Podcasts about Aba

Welcome to Part 3 of my mini-series answering your burning questions! Today, we're diving into the topic of verbal imitation.When it comes to verbal imitation and echoic goals, context is everything. These goals must be functional and meaningful to the individual child in order to support communication development.As an SLP collaborating with a BCBA, and vice versa, rely on assessment tools and an SLP's robust training in speech to identify and shape functional goals. It's crucial that we plan and program with intention—otherwise, we risk discouraging a child from verbalizingThe key? Collaborate early and often. Assess together. Plan together. Use resources like the Autism IEP Goal Bank (don't miss the freebie!). Then, have the SLP on the team focus on those targeted words and move into collaboratively supporting generalization into the natural environment for a robust bank of words.Looking ahead to 2026, we're excited to explore communication disorders more deeply over at ABA Speech Connection. Stay tuned—because sometimes, you don't know what you don't know. #autism #speechtherapy What's Inside:Summer mini-seriesStrategy to work collaboratively as BCBA and SLPsVerbal imitation goals Communication developmentMentioned In This Episode:Verbal Imitation Guide (Hack #19) Join our ethics course Speech Membership - ABA Speech  ABA Speech: Home

Stand Up is a daily podcast. I book,host,edit, post and promote new episodes with brilliant guests every day. Please subscribe now for as little as 5$ and gain access to a community of over 750 awesome, curious, kind, funny, brilliant, generous souls Check out StandUpwithPete.com to learn more Outclassed: How the Left Lost the Working Class and How to Win Them Back Described as having “something approaching rock star status” in her field by The New York Times Magazine, Joan C. Williams is a scholar of social inequality and a prominent public intellectual. Williams is the author of 12 books and 116 academic articles in law, sociology, psychology, medical and management journals. She is the 11th most cited legal scholar both in critical theory and employment law. She is a Sullivan Professor and the Founding Director of the Equality Action Center at UC Law San Francisco, former Founding Director of the Center for WorkLife Law. She has three TED/TEDx talks, including one with over 1.3 million views. Her 2016 essay on why Trump attracted so many non-college voters went viral, with over 3.7 million reads, becoming the most-read article in the 90-year history of Harvard Business Review. She is widely known for “bias interrupters,”—an evidence-based metrics-driven approach to eradicating implicit bias introduced in the Harvard Business Review in 2014. The website  biasinterrupters.org with open-sourced toolkits for individuals and organizations has been accessed over 500,000 times. She was profiled in Financial Times and has published on class dynamics in American politics in The New York Times, Washington Post, The Atlantic, The New Republic, Politico, The Hill, the Wall Street Journal and elsewhere. Her work on class includes her upcoming book Outclassed: How the Left Lost the Working Class – And How to Win Them Back (forthcoming St. Martin's, May 2025) and her critically acclaimed 2017 book White Working Class – one of three books President Biden carried, dog-eared and annotated, during his 2020 presidential campaign, according to the Washington Post. Her work on gender includes What Works for Women at Work: Four Patterns Working Women Need to Know (NYU Press, 2014) and her prize-winning Unbending Gender: Why Family and Work Conflict and What To Do About It (Oxford, 1999). Williams' work helped create the field of work-family studies, modern workplace flexibility policies, and the study of maternal wall bias in sociology. Her work on race includes eight studies documenting how racial and gender bias play out in today's workplaces, including two focused specifically on women of color: Pinning down the Jellyfish: Racial and Gender Bias against Women in Tech (2022) and Double Jeopardy? Gender Bias against Women of Color in STEM (2014). She is a leading voice on diversity, equity, and inclusion; with her team, she has published 39 articles published in Harvard Business Review. In 2014, she launched Bias Interrupters, a data-driven approach to interrupting bias in organizations whose website has been downloaded over half a million times. Williams has received awards in several different fields. For her contributions to the legal profession, she is one of the few people to receive both the American Bar Foundation's Outstanding Scholar Award (2012) and the ABA's Margaret Brent Women Award for Lawyers of Achievement (2006).  For her contributions to the work-family field, she received the Work Life Legacy Award from the Families and Work Institute (2014) and MSOM Responsible Research Award in Operations Management (2022). For her contributions to women's advancement in engineering, she received the President's Award from the Society of Women Engineers (2019). For contributions to psychology, she received the Distinguished Publication Award from the Association for Women in Psychology (2005). Her work has been funded by three National Science Foundation grants, as well as grants from Alfred P. Sloan Foundation, the W. W. Kellogg Foundation, the Ford Foundation, the Robert Wood Johnson Foundation. She holds degrees from Yale, Harvard, and MIT as well as an honorary PhD from Utrecht University in the Netherlands. Join us Monday's and Thursday's at 8EST for our Twice Weekly Happy Hour Hangout's !  Pete on Blue Sky Pete on Threads Pete on Tik Tok Pete on YouTube  Pete on Twitter Pete On Instagram Pete Personal FB page Stand Up with Pete FB page All things Jon Carroll  Follow and Support Pete Coe Buy Ava's Art  Hire DJ Monzyk to build your website or help you with Marketing Gift a Subscription https://www.patreon.com/PeteDominick/gift

Ben and Nathan tackle Parallel Reasoning questions, a question type that some students prefer to skip. They assure listeners that these questions work just like any other LSAT question. Gimmicks—like reading the question first or diagramming—don't help and only distract from the core task. Focus instead on reading for comprehension and understanding the argument. The key is to identify the reasoning and treat everything else as secondary.⁠Study with our Free Plan⁠⁠Download our iOS app⁠⁠Watch Episode 514 on YouTube⁠0:30 – How Cheating Spreads in Law SchoolBen and Nathan discuss a Wall Street Journal article on extended-time accommodations at Pepperdine Law, where 30% of students reportedly receive them. They argue that accommodations should level the playing field, not give an advantage. They question the value of timed essay exams and compare law school to gaining entry into an ABA-approved guild, suggesting that gaming the system might seem rational, ethics aside.LSAT Demon Scholarship Estimator27:25 – WashU Law Pre-Application TrapA listener is contacted for an interview by WashU Law before even applying. Ben and Nathan caution that this is a sales tactic: the school is trying to extract information and create perceived interest to reduce scholarship offers. They revisit their advice about the Candidate Referral Service, suggesting it might be time to reconsider what students share with schools early in the process.36:12 – Parallel Reasoning ClarityThe guys break down Parallel Reasoning questions on the LSAT. They emphasize that matching language or subject matter is secondary—what matters is aligning the logical structure of arguments. To succeed, students must first understand the core argument before worrying about technical parallels. A big-picture approach is key.53:20 – Tips from a Departing DemonA departing Demon, Vox, shares his advice for other students: keep your study streak alive. Even a single question can turn into an hour of productive study. Consistency compounds.54:56 – Zyns on the LSATRedditors wonder if nicotine pouches like Zyn are allowed during the LSAT. Ben and Nathan suggest that they aren't explicitly banned, but advise playing it safe and contacting LSAC directly. Better to assume they're off-limits.1:03:22 – Why Are Others Wrong?Listener Andrew is thinking about writing an LSAT addendum. Ben and Nathan advise him to focus on improving his score with his two remaining attempts. They argue that law school deans who encourage addenda are trying to get applicants to expose weaknesses. Schools are more interested in reporting the highest LSAT scores, driving denial numbers up, and collecting full tuition. Admissions advice is often self-serving.1:18:21 – Personal Statement Gong ShowDanielle sends in their submission for the Personal Statement Gong Show, the show where Ben and Nathan read personal statements and hit the gong when something goes wrong. The standing record to beat is ten lines, held by Greta.1:32:38 - What's the Deal With… Jacksonville University? Ben and Nate take a look at Jacksonville University, the newest school to receive ABA accreditation. While there are reasons why this may be a good fit, you shouldn't pay to be the school's guinea pigs. Catch up on all of our What's the Deal With… segments!1:42:50 - Word of the Week - Legerdemain “Commenting on the county counsel exception, the court termed it a 'legerdemain giving birth to a solution of dubious validity.'”Howitt v. Superior Court, 5 Cal. Rptr. 2d 196, 202 (App. 1992).Get caught up with our ⁠Word of the Week⁠⁠ library. 

It's a Wisconsin road trip this week for a sit down with Jordan Treske, author of "Building the Milwaukee Bucks: Kareem Abdul‑Jabbar, Oscar Robertson and the Rapid Rise of an NBA Franchise," to explore one of the most astonishing turnarounds in modern American pro sports history. Treske walks us through how Milwaukee rebounded from the loss of the MLB Braves to become an NBA basketball powerhouse in just three seasons — thanks to savvy ownership, an historic draft coin flip, and the ultimate pairing of two all-time greats: Kareem Abdul-Jabbar (née Lew Alcindor) and Oscar Robertson. We'll also unpack the racial and cultural tensions of the era, the ABA bidding war, and the community's unique investment in the team. Whether you're a Bucks fan or a basketball history buff, this conversation offers fresh insight into how a franchise — and a city — found its "big league" identity through the game. PLUS: From 1977, the Milwaukee Bucks theme song "Green And Growing (The Bucks Don't Stop Here)!" + + +   SUPPORT THE SHOW: Buy Us a Coffee: https://ko-fi.com/goodseatsstillavailable "Good Seats" Store: https://www.teepublic.com/stores/good-seats-still-avalable?ref_id=35106 BUY THE BOOK (AND SUPPORT THE SHOW!):   "Building the Milwaukee Bucks: Kareem Abdul‑Jabbar, Oscar Robertson and the Rapid Rise of an NBA Franchise": https://amzn.to/3TVtQXI   SPONSOR THANKS (AND SUPPORT THE SHOW!):   Old School Shirts.com (10% off promo code: GOODSEATS): https://oldschoolshirts.com/goodseats   Royal Retros (10% off promo code: SEATS): https://www.503-sports.com?aff=2  Old Fort Baseball Co. (15% off promo code: GOODSEATS): https://www.oldfortbaseballco.com/?ref=seats  Yinzylvania (20% off promo code: GOODSEATSSTILLAVAILABLE): https://yinzylvania.com/GOODSEATSSTILLAVAILABLE   417 Helmets (10% off promo code: GOODSEATS): https://417helmets.com/?wpam_id=3 FIND AND FOLLOW: Linktree: https://linktr.ee/GoodSeatsStillAvailable Web: https://goodseatsstillavailable.com/ Bluesky: https://bsky.app/profile/goodseatsstillavailable.com X/Twitter: https://twitter.com/GoodSeatsStill YouTube: https://www.youtube.com/@goodseatsstillavailable Threads: https://www.threads.net/@goodseatsstillavailable Instagram: https://www.instagram.com/goodseatsstillavailable/ Facebook: https://www.facebook.com/GoodSeatsStillAvailable/ LinkedIn: https://www.linkedin.com/company/good-seats-still-available/

#371>  Sponsored by the Men's Division of Sara Schenirer.They will help you figure out your yeshiva credits, financial aid, and help you choose a degree program that leads to a successful career.They offer degrees in Accounting, Business, ABA, Psychology, Health Science, Pre-Med, Paralegal, Special Education, and Social Work. All degrees are offered through their prestigious partner colleges and their student support is first-rate.Applications are open now for the fall semester. Visit their website https://shorturl.at/YXy7i, call 917-209-8204, or email rpelberg@sarasch.com to connect with a helpful advisor today.> To purchase, "First Impressions: Sefer Hasidim and Early Modern Hebrew Printing": https://amzn.to/3TmWSj1> To purchase "Sefer Hasidim and The Ashkenazi Book in Medieval Europe" by Prof. Ivan Marcus: https://amzn.to/4eFlsFw> The Sefer Hasidim Project: https://judaic.princeton.edu/about-us/resources/sefer-hasidim-project> To join the SeforimChatter WhatsApp community: https://chat.whatsapp.com/DZ3C2CjUeD9AGJvXeEODtK> To join the SeforimChatter WhatsApp status: https://wa.me/message/TI343XQHHMHPN1>  To support the podcast or to sponsor an episode follow this link: https://seforimchatter.com/support-seforimchatter/or email seforimchatter@gmail.com (Zelle/QP this email address)Support the show

Nothing says “summertime” like visiting friends. And what's the podcast equivalent of a summer get together? Why a whole month devoted to guest episodes! This July we're doing a world tour of topics from all over the ABA map. We kick things off with Dr. Roseanne Lesack and Dr. Jillian Wilson updating us on some of the best practices in improving social validity of parent training planning before crossing the country to discuss many of the questionable practices lurking in single-case experimental design with Dr. Matthew Tincani. Next we take a quick trip back home in our ongoing series on professional collaboration with special education teacher/BCBA, Carolyn Beaumier. Finally, , we travel to the other side of the topic world to listen to Dr. James Meindl on his work regarding a hypothetical functional account of mass shooting behavior. It's a podcast vacation for the ages, and you're invited to join us for free! The only thing missing is the little bag of pretzels. Articles for July 2025 Social Validity of Parent Training w/ Dr. Roseanne Lesack + Dr. Jillian Wilson Allen, K.D. & Warzak, W.J. (2000). The problem of parental nonadherence in clinical behavior analysis: Effective treatment is not enough. Journal of Applied Behavior Analysis, 33, 373-391. doi: 10.1901/jaba.2000.33-373 Wilson, J.B. & Lesack, R.S. (2024). Parent perceptions of behavior analytic interventions. Behavior Analysis in Practice, 17, 1050-1073. doi: 10.1007/s40617-024-01010-3   Identifying Questionable Research Practices w/ Dr. Matthew Tincani Tincani, M., Gilroy, S.P., & Dowdy, A. (2024). Extensions of open science for applied behavior analysis: Preregistration for single-case experimental designs. Journal of Applied Behavior Analysis. doi: 10.1002/jaba.2909 Tincani, M., Travers, J., Dowdy, A., Slocum, T.A.,& Dietrich, R. (2025). Questionable and improved research practices in single-case experimental design: Initial investigation and findings. Perspectives on Behavior Science. doi: 10.1007/s40614-025-00441-9   Professional Collaboration (Special Education Teachers) w/ Carolyn Beaumier Giangreco, M.F., Pennington, R.C., & Walker, V.L. (2023). Conceptualizing and utilizing board certified behavior analysts as related services providers in inclusion-oriented schools. Remedial and Special Education, 44, 73-85. doi: 10.1177/07419325211063610 Squires, M., Cutrer-Pãrraga, E.A., Morris, J.R., Miller, E.E., & Hansen, B.D. (2024). Navigating collaboration: Factors influencing special education teachers' relationships with BCBAs in diverse school contexts. Behavior Analysis in Practice, 17, 1033-1049. doi: 10.1007/s40617-024-010009-w Reilly, A.M., Crowell, G.E., Thoele, J.M. et al. School-Based Transdisciplinary Teaming to Maximize Behavioral Supports. Behav Analysis Practice (2025). doi: 10.1007/s40617-025-01054-z   Predicting and Preventing Mass Shootings w/ Dr. James Meindl Meindl, J.N., Ivy, J.W, Delgado, D.M., & Swafford, L. (under review). Towards a functional account of mass-shooting: Prediction and influence of violent behavior. Meindl, J.N. & Ivy, J.W. (2018). Reducing media-induced mass killings: Lessons from suicide prevention. American Behavioral Scientist, 62, 242-259. doi: 10.1177/0002764218756918

Welcome back to the Inside JABA series—this is Episode 23, and it's a must-listen for anyone interested in using Applied Behavior Analysis (ABA) to improve safety in school settings. In this episode, Dr. Jeannie Donaldson and Gabriela Gomes join Dr. John Borrero and me to discuss the paper, "Effects of differential reinforcement and time-out on the unsafe playground behavior of young children" (note: first author, Elizabeth Linton unfortunately was not able to join us).

In this installment of minisodes, we tackle a common AAC challenge: what happens when professionals don't agree? The BCBA recommends PECS, the SLP suggests a dynamic device… Now what? Welcome to the standard trial of non-collaborative chaos.There are plenty of barriers to AAC collaboration, but also practical steps that can lead to smoother teamwork. The first is building familiarity. AAC can feel overwhelming, but taking time to learn the basics makes collaboration more effective.One key reminder: the device belongs to the student. Everyone on the team should be working toward the same goal—supporting the individual's communication needs across their lifespan.Joint assessment can help, and tools like the free ALP AAC assessment offer a shared starting point. Another useful strategy is to assign a single person to program the device. This reduces confusion and ensures consistency.Most importantly, collaboration keeps families from being caught in the middle. When professionals work together, outcomes improve—for everyone involved.#autism #speechtherapy What's Inside:10-minute summer series.Free Assessment.Collaborating every step from assessment through intervention.Mentioned In This Episode:ALP AAC Assessment AAC course bundle Speech Membership - ABA Speech  ABA Speech: Home

In this episode of the Animal Training Academy podcast, we are honoured to welcome back Chirag Patel - an internationally acclaimed behaviour and training consultant whose innovative work spans species, continents, and disciplines. Chirag is perhaps best known for creating the Bucket Game and for his deep commitment to ethical, science-based, cooperative care. During this rich and thoughtful conversation, Chirag and host Ryan Cartlidge explore the origin story of the Bucket Game, the pivotal influence of Susan Friedman and other mentors, and the process of bringing empowerment and agency to animals through training. Chirag offers a rare behind-the-scenes look at the reflective practices that fuel his creativity and the radical behavioural lens through which he navigates the world. Listeners are treated to discussions on maintaining innovation across a long career, embracing the individuality of each learner (human and non-human alike), the role of functional assessments in behavioural design, and the deeply personal journey of adopting behaviour analysis as a worldview. What You'll Discover in This Episode:

#369>  Sponsored by the Men's Division of Sara Schenirer.They will help you figure out your yeshiva credits, financial aid, and help you choose a degree program that leads to a successful career.They offer degrees in Accounting, Business, ABA, Psychology, Health Science, Pre-Med, Paralegal, Special Education, and Social Work. All degrees are offered through their prestigious partner colleges and their student support is first-rate.Applications are open now for the fall semester. Visit their website https://shorturl.at/YXy7i, call 917-209-8204, or email rpelberg@sarasch.com to connect with a helpful advisor today.> To purchase, " Promised Land: Jewish Patriots, the American Revolution, and the Birth of Religious Freedom": https://amzn.to/44wQ6NP> To join the SeforimChatter WhatsApp community: https://chat.whatsapp.com/DZ3C2CjUeD9AGJvXeEODtK> To join the SeforimChatter WhatsApp status: https://wa.me/message/TI343XQHHMHPN1>  To support the podcast or to sponsor an episode follow this link: https://seforimchatter.com/support-seforimchatter/or email seforimchatter@gmail.com (Zelle/QP this email address)Support the show

In this episode, we chat about Bryce's summer adventures including Special Olympics Bowling, hiking and gem-mining in the mountains, and a tour of the FPL nuclear simulator.  We also update the listeners about Bryce's sessions for Cognitive Behavior Therapy. He has been asking for us to find someone to help him with his worries. We are very pleased with how well he has responded to the tools/advice that he has been given during his first two sessions.   Sandy's cancer update is encouraging. She just had her surgery to remove her chemo port and closed that chapter of her journey. It's important to share how life continues in this new season of our autism journey. We know we are not the only parents who have had a health crisis or other unexpected personal change that has impacted their parenting. We continue to trust the Lord and His plan for us as we take one day at a time. You can reach out directly to us if you want to purchase a signed edition of our book, "PARENTING AUTISM: The Early Years." We have several Author copies available.  Bryce is a funny, mechanical, HAPPY little guy who was diagnosed with autism at age two and is now eleven years old. His pure joy makes this world a much better place!We are humbled and honored to follow our calling and be Autism Ambassadors while helping others understand our world a little more than they did before listening to the podcast. We also feel called to bring light to a community that has experienced dark days after the "diagnosis". (Luke 1:79) You can follow us on our Parenting Autism YouTube Channel (Parenting Autism Show) and our Facebook & Instagram pages to see stories, pictures, and videos of our autism journey. You can also contact us through Facebook, Instagram, or by email: parentingautism@att.net.NOTE: Most of our Social Media content is on our YouTube channel @parentingautismpodcastSupport the show

Applied Behavior Analysis is often boxed into narrow stereotypes—and controversy—but what if the real story is far bigger, more collaborative, and more humanistic than you think? Join Dr. Jessica Kendorski and Ray Christner for a candid conversation that busts myths, clarifies what ABA truly is (and isn't), and explores how behavior science radically transforms not only the lives of neurodivergent kids, but entire systems—from families to schools and healthcare. They dive into the ethical essentials, why collaboration and creativity matter more than compliance, and how principles of behavioral science intersect with trauma-informed, neuroaffirming, and systems-based practice. Whether you're a longtime clinician or new to ABA, this episode brings practical, immediate takeaways you can use—and a fresh perspective on building better outcomes for your clients, your practice, and yourself.To hear more and stay up to date with Paul Wagner, MS, LPC and Ray Christner, Psy.D., NCSP, ABPP visit our website at: http://www.psychedtopractice.com Please follow the link below to access all of our hosting sites. https://www.buzzsprout.com/2007098/share “Be well, and stay psyched” #mentalhealth #podcast #psychology #psychedtopractice #counseling #socialwork #MentalHealthAwareness #ClinicalPractice #mentalhealth #podcast

Thumbnail designer:https://instagram.com/design33_mk?igshid=MzRlODBiNWFlZA==Pratite nas na društvenim mrežama!Instagramhttps://www.instagram.com/jaomile_podcast/Facebook https://www.facebook.com/JAOMILEPODCASTTikTokhttps://www.tiktok.com/@jaomile_podcastTwitter https://twitter.com/mileilic00:00:00 Intro00:02:00 Koji mi problem imamo00:23:00 Razlika Kina i Srbija00:27:00 Dejan Tomašević00:38:30 Plejmekeri00:54:00 Dule Vujošević00:55:30 Mega i mladi igrači01:00:00 Titule u mlađim kategorijama01:11:00 NBA u Evropi i Kini01:21:50 KLS01:24:00 Petrušev01:26:10 Evroliga01:33:00 ABA liga01:35:00 Nikola Jokić01:47:00 Savetovanje/ Darko Rajaković01:49:00 Trenerska Karijera01:57:00 Najveći talenti02:01:00 Najbolji trenutak naše košarke02:03:30 Šta je košarka donela u životu02:13:00 Savet za mlade02:14:00 Najbolja petorka koju je treniraoGost: Mile ProtićDatum: 2025. Autor i domaćin: Mile IlićLokacija: Studio na kraju UniverzumaProdukcija: Infinity Lighthouse#jaomilepodcast #draganlabovic #swishfindyourway #djokovic #crvenazvezda #kkpartizan #findyourway #nba  #nikolajokic #abaliga #jokic #bogdanovic #euroleague #doncic #nikolatopic

Marko Šćekić, bivski kosarkas Borca iz BL, Vojvodine, Kantua, Varezea, Buducnosti trenutno obavlja vunkciju prvog trenera Borca BL i novi je gost Jao Mile podcast-a.PRIRODNO I KLINIČKI ISPITANO! https://naturatherapy.rs/Thumbnail designer:https://instagram.com/design33_mk?igshid=MzRlODBiNWFlZA==Pratite nas na društvenim mrežama!Instagramhttps://www.instagram.com/jaomile_podcast/Facebook https://www.facebook.com/JAOMILEPODCASTTikTokhttps://www.tiktok.com/@jaomile_podcastTwitter https://twitter.com/mileilic00:00:00 Intro00:02:40 Trenutno stanje u Borcu00:06:30 ABA 2 Format00:13:30 Prvenstvo BiH00:20:00 Početak i uzori00:31:15 Borac u Saporta kupu00:40:00 Trenerski posao i čelenži00:46:40 Vojvodina i Univerzijada00:59:00 Poljska01:02:50 Nemačka01:13:00 Podgorica/ Budućnost01:21:30 Italija01:36:30 Pauza iHelios01:40:40 Kraj karijere 01:47:00 Najteži protivnik01:50:40 Najveći talenat01:55:20 Savet za mlade01:56:00 Prva petorka saigrača02:00:00 OdjavaGost: Marko ŠćekićDatum: 18.jun2025. Autor i domaćin: Mile IlićLokacija: Studio na kraju UniverzumaProdukcija: Infinity Lighthouse#jaomilepodcast #markoscekic #swishfindyourway #djokovic #crvenazvezda #kkpartizan #findyourway #nba  #nikolajokic #abaliga #jokic #bogdanovic #euroleague #doncic #nikolatopic

In Episode 2 of our thought leadership podcast series, the Deep Think, ALPS COO and long-time attorney well-being advocate Chris Newbold sits down with ALPS Director of Strategic Partnerships Rio Lane to discuss the surprising and heartening results of our solo well-being survey and trends report. — Rio Laine:  Hey, everyone. I'm Rio Laine with ALPS Insurance, and welcome to the ALPS In Brief Podcast. Today, we'll be talking to ALPS COO Chris Newbold about wellness and ALPS's new Solo Attorney Wellness Trends Report. Hi, Chris. Thanks for joining me today.  Chris Newbold:  Hey, thanks, Rio. Thanks for having me.  Rio Laine:  Yeah. Absolutely. So I would like to start with maybe giving you a chance to introduce yourself to our audience, a little bit about who you are and what you do at ALPS.  Chris Newbold:  Yeah. I'm Chris Newbold. I'm the chief operating officer of ALPS, and one of my great passions, I think, in terms of giving back to the profession has been thinking about the notion of attorney wellness. And not just attorney wellness, but well-being in law more broadly, and that's given me the opportunity to really think about how the legal profession is structured, what people are looking for, where they may perhaps were missing the mark, and then thinking about the systemic reasons why.  I think a lot of lawyers today are struggling in terms of their selection of a profession in which they're not necessarily finding the professional satisfaction that they may have sought when they went into law school.  Rio Laine:  Yeah. Absolutely. And, I mean, I think, as we all know, the concept of wellness and taking care of yourself as a lawyer is relatively new. Up until recently, there was a lot of stigma around that. So it's excellent that we actually get a chance to talk about that and are starting to see good work and traction as far as that's concerned.  Chris Newbold:  Yeah. And the movement, the attorney well-being movement is almost about 10 years old now in terms of a groundbreaking report coming out that stimulated a lot of thought in legal circles around where is this profession, where does it need to go, and then thinking strategically about that.  And again, I've been really fortunate to be at the epicenter of a lot of those conversations in terms of convening groups, convening stakeholders, thinking about research and other things that we can do to kind of document where is the profession and where does it need to go so that we're attracting more people into the profession and not seeing more people exit the profession.  Rio Laine:  Mm-hmm. Yeah. Absolutely. And so, speaking of groundbreaking reports, we're going to be talking about ALPS's Solo Attorney Wellness Trends Report, which you have really spearheaded an effort in gathering important data and information about wellness as it relates to solo attorneys. So before we dive into that, I'd like to kind of explore your history in the wellness space. And now, you've been a proponent for well-being in law, and you've done a lot of work with the Institute for Well-Being in Law for some time now. So tell me how you got here and why this is something that really resonates with you.  Chris Newbold:  Yeah. Thinking back on my experiences, one of the things that we were really looking to do is to understand... I went to a small law school with 75 students, and everybody was very excited, I think, about going to law school. Yet, now that I'm out of law school for more than 20 years, the number of folks who have actually reflected and said, "I really am proud of my decision, and I've really enjoyed practicing law," a lot lower than I think that you would obviously think. And so, I think there was an expectations gap between what people thought versus the reality.  And I think one of the things that... Again, I started to lean in on the subject, wrote part of the section for the groundbreaking report, spent three years as the co-chair of the National Task Force on Lawyer Well-Being, and then we parlayed that into creating the Institute for Well-Being in Law, which is something that is really kind of the preeminent think tank in the lawyer well-being space. And so, that organization continues to work to elevate the nature of discussion in legal circles about where this particular issue sits and where we need to go.  Rio Laine:  Right. And just for our audience at home, the kind of initial report that you're referring to was produced by the ABA.  Chris Newbold:  It was actually not.  Rio Laine:  Oh, wow.  Chris Newbold:  It was actually produced by a consortium of groups that were really interested in it. It was the Path to Well-Being in Law, and it provided a number of different recommendations for where the legal profession had needed to go, from the judiciary to lawyer assistance programs, to law firms, to a whole, again, consortium of groups. ABA was part of that, but not necessarily it being kind of an ABA report in and of itself.  Rio Laine:  Got it. Okay. Okay. Excellent. So in terms of attorney wellness, how do you see that kind of impacting not just individuals, but the broader profession?  Chris Newbold:  Yeah. I think you said it well earlier, which is, to be a good lawyer, one has to be a healthy lawyer. And when you have healthy lawyers serving their clients, you're generally going to get better legal services, better results. The notion of what lawyers do is solve problems affecting conflicts within society. And when lawyers aren't well, when they're overstressed, when they're overburdened, when they're burnt out, when they're subject to substance abuse, you can kind of see, when they're not at their best, it's hard to deliver legal services in a way that allows the profession to function well and its ability to serve society well.  So I think there's a real notion that to be a good lawyer, one has to be a healthy lawyer, and that notion, I think, is carrying over to why law firms and bar associations are so interested in the issue, because if we're all unhealthy, then we're not able to ultimately serve what we're here to do, which is to serve the interest of clients.  Rio Laine:  Yeah. Absolutely. That makes a lot of sense. And, I mean, I know we've kind of had this conversation off podcast earlier, but yeah, there is definitely a lot to be said for taking care of yourself so that you can do the best work possible and giving yourself that time. And I know that's something that has been typically very difficult for lawyers. There's been a lot of stigma around mental health and well-being. And so, it's nice to see that that is starting to be something that is a major focus. Well, not starting. Has been for a while, but is really coming to the forefront of people's consciousness.  Chris Newbold:  Yeah. And it's a tough issue, because you have to think about the nature of the profession itself. Right? We're structured in an adversarial system with people pitting one against the other. And so, there's natural conflict. And when you have conflict, a lot of times, that brings a lot of stress and pressure, and you have a lot of Type A personalities that are very motivated and trying to be vigorous advocates on behalf of their clients.  And so, you think about the profession, the personalities, and the task at hand, and you get the perfect storm of why well-being can sometimes be ignored, and I think a lot of us are focused on trying to bring a little bit of that focus back and ultimately create an environment in which people feel a genuine sense of professional satisfaction being a lawyer, which I think that, unfortunately, we're probably not as high on that standard as we need to be.  Rio Laine:  Right. Well, hopefully, we can get there, and I think this report is definitely helping to pave the way for that. So tell me a little bit about what inspired you and ALPS to conduct this research and this survey and to really dig into not just attorney wellness, but solo-specific wellness.  Chris Newbold:  Yeah. I think that we were really thinking internally. Obviously, ALPS itself has an interest in serving the solo community. That's one of the reasons that we exist. But I think more holistically, the notion of the solo practitioner, there's a lot of them out there. Right? 49% of private practitioners are solo practitioners. And when you look at the research in the well-being space, most of it is, there is really no definitive report, like ALPS just produced, that actually gets at this particular demographic.  Yes, there's issues on substance abuse and on stress and hardships and so forth, and kind of broader surveys that look at the totality of the profession, but with the solos being such a big part of the community, to not have any specific research on solos was a real void. ALPS wanted to step in and fill that void.  Rio Laine:  Yeah. Absolutely. And it makes sense. It absolutely makes sense. I think solos tend to be overlooked in a lot of different respects, which is, it's nice to see that we're spending the time to give them the resources and information they need to move forward.  Chris Newbold:  That's right.  Rio Laine:  So do you want to tell me a little bit about how our survey participants were selected for that?  Chris Newbold:  Yeah. The survey participants were ALPS policyholders. One of the great things about ALPS is we have a national geographic footprint. And so, our ability to know that we were able to enlist and invite a large group of solo practitioners into the survey itself ultimately ended up with approximately 300 respondents, which is certainly a scientifically solid sample size to be able to execute on a survey of this magnitude. And so, responses from around the country, primarily all being from the ALPS policyholder base.  Rio Laine:  Got it. So going into this survey, were there any kind of maybe trends or results that you thought were going to happen but maybe came up different or were surprising, or anything that surprised you in the data analysis?  Chris Newbold:  Yeah. Again, I would say that most of the research that's been produced on well-being in law has generally cast what I would call kind of a glaring reality of how hard things are.  Rio Laine:  Yeah.  Chris Newbold:  When you think about things like depression and suicide and substance abuse, I mean, it generally is going to naturally come out in what I would call a negative perspective of the reality of what's affecting lawyers. One of the things that was really kind of cool and, I think, enlightening about the report was the number of professionally satisfied and happy lawyers we saw kind of saying, "I really like what I do." And I think there's something to be said as you kind of think about why lawyers do what they do and what professional setting they put themselves in.  I think there's a lot to learn from these solo results that may give a pathway for people who are looking for things like flexibility and general greater professional satisfaction. And so, I was pleasantly surprised at how much of our community ultimately came back and said, "I'm proud to be a solo, and I really enjoy what comes along with being a solo, including what it does for my personal wellness."  Rio Laine:  Yeah. Yeah. Absolutely. And so, speaking of being satisfied, I think 74% of the respondents said that they were either satisfied or very satisfied with their careers. So how do you interpret that result considering the broader legal profession stress data that's out there?  Chris Newbold:  Yeah. I mean, again, just think of the numbers.  Rio Laine:  Yeah.  Chris Newbold:  Three out of four said that they're very satisfied or somewhat satisfied being a solo practitioner. My sense is that the higher that you go up the law firm size hierarchy, the lower that number ultimately gets.  Rio Laine:  Yeah.  Chris Newbold:  Right? And I can't definitively point to specific numbers on that. But when you think about notions of the billable hour, the expectations, how guilty folks feel for taking a vacation, how much they ignore their own personal well-being when it comes to physical activity and exercise and diet and all of those things, again, there are lots of lawyers who are thriving in all manners of the spectrum, but I would pose to you that finding three out of four in the solo space is going to be the highest that you're going to see of any grouping in private practice.  Rio Laine:  Yeah. Absolutely. And I think it's pretty common at larger law firms. There's a lack of flexibility in your schedule, a lack of bandwidth and time for yourself. But it's interesting, because conversely, solos in our survey cited flexibility as the top benefit to being a solo attorney. So can you tell us what are some other ways or some ways that solos are experiencing flexibility in their practice?  Chris Newbold:  Yeah. Again, I think a lot of it comes back to work-life balance. Right? Their ability to be able to call the shots, dictate and control their schedule. When you're in a multimember firm, particularly the larger firm that you get, there's a lot of expectations, that you're in the office, that you're in the office until your senior partner leaves the office.  I mean, there's just kind of built-in notions, and I think what our solo community is finding is that ability to be able to chart your own journey. If you've got a kids' choir concert that you want to go to, that you can go to that without feeling guilty, because you can ultimately manage the schedule in a manner that fits what you want. You can think about the caseload that you take on. Right?  Rio Laine:  Right.  Chris Newbold:  You don't have 1,800-, 2,100-hour billing requirements. You're going to build and construct a professional journey and a professional life that suits who you are, what you need. And for a lot of people, that's not necessarily compensation-oriented. It can be around family. It can be around the types of customers that you ultimately want to take on. You have the ability to say, "I'll take that customer, but not that customer." Right? I think there's a lot of notion of autonomy and ability to set the direction of where you want your professional life to go, and I think that that's pretty exciting for folks that we found in the survey.  Rio Laine:  Yeah. Absolutely. And do you think that's something that a lot of people who are considering going off on their own and becoming solos would even think about that is an option for them? I mean, do you think that flexibility is something that they would even be like, "Oh, yeah. Actually, that is an opportunity"?  Chris Newbold:  Yeah. I think it's absolutely calculated, and I think the reason that we know that is, oftentimes, people who become solos have started their career in a different capacity.  Rio Laine:  Yeah.  Chris Newbold:  So they have reflected upon what they like and what they don't like, and ultimately are making a decision that may fit better the lifestyle that they want to ultimately live, and it's really interesting, I think. As we think about coming out of the pandemic, I think there was this notion of a great reassessment of, "Where am I at in my life? What do I want?" And a lot of, I think, lawyers...  I have a tendency to believe that there are more lawyers coming into the small firm space, because they want more of that autonomy. They've learned, again, some of the pressures and some of the stigmas and other things that they haven't found particularly appealing. And so, more folks, I think, are naturally kind of gravitating to taking control of that and then focusing on the things that they want to prioritize in life, both personally and professionally.  Rio Laine:  Yeah. Yeah. Absolutely, which is a pretty empowering thing to be able to have that influence over your own kind of career and, for lack of a better term, your destiny.  Chris Newbold:  But I should also say it's scary.  Rio Laine:  Yes.  Chris Newbold:  Right? There's a lot of risk in that value proposition, because there's... And we know that among solos, it's among the more transient of populations, and not everybody can go out and hang up a shingle and do that. But again, I think the ones that are really kind of thoughtful about, "I've been in practice for 10 years. I'm looking for this." Generally, when they make that decision, I think that they are finding that it's the right decision for them, but it does take some conviction and some courage, frankly, to kind of take a bet on yourself. But I think that those who are doing it are finding that the rewards of taking that risk are outpacing the risks of failure and otherwise.  Rio Laine:  Yeah. Absolutely. And along the same vein, I mean, something that I thought was really interesting about this survey and that I think would also be a risk is the risk of being lonely.  Chris Newbold:  Yeah.  Rio Laine:  I mean, particularly if you're going from a larger firm and you've got lots of coworkers and support staff, other folks around. So I would assume that a lot of solo lawyers would have said, "Yes, I experience a lot of loneliness." But interestingly enough, most respondents in the survey said that they actually don't experience much loneliness. And so, I'm really curious to know, why do you think that is? I mean-  Chris Newbold:  Yeah. I think a lot of it has to do with the stage of career that some of those solos may be in. Right? If you had to hang up your shingle right out of law school and you didn't have a good connection base within the legal community already, I think that would be difficult. Right?  Rio Laine:  Yes.  Chris Newbold:  But if you've been out 15 years, you've met people. You've litigated cases against other people. You've referred cases or had cases referred to you. And so, your network of people that you know, you know other solos.  Rio Laine:  Yeah.  Chris Newbold:  You can reach out to other solos, go grab a cup of coffee, and then I think they're also garnering support from their families and their spouses and other entities. It does get a little bit challenging when you don't have that person down the office that you can knock on the door and say, "I'm struggling with this particular set of facts or circumstances or this relationship." But that's where, I think, there's a real opportunity for other organized bars to step into that void, thinking about state bars, local bars, because I think there's a real opportunity for them to add value to the solo legal community because of some of those loneliness elements.  But I think, again, the report would tell you that a lot of these folks are pretty well-grounded and have their priorities in line. And so, whether it's, again, exercising and doing the things that make you naturally healthy, I think they have existing networks and professional relationships, and then I think they're making good lifestyle choices.  Rio Laine:  Yeah. So what's some advice then that you would offer to someone who say, "I wanted to be a solo right out of law school"? I mean, obviously, they're going to need to be intentional about building that network.  Chris Newbold:  Yeah. Meet people.  Rio Laine:  Yeah. Yeah.  Chris Newbold:  Go to local bar meetings. Introduce yourself. Talk about who you are. Seek advice.  Rio Laine:  Yeah.  Chris Newbold:  Right? I think one of the great things that you can do in life when you don't know a whole lot is ask other people who've been doing it a long time. Right? And that notion of being able to seek advice. You'd be surprised by seeking the advice of others, how much natural stuff comes back to you in terms of other referrals down the road.  Rio Laine:  Yeah.  Chris Newbold:  So, again, get out there, network, shake some hands. I know a lot of folks like to just hunker down in an office in this day and age. I think that's the wrong move if you're going out there and trying to build a firm from scratch. I think you got to get out there, tell people what you're doing, invite people to coffee, seek that advice, and I think you'll set yourself up for success.  Rio Laine:  Yeah. That's fantastic. And I think I would also add to that, I mean, don't be shy, and it's okay to not know the answer to something. You're not born knowing everything, and there's definitely another professional out there who has probably asked themselves the same question or handled the same issue.  Chris Newbold:  Yeah. And on a representation side of things, you can actually also ask them to be a co-counsel on the case. You can share cases. If it's above what you've done or the sophistication level, you can refer to them. You can participate in watching how that all goes.  Rio Laine:  Yeah.  Chris Newbold:  But again, it's that notion of being a lifelong learner and understanding how you can benefit by watching others and seeking the counsel of others.  Rio Laine:  Yeah. Yeah. So let's kind of shift our focus a little now to the topic of burnout. Now, this is something that is very common amongst attorneys, and 44% of our respondents said that they had experienced occupational burnout at some point, but also, though, they reported high levels of satisfaction, as we discussed earlier. So how do you reconcile those two things? I mean, you've experienced burnout, but you're also very satisfied. How do we get there?  Chris Newbold:  Yeah. Representing clients and knowing that you have the livelihood of others depending upon your ability to get to solutions? Stressful.  Rio Laine:  Yes.  Chris Newbold:  Right?  Rio Laine:  Yeah.  Chris Newbold:  It's just stressful work. Being a lawyer can be stressful. You think about appearing in front of a judge, conducting a deposition, drafting a complex transaction. There's a lot that can be riding. Sometimes millions of dollars can be riding on your crafting the right type of a transactional document. And so, I think the notion of burnout is, I would also kind of put it in this way, that you're going to see peaks and valleys in terms of law practice.  Sometimes you're all in on a trial, and then you kind of crash, and then everything kind of level sets, and sometimes it's not as busy. Right? And so, again, I think, as with most professions, there are going to be fluctuations in the level of stress and anxiety that's created by the workload, and that's where I think some of the coping techniques of how are you dealing with that at those times of burnout becomes so important for you to not go further down that hole, but to kind of maintain a healthy equilibrium that allows you to be your best professional self.  Rio Laine:  Yeah. Yeah. Absolutely. And I think that really kind of ties back to the notion of flexibility too. If you're finding that your workload is such that you cannot, it's just overwhelming, and it can't be manageable, then there's an opportunity to maybe pull back and reassess and adjust.  Chris Newbold:  But you got to be really self-reflective, I think, to be able to do that, because I do think one of probably the great stressors of a solo practitioner would be taking on too much than you can handle.  Rio Laine:  Right.  Chris Newbold:  Right? Obviously from a malpractice perspective of caution that, because again, one of the great benefits is you don't have to take on all clients. Again, at some point in your career, you're going to have to take on clients because you need the revenue to be able to do that, but the notion of really being thoughtful about your caseload and what's the right amount of caseload relative to what you can handle, you got to be self-reflective of being able to judge that well.  Rio Laine:  Mm-hmm. Yeah. And I think our survey respondents were definitely reflective, because they did cite workload as kind of the top stressor. So I think aside from self-reflection and being aware of your workload, technology is probably also a good option to help.  Chris Newbold:  Yeah.  Rio Laine:  What are some ways that technology could maybe support with some of those administrative tasks, those things that contribute to a heightened workload?  Chris Newbold:  Yeah. I think one of the realities of solo practitioners is sometimes what they really love doing is lawyering, and not necessarily running the business.  Rio Laine:  Right.  Chris Newbold:  Right? And the reality is, when you open up a solo practice, you are also running a business. And I think we're fortunate that we're picking up more and more tailwind of technology being an important asset that allows lawyers to do what they love and to rely on technology for the administration of the firm itself, and that's also reducing the cost of entry into the solo space. There used to be a time where you had to go hire a full-time paralegal to be part of your staff as well.  But if you could take out a 60 to $80,000 expense reliance of technology, we haven't even talked about artificial intelligence yet and some of the kind of cautious optimism that technology and AI may be, again, allowing more people to do what they love most, which is lawyering, and doing what they least love about lawyering, and pushing that toward artificial intelligence and the leveraging of technology and case management systems that I think continue to get better and better and better, which allows... Those used to be the domains for larger firms, that they always had all the riches of technology. Now you see almost the democratization of technology coming into the small space, which opens up more opportunity for more people to come into the space.  Rio Laine:  Mm-hmm. Absolutely. And more opportunity for flexibility in your practice-  Chris Newbold:  That's right.  Rio Laine:  ... and structuring your time. Yeah.  Chris Newbold:  That's right. And efficiency.  Rio Laine:  Yes. Yeah.  Chris Newbold:  Right? And collecting on your billable hours as opposed to writing those off. Again, when you think about the law practice management systems, they're getting better and better at tracking what are you billing, what are you not billing, what are the causation elements of that, and really feeling like technology is reducing the barriers inherent in people wanting to pursue these types of solo practitioner careers.  Rio Laine:  Mm-hmm. And speaking of folks moving towards the solo space, and you have a theory that people are kind of, in larger, larger numbers, leaving big law and shifting into solo practice. So what do you think is driving that migration?  Chris Newbold:  I would say two things. Again, I think the pandemic was an important kind of demarcation point for a lot of lawyers to say, "What am I doing? Am I genuinely happy or professionally satisfied in practicing law?" And for those who answered negatively, I think that they've thought about, "Maybe I should take my career in a different direction."  Rio Laine:  Yeah.  Chris Newbold:  And so, I think one path to do that would be thinking about a solo practice career. The second is, again, that seeking of flexibility and work-life balance. More and more of us are thinking about considerations like family, parenting time, spouse time, vacation time, and living a well-rounded life where, historically, for a lot of lawyers, being a lawyer was being a lawyer 24/7.  Rio Laine:  Yeah.  Chris Newbold:  Right? And that came with a lot of consequence, I think, to relationships and so forth. And so, when people, again, think about... I think one of the real interesting elements is the generational realities of what law students are now coming out and saying and what questions they're asking in their interviews as they think about where do they want to go to work, and they're asking about, "Tell me about the wellness commitment of this firm in terms of me being a well-rounded person." That didn't used to be the case. Right?  Rio Laine:  Yeah.  Chris Newbold:  And so, they are thinking about things like flexibility, and that may come. Many firms pay large dollar amounts to associates to come into that firm, but I think that's becoming more and more of a, "Is that exactly what I want? Am I chasing compensation, or am I chasing quality of life?" Most people would want both. So I think that there is a right balance, and I'm not saying it's one versus the other, but I think that there is some real thoughtfulness coming generationally and societally as to, "I only have certain amount of hours in the day. Where do I want those hours to go?" And they're tending toward maybe that being a little bit less work in favor of a more well-rounded work-life balance.  Rio Laine:  Right. And it's interesting, because that is definitely reflected in the survey. I mean, solos tend to be much more proactive about their physical health, about their sleep schedules, taking regular breaks, et cetera, and that's certainly not the case as far as the broader legal community goes. So other than, say, generational kind of considerations, why do you think solos tend to be much more proactive when taking care of their health?  Chris Newbold:  Well, again, I think they have a keener sense of probably who they are and what they're looking for. Again, they probably have experienced some things that have caused them to migrate to wanting to do something different. And when you know yourself, when you know where you are, when you're at your best, there is a tendency for you to then run to that direction.  Rio Laine:  Yeah.  Chris Newbold:  Right? And again, the only thing that I think has held a lot of people back is, well, a couple things. One, it's pretty scary to be able to do that. The other part of it, frankly, and this is a totally different podcast, frankly, is the realities of law student debt and how many people feel boxed into a career that they generally don't love, because they have to pay law school debts that had them come out of law school with over $100,000 of debt, and they don't feel like they can take that bet on themselves, because they're nervous about the obligations they have in terms of law school debt repayment.  So that's creating what I would call financial anxiety. That does affect the well-being of a lawyer, because when you feel like you're, in essence, doing a law job because you have to service a debt obligation and maybe even doing something that's in an area of practice that you would have been like, "I would have never thought I would be doing this in law. This is not why I went to law school," and some of those realities, I think, are really real for folks who are engaged in law, but in spots where they don't feel like they really want to be for that reason.  Rio Laine:  That makes a lot of sense. Aside from solos kind of having that experience where maybe they kind of had a moment of realization where they were like, "Oh, I need to actually prioritize my well-being," something that I found really interesting and surprising was that only 22% of respondents actually sought mental health treatment despite having experienced high stress. So I'm curious, I mean, what kind of barriers still exist to that, and what are the reasons maybe that someone would be hesitant to kind of seek that support?  Chris Newbold:  My hunch, first of all, is that number is probably even underreported on the survey itself.  Rio Laine:  Right.  Chris Newbold:  Right? A lot of people, I think, are still grappling with... I think one of the things that's been really awesome in society is a willingness for people to talk about their mental health challenges. When you see instances like Simone Biles in the Olympics, that normalizes the reality of people saying, "It's okay to have mental health struggles, and it's okay to seek help." But I will still say, in legal circles, that ability to raise your hand and say, "I need help," is still kind of generally frowned upon as weakness.  Rio Laine:  Yeah.  Chris Newbold:  Right? And so, that notion of overcoming that and saying, just as when we are dealing with physical ailments, we go to a physical therapist.  Rio Laine:  Yes.  Chris Newbold:  Right? When you're dealing with mental challenges, going and seeking the support of somebody who's trained in that particular area is really a sign of strength. And I think that those numbers over time, generationally, societally, and within the legal sector itself, I think that they will continue to increase.  But we also have a lot of lawyers who think pretty fondly of their ability to be their own problem-solver, and they just kind of naturally kind of say, "I got this," even though sometimes... And a lot of times, there's probably a strong support group around them as well who are probably helping them through some of those issues. So I think it's probably underreported a little bit. It's happening more than you think, but there's still a stigma out there.  Rio Laine:  Right. Absolutely. And do you think that bar associations and legal insurers could maybe be doing more to address that stigma and to break down those barriers and to support solos in reporting and saying, when they do need help, to reach out?  Chris Newbold:  I do. I do. I think the ability for bar associations in specifically to be able to normalize asking for help as being okay, I think, is a real opportunity for them to kind of take the bully pulpit as a voice of the profession and be able to do that. We go to a lot of annual meetings, as you know, at ALPS, and that ability, when you have a wellness panel, to have two or three people who are there to share their stories about challenges, about resilience, about some of the things that they did when they were at their low point, that normalizes behavior for everybody else, and you'd be surprised at how many people walk up to them afterwards and say, "Thank you for sharing your story," because they are struggling as well. And again, that notion of normalizing.  And then I think bar associations, more broadly, they have that ability to, I think, build community, particularly in the solo... When you're in a multimember firm, you have a natural community. When you're a solo, I think bar associations have a real opportunity to become a community-oriented builder of a section or a space for people to come together and share common challenges or common pursuits.  And it doesn't even have to be law-related, frankly. I think that there's innovative ways for bar associations to be able to do that, but I think there's a real opportunity for us as legal insurers who care about solos and bar associations to, in essence, work in partnership to be able to greater provide the support infrastructure for these individuals to thrive in their practice.  Rio Laine:  Yeah. Absolutely. And, I mean, I think I would also question, I mean, do you think there's a connection between mental health and frequency of claims from a malpractice standpoint? If you're struggling, you think it's more likely that you'll have a claim?  Chris Newbold:  Absolutely.  Rio Laine:  Yeah.  Chris Newbold:  Yeah. I mean, because when you begin a spiral, when you move into a depressed mode, when the stress and anxiety is too much, you're not in your game.  Rio Laine:  Yeah.  Chris Newbold:  Right? When you're not on your game, you miss the statute of limitations. You don't do a conflict check. You don't do some of the things that healthy lawyers are naturally doing. And again, that's when you turn to substance abuse, self-medication, and other things. And we have seen in our own claims files, just when things start to spiral downward, the likelihood of a claim is going to shoot upward.  Rio Laine:  Got it. Yup. That makes sense. Makes sense. So stepping back a little bit from, say, mental health support, I mean, do you believe that the profession as a whole is doing enough to support solos?  Chris Newbold:  Yeah. I mean, I think I have said this publicly that I think that the well-being movement in general is focused on a lot of great things, but one of the things that needs more attention is the solo community. Now, you could argue that the results of our survey may indicate that they may not need as much help as other portions of the legal community.  But again, I think that there are notions of a lot of people out there practicing law, perhaps on the lonely scale, workload, burnout, and stress because of the nature of the job, who have a greater, not likelihood, but propensity to find themselves in a struggling spot more quickly without infrastructure support underneath them or a safety net.  And so, I think, again, state bars are thinking about that more and more. But again, I'm cautiously optimistic that with technology, with greater discussion, with reduced stigmatization on a variety of these types of issues, that you will start to see, hopefully, these numbers continue to kind of go in a positive direction, because I think, again, when you set the baseline for the profession, it's generally a negative story. I think this is an indication of where our profession can go if we take some of what people are looking for and embrace that from a flexibility and work-life balance perspective.  Rio Laine:  Yeah. So based on the findings and the somewhat surprising findings of the reports, what is some advice that you would offer to someone considering solo practice?  Chris Newbold:  Yeah. Do your research. Talk to folks who are already engaged in it. Understand the challenges before you decide to take that jump. Again, there are fewer and fewer barriers that I think are natural impediments for people wanting to take that jump, but know what they are. Be aware of what they are. Try to mitigate those, and then go out and find more community within your network.  And I think, again, I'm optimistic in this particular space that people will find what they're looking for and generally reflect on their legal career and say, "Moving into becoming a solo practitioner was the best thing I ever did."  Rio Laine:  Yeah.  Chris Newbold:  And we hear that story time and time again. We heard it in the anecdotal comments in the survey, that people are genuinely finding their groove as opposed to leaving the profession, which is a net brain drain, and we need more lawyers to fill that. Staying in the profession allows the profession to grow. As the profession grows, you can meet more and more of society's needs from a problem-solving perspective, and we know that there are a lot of needs out there that generally go unmet.  Rio Laine:  Yeah. Absolutely. Well, that's fantastic advice. So just to kind of wrap it up, I'm curious to know, what are some trends that you think that we'll see over the next five years? So if we were to do this survey again in five years, do you think there's anything that would continue? Do you think there's new things that would emerge? What are your thoughts?  Chris Newbold:  Yeah. I think the circumstances are right. Societally, we're talking about mental health more. Generationally, folks are being raised in a way in which they're paying more attention to those types of things. And with technology coming, artificial intelligence coming, I think that I'm excited about the prospects for people who want to pursue a solo career, having the means, the willingness, and the courage to naturally kind of go in that direction.  Is it going to work out for everybody? No. Right? But how much will you learn about yourself knowing that you have this great, valuable law degree that your passion is helping people, and then you can do that in a way that doesn't have you bill your time necessarily in eight-minute increments and feel like you're giving up a lot of the things that I think a lot of lawyers struggle with?  And generally, my greatest fear is that people go to law school and ultimately find that they regret the decision that they made. I speak in front of a lot of annual bar meetings. There could be 500 people in the room. I'll ask a very simple question, "If your son or daughter came to you and said, 'Should I go to law school?' would you advise for them to go?" And generally speaking, less than half of the room will raise their hand, and that's a shame.  Rio Laine:  That is a shame.  Chris Newbold:  That indicates that there are systemic issues that people are sitting there going, "I regret the decision that I made." And I am optimistic that through this discussion, through these types of reports and the findings, that we can find a better way for people to thrive and really enjoy being a private practitioner in the legal profession.  Rio Laine:  Awesome. Well, I really hope that that is the case, because, I mean, we need all the lawyers we can get, really.  Chris Newbold:  Yeah.  Rio Laine:  Definitely.  Chris Newbold:  And one of the things, again, what happens with lawyers who are unhappy is they do generally leave the profession. The numbers are pretty staggering. The number of women lawyers who have left the profession, even though they make up more than half the law school classes. Right? Again, you talk about issues of flexibility, acceptance, inclusivity. There are some real devastating impacts on the profession's ability to serve the legal needs of the country when we haven't set up the construct for people to thrive.  And so, I'm most excited about how do we identify those, address those, and then create an environment in which professional satisfaction is where people generally sit there and say, "I'm really proud of being a lawyer, and I don't regret being a lawyer. I'm actually proud to be in this space and the work that I can do to help other people."  Rio Laine:  Yeah. Proud and satisfied.  Chris Newbold:  That's right.  Rio Laine:  That's what we're going for. Great. Well, thanks so much for taking time to sit down with me and talk about the survey and the trends report, Chris.  Chris Newbold:  Thanks, Rio.  Rio Laine:  Really appreciate it. It's always great to hear your insights.  Chris Newbold:  It was fun.  Rio Laine:  Yeah. Thank you so much.  Chris Newbold:  All right.  Rio Laine:  So thank you so much, everybody, for joining us. We'll see you next time on the ALPS In Brief Podcast.   

ABA's new online platform to provide members with free access to the Treasury Check Verification System is now live. On a special joint episode of the ABA Banking Journal Podcast and ABA Fraudcast — presented by Intrafi's Banking with Interest podcast — ABA anti-fraud experts Paul Benda and Hannah Ibberson discuss the platform and how banks can put it to use. Among other topics, Benda and Ibberson discuss: The scale of physical U.S. Treasury checks and why they remained a potential vector for fraud How and why ABA developed the platform How ABA member bank employees — including frontline staff — can access the portal to verify a payee Ways this new platform fits into ABA's overall anti-fraud initiatives Click here to download the episode if you can't see the player above. Access the TCVS portal (ABA bank members only)

In this insightful episode of ABA On Call, Rick Kubina and Doug Kostewicz tackle some of the most commonly misunderstood and misapplied concepts in Applied Behavior Analysis. From the mislabeling of reinforcement to the confusion between negative reinforcement and punishment, the hosts explore why technical accuracy matters and how misunderstanding core terms can derail effective practice. Using real-world stories, data interpretation, and even a behavioral lightning round, the episode clarifies foundational concepts like prompting, fluency, task analysis, motivation, and generalization. Whether you're a student, a supervisor, or a seasoned BCBA, you'll walk away with a deeper appreciation for precision in both language and application.   To earn CEUs for listening, click here, log in or sign up, pay the CEU fee, + take the attendance verification to generate your certificate! Don't forget to subscribe and follow and leave us a rating and review.

As part of the work of a behavior analyst, our ethical code requires us to explain our services in language that can be understood by clients and stakeholders. That holds doubly true when our clients speak a primary language other than English. And just busting out Google Translate isn't going to cut it! In the next entry in our Tutorial series, we break out the “how to” basics behind following best practices when working with an interpreter in delivering ABA services. From meaningful feedback and collaboration with an interpreter to ensuring a respectful flow of communication between all parties, we'll get your practice up to speed in no time. Well, at least in the time it takes to listen to this episode. This episode is available for 1.0 CULTURAL (ETHICS) CEU. Articles discussed this episode: Dowdy, A., Obidimalor, K.C., Tinanci, M., & Travers, J.C. (2021). Delivering culturally sound and high-quality behavior analytic services when working with an interpreter. Behavior Analysis: Research and Practice, 21, 51-64. doi: 10.1037/bar0000206 Vasquez, D.J., Lechago, S.A., & McCarville, M.J. (2024). Training behavior analysis graduate students to work with an interpreter. Behavior Analysis in Practice, 17, 1160-1174. doi: 10.1007/s40617-024-00938-w Hadziabdic, E., Albin, B., Heikkila, K., & Hjelm, K. (2014). Family members' experiences of the use of interpreters in healthcare. Primary Health Care Research and Development, 15, 156-169. doi: 10.1017/S1463423612000680 If you're interested in ordering CEs for listening to this episode, click here to go to the store page. You'll need to enter your name, BCBA #, and the two episode secret code words to complete the purchase. Email us at abainsidetrack@gmail.com for further assistance.

Kelly McMasters is an essayist, professor, mother, and former bookshop owner. She is the author of the Zibby Book Club pick The Leaving Season: A Memoir-in-Essays (WW Norton) and co-editor of the ABA national bestseller Wanting: Women Writing About Desire (Catapult). She is currently an Associate Professor of English and Director of Publishing Studies at Hofstra University in NY.  The Leaving Season: A Memoir, a Zibby Book Club Pick & Good Morning America  May Books Pick Wanting: Women Writing About Desire,  a Library Journal  Best Book of the Year & ABA National Bestseller This Is the Place: Women Writing About Home,  a New York Times  Editors' Choice Welcome to Shirley: A Memoir From an Atomic Town, an Orion  Book Award nominee  

Is your therapist accidentally making your dissociation worse? Why does ketamine - a dissociative drug - keep getting prescribed for dissociative disorders? And what if everything we think we know about treating trauma is backwards? https://gettherapybirmingham.com/understanding-dissociation-trauma-and-addiction-insights-from-adam-obrien-and-the-wounded-healer-institute/ https://youtu.be/6SxxhB10G8U  In this eye-opening episode, trauma specialist Adam O'Brien (founder of the Wounded Healer Institute) reveals why the body IS the psychological unconscious and how dissociation connects directly to our natural opioid and cannabinoid systems. You'll discover: ✓ Why it takes YEARS to diagnose dissociative disorders (and why that's insane) ✓ The hidden link between dissociation and addiction that most therapists miss ✓ How "skilled dissociation" can actually be protective (and when it becomes problematic) ✓ Why Brainspotting accesses preverbal trauma that talk therapy can't touch ✓ The 3 "missing addictions" society rewards: perfectionism, altruism, and ambition ✓ How to work with non-verbal parts of yourself that hold trauma ✓ Why "checking out" actually means you're "checking in" somewhere else ✓ The real reason some therapies (CBT, ABA) might induce dissociation Adam drops truth bombs about: The medical system's resistance to qualitative research Why calling alternative therapies "pseudoscience" is often gaslighting How insurance companies dictate mental health treatment The historical use of psychedelics in healing (and what we lost) Plus: Learn about the Wounded Healer Institute's revolutionary peer-support model that values lived experience alongside professional training. Perfect for: therapists, anyone with complex PTSD/DID, trauma survivors, addiction counselors, and people failed by traditional therapy. ⚠️ Content note: Frank discussion of trauma, dissociation, and mental health system failures. TIMESTAMPS: [00:00] Cold open - "The body is the psychological unconscious" [01:05] The dissociation-addiction connection no one talks about [02:38] What is the Wounded Healer Institute? [06:08] "Your lived experience matters more than their data" [15:27] Preverbal trauma: Why talk therapy isn't enough [19:14] Your body IS your unconscious mind [29:39] Brainspotting: The therapy that changes everything [41:25] Plot twist: Dissociation is checking IN, not out [42:24] The ketamine scandal no one's discussing [44:16] How to talk to parts that don't use words [53:49] Time doesn't exist in trauma (literally) [1:03:24] The addictions we celebrate (that are killing us) [1:06:37] Building the healing community we actually need Guest Bio: Adam O'Brien is a researcher, Brainspotting expert, and founder of the Wounded Healer Institute. Specializing in the transdiagnostic nature of dissociation and addiction, Adam challenges the biomedical model with integrated approaches combining neurofeedback, somatic therapy, and lived experience. Their groundbreaking work reframes dissociation as a navigable healing journey rather than a life sentence. Resources Mentioned: Wounded Healer Institute Brainspotting International QEEG Brain Mapping Progressive Counting Technique Emotional Transformation Therapy (ETT)

Responding with “Where's the research for that?” may be quick, but it can strain professional relationships. Today, we're diving into a simple framework you can start using in your school or clinic—starting tomorrow!So, how do we navigate disagreements when our training and backgrounds differ? The truth is—our way isn't the only way.Consider this quote from the article Maintaining Professional Relationships in an Interdisciplinary Setting: Strategies for Navigating Nonbehavioral Treatment Recommendations for Individuals with Autism:“An interdisciplinary collaboration for individuals with ASD involves combining the strengths of multiple disciplines in order to maximize client outcomes.”As we walk through the decision-making flowchart featured in the article, remember: keep an open mind, take time to understand the treatment in question, and always prioritize the client's outcome and safety.Stay tuned for more of my 10-minute episodes, where I answer the most commonly asked questions.#autism #speechtherapy What's Inside:A simple framework for avoiding conflict in collaboration.The importance of a multidisciplinary approach.10-minute summer series.Mentioned In This Episode:Maintaining Professional Relationships in an Interdisciplinary Setting: Strategies for Navigating Nonbehavioral Treatment Recommendations for Individuals with Autism - PMCJoin Our Ethics Course! Speech Membership - ABA Speech  ABA Speech: Home

Ever wonder how playful moments like peekaboo or a silly song can support meaningful progress in young children with autism? Here, we explore sensory social routines and how the Early Start Denver Model (ESDM) uses them to build engagement, communication, and joint attention through everyday play. These simple, predictable routines can become powerful teaching tools when paired with a child's natural interests.We share what these routines are, why they work, and how we use them to follow a child's lead while embedding teaching moments. From chasing games to puzzle play, we offer real-life examples and practical tips to spark connection, shape behavior, and celebrate small wins at home or in therapy. With the right strategies, even the smallest interactions can lead to big developmental breakthroughs.What's Inside:An overview of the Early Start Denver Model (ESDM)How to use ESDM routines in teachingReal-life examples and practical tips for working with learnersMentioned In This Episode:HowToABA.com/joinHow to ABA on YouTubeFind us on FacebookFollow us on Instagram Play-Based Tip Sheet Episode 106: ABA Assessments  

In this inaugural “Legal Tuesday” edition of The Rainmaking Podcast, Scott Love introduces a new series focused specifically on legal professionals, offering expert insight for lawyers navigating complex transitions. Scott speaks with Hilary Gerzhoy, a seasoned ethics lawyer and thought leader on professional responsibility, who shares valuable guidance on avoiding ethical pitfalls during lateral partner moves. She outlines real-world examples of landmines, such as premature client contact, improper solicitation of team members, and breach of fiduciary duty—each of which can derail a move or trigger legal retaliation. The conversation covers essential considerations for departing lawyers, including how to handle sensitive communications, what firms can legally withhold, and how to protect client relationships ethically. The episode is especially timely for law firm partners considering a move, and serves as a cautionary guide to avoid becoming tomorrow's legal headline. This Tuesday edition of the podcast delivers focused legal guidance, while Thursday episodes will continue serving broader professional services audiences. Visit: https://therainmakingpodcast.com/ YouTube: https://youtu.be/LAtWIzixoeY ----------------------------------------

Come, Joni with me to the cosmos and engage ABA father

Welcome to the ABA Business Leaders News, the go-to show for aspiring and current ABA practice owners who want to keep up to date with the latest happenings in the world of ABA. Every week, your hosts April and Stephen Smith bring you actionable insights, news, and real-world advice to help you navigate the challenges and celebrate the wins of starting and running your own ABA practice.

Tina Sullivan, with the Riverside ABA Therapy Clinic, and Drew Haverstock, with Milestone Therapy, discuss the addition at the Atrium building of the ABA clinic through Riverside Behavioral Health.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

Summary In this episode of the Pain Exam Podcast, Dr. David Rosenblum provides a comprehensive review of herpes zoster and postherpetic neuralgia (PHN), focusing on pathophysiology, diagnosis, and treatment options. Dr. Rosenblum explains that postherpetic neuralgia affects approximately 25% of patients with acute herpes zoster, causing debilitating unilateral chronic pain in one or more dermatomes. He discusses the three phases of herpes zoster: acute (up to 30 days), subacute (up to 3 months), and postherpetic neuralgia (pain continuing beyond 3 months). Dr. Rosenblum identifies risk factors for developing PHN, including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. He details the pathophysiology involving peripheral and central sensitization, and explains different phenotypes of PHN that can guide treatment approaches. For treatment, Dr. Rosenblum reviews various options including antiviral medications (which should be started within 72 hours of onset), corticosteroids, opioids, antidepressants (particularly tricyclics and SNRIs), antiepileptics (gabapentin and pregabalin), topical agents (lidocaine and capsaicin), and interventional procedures such as epidural injections and pulsed radiofrequency. He emphasizes that prevention through vaccination with Shingrix is highly effective, with 97% effectiveness in preventing herpes zoster in patients 50-69 years old and 89% effectiveness in those over 70. Dr. Rosenblum mentions that he's currently treating a patient with trigeminal postherpetic neuralgia and is considering a topical sphenopalatine ganglion block as a minimally invasive intervention before attempting more invasive procedures. Chapters Introduction to the Pain Exam Podcast and Topic Overview Dr. David Rosenblum introduces the Pain Exam Podcast, mentioning that it covers painful disorders, alternative treatments, and practice management. He explains that this episode focuses on herpes zoster and postherpetic neuralgia as board preparation for fellows starting their programs, with ABA boards coming up in September. Dr. Rosenblum notes that he's not only preparing listeners for boards but also seeking the latest information to help treat his own patients with this notoriously difficult disease. Upcoming Conferences and Educational Opportunities Dr. Rosenblum announces several upcoming conferences including Aspen in July, Pain Week in September, and events with NYSIP and the Latin American Pain Society. He mentions he'll be teaching ultrasound and regenerative medicine at these events. Dr. Rosenblum invites listeners to sign up at nrappain.org to access a community discussing regenerative medicine, ultrasound-guided pain medicine, regional anesthesia, and board preparation. He also offers ultrasound training in New York and elsewhere, with upcoming sessions in Manhattan on July 12th and October 4th, plus private shadowing opportunities. Overview of Postherpetic Neuralgia Dr. Rosenblum defines postherpetic neuralgia as typically a unilateral chronic pain in one or more dermatomes after acute herpes zoster infection. He states that the incidence of acute herpes zoster ranges between 3-5 patients per thousand person-years, and one in four patients with acute herpes zoster-related pain will transition into postherpetic neuralgia. Dr. Rosenblum emphasizes that while this condition won't kill patients, it can be extremely debilitating and significantly reduce quality of life. Treatment Options Overview Dr. Rosenblum reviews treatment options according to the WHO pain ladder, including tricyclics like nortriptyline and antiepileptic drugs such as gabapentin. He explains that if pain is not significantly reduced, interventional treatments like epidural injections with local anesthetics and corticosteroids or pulsed radiofrequency of the dorsal root ganglion are options. For postherpetic neuralgia specifically, Dr. Rosenblum notes that preferred treatments include transdermal capsaicin, lidocaine, or oral drugs such as antidepressants or antiepileptics. Phases of Herpes Zoster and Definitions Dr. Rosenblum outlines the three phases during herpes zoster reactivation: acute herpes zoster-related pain (lasting maximum 30 days), subacute herpes zoster-related pain (pain after healing of vesicles but disappearing within 3 months), and postherpetic neuralgia (typically defined as pain continuing after 3 months). He mentions that acute herpes zoster pain often begins with prodromal pain starting a few days before the appearance of the rash. Incidence and Risk Factors Dr. Rosenblum states that the incidence of herpes zoster ranges between 3-5 patients per 1,000 person-years, with approximately 5-30% of cases leading to postherpetic neuralgia. He identifies risk factors including older age, female sex, immunosuppression, prodromal pain, severe rash, and greater acute pain severity. Dr. Rosenblum describes the clinical manifestations as a mosaic of somatosensory symptoms including burning, deep aching pain, tingling, itching, stabbing, often associated with tactile and cold allodynia. Impact on Quality of Life Dr. Rosenblum emphasizes that postherpetic neuralgia can be debilitating, impacting both physical and emotional functioning and causing decreased quality of life. He notes that it leads to fatigue, insomnia, depression, anorexia, anxiety, and emotional distress. Dr. Rosenblum stresses the importance of exploring methods for prevention of postherpetic neuralgia and optimizing pain treatment for both subacute herpes zoster-related pain and postherpetic neuralgia. Literature Review and Pathophysiology Dr. Rosenblum mentions that he's discussing a literature review from 2024 that updates previous practical guidelines published in 2011. He explains the pathophysiology of postherpetic neuralgia, which involves sensitization of peripheral and sensory nerves from damage. Dr. Rosenblum describes how inflammatory mediators reduce the stimulus threshold of nociceptors and increase responsiveness, resulting in pathological spontaneous discharges, lower thresholds for thermal and mechanical stimuli, and hyperalgesia. Central Sensitization and Nerve Damage Dr. Rosenblum explains that central sensitization results from peripheral nociceptor hyperactivity leading to plastic changes in the central nervous system, involving amplification of pain signals and reduced inhibition. He describes how nerve damage in postherpetic neuralgia patients results from neuronal death due to severe inflammatory stimuli or secondary to neuronal swelling. Dr. Rosenblum notes that motor defects occur in 0.05% of patients with herpes zoster, observed as abdominal pseudohernias or motor weakness of limbs limited to the affected myotome. Different Phenotypes and Classification Dr. Rosenblum discusses different phenotypes of postherpetic neuralgia and how phenotyping can determine treatment. He explains that there are several ways to classify the phenotypes, with one categorizing patients into three subtypes: sensory loss (most common), thermal gain, and thermal loss with mechanical gain. Dr. Rosenblum describes the mechanistic categorization, including the irritable nociceptive phenotype characterized by preserved sensation, profound dynamic mechanical allodynia, reduced pressure pain threshold, and relief with local anesthetic infiltration. Deafferentation Phenotype Dr. Rosenblum explains that a deafferentation phenotype may arise from destruction of neurons by the virus in the dorsal root ganglion. This phenotype is characterized by sensory loss, including thermal and vibratory sensation without prominent thermal allodynia. He notes that mechanical allodynia can occur secondary to A-beta fibers activating spinothalamic pathways (known as phenotypic switches), along with pressure hyperalgesia and temporal summation suggesting central sensitization. Dr. Rosenblum mentions that in one study, this phenotype was present in 10.8% of individuals, and for those with deafferentation pain, gabapentinoids, antidepressants, and neuromodulatory therapies like repetitive transcranial magnetic stimulation may be beneficial. Diagnosis and Physical Examination Dr. Rosenblum discusses the diagnosis of herpes zoster and postherpetic neuralgia, emphasizing the importance of physical examination. He explains that diagnosis is based on the rash, redness, papules, and vesicles in the painful dermatomes, with healing vesicles showing crust formation. Dr. Rosenblum notes that the rash is generally unilateral and does not cross the midline of the body. In postherpetic neuralgia patients, he mentions that scarring, hyper or hypopigmentation is often visible, with allodynia present in 45-75% of affected patients. Sensory Testing and Assessment Dr. Rosenblum explains that in patients with postherpetic neuralgia, a mosaic of somatosensory alterations can occur, manifesting as hyperalgesia, allodynia, and sensory loss. These can be quantified by quantitative sensory testing, which assesses somatosensory functions, dermal detection thresholds for perception of cold, warmth, and paradoxical heat sensations. He notes that testing can provide clues regarding underlying mechanisms of pain, impaired conditioned pain modulation, temporal summation suggesting central sensitization, and information about the type of nerve damage and surviving afferent neurons. Prevention Through Vaccination Dr. Rosenblum discusses prevention of acute herpes zoster through vaccination, noting that the risk increases with reduced immunity. He highlights studies evaluating Shingrix, a vaccine for herpes zoster, which showed 97% effectiveness in preventing herpes zoster in patients 50-69 years old with healthy immune systems and 89% effectiveness in patients over 70. Dr. Rosenblum states that Shingrix is 89-91% effective in preventing postherpetic neuralgia development in patients with healthy immune systems and 68-91% effective in those with weakened or underlying conditions. Treatment Objectives Dr. Rosenblum outlines the treatment objectives for herpes zoster and postherpetic neuralgia. For acute herpes zoster, objectives include relieving pain, reducing severity and duration of pain, accelerating recovery of epidermal defects, and preventing secondary infections. For postherpetic neuralgia, the objectives are pain alleviation and improved quality of life. Dr. Rosenblum lists available treatments including psychotherapy, opiates, antidepressants, antiepileptics, NMDA antagonists, topical agents, and interventional treatments such as epidurals, pulsed radiofrequency, nerve blocks, and spinal cord stimulation. Antiviral Medications Dr. Rosenblum emphasizes that antiviral drugs should be started within 72 hours of clinical onset, mentioning famciclovir, valacyclovir, and acyclovir. He notes there is no evidence for effectiveness after 72 hours in patients with uncomplicated herpes zoster. Dr. Rosenblum provides dosing information: for immunocompetent patients, famciclovir 500mg and valacyclovir 1000mg three times daily for seven days; for immunocompromised patients, famciclovir 1000mg three times daily for 10 days, while acyclovir should be given IV in the immunocompromised. Benefits of Antiviral Therapy Dr. Rosenblum explains that antiviral medication accelerates the disappearance of vesicles and crusts, promotes healing of skin lesions, and prevents new lesions from forming. By inhibiting viral replication, he notes that antiviral therapy likely reduces nerve damage, resulting in reduced incidence of postherpetic neuralgia, and should be started as soon as possible. Corticosteroids and Opioids Dr. Rosenblum discusses the use of corticosteroids, noting that when added to antiviral medications, they may reduce the severity of acute herpes zoster-related pain, though increased healing of skin lesions was not observed in one study. He mentions that a Cochrane review found oral corticosteroids ineffective in preventing postherpetic neuralgia. Regarding opioids, Dr. Rosenblum states they are commonly used alongside antivirals for controlling acute herpes zoster pain, with tramadol having a number needed to treat (NNT) of 4.7 and strong opioids having an NNT of 4.3 for 50% pain reduction. Methadone and Antidepressants Dr. Rosenblum discusses methadone as an NMDA receptor antagonist used in acute and chronic pain management, though he notes there are no randomized controlled trials determining its efficacy in acute herpes zoster pain or postherpetic neuralgia. He explains that methadone can modulate pain stimuli by inhibiting the uptake of norepinephrine and serotonin, resulting in decreased development of hyperalgesia and opioid tolerance, but has side effects including constipation, nausea, sedation, and QT prolongation that can trigger torsades de pointes. Dr. Rosenblum identifies antidepressants as first-line therapy for postherpetic neuralgia, including tricyclics and SNRIs, with tricyclics having an NNT of 3 and SNRIs an NNT of 6.4 for 50% pain reduction. Antiepileptics and Pharmacological Treatment Summary Dr. Rosenblum discusses antiepileptics like gabapentin and pregabalin for postherpetic neuralgia. He cites two trials measuring gabapentin's effect, concluding it was effective compared to placebo with a pooled NNT of 4.4, while pregabalin had an NNT of 4.9. Dr. Rosenblum summarizes that pharmacological treatment is well established for subacute herpes zoster pain, though new high-quality evidence has been lacking since the last update in 2011. Topical Agents Dr. Rosenblum discusses local anesthetic topical agents including lidocaine and capsaicin creams and patches. He notes that 8% capsaicin provided significant pain reduction during 2-8 weeks, while 5% lidocaine patches provided moderate pain relief after eight weeks of treatment. Dr. Rosenblum also mentions acute herpes zoster intracutaneous injections, citing a study where single intracutaneous injection with methylprednisolone combined with ropivacaine versus saline alone showed significant difference in VAS score at 1 and 4 weeks post-intervention favoring the intervention group. Intracutaneous Injections Dr. Rosenblum discusses the effect of repetitive intracutaneous injections with ropivacaine and methylprednisolone every 48 hours for one week. He cites a randomized control trial comparing antivirals plus analgesics to antivirals plus analgesics and repeat injections, finding the intervention group had significantly shorter duration of pain, lower VAS scores, and lower incidence of postherpetic neuralgia (6.4% vs 28% at 3 months). Dr. Rosenblum notes that a potential side effect of cutaneous methylprednisolone injection is fat atrophy, though this wasn't reported in the study. Summary of Local Anesthetics Dr. Rosenblum summarizes that there are no new studies reporting the efficacy of capsaicin 8% for postherpetic neuralgia, but it remains widely used in clinical practice and is approved in several countries. He notes that lidocaine patches can reduce pain intensity in patients with postherpetic neuralgia but may be more beneficial in patients with allodynia. Dr. Rosenblum adds that intracutaneous injections may be helpful for short periods, while repetitive injections with local anesthetics may reduce VAS scores for up to six months but can cause subcutaneous fat atrophy. Interventional Treatments: Epidural and Paravertebral Injections Dr. Rosenblum discusses interventional treatments, noting that previous guidelines found epidural injection with corticosteroids and local anesthetic as add-on therapy superior to standard care alone for up to one month in managing acute herpes zoster pain. He mentions a randomized controlled trial showing no difference between interlaminar and transforaminal epidural steroid injections for up to three months after the procedure. Dr. Rosenblum adds that previous guidelines reported high-quality evidence that paravertebral injections of corticosteroids or local anesthetic reduces pain in the active phase of herpes zoster. Comparative Studies on Injection Approaches Dr. Rosenblum discusses a trial comparing efficacy of repetitive paravertebral blocks with ropivacaine versus dexmedetomidine to prevent postherpetic neuralgia, which showed significantly lower incidence of zoster-related pain one month after therapy in the dexmedetomidine group, with effects still significant at three months. He also mentions a study comparing steroid injections administered via interlaminar versus transforaminal approaches, finding both groups had significantly lower VAS scores at 1 and 3 months follow-up compared to baseline, though this could align with the natural course of herpes zoster. Timing of Interventions and Continuous Epidural Blockade Dr. Rosenblum cites a retrospective study showing that transforaminal epidural injections administered for acute herpes zoster-related pain were associated with significantly shorter time to pain relief compared to those performed in the subacute phase. He also mentions a randomized controlled trial finding that continuous epidural blockade combined with opioids and gabapentin reduced NRS pain scores more than analgesic drug treatments alone during three-day follow-up, though both studies were low-quality. Interventions for Postherpetic Neuralgia Dr. Rosenblum discusses interventions specifically for postherpetic neuralgia, citing a small randomized controlled trial that demonstrated decreased NRS pain scores six months post-treatment for repeat versus single epidural steroid injections (15mg vs 5mg dexamethasone) administered over 24 days. The trial also found increased likelihood of complete remission during 6-month follow-up in the group receiving repeat epidural dexamethasone, though this was low-quality evidence. Summary of Epidural and Paravertebral Injections Dr. Rosenblum summarizes that epidural or paravertebral injections of local anesthetic and/or glucocorticoids could be considered in treating acute herpes zoster-related pain. For subacute postherpetic neuralgia pain, he notes low-quality evidence supporting epidural injections, while for postherpetic neuralgia, evidence supports continuous epidural infusion, though also of low quality. Dr. Rosenblum emphasizes that none of the included studies for postherpetic neuralgia investigating epidural or paravertebral injections resulted in decreased pain compared to standard therapy. Pulsed Radiofrequency (PRF) Evidence Dr. Rosenblum discusses pulsed radiofrequency (PRF), noting that previous guidelines indicated moderate quality evidence that PRF of the intercostal nerve reduces pain for 6 months in patients with postherpetic neuralgia, and very low-quality evidence that PRF to the dorsal root ganglion (DRG) reduces pain for 6 months. He mentions that multiple studies have been published since then assessing PRF efficacy. PRF Studies for Acute Herpes Zoster Dr. Rosenblum discusses a randomized controlled trial with 60 patients comparing high-voltage bipolar PRF of the cervical sympathetic chain versus sham, with treatment repeated after three days in both groups. He reports that VAS scores in the PRF group at each post-interventional point (1 day, 2 days, 1 month, 2 months, 3 months) were significantly lower than in the sham group, and at 3 months, the incidence of postherpetic neuralgia was 16.7% in the PRF group compared to 40% in the sham group. PRF for Trigeminal Neuralgia Dr. Rosenblum cites another randomized controlled trial evaluating high-voltage long-duration PRF of the Gasserian ganglion in 96 patients with subacute herpes-related trigeminal neuralgia, which found decreased VAS pain scores at all post-interventional time points (3, 7, 14 days and 1, 3, and 6 months) compared to the sham group. He also mentions a randomized comparative effectiveness study in 120 patients with subacute trigeminal herpes zoster, comparing a single application of high-voltage PRF to the Gasserian ganglion versus three cycles of conventional PRF treatment, finding significantly lower mean VAS pain scores for up to six months in the high-voltage PRF group. PRF Compared to Other Interventions Dr. Rosenblum discusses a randomized controlled trial comparing PRF to short-term spinal cord stimulation, which found decreased pain and improved 36-item short-form health survey scores in both groups at six months. He also mentions a randomized controlled trial in 72 patients where PRF of spinal nerves or peripheral branches of cranial nerves combined with five-day infusion of IV lidocaine resulted in greater pain reduction, less rescue analgesia, and reduced inflammatory cytokines at two months compared to PRF with saline infusions. Dr. Rosenblum notes a major limitation of this study was not accounting for the high natural recovery rate. Summary of PRF and Final Recommendations Dr. Rosenblum summarizes that PRF provides significant pain relief lasting over three months in patients with subacute herpes zoster and postherpetic neuralgia. He notes that since few studies have compared PRF versus sham, it's not possible to calculate an accurate number needed to treat. Dr. Rosenblum mentions there are no comparative studies comparing PRF to the intercostal nerves versus PRF of the DRG, but both preclinical and clinical studies suggest superiority of the DRG approach. He adds that evidence for spinal cord stimulation for postherpetic neuralgia is of low quality, and more research is needed given its invasive nature. Sympathetic Blocks and Conclusion Dr. Rosenblum notes there is low-quality evidence for using sympathetic blocks to treat acute herpes zoster-related pain, but no evidence for their use in postherpetic neuralgia. He mentions that risks of treatment with intrathecal methylprednisolone are unclear and therefore not recommended. Dr. Rosenblum concludes by praising the comprehensive article he's been discussing and mentions it provides insight for treating his patients, including a recent case of trigeminal postherpetic neuralgia. Personal Clinical Approach and Closing Dr. Rosenblum shares that he doesn't currently perform PRF in his practice, partly because it's not standard of care and not well reimbursed, creating barriers to implementation. However, he notes that PRF is a very safe procedure as it doesn't involve burning tissue. For his patient with trigeminal neuralgia pain, Dr. Rosenblum plans to try a topical sphenopalatine ganglion block as the least invasive intervention before considering injecting the trigeminal nerves at the foramen, in addition to pharmacotherapy. He concludes by thanking listeners, encouraging them to check the show notes and links, mentioning institutional memberships and shadowing opportunities, and asking listeners to rate and share the podcast. Q&A No Q&A session in this lecture Pain Management Board Prep   Ultrasound Training REGISTER TODAY!   Create an Account and get Free Access to the PainExam- NRAP Academy Community Highlights     David Rosenblum, MD, currently serves as the Director of Pain Management at Maimonides Medical Center and AABP Integrative Pain Care.  As a member of the Department of Anesthesiology, he is involved in teaching, research, CME activities, and was key faculty in developing the anesthesiology residency's regional anesthesia block rotation, as well as institutional wide acute and chronic pain management protocols to ensure safe and effective pain management. He currently is a managing partner in a multi-physician private pain practice, AABP Integrative Pain Care, located in Brooklyn, NY. He is one of the earliest interventional pain physicians to integrate ultrasound guidance to improve the safety and accuracy of interventional pain procedures.   Awards New York Magazine: Top Doctors: 2016, 2017, 2018, 2021, 2022, 2023, 2024, 2025 Schneps Media: 2015, 2016, 2017, 2019, 2020 Top Doctors New York Metro Area (digital guide): 2016, 2017, 2018, 2019, 2020, 2021, 2022, 2023 2025 Schneps Media - Brooklyn Courier Life: 2021, 2022, 2023   Dr. Rosenblum written several book chapters on Peripheral Neuromodulation, Radiofrequency Ablation, and Pharmacology.  He has published numerous noteworthy articles and most recently is developing the ASIPP Guidelines for Peripheral Neuromodulation in the treatment of chronic pain. He has been named several times in NY Magazine's Best Pain Management Doctor List, Nassau County's Best Pain Physician, has appeared on NY1 News, and has made several appearances on XM Radio's Doctor Talk. He currently is lecturing on a national and international level and has partnered with the American Society of Interventional Pain Physicians (ASIPP), American Society of Pain and Neuroscience (ASPN), IASP Mexican Chapter, Eastern Pain Association (EPA), the North American Neuromodulation Society (NANS), World Academy of Pain Medicine United, as well as various other organizations, to support educational events and develop new courses. Since 2008, he has helped over 3000 physicians pass the Pain Management Boards, and has been at the forefront of utilizing ultrasound guidance to perform pain procedures.  He now hosts the PainExam podcast, AnesthesiaExam Podcast, PMRExam Podcasts and uses this platform to promote the safe and effective use of ultrasound in the performance of various procedures such as Peripheral Nerve Stimulation, Caudal Epidurals, Selective Nerve Root Blocks, Cluneal Nerve Blocks, Ganglion impar Blocks, Stellate Ganglion Blocks, Brachial Plexus Blocks, Joint Injections and much more!   Doctor Rosenblum created the NRAP (Neuromodulation Regional Anesthesia and Pain) Academy  and travels to teach various courses focused on Pain Medicine, Regenerative Medicine, Ultrasound Guided Pain Procedures and Regional Anesthesia Techniques.  Dr. Rosenblum is persistent when it comes to eliminating pain and has gained a reputation among his patients for thinking "outside the box" and implements ultrasound guidance to deposit medications, biologics (PRP, Bone Marrow Aspirate, etc.) and Peripheral Nerve Stimulators near pain generators. He is currently treating patients in his great neck and Brooklyn office.  For an appointment go to AABPpain.com or call Brooklyn     718 436 7246 Reference Adriaansen, E. J., Jacobs, J. G., Vernooij, L. M., van Wijck, A. J., Cohen, S. P., Huygen, F. J., & Rijsdijk, M. (2025). 8. Herpes zoster and post herpetic neuralgia. Pain Practice, 25(1), e13423.

The American Bar Association has sued Donald Trump for his unconstitutional executive orders punishing law firms. Given that multiple judges have already ruled that such executive orders are unconstitutional (rulings that the Trump administration didn't appeal), it seems like the ABA's suit should be a lay-down winner on the merits. The challenge for the ABA may be getting to the merits, as they will first have to prove they have standing to bring the suit.If you're interested in supporting our all-volunteer efforts, you can become a Team Justice patron at: / glennkirschner If you'd like to support Glenn and buy Team Justice and Justice Matters merchandise visit:https://shop.spreadshirt.com/glennkir...Check out Glenn's website at https://glennkirschner.com/Follow Glenn on:Threads: https://www.threads.net/glennkirschner2Facebook: https://www.facebook.com/glennkirschner2Instagram: https://www.instagram.com/glennkirsch...Bluesky: https://bsky.app/profile/glennkirschn...TikTok: https://www.tiktok.com/glennkirschner2See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

It's our 400th, so we're going big with a guest who's called it all, seen it all, and somehow lived to laugh about it. Steve Albert ("A Funny Thing Happened on the Way to the Broadcast Booth") -- Hall of Fame broadcaster and proud member of the legendary Albert sportscasting family (including nephew/Episode 320 guest Kenny) -- joins us for a deep dive into his one-of-a-kind, 45-year ride through the wilds of professional sports. From vanished leagues to unforgettable fights, from Brooklyn bedrooms-turned-broadcast-booths to center stage at Showtime Championship Boxing, Albert's stories are equal parts history and hilarity. In this special milestone episode, we retrace Albert's journey through memorable stops like: The WHA's Cleveland Crusaders, where his broadcast partner was the coach's elbow-needling wife; The MISL's New York Arrows, where goal-scoring was nonstop and whiplash an occupational hazard; The final ABA game ever played, which he and his older brother Al called from opposing sides; 30+ years across the NBA, including 19 seasons with the New York and New Jersey versions of the Nets, and a career-capping, Emmy-winning turn with the Phoenix Suns; Local New York TV sports anchor stints, where juggling 6 o'clock newscasts and rush-hour traffic to call evening games became an art; And, of course, his nearly quarter-century ringside seat with Showtime Championship Boxing -- including the infamous Tyson–Holyfield (II) “Bite Fight” We also talk about growing up in a house where three brothers fought over the mic instead of the remote, how a botched bathroom door nearly derailed a broadcast, and why the strangest moments in sports often happen outside the lines of the game.   + + +    SUPPORT THE SHOW: Buy Us a Coffee: https://ko-fi.com/goodseatsstillavailable "Good Seats" Store: https://www.teepublic.com/stores/good-seats-still-avalable?ref_id=35106 BUY THE BOOK (AND SUPPORT THE SHOW!):    "A Funny Thing Happened on the Way to the Broadcast Booth": https://amzn.to/4negHqc SPONSOR THANKS (AND SUPPORT THE SHOW!): Old School Shirts.com (10% off promo code: GOODSEATS): https://oldschoolshirts.com/goodseats   Royal Retros (10% off promo code: SEATS): https://www.503-sports.com?aff=2 Old Fort Baseball Co. (15% off promo code: GOODSEATS): https://www.oldfortbaseballco.com/?ref=seats Yinzylvania (20% off promo code: GOODSEATSSTILLAVAILABLE): https://yinzylvania.com/GOODSEATSSTILLAVAILABLE   417 Helmets (10% off promo code: GOODSEATS): https://417helmets.com/?wpam_id=3 FIND AND FOLLOW: Linktree: https://linktr.ee/GoodSeatsStillAvailable Web: https://goodseatsstillavailable.com/ Bluesky: https://bsky.app/profile/goodseatsstillavailable.com X/Twitter: https://twitter.com/GoodSeatsStill YouTube: https://www.youtube.com/@goodseatsstillavailable Threads: https://www.threads.net/@goodseatsstillavailable Instagram: https://www.instagram.com/goodseatsstillavailable/ Facebook: https://www.facebook.com/GoodSeatsStillAvailable/ LinkedIn: https://www.linkedin.com/company/good-seats-still-available/

The American Bar Association has sued Donald Trump for his unconstitutional executive orders punishing law firms. Given that multiple judges have already ruled that such executive orders are unconstitutional (rulings that the Trump administration didn't appeal), it seems like the ABA's suit should be a lay-down winner on the merits. The challenge for the ABA may be getting to the merits, as they will first have to prove they have standing to bring the suit.If you're interested in supporting our all-volunteer efforts, you can become a Team Justice patron at: / glennkirschner If you'd like to support Glenn and buy Team Justice and Justice Matters merchandise visit:https://shop.spreadshirt.com/glennkir...Check out Glenn's website at https://glennkirschner.com/Follow Glenn on:Threads: https://www.threads.net/glennkirschner2Facebook: https://www.facebook.com/glennkirschner2Instagram: https://www.instagram.com/glennkirsch...Bluesky: https://bsky.app/profile/glennkirschn...TikTok: https://www.tiktok.com/glennkirschner2See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Want to take your commercial baking business to the next level? Discover how the American Bakers Association fuels growth through advocacy, networking, and industry insights. In this episode of Bake to the Future, Clyde's Donuts President Josh Bickford, and Cain Food CEO Terry McCurry sit down with ABA Senior Director of Membership Ben Simpson and ABA Director of Marketing and Communications Anne Fairfield-Sonn to discuss how ABA membership has empowered their companies to lead, innovate, and thrive in a rapidly evolving environment. With special guests: Josh Bickford, Clyde's Donuts President and Tom McCurry, Cain Food CEO Hosted by: Anne Fairfield-Sonn, ABA Director of Marketing and Communications and Ben Simpson, ABA Senior Director of Membership

This episode features a comprehensive discussion of research examining socially assisted robotics for children with autism. Madeline Jürgensen presents findings from two single-case design studies that investigated whether children with autism would attend to and learn from a small humanoid robot called Kebbi. The first study used a multiple baseline design to measure attending behaviors, revealing dramatic increases in eye contact and engagement when children worked with the robot versus human instructors. The second study employed an adaptive alternating treatment design to compare learning outcomes between robot and human instruction, finding that while children learned academic skills from both modalities, they showed preference for robot-delivered activities despite sometimes performing better with human instruction. The discussion includes important considerations about the novelty effect, social validity, and the future role of robotics in behavior analysis practice.  To earn CEUs for listening, click here, log in or sign up, pay the CEU fee, + take the attendance verification to generate your certificate! Don't forget to subscribe and follow and leave us a rating and review. Show Notes References:   Berens, K. N. (2020). Blind spots: Why students fail and the science that can save them. Oakland, CA: The Collective Book Studio.  Darling, K. (2021). The new breed: What our history with animals reveals about our future with robots. Henry Holt and Company.  Shi, Z., Groechel, T. R., Jain, S., Chima, K., Rudovic, O., & Matarić, M. J. (2022). Toward personalized affect-aware socially assistive robot tutors for long-term interventions with children with autism. Journal of Human-Robot Interaction, 11(4), Article 39. https://doi.org/10.1145/3526111  Resources:   Association for Behavior Analysis International (ABAI): https://www.abainternational.org/  CentralReach Institute: https://centralreach.com/  University of Southern California Robotics and Autonomous Systems Center (RASC): https://rasc.usc.edu/research/    If you would like a copy of the articles discussed please reach out to madeline.jurgensen@centralreach.com

#368>  Sponsored by the Men's Division of Sara Schenirer.They will help you figure out your yeshiva credits, financial aid, and help you choose a degree program that leads to a successful career.They offer degrees in Accounting, Business, ABA, Psychology, Health Science, Pre-Med, Paralegal, Special Education, and Social Work. All degrees are offered through their prestigious partner colleges and their student support is first-rate.Applications are open now for the fall semester. Visit their website www.sarasch.com, call 917-209-8204, or email rpelberg@sarasch.com to connect with a helpful advisor today.>  Sponsored by The Torah of Tomorrow: One Song, a Hebrew-English edition of a selection of Rav Kook's teachings. To purchase, use code CHATTER for 15% off at https://mosaicapress.com/product/the-torah-of-tomorrow/?sld=seforimchatter> To purchase "The Dybbuk: Its Origins and History": https://amzn.to/4e9rKNe> To join the SeforimChatter WhatsApp community: https://chat.whatsapp.com/DZ3C2CjUeD9AGJvXeEODtK> To join the SeforimChatter WhatsApp status: https://wa.me/message/TI343XQHHMHPN1>  To support the podcast or to sponsor an episode follow this link: https://seforimchatter.com/support-seforimchatter/or email seforimchatter@gmail.com (Zelle/QP this email address)Support the show

Send us a textABA on Tap is so proud to spend some time with the illustrious Portia James. (Part 2 of 2)As a visionary, a powerhouse of a leader, and a pioneer for women and people of color in her field, Portia James has been shaking conference room tables for nearly two decades. She shares bold perspectives on the lack of representation for black leadership in the workplace and how it impacts decision-making and strategic execution at the executive level. She is one of few Behavior Analysts to have been featured in both Forbes and Harvard Business Review.Portia is a sought-after Board Certified Behavior Analyst and Organizational Behavior Management specialist who helps black Behavior Analysts launch and scale companies that thrive. As the founder and CEO of Behavior Genius, she has served hundreds of staff and families impacted by Autism.Portia is a wife to an MMA fighter (of course she is!)  and mother of 3 dynamic children, a travel junkie, and a red wine enthusiast. Portia serves up a flight of bold and complex flavors. Sip this one slowly and carefully. Don't forget to swirl, take in the bouquet, and always analyze responsibly. iLearn-ABA --- your CEU source!iLearn-ABA is a learning platform designed by BCBAs, for BCBAs and related professionals. Disclaimer: This post contains affiliate links. If you make a purchase, I may receive a commission at no extra cost to you.Support the show

Get the brand new ReSIStance T-Shirt & Mini Tote at politicon.com/merch Barb McQuade hosts #SistersInLaw to lay out the legal implications of the growing political violence in the country and call upon leaders in both parties to take a strong stand against it.  Then, the #Sisters examine the alarming arrests of Democratic lawmakers and investigate whether their civil rights were violated, weighing what it says about the state of our democracy.  They also discuss the ABA's lawsuit against the Trump administration and explain how it seeks to preserve the independence of the legal system, as well as break down the slew of recent actions by the courts. Add the #Sisters & your other favorite Politicon podcast hosts on Bluesky #SistersInLaw Spin-off Shows Are Here! Check out Jill's New Politicon YouTube Show: Just The Facts Check out Kim's New Politicon Podcast: Justice By Design Register for Barb's 6/3 book talk in New York (with Loretta Lynch!) Get Barb's book, Attack From Within, coming out in paperback! Joyce's new book, Giving Up Is Unforgivable, is now available for pre-order!  Get your #SistersInLaw MERCH at politicon.com/merch WEBSITE & TRANSCRIPT Email: SISTERSINLAW@POLITICON.COM or Thread to @sistersInLaw.podcast Get text updates from #SistersInLaw and Politicon.  Mentioned by the #Sisters Recommended By Jill:  My Daughter Was at the Center of the Supreme Court Case on Trans Care. Our Hearts Are Broken Political Violence Came to Minnesota. It Didn't Start There. Support This Week's Sponsors Mixtiles: Get 35% off on all orders above $139 @Mixtiles with code SIL at https://www.mixtiles.com/SIL #Mixtilespod Wild Grain:  Get $30 off and free croissants in every box when you start your subscription to delicious quick-bake artisanal pastries, pasta, and bread at wildgrain.com/sisters with promo code: SISTERS Calm: Perfect your meditation practice and get better sleep with 40% off a premium subscription when you go to calm.com/sisters Quince: Get 365-day returns and free shipping on high-quality, stylish, and affordable clothing you'll wear for years to come when you go to quince.com/sisters Get More From The #SistersInLaw Joyce Vance: Bluesky | Twitter | University of Alabama Law | MSNBC | Civil Discourse Substack | Author of “Giving Up Is Unforgiveable” Jill Wine-Banks: Bluesky | Twitter | Facebook | Website | Author of The Watergate Girl: My Fight For Truth & Justice Against A Criminal President | Just The Facts YouTube Kimberly Atkins Stohr: Bluesky | Twitter | Boston Globe | WBUR | The Gavel Newsletter | Justice By Design Podcast Barb McQuade: Bluesky | Twitter | University of Michigan Law | Just Security | MSNBC | Attack From Within: How Disinformation Is Sabotaging America

I dalje rasuti po svim meridijanima - od Podrinja do Zlatiborskog okruga i Lajpciga - jedva smo se skupili (na Zoom-u, kao da je opet pandemija, daleko bilo). Prvi deo epizode koja zatvara sezonu 6 posvetili smo (uglavnom) delikantnom momentu u kome se nalazi fudbalski klub. "Samo starci, ranjenici i nejač." 1:17:20 U drugom delu podcasta, Milenko nas je vodio kroz finalnu ABA seriju, a pokušali smo da obradimo i brzu rekapitulaciju sezone. Da li je iko, ikada, bez ubedljivog razloga, ovoliko puta pomenuo Trapani Sharks? Stalne rubrike. I rafal pozdrava za Stefana Čupića. Zoom sastančili: Vili, Gazza, Gogec, Trobi, Paddy + Lemmy Dužina trajanja: REKORDNIH 203 min. (iz dva puta) ---------------------------------- Pokrenuli smo PATREON, pa ko želi sada može da časti za neko pivo, dodatne sadržaje i/ili tehničke popravke na podcastu: www.patreon.com/pfchisterical A ima i opcija za direktne donacije: paypal.me/partizanhisterical ---------------------------------- NOVO!!! HISTI MIX TAPE br. 89 https://youtube.com/playlist?list=PLwhKCZrlUHqgiyO_xm0_KxFlZ7WFqjsSk&si=2x0-MW3R8fHaJqvQ Twitter: www.twitter.com/pfchisterical Instagram: www.instagram.com/pfchisterical/ Youtube: www.youtube.com/c/PartizanHistericalPodcast podcast.rs/show/histerical/ NAPRED PARTIZAN! NAPOMENA: Ovo je "uradi sam" podkast u kome navijači Partizana razgovaraju o zbivanjima u svom voljenom klubu. Izneta mišljenja i stavovi su lični, kafanski, i ne predstavljaju stavove bilo koje navijačke grupe, frakcije, dela uprave, radne ili druge organizacije. Nismo insajderi, eksperti, sportski radnici. Apsolutna vernost, ne apsolutna istina. Trudimo se da jezik koji koristimo bude fin književni - možete ga čuti na svakom stadionu i u svakoj sportskoj hali. Cover foto: Dragana Stjepanović / KK Partizan Majstor zvuka: Eh? Realizacija: Slavko Tatić, gajtan, štap, kanap, Zoom app, The Boss & Histi

Today’s Best of Features: (00:00-16:26) – Austin Croshere returns to the program to discuss last night’s win from his perspective at Gainbridge Fieldhouse, highlights a couple of plays that had the crowd going nuts, agrees with Jake that it was hard to tell when the Pacers really felt like they were at a point to start resting their starters because of how involved the entire roster is in every game, and weighs in on whether this loss could loom in the back of the minds of OKC. (16:26-27:46) – Dr. Dunk, Darnell Hillman, makes an appearance on the program to discuss how winning championships on the road could become a tradition if the Pacers win it all on Sunday. He admits that his favorite player is T.J. McConnell just because of the way he plays the game and embodies being a Hoosier, explains how winning a championship changes your life, and believes that the Pacers will be able to get it done on Sunday because of the way they embody us against the world when they aren’t at Gainbridge Fieldhouse. (27:46-38:15) – The second hour of today’s show wraps up with Rik Smits joining the show to share the thrill he had firing t-shirts to fans last night, illustrates what impresses him the most about this time, notes where he has seen Rick Carlisle grow over the years as a coach, and comments on whether the loss will longer in the minds of Oklahoma City in game seven after the way they were beat down last night. (38:15-53:48) – Former Indiana Pacer, Bob Netolicky, joins the program and shares what Slick Leonard told his team’s during the ABA years when they were winning championships because he sees the same thing with this collection of players. Additionally, he reveals what happened to some of the things from his bar after it closed and comments on how the Pacers need to treat the game on Sunday with them being on the road in their final game of the year. Support the show: https://1075thefan.com/query-and-company/See omnystudio.com/listener for privacy information.

(00:00-24:10) – Query & Company opens on a Friday with Jake Query sharing his thoughts on the game six win for the Pacers over the Thunder. He takes you through the environment inside Gainbridge Fieldhouse. (24:10-36:46) – Mark Montieth joins Jake Query to continue celebrating Indiana’s dominating win last night over Oklahoma City. They discuss the history of some of the iconic moments and games in Pacers history coming away from their home arena. Jake and Mark also debate on how large of a crowd could be attendance for a parade if Indiana is able to defeat OKC on Sunday night. (36:46-42:57) – The first hour of the program concludes with Jake and Eddie crediting all the people that helped Tyrese Haliburton get healthy enough to play in game six last night and for the work they will put in with him to have him ready for game seven. (42:57-1:06:06) – Austin Croshere returns to the program to discuss last night’s win from his perspective at Gainbridge Fieldhouse, highlights a couple of plays that had the crowd going nuts, agrees with Jake that it was hard to tell when the Pacers really felt like they were at a point to start resting their starters because of how involved the entire roster is in every game, and weighs in on whether this loss could loom in the back of the minds of OKC. (1:06:06-1:17:35) – Dr. Dunk, Darnell Hillman, makes an appearance on the program to discuss how winning championships on the road could become a tradition if the Pacers win it all on Sunday. He admits that his favorite player is T.J. McConnell just because of the way he plays the game and embodies being a Hoosier, explains how winning a championship changes your life, and believes that the Pacers will be able to get it done on Sunday because of the way they embody us against the world when they aren’t at Gainbridge Fieldhouse. (1:17:35-1:28:09) – The second hour of today’s show wraps up with Rik Smits joining the show to share the thrill he had firing t-shirts to fans last night, illustrates what impresses him the most about this time, notes where he has seen Rick Carlisle grow over the years as a coach, and comments on whether the loss will longer in the minds of Oklahoma City in game seven after the way they were beat down last night. (1:28:09-1:49:40) – Former Indiana Pacer, Bob Netolicky, joins the program and shares what Slick Leonard told his team’s during the ABA years when they were winning championships because he sees the same thing with this collection of players. Additionally, he reveals what happened to some of the things from his bar after it closed and comments on how the Pacers need to treat the game on Sunday with them being on the road in their final game of the year. (1:49:40-2:01:33) – Every Friday is a Good For The Heart Friday brought to you by Franciscan Health! Today, Jake is joined by Dr. Alicia Topoll to discuss how you can improve your heart health. (2:01:33-2:05:55) – Today’s show closes out with Jake and Eddie sharing some final thoughts on game six of the NBA Finals and previewing game seven!Support the show: https://1075thefan.com/query-and-company/See omnystudio.com/listener for privacy information.

This week, John and Elliot discuss key outcomes from the June FATF Plenary, OFAC enforcement actions, the DOJ's evolving stance on white collar crime, the ABA's lawsuit challenging executive orders targeting law firms, a request for comment from the US bank regulators on payment and check fraud, and other issues affecting the financial crime prevention community.

In this insightful episode, we talk with Nicole Stewart, BCBA, about her personal and professional journey supporting gifted children with ADHD and Autism. Nicole shares how raising her own neurodivergent child shaped the innovative, non-traditional work she does today. We explore why traditional talk therapy often misses the mark, how she uses creative tools to build emotional regulation and working memory, and why giving families a shared language is so transformative. Nicole also explains how she weaves principles from ACT and ABA into her sessions—without sticking rigidly to either—and offers powerful advice for parents just starting out on this path. If you're looking for a fresh, honest perspective on supporting neurodivergent kids, this conversation is not to be missed.

Kaelynn Partlow is an autism advocate and author, and one of the stars of the Netflix series, Love on the Spectrum. Today she joins Emily to talk about her experiences with autism, and they cover a lot of ground in this conversation. They discuss the evolution and effectiveness of ABA therapy, the need for accurate labeling, and using declarative language in communication. They also offer advice for parents of newly diagnosed children, and talk about the importance of finding community. TAKEAWAYS The world will label children if parents don't. The superpower label is a double-edged sword. Nuance is often lost in discussions about autism. Profound autism requires specific understanding and advocacy. Declarative language can reduce pressure in communication. Specific questions help autistic individuals engage better. Finding community is essential for parents of autistic children. Have Emily come and speak to your school district, company, or organization. Here's where you can find out more and get in touch. Kaelynn Partlow is an autism advocate, speaker, and author widely recognized for her appearance on the Netflix series Love on the Spectrum. Through her impactful social media presence, she promotes meaningful inclusion and practical support, reaching millions with her message of autism acceptance and understanding. Kaelynn is the author of Life on the Bridge, a book that offers both personal and professional insights to foster deeper connection between autistic and non-autistic people. Since joining Project Hope in 2015 as a Registered Behavior Technician, she has led therapy sessions, developed staff training materials, and shared her expertise nationally to support more informed and compassionate autism care. BACKGROUND READING Kaelynn's LinkTree links

There may be two sides of the IEP table, but at the end of the day, we're all on the same team — the learner's.I had the pleasure of chatting with Ryan Hogan, also known as @TheWorldsOkayestSchoolPsych, the creator behind the popular, lighthearted school psych meme account on Instagram.We talked about the intersection of ABA, special education, and school-based work in the social media space. Ryan shared some great insights, especially the reminder that you control your own online space. Protect your peace: block people, delete comments. Thoughtful questions and concerns deserve a response; negativity for its own sake does not.As both a school psychologist and an autism parent, Ryan brings a unique and deeply personal perspective to the IEP table. He knows firsthand what it feels like to be both the professional and the parent — and how overwhelming it can be. Sometimes, parents need not just data and research, but connection, empathy, and that parent-to-parent understanding.It was a meaningful and insightful conversation — one that reminds us that compassion and collaboration go a long way (and so does a joke!).#autism #speechtherapy What's Inside:Navigating Negativity on Social MediaWhat it's like to be a parent AND a professionalA perspective from both sides of the IEP tableMentioned In This Episode:(@worldsokayestschoolpsych) on InstagramSpeech Membership - ABA Speech  ABA Speech: Home

Play is a fundamental part of childhood, so what happens when a child struggles to engage in it? In this episode, we explore the many forms play can take, why it's essential for development, and how to support learners who find it challenging.We break down what "play" really means (beyond just pretend scenarios) and include everything from sports and games to musical instruments and picture books. We talk about common barriers to play, such as social challenges, sensory sensitivities, and limited interests, and how to meet kids where they are by shaping existing interests into meaningful, engaging activities.You'll hear practical strategies for teaching and supporting play: using visual models, offering choices, setting up structured yet flexible play environments, and carefully selecting peers for playdates. We also discuss the value of parallel play and when to pivot from play to leisure skills—emphasizing that enjoyment and engagement are what matter most.What's Inside:What is play? Identifying common barriers that make play challenging for some children.Strategies for supporting and shaping meaningful play experiences.Pivoting from play skills to leisure skills for lifelong enjoyment.Mentioned In This Episode:HowToABA.com/joinHow to ABA on YouTubeFind us on FacebookFollow us on Instagram An Early Start for Your Child with Autism: Using Everyday Activities to Help Kids Connect, Communicate, and Learn

GOOD EVENING: The show begins in LA, where Colleague John Yoo comments that POTUS has law and SCOTUS authority for deploying National Guard and Marines and more. 1863 DRAFT RIOT NYC CBS EYE ON THE WORLD WITH JOHN BATCHELOR FIRST HOUR 9:00-9:15 LA: POTUS and SCOTUS determinative authority. John Yoo, Civitas Institute. 9:15-9:30 SCOTUS: And the ABA. John Yoo, Civitas Institute. 9:30-9:45 Turkey: Erdogan's Syria project. Sinan Ciddi, FDD. 9:45-10:00 Turkey: The Kremlin model. SECOND HOUR 10:00-10:15 Iran: Suspect nuclear weapons program. Andrea Stricker, FDD. 10:15-10:30 Iran: Suspect nuclear weapons program. Andrea Stricker, FDD. 10:30-10:45 Africa: ISIS in Uganda and Congo. Caleb Weiss, Bill Roggio, FDD. 10:45-11:00 Africa: ISIS in Uganda and Congo. Caleb Weiss, Bill Roggio, FDD. THIRD HOUR 11:00-11:15 PRC: Needs a trade deal. Andrew Collier, @gordongchang, Gatestone, Newsweek, The Hill. 11:15-11:30 USAF: What about drone attacks? General Blaine Holt USAF (Ret.), @gordongchang, Gatestone, Newsweek, The Hill. 11:30-11:45 CCP: Xi Jinping in eclipse. Charles Burton, @gordongchang, Gatestone, Newsweek, The Hill. 11:45-12:00 Biowar: Smugglers from the PRC. Brandon Weichert, @gordongchang, Gatestone, Newsweek, The Hill. FOURTH HOUR 12:00-12:15 #France: Plum tree ripens. Simon Constable, Occitanie. 12:15-12:30 POTUS: Hoover signed Smoot-Hawley June 1930. 12:30-12:45 POTUS: Space regulations arrive. Bob Zimmerman behindtheblack.com. 12:45-1:00 AM Big Astronomy: Colliding galaxy clusters. Bob Zimmerman behindtheblack.com.

The Pacers take a pivotal game 3 last night in this arena... they are now only TWO games away from their first NBA title... remember, they do have ABA titles in their franchise history! Kevin Durant's potential landing spots have seemingly narrowed but we can always dream, right?! Big Perk gives us HIS dream landing spots for KD. I caught up with two of heroes from last night just moments ago, hear what TJ McConnell and Pascal Siakam are saying about being two wins away. What adjustments NEED to be made for OKC in a must-win game 4 tomorrow night? Learn more about your ad choices. Visit podcastchoices.com/adchoices

Chinese Student Visas and Espionage Concerns The Trump administration's decision to revoke visas of Chinese students suspected of ties to the Chinese Communist Party. Broader concerns about intellectual property theft and espionage by China. Discussion of Confucius Institutes and legislation led by Cruz to defund them. Transgender Athletes and Women’s Sports California's policy shift to protect biological girls in track and field competitions. Broader debate on transgender participation in women’s sports. Cruz’s campaign strategy focusing on this issue and its resonance with moderate voters, especially women. Tribute to Phil Robertson Reflections on the life and legacy of Phil Robertson of Duck Dynasty, who recently passed away. Personal anecdotes from Cruz about hunting with Robertson and his support during the 2016 presidential campaign. Emphasis on Robertson’s faith, authenticity, and cultural impact. American Bar Association (ABA) and Judicial Nominations The Trump administration's move to strip the ABA of its special role in vetting judicial nominees. Criticism of the ABA as a biased, left-leaning organization. Examples of perceived ABA bias against conservative nominees and support for unqualified liberal ones. Please Hit Subscribe to this podcast Right Now. Also Please Subscribe to the 47 Morning Update with Ben Ferguson and the Ben Ferguson Show Podcast Wherever You get You're Podcasts. Thanks for Listening #seanhannity #hannity #marklevin #levin #charliekirk #megynkelly #tucker #tuckercarlson #glennbeck #benshapiro #shapiro #trump #sexton #bucksexton#rushlimbaugh #limbaugh #whitehouse #senate #congress #thehouse #democrats#republicans #conservative #senator #congressman #congressmen #congresswoman #capitol #president #vicepresident #POTUS #presidentoftheunitedstatesofamerica#SCOTUS #Supremecourt #DonaldTrump #PresidentDonaldTrump #DT #TedCruz #Benferguson #Verdict #justicecorrupted #UnwokeHowtoDefeatCulturalMarxisminAmericaYouTube: https://www.youtube.com/@VerdictwithTedCruzSee omnystudio.com/listener for privacy information.