zal Rutte met een diepe zucht van tevredenheid Donald Trump uitzwaaien? En overleeft het kabinet-Schoof het allemaal? Jaap Jansen en PG Kroeger noteren nu alvast opmerkelijke aspecten van deze top. Zo zal - anders dan in 2024 in Washington DC – ‘Den Haag' niet worden afgesloten met een uitgebreide uitdieping van de NAVO-strategie wereldwijd. Er komt een ultrakort communiqué dat de kern van de afspraken bevat: een 'The Hague Pledge' met een akkoord over zeer forse nieuwe investeringen door elke lidstaat. ***Deze aflevering is mede mogelijk gemaakt met donaties van luisteraars die we hiervoor hartelijk danken. Word ook vriend van de show!Heb je belangstelling om in onze podcast te adverteren of ons te sponsoren? Zend een mailtje naar adverteren@dagennacht.nl en wij zoeken contact.Op sommige podcast-apps kun je niet alles lezen. De complete tekst plus linkjes en een overzicht van al onze eerdere afleveringen vind je hier***Nieuw is een sessie op de eerste dag waarin de intensivering van de hightech defensie-industrie centraal staat. De 32 ministers van Defensie mogen uit hun land elk een gast meenemen. Inviteert Pete Hegseth Elon Musk? En neemt Ruben Brekelmans de chef van de Rotterdamse haven mee, omdat ons land als 'host nation' van de NAVO-logistiek een cruciale rol speelt? Tijdens de bilaterale dagdelen kunnen bevriende landen – Oekraïne bijvoorbeeld, en uit de Indo-Pacific - hun contacten versterken. Mogelijk zal het viertal Macron-Merz-Tusk-Starmer een Oekraïne-top binnen de top houden. Is Trump daar dan ook bij? Of wil hij liever gaan golfen? Aan alles is gedacht.De top zal hoe dan ook het uiterste vergen van de Trumpfluisteraars onder de wereldleiders, allereerst Rutte. Hoe voorkomt hij explosies of irritaties van een president die zich verveelt of door vage compromissen de kont tegen de krib gooit? Let daarbij op hoe andere fluisteraars ingezet worden. Met name de Fin Alexander Stubb. En laat Friedrich Merz zich meteen gelden met zijn €1000 miljard aan investeringen? Rutte is blij als de 'Pledge' kort en bondig op papier staat. En als de lidstaten voldoende comfort krijgen voor hun concrete uitwerking van de nieuwe plannen. Als Trump bij de slotverklaring dan maar niet onverhoeds met oude frustraties en nieuwe obsessies de zaak laat ontploffen, klinkt het onder diplomaten.Want de president is onvoorspelbaar en het beleid van zijn regering incoherent. Terwijl de Europese Unie een nieuwe, nu al historisch te noemen aanpak van defensie-inspanningen en voor de defensie-industrie in gang zet, hangen Trumps heffingen nog steeds boven de markt. NAVO-planners vrezen dat hij daarmee ook nog de inflatie aanwakkert en voor meer geld minder mogelijk maakt. Houdt hij zich met zijn handelsoorlog eigenlijk wel aan artikel 2 van het NAVO-handvest?Tegelijkertijd komt hij met een ultiem 'America First' plan: de 'Golden Dome' die zijn bondgenoten in de kou laat staan bij de bescherming tegen raketaanvallen. Om over de dreigementen naar Groenland en Canada nog maar te zwijgen. Deze Haagse top kon daarom weleens de eerste zijn van een NAVO met een 'Europese pijler' die bovendien verder strekt dan alleen de EU. Ursula von der Leyen staat in de startblokken. Meteen na de Top al komt in Brussel de Europese Raad bijeen.Op de Haagse top dreigen gastheer Dick Schoof en zijn ministers met lege handen te verschijnen. Rutte waarschuwde al nadrukkelijk dat zij duidelijkheid moeten verschaffen. Een ‘Haagse Belofte' zonder Den Haag zou ridicuul zijn.Brekelmans maakte een berekening wat Nederland kan bijdragen aan de NAVO-investeringen en kwam precies uit op Ruttes percentage: voor harde defensie-investeringen 3,5 procent van het bnp. Maar PVV en BBB willen zulke nieuwe uitgaven niet. Schoof zit bovendien vast met de stikstofperikelen en hun impact op Defensie en de benodigde infrastructuur. En het begrotingstekort is minstens zo'n pijnlijke klem. Moet het kabinet straks bij de Europese Commissie smeken om een uitzondering op de begrotingsregels voor de 19 miljard euro extra defensieschulden? "Liever niet," mompelt de premier. Maar kan hij nog een kant op?***Verder luisteren507 - Het strenge oordeel van Rekenkamerpresident Pieter Duisenberg492 – Macrons Europese atoombom490 – Duitslands grote draai. Friedrich Merz, Europa en Nederland486 - ‘Welkom in onze hel' Een jonge verslaggever aan het front in Oekraïne484 - Hoe Trump chaos veroorzaakt en de Europeanen in elkaars armen drijft476 – Trump II en de gevolgen voor Europa en de NAVO468 – Polen brengt nieuwe dynamiek in Europa455 - De bufferstaat als historische - maar ongewenste - oplossing voor Oekraïne447 - Als Trump wint staat Europa er alleen voor446 - Doe wat Draghi zegt of Europa wacht een langzame doodsstrijd434 – Vier iconische NAVO-leiders en hun lessen voor Mark Rutte427 - Europa wordt een grootmacht en daar moeten we het over hebben419 - Europa kán sterven - Emmanuel Macrons visie op onze toekomst413 - "Eensgezind kunnen we elke tegenstander aan." Oana Lungescu over Poetin, Trump, Rutte en 75 jaar NAVO404 - 75 jaar NAVO: in 1949 veranderde de internationale positie van Nederland voorgoed361 - Vilnius, juli 2023: NAVO-top in het oog van de storm279 - Jaap de Hoop Scheffer over Poetin, Oekraïne, de NAVO en de toekomst van de EU273 - Opnieuw actueel: 75 jaar Marshall Plan272 - Dankzij Poetin: nu écht intensief debat over de toekomst van Europa265 - Toetreding tot de NAVO, de reuzensprong van Finland256 - Na de inval in Oekraïne: 'Nu serieus werk maken van Europese defensiesamenwerking'107 - Jean Monnet, de vader van Europa32 - Churchill en Europa: biografen Andrew Roberts en Felix Klos (vanaf 1 uur 3)***Tijdlijn00:00:00 – Deel 100:41:28 – Deel 201:06:25 – Deel 301:26:11 – Einde Zie het privacybeleid op https://art19.com/privacy en de privacyverklaring van Californië op https://art19.com/privacy#do-not-sell-my-info.

#274 - Makreel

Etenstijd!

Play Episode Listen Later May 26, 2025 28:11

Een broodje makreel is het lekkerste wat er is. Aan welke andere lekkere vissensoorten is de makreel verwant? Welke Japanse makreel is nu ook populair in IJmuiden? Waarom mogen vissers rode makreel vangen? En wat betekent dat eigenlijk? Je hoort het in Etenstijd!Onze sponsor:Upway: Gebruik de kortingscode Etenstijd150 voor €150 korting op een bestelling van minimaal €750. Ga naar upway.nlTips:Trouw over de makreelVisserij.nlNOS over de makreelProductie: Meer van ditMuziek: Keez GroentemanWil je adverteren in deze podcast? Stuur een mailtje naar: Adverteerders (direct): adverteren@meervandit.nl(Media)bureaus: adverteren@bienmedia.nl Hosted on Acast. See acast.com/privacy for more information.

media ga acast waarom onze aan stuur ijmuiden adverteerders

We screenen onszelf ziek met preventieve gezondheidscontroles

Beter | BNR

Play Episode Listen Later May 26, 2025 26:42

Steeds meer Nederlanders kiezen ervoor om hun gezondheid preventief te controleren. Met behulp van wearables die constant vitale functies meten, preventieve total body scans en extra bevolkingsonderzoeken, hopen we eventuele ziektes vroegtijdig op te sporen. "Meten is weten", is vaak het motto. Maar is al dat meten echt nuttig, of heeft het ook een negatieve impact op onze zorg? Tijdens de Radiologendagen in Den Bosch sprak presentatrice Nina van den Dungen met drie gasten over dit onderwerp: Catrien Schimmelpenninck, senior-adviseur bij de Raad voor Volksgezondheid & Samenleving (RVS), vertelt over het rapport 'iedereen bijna ziek', waarin wordt gewaarschuwd voor het gevaar van overdiagnose. Het fenomeen waarbij mensen onnodig als patiënt worden bestempeld en dit onrust en stress met zich meebrengt. Jet Quarles van Ufford, radioloog bij het Haaglanden Medisch Centrum en voorzitter van de Nederlandse Vereniging voor Radiologie, wijst erop dat de toenemende vraag naar preventieve scans een enorme druk legt op de radiologische zorg. Zij ziet problemen bij de toename van commerciële aanbieders voor total body scans, die volgens haar vaak zorgen voor onnodige vervolgonderzoeken en daarmee bijdragen aan langere wachttijden. Danka Stuijver, huisarts en columnist bij De Volkskrant, benadrukt dat preventieve testen vaak leiden tot extra belasting van huisartsen en specialisten. Veel patiënten komen terug met uitslagen van scans die vaak geen medische meerwaarde hebben. Zij pleit voor terughoudendheid en roept op om de focus te verleggen naar echte preventie door betere leefstijlkeuzes. Aan bod komen onder meer de gevolgen van gratis levertesten, zoals recent in Amsterdam werd aangeboden, en het fenomeen van zogenaamde 'pre-ziekte', waarbij mensen zonder echte klachten al gediagnostiseerd worden. Daarnaast passeren ook de voor- en nadelen van bevolkingsonderzoeken de revue. De oplossing? We moeten scherpere keuzes maken, met een focus op echte preventie en beter gereguleerde commerciële screenings om de druk op de zorg niet verder te vergroten. Redactie: Stijn GoossensSee omnystudio.com/listener for privacy information.

amsterdam maar veel zij daarnaast tijdens aan steeds nederlanders raad den bosch meten ziek volksgezondheid de volkskrant radiologie dungen nederlandse vereniging

Fleur Agema, Erik Gerritsen, Anne Kremers, Pieter Waterdrinker

daar aan welzijn volksgezondheid gerritsen buitenhof kremers pieter waterdrinker

Play Episode Listen Later May 25, 2025 54:19

Aan tafel deze week: Vicepremier en minister van Volksgezondheid, Welzijn en Sport Fleur Agema, Ymere directeur Erik Gerritsen, museumdirecteur Anne Kremers en schrijver Pieter Waterdrinker. Presentatie: Maaike Schoon Wil je meer weten over de gasten in Buitenhof? Op onze website vind je meer informatie. Daar kan je deze aflevering ook terugkijken en je vindt er natuurlijk nog veel meer gesprekken: https://bit.ly/buitenhof-25-5-25

729. Wie wordt straks de baas van de wereld?

De Universiteit van Nederland Podcast

Play Episode Listen Later May 25, 2025 13:02

Decennialang stond Amerika stevig bovenaan als de machtigste natie ter wereld. Maar die tijd lijkt voorbij. China, Rusland, India — en zelfs Europa — eisen steeds vaker een plek aan tafel op. De wereldorde is in beweging. Maar wie bepaalt eigenlijk de spelregels?In deze aflevering onderzoeken we die vraag met onderzoeker parlementaire geschiedenis, Laurien Crump (Radboud Universiteit). Aan de hand van biljart, Catan en een potje kaarten laat zij op verrassende en speelse wijze zien hoe landen elkaar uitdagen, omzeilen of juist samenwerken. Veranderen we van een wereld met vaste regels naar een chaotisch spel zonder scheidsrechter? En wat betekent dat voor jou?00:00 Wie is de baas van de wereld?00:57 Hoe werd Amerika het machtigste land van de wereld?02:30 Waarom was Amerika het machtigste land?03:06 Kunnen andere landen machtiger worden dan Amerika?04:03 Wordt China machtiger dan Amerika?05:20 Hoe werd de wereldorde vroeger bepaald?06:00 Hoe wordt de wereldorde in westerse landen bepaald?07:10 Hoe wordt de wereldorde bepaald in niet-westerse landen?09:00 Hoe verandert Trump de wereldorde?10:45 Wie is de baas van de wereld?11:42 Wat gaat er in Nederland veranderen door de nieuwe wereldorde?Wil je ons iets vragen? Of heb je een opmerking? Dat kan via dit formulier: https://forms.gle/5YTUR72pTwzXRAFk6Meer wetenschap? Check:Onze website ► http://www.universiteitvannederland.nl/Instagram ►https://www.instagram.com/UniversiteitNLFacebook ► https://www.facebook.com/UniversiteitvanNederlandVoor niet-commercieel gebruik is het toegestaan om fragmenten (mits de context behouden) te gebruiken. Vermeld wel altijd bron: Universiteit van Nederland. Bij twijfel, mail ons op info@universiteitvannederland.nlOver de Universiteit van Nederland:De Universiteit van Nederland heeft een onafhankelijke redactie die elke week podcasts, video's en social posts maakt over wetenschappelijke onderwerpen. Wij geloven dat iedereen moet kunnen leren van de topwetenschappers die we hebben in Nederland. Zonder collegegeld of tentamens. Wij zijn de universiteit voor iederéén.Zie het privacybeleid op https://art19.com/privacy en de privacyverklaring van Californië op https://art19.com/privacy#do-not-sell-my-info.

donald trump china europa amerika maar nederland wil waarom aan wij bij zonder wordt kunnen catan rusland zie de wereld baas universiteit veranderen californi straks

Symptomatic Treatment of Neuro-ophthalmic Visual Disturbances With Dr. Sachin Kedar

Neurology Today - Neurology Today Editor’s Picks

Play Episode Listen Later May 21, 2025 22:46

Neuro-ophthalmic deficits significantly impair quality of life by limiting participation in employment, educational, and recreational activities. Low-vision occupational therapy can improve cognition and mental health by helping patients adjust to visual disturbances. In this episode, Katie Grouse, MD, FAAN, speaks with Sachin Kedar, MD, FAAN, author of the article “Symptomatic Treatment of Neuro-ophthalmic Visual Disturbances” in the Continuum® April 2025 Neuro-ophthalmology 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. Kedar is the Cyrus H Stoner professor of ophthalmology and a professor of neurology at Emory University School of Medicine in Atlanta, Georgia. Additional Resources Read the article: Symptomatic Treatment of Neuro-ophthalmic Visual Disturbances 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: @AIIMS1992 Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Sachin Kedar about his article on symptomatic treatment of neuro-ophthalmic visual disturbances, which appears in the April 2025 Continuum issue on neuro-ophthalmology. Welcome to the podcast, and please introduce yourself to our audience. Dr Kedar: Thank you, Katie. This is Sachin Kedar. I'm a neuro-ophthalmologist at Emory University, and I've been doing this for more than fifteen years now. I trained in both neurology and ophthalmology, with a fellowship in neuro-ophthalmology in between. It's a pleasure to be here. Dr Grouse: Well, we are so happy to have you, and I'm just so excited to be discussing this article with you, which I found to be a real treasure trove of useful clinical information on a topic that many find isn't covered enough in their neurologic training. I strongly recommend all of our listeners who work with patients with visual disturbances to check this out. I wanted to start by asking you what you hope will be the main takeaway from this article for our listeners? Dr Kedar: The most important takeaway from this article is, just keep vision on your radar when you are evaluating your patients with neurological disorders. Have a list of a few symptoms, do a basic screening vision, and ask patients about how their vision is impacting the quality of life. Things like activities of daily living, hobbies, whether they can cook, dress, ambulate, drive, read, interact with others. It is very important for us to do so because vision can be impacted by a lot of neurological diseases. Dr Grouse: What in the article do you think would come as the biggest surprise to our listeners? Dr Kedar: The fact that impairment of vision can magnify and amplify neurological deficits in a lot of what we think of as core neurological disorders should come as a surprise to most of the audience. Dr Grouse: On that note, I think it's probably helpful if you could remind us about the types of visual disturbances we should be thinking about and screening for in our patients? Dr Kedar: Patients who have neurological diseases can have a whole host of visual deficits. The simplest ones are deficits of central vision. They can have problems with their visual field. They can have abnormalities of color vision or even contrast sensitivity. A lot of our patients also complain of light sensitivity, eyes feeling tired when they're doing their usual stuff. Some of our patients can have double vision, they can have shaky vision, which leads to their sense of imbalance and maybe a fall risk to them. Dr Grouse: It's really helpful to think about all the different aspects in which vision can be affected, not just sort of the classic loss of vision. Now, your article also serves as a really important reminder, which you alluded to earlier, about how impactful visual disturbances can be on daily activities. Could you elaborate a little further on this, and particularly the various domains that can be affected when there are visual disturbances present? Dr Kedar: So, when I look at how visual disturbances affect quality of life, I look at two broad categories. One is activities of basic daily living. These would be things like, are you able to cook? Are you able to ambulate not just in your home, but in your neighborhood? Are you able to drive to your doctor's appointment or to visit with your family? Are you able to dress yourself appropriately? Are you able to visualize the clothing and choose them appropriately? And then the second category is recreational activities. Are you able to read? Are you able to watch television? Are you able to visit the theatre? Are you able to travel? Are you able to participate in group activities, be it with your family or be it with your social group? It is very important for us to ask our patients if they have problems doing any of this because it really can adversely impact the quality of life. Dr Grouse: I think, certainly with all the things we try to get through talking with our patients, this may not be something that we do spend a lot of time on. So, I think it's it is a good reminder that when we can, being able to ask about these are going to be really important and help us hit on a lot of other things we may not even realize or know to ask about. Now, I was really struck when I was reading your article by the meta-analysis that you had quoted that had showed 47% higher risk of developing dementia among the visually impaired compared to those without visual impairments. Should we be doing more in-depth visual testing on all of our patients with cognitive symptoms? Dr Kedar: This is actually the most interesting part of this article, and kind of hones in on the importance of vision in neurological disorders. Now I want to clarify that patients with visual disorders, it's not a causative influence on dementia, but if you have a patient with an underlying cognitive disorder, any kind of visual disturbance will significantly make it worse. And this has been shown in several studies, both in the neurologic and in the ophthalmological literature. So, I quoted one of the big meta-analysis over there, but studies have clearly shown that if you have these patients and treat them for their visual deficits, their cognitive indices can actually significantly improve. To answer your question, I would say a neurologist should include basic vision screening as part of every single evaluation. Now, I know it's a hard thing in, you know, these days when we are literally running on the hamster wheel, but I can assure you that it won't take you more than 2 to 3 minutes of your time to do this basic screening; in fact, you can have one of your assistants included as part of the vital signs assessment. What are these basic screening tools? Measure the visual acuity for both near and distance. Check and see if their visual field's off with the confrontation. Look at their eye movements. Are they able to move their eyes in all directions? Are the eyes stable when they're trying to fixate on a particular point? I think if you can do these basic things, you will have achieved quite a bit. Dr Grouse: That's really helpful, and thanks for going through some of the standard, or really, you know, solid basic foundation of visual testing we should be thinking about doing. I wanted to move on to some more details about the visual disturbances. You made an excellent point that there are many types of primary ophthalmologic conditions that can cause visual disturbances that we should keep in mind. So maybe not things that we think about a lot on a day-to-day basis, but, you know, are still there and very common. What are some of the most common ones, and when should we be referring them to see an ophthalmologist? Dr Kedar: So, it depends on the age group of your patient population. Now, the majority of us are adult neurologists, and so the kinds of ophthalmic conditions that we see in this population is going to be different from the pediatric age group. So in the adult population, we might see patients with uncorrected refractive error, presbyopia, patients who have cataracts creep on them, they may have glaucoma, they may have macular degeneration, and these tend to have a slightly higher incidence in the older age group. Now for those of us who are taking care of the younger population, uncorrected refractive errors, strabismus and amblyopia tend to be fairly common causes of visual deprivation in this age group. What I would encourage all of our neurologists is, make sure that your patients get a basic eye examination at least once a year. Just like you want them to go to their primary care and get an annual maintenance visit, everybody should go to the ophthalmologist or the optometrist and get a basic examination. And, if you're resourceful enough, have your patients bring a copy of that assessment. Whether it is normal or there's some abnormality, it is going to help you in the management. Dr Grouse: Absolutely. I think that's a great piece of advice, to think of it almost, like, them seeing their primary care doctor, which of course we offer encourage our patients to do, thinking of this as another very important piece of standard primary care. If a patient comes to you reporting difficulty reading due to possible visual disturbances, I'm curious, can you walk us through how you would approach this evaluation? Dr Kedar: It is not a very common presenting complaint of our patients, even in the neuro-ophthalmology clinic. It's a very rare patient that I see who comes and says, I cannot read or, I have difficulty reading. Most of the patients will come saying, oh, I cannot see. And then you have to dig in to find out, what does that actually mean? What can you not see? Is it a problem in your driving? Is it a problem in your reading? Or is it a problem that occurs at all times? Now you asked me, how do you approach this evaluation? One of the things that all of us, whether we are neurologists, ophthalmologists, or neuro-ophthalmologists, forget to do is to actually have the patient read a paragraph, a sentence, when they are in clinic. And that will give you a lot of ideas about what might actually be going wrong with the patient. Now, as far as how do I approach this evaluation, I will do a basic screening examination to make sure that their visual acuity is good for both distance and near. A lot of us tend to do either distance or near and we will miss the other parameter. You want to do a basic confrontation visual field to make sure that they do not have any subtle deficits that's impacting their ability to read. Examine the eye movements, do a fundoscopic examination. Now, once you've done this basic screening, as a neurologist, you already have some idea of whether your patient has a lesion along the visual pathways. If you suspect that this is a problem with, say, the visual pathways, ask your ophthalmology colleague to do a formal visual field assessment, and that'll pick up subtle deficits of central visual field. And lastly, don't forget higher visual function testing or cortical visual function testing. So basically, you're looking for neglect, phenomenon, or simultanagnosia, all of which tends to have an impact on reading. So, in the manuscript I have a schema of how you can approach a patient with reading difficulties, and in that ischemia you will see categories of where things can go wrong during the process of reading. And if you can approach your patient systematically through one of those domains, there's a fairly good chance that you'll be able to pick up a problem. Dr Grouse: Going a little further on to when you do identify problems with loss of central or peripheral vision, what are some strategies for symptomatic management of these types of visual disturbances? Dr Kedar: As a neurologist, if you pick up a problem with the vision, you have to send this patient to an eye care provider. The vast majority of people who have visual disturbances, it's from an eye disease. You know, as I alluded to earlier, it can be something as simple as uncorrected refractive error, and that can be fixed easily. A lot of patients in our older age group will have dry eye syndrome, which means they are unable to adequately lubricate the surface of the eye, and as a result, it degrades the quality of their vision. So, they tend to get intermittent episodes of blurred vision, or they tend to get glare. They tend to get various forms of optical aberration. Patients can have cataracts, patients can have glaucoma or macular degeneration. And in all of those instances, the goal is to treat the underlying disease, optimize the vision, and then see what the residual deficit is. By and large, if a patient has a problem with the central vision, then magnification will help them for activities that they perform at near; say, reading. Now for patients with peripheral vision problem, it's a different entity altogether. Again, once you've identified what the underlying cause is, your first goal is to treat it. So, for example, if your patient has glaucoma, which is affecting peripheral vision, you're going to treat glaucoma to make sure that the visual field does not progress. Now a lot of what happens after that is rehabilitation, and that is always geared towards the specific activities that are affected. Is it reading? Is it ambulating? Is it watching television? Is it driving? And then you can advise as a neurologist, you can advise your occupational therapist or low vision specialist and say, hey, my patient is not able to do this particular activity. Can we help them? Dr Grouse: Moving on from that, I wanted to also hit on your approach when patients have disorders of ocular motility. What are some things you can do for symptomatic management of that? Dr Kedar: So, patients with ocular motility can have two separate symptoms. Two, you know, two disabling symptoms, as they would call it. One is double vision and the other is oscillopsia, or the feeling or the visualization of the environment moving in response to your eyes not being able to stay still. Typically, you would see this in nystagmus. Now, let's start with diplopia. Diplopia is a fairly common presenting complaint for neurologists, ophthalmologists, and the neuro-ophthalmologist. The first aspect in the management of diplopia is to differentiate between monocular diplopia and binocular diplopia. Now, monocular diplopia is when the double vision persists even after covering one eye. And that is never a neurological issue. It's almost always an ophthalmic problem, which means the patient will then have to be assessed by an eye care provider to identify what's causing it. And again, refractive error, cataracts, opacities, they can do it. Now, if the patient is able to see single vision by covering one eye at a time, that's binocular diplopia. Now, in patients with binocular diplopia in the very early stages of the disease, the standard treatment regimen is just monocular occlusion. Cover one eye, the diplopia goes away, and then give it time to improve on its own. So, this is what we would typically do in a patient with, say, acute sixth nerve palsy or fourth nerve palsy or third nerve palsy, maybe expect spontaneous improvement in a few months. Now if the double vision does not improve and persists long term, then the neuro-ophthalmologist or the ophthalmologist will monitor the amount of deviation to see if it fluctuates or if it stays the same. So, what are the treatment options that we have in a patient who absolutely refuses any intervention or is not a candidate for any intervention? Monocular occlusion still remains the viable option. Now, patients who have stable ocular deviation can benefit from using prisms in their glasses, or they can be sent to a surgeon to have a strabismus surgery that can realign their eyes. So, again, a broad answer, but there are options available that we can use. Dr Grouse: Thank you for that overview. I think that's just really helpful to keep in mind as we're working with these patients and thinking about what their options are. And then finally, I wanted to touch on patients with higher-order vision processing and attention difficulties. What are some strategies for them? Dr Kedar: These are frankly the most difficult patients that I get to manage in my clinic, simply because there is no effective therapies for managing them. In fact, I think neurologists are far better at this than ophthalmologists or even neuro-ophthalmologists. In patients with attentional disorders, everything boils down to the underlying cause, whether you can treat it or whether it is a slowly progressive, you know, condition, such as from neurodegenerative diseases. And that tailors our goals towards therapy. The primary goal is for safety. A lot of these patients who have visual disturbances from vision processing or attention, they are at accident and fall risk. They have problems with social interactions. And, importantly, there is a gap of understanding of what's going on, not just from their side but also from the family's side. So, I tend to approach these patients from a safety perspective and social interaction perspective. Now, I have a table listed in the manuscript which will go into details of what the specific things are. But in a nutshell, if your patient has neglect in a specific part of the visual field, they have accident risk on that side. Simple things like walking through a doorway, they can hurt their shoulders or their knees when they bang into the wall on that side because they are unable to judge what's on the other side. Another example would be a patient who has simultanagnosia or a downgaze policy, such as from progressive super nuclear policy. They are unable to look down fast enough, or they are simply unable to look down and appreciate things that are on the floor, and so they can trip and fall. Walking downstairs is also not a huge risk because they are unable to judge distances as they walk down. A lot of what we see in these patients are things that we have to advise occupational therapists and help them improve these safety parameters at home. Another thing that we often forget is patients can inadvertently cause a social incident when they tend to ignore people on their affected side. So, if there is a family gathering, they tend to consistently ignore a group of people who are sitting on the affected side as opposed to the other side. And I've had more than a few patients who've come and said that, I may have offended some of my friends and family. In those instances, it's always helpful when they are in clinic to demonstrate to the family how this can be awkward and how this can be mitigated. So, having everybody sit on one side is a useful strategy. Advise your family and friends before a gathering that, hey, this may happen. And it is not because it is deliberate, but it's because of the medical condition. And that goes a lot, you know, further in helping our patients come out of social isolation because they are also afraid of offending people, you know. And they can also participate socially, and it can overall improve their quality of life. Dr Grouse: That's a really helpful tip, and something I'll keep in mind with my patients with neglect and visual field cuts. Thank you so much for coming to talk with us today. Your article has been so helpful, and I urge everybody listening today to take a look. Dr Kedar: Thank you, Katie. It was wonderful talking to you. Dr Grouse: I've been interviewing Dr Sachin Kedar about his article on symptomatic treatment of neuro-ophthalmic visual disturbances, which appears in the most recent issue of Continuum on neuro-ophthalmology. 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.

S7E224: ‘Zesde trainer in vier jaar, dan mag je wel van een trainerskerkhofje spreken'

AD Voetbal podcast

Play Episode Listen Later May 20, 2025 47:07

De strijd tussen Telstar en FC Den Bosch om de finale te halen van de play-offs ligt nog open na de 0-0 in Den Bosch. En zijn de overgebleven ploegen nu in het voor- en nadeel van Willem II dat degradatie probeert te voorkomen? Verder staat Etienne Verhoeff in de AD Voetbalpodcast met Johan Inan uitgebreid stil bij de situatie in Amsterdam. De Ajax-clubwatcher was de laatste dagen getuigen van wat er allemaal gebeurde rondom Francesco Farioli. Aan hem ook de vraag, wat erft zijn opvolger? Lex Lammers vertelt over het kampioenschap in de tweede Bundesliga van FC Köln. Beluister de hele AD Voetbalpodcast nu via AD.nl, de AD App of jouw favoriete podcastplatform.Support the show: https://krant.nl/See omnystudio.com/listener for privacy information.

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AAN's President's Award Recipient for 2025 - Part 2

Neurology Minute

Play Episode Listen Later May 19, 2025 3:07

In the second installment of this two-part series, Dr. Stacey Clardy and Dr. Janis Miyasaki discuss how she got involved with the AAN. Show reference: https://www.aan.com/news/aan-honors-leader-volunteer-2025-presidents-award

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Advances in cell therapies for Parkinson's, GLP-1 agonists and dementia risk, FDA accelerated approvals for neurology drugs

Play Episode Listen Later May 15, 2025 4:14

In this episode, editor-in-chief Joseph E. Safdieh, MD, FAAN, highlights articles about early studies finding dopamine cellular therapies were safe and tolerable for patients with Parkinson's, use of GLP-1 agonists were associated with reduced dementia risks, and the FDA use of accelerated approvals for several neurology drugs are under scrutiny.

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Supranuclear Disorders of Eye Movements With Dr. Gregory Van Stavern