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Dr. Diwakar Davar and Dr. Jason Luke discuss novel agents in melanoma and other promising new data in the field of immunotherapy that were presented at the 2025 ASCO Annual Meeting. TRANSCRIPT Dr. Diwakar Davar: Hello. My name is Diwakar Davar, and I am welcoming you to the ASCO Daily News Podcast. I'm an associate professor of medicine and the clinical director of the Melanoma and Skin Cancer Program at the University of Pittsburgh's Hillman Cancer Center. Today, I'm joined by my colleague and good friend, Dr. Jason Luke. Dr. Luke is a professor of medicine. He is also the associate director of clinical research and the director of the Phase 1 IDDC Program at the University of Pittsburgh's Hillman Cancer Center. He and I are going to be discussing some key advancements in melanoma and skin cancers that were presented at the 2025 ASCO Annual Meeting. Our full disclosures are available in the transcript of this episode.  Jason, it is great to have you back on the podcast. Dr. Jason Luke: Thanks again so much for the opportunity, and I'm really looking forward to it. Dr. Diwakar Davar: Perfect. So we will go ahead and start talking a little bit about a couple of key abstracts in both the drug development immunotherapy space and the melanoma space. The first couple of abstracts, the first two, will cover melanoma. So, the first is LBA9500, which was essentially the primary results of RELATIVITY-098. RELATIVITY-098 was a phase 3 trial that compared nivolumab plus relatlimab in a fixed-dose combination against nivolumab alone for the adjuvant treatment of resected high-risk disease. Jason, do you want to maybe give us a brief context of what this is? Dr. Jason Luke: Yeah, it's great, thanks. So as almost all listeners, of course, will be aware, the use of anti–PD-1 immunotherapies really revolutionized melanoma oncology over the last 10 to 15 years. And it has become a standard of care in the adjuvant setting as well. But to review, in patients with stage III melanoma, treatment can be targeted towards BRAF with BRAF and MEK combination therapy, where that's relevant, or anti–PD-1 with nivolumab or pembrolizumab are a standard of care. And more recently, we've had the development of neoadjuvant approaches for palpable stage III disease. And in that space, if patients present, based on two different studies, either pembrolizumab or nivolumab plus ipilimumab can be given prior to surgery for somewhere in the 6- to 9-week range. And so all of these therapies have improved time-to-event endpoints, such as relapse-free or event-free survival. It's worth noting, however, that despite those advances, we've had a couple different trials now that have actually failed in this adjuvant setting, most high profile being the CheckMate-915 study, which looked at nivolumab plus ipilimumab and unfortunately was a negative study. So, with RELATIVITY-047, which was the trial of nivolumab plus relatlimab that showed an improvement in progression-free survival for metastatic disease, there's a lot of interest, and we've been awaiting these data for a long time for RELATIVITY-098, which, of course, is this adjuvant trial of LAG-3 blockade with relatlimab plus nivolumab. Dr. Diwakar Davar: Great. So with that, let's briefly discuss the trial design and the results. So this was a randomized, phase 3, blinded study, so double-blinded, so neither the investigators knew what the patients were getting, nor did the patients know what they were getting. The treatment investigational arm was nivolumab plus relatlimab in the fixed-dose combination. So that's the nivolumab standard fixed dose with relatlimab that was FDA approved in RELATIVITY-047. And the control arm was nivolumab by itself. The duration of treatment was 1 year. The patient population consisted of resected high-risk stage III or IV patients. The primary endpoint was investigator-assessed RFS. Stage and geography were the standard stratifying factors, and they were included, and most of the criteria were balanced across both arms. What we know at this point is that the 2-year RFS rate was 64% and 62% in the nivolumab and nivolumab-combination arms, respectively. The 2-year DMFS rate was similarly equivalent: 76% with nivolumab monotherapy, 73% with the combination. And similar to what you had talked about with CheckMate 915, unfortunately, the addition of LAG-3 did not appear to improve the RFS or DMFS compared to control in this patient population. So, tell us a little bit about your take on this and what do you think might be the reasons why this trial was negative? Dr. Jason Luke: It's really unfortunate that we have this negative phase 3 trial. There had been a lot of hope that the combination of nivolumab with relatlimab would be a better tolerated combination that increased the efficacy. So in the metastatic setting, we do have 047, the study that demonstrated nivolumab plus relatlimab, but now we have this negative trial in the adjuvant setting. And so as to why exactly, I think is a complicated scenario. You know, when we look at the hazard ratios for relapse-free survival, the primary endpoint, as well as the secondary endpoints for distant metastasis-free survival, we see that the hazard ratio is approximately 1. So there's basically no difference. And that really suggests that relatlimab in this setting had no impact whatsoever on therapeutic outcomes in terms of efficacy. Now, it's worth noting that there was a biomarker subanalysis that was presented in conjunction with these data that looked at some immunophenotyping, both from circulating T cells, CD8 T cells, as well as from the tumor microenvironment from patients who were treated, both in the previous metastatic trial, the RELATIVITY-047 study, and now in this adjuvant study in the RELATIVITY-098 study. And to briefly summarize those, what was identified was that T cells in advanced melanoma seemed to have higher expression levels of LAG-3 relative to T cells that are circulating in patients that are in the adjuvant setting. In addition to that, there was a suggestion that the magnitude of increase is greater in the advanced setting versus adjuvant. And the overall summary of this is that the suggested rationale for why this was a negative trial may have been that the target of LAG-3 is not expressed as highly in the adjuvant setting as it is in the metastatic setting. And so while the data that were presented, I think, support this kind of an idea, I am a little bit cautious that this is actually the reason for why the trial was negative, however. I would say we're not really sure yet as to why the trial was negative, but the fact that the hazard ratios for the major endpoints were essentially 1 suggests that there was no impact whatsoever from relatlimab. And this really makes one wonder whether or not building on anti–PD-1 in the adjuvant setting is feasible because anti–PD-1 works so well. You would think that even if the levels of LAG-3 expression were slightly different, you would have seen a trend in one direction or another by adding a second drug, relatlimab, in this scenario. So overall, I think it's an unfortunate circumstance that the trial is negative. Clearly there's going to be no role for relatlimab in the adjuvant setting. I think this really makes one wonder about the utility of LAG-3 blockade and how powerful it really can be. I think it's probably worth pointing out there's another adjuvant trial ongoing now of a different PD-1 and LAG-3 combination, and that's cemiplimab plus fianlimab, a LAG-3 antibody that's being dosed from another trial sponsor at a much higher dose, and perhaps that may make some level of difference. But certainly, these are unfortunate results that will not advance the field beyond where we were at already. Dr. Diwakar Davar: And to your point about third-generation checkpoint factors that were negative, I guess it's probably worth noting that a trial that you were involved with, KeyVibe-010, that evaluated the PD-1 TIGIT co-formulation of vibostolimab, MK-4280A, was also, unfortunately, similarly negative. So, to your point, it's not clear that all these third-generation receptors are necessarily going to have the same impact in the adjuvant setting, even if they, you know, for example, like TIGIT, and they sometimes may not even have an effect at all in the advanced cancer setting. So, we'll see what the HARMONY phase 3 trial, that's the Regeneron cemiplimab/fianlimab versus pembrolizumab control with cemiplimab with fianlimab at two different doses, we'll see how that reads out. But certainly, as you've said, LAG-3 does not, unfortunately, appear to have an impact in the adjuvant setting. So let's move on to LBA9501. This is the primary analysis of EORTC-2139-MG or the Columbus-AD trial. This was a randomized trial of encorafenib and binimetinib, which we will abbreviate as enco-bini going forward, compared to placebo in high-risk stage II setting in melanoma in patients with BRAF V600E or K mutant disease. So Jason, you know, you happen to know one or two things about the resected stage II setting, so maybe contextualize the stage II setting for us based on the trials that you've led, KEYNOTE-716, as well as CheckMate-76K, set us up to talk about Columbus-AD. Dr. Jason Luke: Thanks for that introduction, and certainly stage II disease has been something I've worked a lot on. The rationale for that has been that building off of the activity of anti–PD-1 in metastatic melanoma and then seeing the activity in stage III, like we just talked about, it was a curious circumstance that dating back about 7 to 8 years ago, there was no availability to use anti–PD-1 for high-risk stage II patients, even though the risk of recurrence and death from melanoma in the context of stage IIB and IIC melanoma is in fact similar or actually higher than in stage IIIA or IIIB, where anti–PD-1 was approved. And in that context, a couple of different trials that you alluded to, the Keynote-716 study that I led, as well as the CheckMate 76K trial, evaluated pembrolizumab and nivolumab, respectively, showing an improvement in relapse-free and distant metastasis-free survival, and both of those agents have subsequently been approved for use in the adjuvant setting by the US FDA as well as the European Medicines Agency.  So bringing then to this abstract, throughout melanoma oncology, we've seen that the impact of anti–PD-1 immunotherapy versus BRAF and MEK-targeted therapy have had very similar outcomes on a sort of comparison basis, both in frontline metastatic and then in adjuvant setting. So it was a totally reasonable question to ask: Could we use adjuvant BRAF and MEK inhibitor therapy? And I think all of us expected the answer would be yes. As we get into the discussion of the trial, I think the unfortunate circumstance was that the timing of this clinical trial being delayed somewhat, unfortunately, made it very difficult to accrue the trial, and so we're going to have to try to read through the tea leaves sort of, based on only a partially complete data set. Dr. Diwakar Davar: So, in terms of the results, they wanted to enroll 815 patients, they only enrolled 110. The RFS and DMFS were marginally improved in the treatment arm but certainly not significantly, which is not surprising because the trial had only accrued 16% to 18% of its complete accrual. As such, we really can't abstract from the stage III COMBI-AD data to stage II patients. And certainly in this setting, one would argue that the primary treatment options certainly remain either anti–PD-1 monotherapy, either with pembrolizumab or nivolumab, based on 716 or 76K, or potentially active surveillance for the patients who are not inclined to get treated.  Can you tell us a little bit about how you foresee drug development going forward in this space because, you know, for example, with HARMONY, certainly IIC disease is a part of HARMONY. We will know at least a little bit about that in this space. So what do you think about the stage IIB/C patient population? Is this a patient population in which future combinations are going to be helpful, and how would you think about where we can go forward from here? Dr. Jason Luke: It is an unfortunate circumstance that this trial could not be accrued at the pace that was necessary. I think all of us believe that the results would have been positive if they'd been able to accrue the trial. In the preliminary data set that they did disclose of that 110 patients, you know, it's clear there is a difference at a, you know, a landmark at a year. They showed a 16% difference, and that would be in line with what has been seen in stage III. And so, you know, I think it's really kind of too bad. There's really going to be no regulatory approach for this consideration. So using BRAF and MEK inhibition in stage II is not going to be part of standard practice moving into the future. To your point, though, about where will the field go? I think what we're already realizing is that in the adjuvant setting, we're really overtreating the total population. And so beyond merely staging by AJCC criteria, we need to move to biomarker selection to help inform which patients truly need the treatment. And in that regard, I don't think we've crystallized together as a field as yet, but the kinds of things that people are thinking about are the integration of molecular biomarkers like ctDNA. When it's positive, it can be very helpful, but in melanoma, we found that, unfortunately, the rates are quite low, you know, in the 10% to 15% range in the adjuvant setting. So then another consideration would be factors in the primary tumor, such as gene expression profiling or other considerations.  And so I think the future of adjuvant clinical trials will be an integration of both the standard AJCC staging system as well as some kind of overlaid molecular biomarker that helps to enrich for a higher-risk population of patients because on a high level, when you abstract out, it's just clearly the case that we're rather substantially overtreating the totality of the population, especially given that in all of our adjuvant studies to date for anti–PD-1, we have not yet shown that there's an overall survival advantage. And so some are even arguing perhaps we should even reserve treatment until patients progress. I think that's a complicated subject, and standard of care at this point is to offer adjuvant therapy, but certainly a lot more to do because many patients, you know, unfortunately, still do progress and move on to metastatic disease. Dr. Diwakar Davar: Let's transition to Abstract 2508. So we're moving on from the melanoma to the novel immunotherapy abstracts. And this is a very, very, very fascinating drug. It's IMA203. So Abstract 2508 is a phase 1 clinical update of IMA203. IMA203 is an autologous TCR-T construct targeting PRAME in patients with heavily pretreated PD-1-refractory metastatic melanoma. So Jason, in the PD-1 and CTLA-4-refractory settings, treatment options are either autologous TIL, response rate, you know, ballpark 29% to 31%, oncolytic viral therapy, RP1 with nivolumab, ORR about 30-ish percent. So new options are needed. Can you tell us a little bit about IMA203? Perhaps tell us for the audience, what is the difference between a TCR-T and traditional autologous TIL? And a little bit about this drug, IMA203, and how it distinguishes itself from the competing TIL products in the landscape. Dr. Jason Luke: I'm extremely enthusiastic about IMA203. I think that it really has transformative potential based on these results and hopefully from the phase 3 trial that's open to accrual now. So, what is IMA203? We said it's a TCR-T cell product. So what that means is that T cells are removed from a patient, and then they can be transduced through various technologies, but inserted into those T cells, we can then add a T-cell receptor that's very specific to a single antigen, and in this case, it's PRAME. So that then is contrasted quite a bit from the TIL process, which includes a surgical resection of a tumor where T cells are removed, but they're not specific necessarily to the cancer, and they're grown up in the lab and then given to the patient. They're both adoptive cell transfer products, but they're very different. One is genetically modified, and the other one is not. And so the process for generating a TCR-T cell is that patients are required to have a new biomarker that some may not be familiar with, which is HLA profiling. So the T-cell receptor requires matching to the concomitant HLA for which the peptide is bound in. And so the classic one that is used in most oncology practices is A*02:01 because approximately 48% of Caucasians have A*02:01, and the frequency of HLA in other ethnicities starts to become highly variable. But in patients who are identified to have A*02:01 genotype, we can then remove blood via leukapheresis or an apheresis product, and then insert via lentiviral transduction this T-cell receptor targeting PRAME. Patients are then brought back to the hospital where they can receive lymphodepleting chemotherapy and then receive the reinfusion of the TCR-T cells. Again, in contrast with the TIL process, however, these T cells are extremely potent, and we do not need to give high-dose interleukin-2, which is administered in the context of TIL. Given that process, we have this clinical trial in front of us now, and at ASCO, the update was from the phase 1 study, which was looking at IMA203 in an efficacy population of melanoma patients who were refractory at checkpoint blockade and actually multiple lines of therapy. So here, there were 33 patients and a response rate of approximately 50% was observed in this population of patients, notably with a duration of response approximately a year in that treatment group. And I realize that these were heavily pretreated patients who had a range of very high-risk features. And approximately half the population had uveal melanoma, which people may be aware is a generally speaking more difficult-to-treat subtype of melanoma that metastasizes to the liver, which again has been a site of resistance to cancer immunotherapy. So these results are extremely promising. To summarize them from what I said, it's easier to make TCR-T cells because we can remove blood from the patient to transduce the T cells, and we don't have to put them through surgery. We can then infuse them, and based on these results, it looks like the response rate to IMA203 is a little bit more than double what we expect from lifileucel. And then, whereas with lifileucel or TILs, we have to give high-dose IL-2, here we do not have to give high-dose IL-2. And so that's pretty promising. And a clinical trial is ongoing now called the SUPREME phase 3 clinical trial, which is hoping to validate these results in a randomized global study. Dr. Diwakar Davar: Now, one thing that I wanted to go over with you, because you know this trial particularly well, is what you think of the likelihood of success, and then we'll talk a little bit about the trial design. But in your mind, do you think that this is a trial that has got a reasonable likelihood of success, maybe even a high likelihood of success? And maybe let's contextualize that to say an alternative trial, such as, for example, the TebeAM trial, which is essentially a T-cell bispecific targeting GP100. It's being compared against SOC, investigator's choice control, also in a similarly heavily pretreated patient population. Dr. Jason Luke: So both trials, I think, have a strong chance of success. They are very different kinds of agents. And so the CD3 bispecific that you referred to, tebentafusp, likely has an effect of delaying progression, which in patients with advanced disease could have a value that might manifest as overall survival. With TCR-T cells, by contrast, we see a very high response rate with some of the patients going into very durable long-term benefit. And so I do think that the SUPREME clinical trial has a very high chance of success. It will be the first clinical trial in solid tumor oncology randomizing patients to receive a cell therapy as compared with a standard of care. And within that standard of care control arm, TILs are allowed as a treatment. And so it will also be the first study that will compare TCR-T cells against TILs in a randomized phase 3. But going back to the data that we've seen in the phase 1 trial, what we observe is that the duration of response is really connected to the quality of the response, meaning if you have more than a 50% tumor shrinkage, those patients do very, very well. But even in patients who have less than 50% tumor shrinkage, the median progression-free survival right now is about 4.5 months. And again, as we think about trial design, standard of care options for patients who are in this situation are unfortunately very bad. And the progression-free survival in that population is probably more like 2 months. So this is a trial that has a very high likelihood of being positive because the possibility of long-term response is there, but even for patients who don't get a durable response, they're likely going to benefit more than they would have based on standard chemotherapy or retreatment with an anti–PD-1 agent. Dr. Diwakar Davar: Really, a very important trial to enroll, a trial that is first in many ways. First of a new generation of TCR-T agents, first trial to look at cell therapy in the control arm, a new standard of efficacy, but potentially also if this trial is successful, it will also be a new standard of trial conduct, a new kind of trial, of a set of trials that will be done in the second-line immunotherapy-refractory space. So let's pivot to the last trial that we were going to discuss, which was Abstract 2501. Abstract 2501 is a first-in-human phase 1/2 trial evaluating BNT142, which is the first-in-class mRNA-encoded bispecific targeting Claudin-6 and CD3 in patients with Claudin-positive tumors. We'll talk a little bit about this, but maybe let's start by talking a little bit about Claudin-6. So Claudin-6 is a very interesting new target. It's a target that's highly expressed in GI and ovarian tumors. There are a whole plethora of Claudin-6-targeting agents, including T-cell bispecifics and Claudin-6-directed CAR-Ts that are being developed. But BNT142 is novel. It's a novel lipid nanoparticle LNP-encapsulated mRNA. The mRNA encodes an anti–Claudin-6 CD3 bispecific termed RiboMAB-021. And it then is administered to the patient. The BNT142-encoding mRNA LNPs are taken up by the liver and translated into the active drug. So Jason, tell us a little bit about this agent. Why you think it's novel, if you think it's novel, and let's talk a little bit then about the results. Dr. Jason Luke: So I certainly think this is a novel agent, and I think this is just the first of what will probably become a new paradigm in oncology drug development. And so you alluded to this, but just to rehash it quickly, the drug is encoded as genetic information that's placed in the lipid nanoparticle and then is infused into the patient. And after the lipid nanoparticles are taken up by the liver, which is the most common place that LNPs are usually taken up, that genetic material in the mRNA starts to be translated into the actual protein, and that protein is the drug. So this is in vivo generation, so the patient is making their own drug inside their body. I think it's a really, really interesting approach. So for any drug that could be encoded as a genetic sequence, and in this case, it's a bispecific, as you mentioned, CD3-Claudin-6 engager, this could have a tremendous impact on how we think about pharmacology and novel drug development moving into the future in oncology. So I think it's an extremely interesting drug, the like of which we'll probably see only more moving forward. Dr. Diwakar Davar: Let's maybe briefly talk about the results. You know, the patient population was heavily pretreated, 65 or so patients, mostly ovarian cancer. Two-thirds of the patients were ovarian cancer, the rest were germ cell and lung cancer patients. But let's talk a little bit about the efficacy. The disease control rate was about 58% in the phase 1 population as a whole, but 75% in the ovarian patient population. Now tell us a little bit about the interesting things about the drug in terms of the pharmacokinetics, and also then maybe we can pivot to the clinical activity by dose level. Dr. Jason Luke: Well, so they did present in their presentation at ASCO a proportionality showing that as higher doses were administered, that greater amounts of the drug were being made inside the patient. And so that's an interesting observation, and it's an important one, right? Suggesting that the pharmacology that we classically think of by administering drugs by IV, for example, would still be in play. And that did translate into some level of efficacy, particularly at the higher dose levels. Now, the caveat that I'll make a note of is that disease control rate is an endpoint that I think we have to be careful about because what that really means is sometimes a little bit unclear. Sometimes patients have slowly growing tumors and so on and so forth. And the clinical relevance of disease control, if it doesn't last at least 6 months, I think is probably pretty questionable. So I think these are extremely interesting data, and there's some preliminary sense that getting the dose up is going to matter because the treatment responses were mostly observed at the highest dose levels. There's also a caveat, however, that across the field of CD3 bispecific molecules like this, there's been quite a bit of heterogeneity in terms of the response rate, with some of them only really generating stable disease responses and other ones having more robust responses. And so I think this is a really interesting initial foray into this space. My best understanding is this molecule is not moving forward further after this, but I think that this really does set it up to be able to chase after multiple different drug targets on a CD3 bispecific backbone, both in ovarian cancer, but then basically across all of oncology. Dr. Diwakar Davar: Perfect. This is a very new sort of exciting arena where we're going to be looking at, in many ways, these programmable constructs, whether we're looking at in vivo-generated, in this case, a T-cell bispecific, but we've also got newer drugs where we are essentially giving drugs where people are generating in vivo CAR T, and also potentially even in vivo TCR-T. But certainly lots of new excitement around this entire class of drugs. And so, what we'd like to do at this point in time is switch to essentially the fact that we've got a very, very exciting set of data at ASCO 2025. You've heard from Dr. Luke regarding the advances in both early drug development but also in advanced cutaneous melanoma. And Jason, as always, thank you so much for sharing your very valuable and great, fantastic insights with us on the ASCO Daily News Podcast. Dr. Jason Luke: Well, thanks again for the opportunity. Dr. Diwakar Davar: And thank you to our listeners for taking your time to listen today. You will find the links to the abstracts that we discussed today in the transcript of this episode. And finally, if you value the insights that you hear on the ASCO Daily News Podcast, please take a moment to rate, review, and subscribe wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Follow today's speakers:    Dr. Diwakar Davar    @diwakardavar    Dr. Jason Luke @jasonlukemd Follow ASCO on social media:     @ASCO on Twitter       ASCO on Bluesky   ASCO on Facebook       ASCO on LinkedIn   Disclosures:     Dr. Diwakar Davar:      Honoraria: Merck, Tesaro, Array BioPharma, Immunocore, Instil Bio, Vedanta Biosciences     Consulting or Advisory Role: Instil Bio, Vedanta Biosciences     Consulting or Advisory Role (Immediate family member): Shionogi     Research Funding: Merck, Checkmate Pharmaceuticals, CellSight Technologies, GSK, Merck, Arvus Biosciences, Arcus Biosciences     Research Funding (Inst.): Zucero Therapeutics     Patents, Royalties, Other Intellectual Property: Application No.: 63/124,231 Title: COMPOSITIONS AND METHODS FOR TREATING CANCER Applicant: University of Pittsburgh–Of the Commonwealth System of Higher Education Inventors: Diwakar Davar Filing Date: December 11, 2020 Country: United States MCC Reference: 10504-059PV1 Your Reference: 05545; and Application No.: 63/208,719 Enteric Microbiotype Signatures of Immune-related Adverse Events and Response in Relation to Anti-PD-1 Immunotherapy     Dr. Jason Luke:     Stock and Other Ownership Interests: Actym Therapeutics, Mavu Pharmaceutical, Pyxis, Alphamab Oncology, Tempest Therapeutics, Kanaph Therapeutics, Onc.AI, Arch Oncology, Stipe, NeoTX     Consulting or Advisory Role: Bristol-Myers Squibb, Merck, EMD Serono, Novartis, 7 Hills Pharma, Janssen, Reflexion Medical, Tempest Therapeutics, Alphamab Oncology, Spring Bank, Abbvie, Astellas Pharma, Bayer, Incyte, Mersana, Partner Therapeutics, Synlogic, Eisai, Werewolf, Ribon Therapeutics, Checkmate Pharmaceuticals, CStone Pharmaceuticals, Nektar, Regeneron, Rubius, Tesaro, Xilio, Xencor, Alnylam, Crown Bioscience, Flame Biosciences, Genentech, Kadmon, KSQ Therapeutics, Immunocore, Inzen, Pfizer, Silicon Therapeutics, TRex Bio, Bright Peak, Onc.AI, STipe, Codiak Biosciences, Day One Therapeutics, Endeavor, Gilead Sciences, Hotspot Therapeutics, SERVIER, STINGthera, Synthekine     Research Funding (Inst.): Merck , Bristol-Myers Squibb, Incyte, Corvus Pharmaceuticals, Abbvie, Macrogenics, Xencor, Array BioPharma, Agios, Astellas Pharma , EMD Serono, Immatics, Kadmon, Moderna Therapeutics, Nektar, Spring bank, Trishula, KAHR Medical, Fstar, Genmab, Ikena Oncology, Numab, Replimmune, Rubius Therapeutics, Synlogic, Takeda, Tizona Therapeutics, Inc., BioNTech AG, Scholar Rock, Next Cure     Patents, Royalties, Other Intellectual Property: Serial #15/612,657 (Cancer Immunotherapy), and Serial #PCT/US18/36052 (Microbiome Biomarkers for Anti-PD-1/PD-L1 Responsiveness: Diagnostic, Prognostic and Therapeutic Uses Thereof)     Travel, Accommodations, Expenses: Bristol-Myers Squibb, Array BioPharma, EMD Serono, Janssen, Merck, Novartis, Reflexion Medical, Mersana, Pyxis, Xilio

ReferencesBiophys J. 2013 Mar5;104(5):1049–1055Chem Phys Lipids. 2021 Aug: 238:105091PNAS 2013. November5, vol. 110 no. 45Biomolecules.2024 Feb3;14(2):184Furay, R. 1968. "Kind Woman" Buffalo Springfield/Pocohttps://music.youtube.com/watch?v=9Yl8SW5s11s&si=KYQQ0CtDyu67imSA Clarke, Nash, Hicks. 1967. "On a Carousel" Hollieshttps://music.youtube.com/watch?v=tK4_7I1YIOc&si=jwcDBSdO9KwZS8bUSchubert, F. 1815-1821. "Der Lieder"https://music.youtube.com/watch?v=tyBp3lpdi-k&si=uyqtU25uDdjRdQPA

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Bonnaroo 2025: The Festival That Ended Too Soon

Dr. Shaalan Beg and Dr. Kristen Ciombor discuss practice-changing studies in GI cancers and other novel treatment approaches that were presented at the 2025 ASCO Annual Meeting. Transcript Dr. Shaalan Beg: Hello, I'm Dr. Shaalan Beg, welcoming you to the ASCO Daily News Podcast. I'm a medical oncologist and an adjunct associate professor at UT Southwestern Medical Center in Dallas, Texas. There were some remarkable advances in gastrointestinal cancers that were presented at the 2025 ASCO Annual Meeting, and I'm delighted to be joined by Dr. Kristen Ciombor to discuss some exciting GI data. Dr. Ciombor is the Ingram Associate Professor of Cancer Research and a co-leader of Translational Research and the Interventional Oncology Research Program at the Vanderbilt Ingram Cancer Center. Our full disclosures are available in the transcript of this episode. Dr. Ciombor, it's great to have you on the podcast today. Dr. Kristen Ciombor: Thanks, Dr Beg. It's great to be here. Dr. Shaalan Beg: Alright, let's kick it off. Big year for GI cancers. We'll start off with LBA1. This was the ATOMIC study sponsored by NCI and the National Clinical Trials Network (NCTN) and the Alliance group. This is a randomized study of standard chemotherapy alone or combined with atezolizumab as adjuvant therapy for stage III mismatch repair deficient colorectal cancer. Dr. Kristen Ciombor: I think this study was really definitely practice-changing, as you can tell because it was a Plenary. But I do have some concerns in terms of how we're actually going to implement this and whether this is the final answer in this disease subtype. So, as you said, the patients were enrolled with stage III resected mismatch repair deficient colon cancer, and then they were randomized to either modified FOLFOX6 with or without atezolizumab. And that's where it starts to become interesting because not many of us give FOLFOX for 6 months like was done in this study. Obviously, the study was done over many years, so that was part of that answer, but also the patients received atezolizumab for a total of 12 months. So the question, I think, that comes from this abstract is, is this practical and is this the final answer? I do think that this is practice-changing, and I will be talking to my patients with resected mismatch repair deficient colon cancer about FOLFOX plus atezolizumab. I think the big question is, do these patients need chemotherapy? And can we do a neoadjuvant approach instead? And that's where we don't have all the answers yet. Dr. Shaalan Beg: Yeah, but it has been great to see immunotherapy make its way into the adjuvant space after having made such a big impact in the metastatic space, but still some unanswered questions in terms of the need for chemotherapy and then the duration of therapy, which I guess we'll have to stay tuned in for the next couple of years to to get a lot of those questions answered. Dr. Kristen Ciombor: Yeah, but a big congratulations to the study team, to the NCTN, the NCI. I mean, this is really a great example of federally funded research that needs to continue. So, great job by the study team. The DFS 10% difference is really very large and certainly a practice-changing study. Dr. Shaalan Beg: Yeah, and and sticking with colon cancer, and and this another federally funded study, but this time funded by a Canadian cancer clinical trials group was LBA3510. This is the CHALLENGE study. It's a randomized phase 3 trial of the impact of a structured exercise program on disease-free survival for stage III or high-risk stage II colon cancer. This study got a lot of buzz, a lot of mainstream press coverage, and a lot of discussions on what that means for us for the patients who we're going to be seeing next week in our clinic. What was your takeaway? Dr. Kristen Ciombor: Yeah, this is a really interesting study, and I was so glad to see it presented because this partially answers one of the questions that patients always have for us in clinic, right? You know, once they've completed their standard chemotherapy and surgery, what else can they do to help prevent recurrence? And so we've always known and sort of extrapolated that healthy lifestyle habits are good, but now we have data, particularly in these patients. Most of them were stage III colon cancer patients, those had high-risk stage II cancer. And basically, the goal was to increase their physical activity by at least 10 MET hours per week. So, my big question, of course, as I came into this presentation was, “Okay, what does that mean exactly? How does that translate to real life?” And really what the author presented and explained was that basically most patients could hit their target by adding a 45- to 60-minute brisk walk 3 to 4 times a week. So I think this is very approachable.  Now, in the confines of the study, this was a structured exercise program, so it wasn't just patients doing this on their own. But I do think kind of extrapolating from that, that this is very achievable for most patients. And not only did this prevent recurrence of their prior cancer, but actually the rate of new primary cancer diagnoses, was less, which is really interesting, especially in the breast and prostate cancer. So this was a really interesting, and I think practice-changing study as well, especially given that this is something that most patients can do. Dr. Shaalan Beg: Yeah, and there was a lot of discussion in the hallways after the presentation in terms of how this really changes our existing practice because most folks already recommend exercise as a way for improving outcomes in cancer patients. So we've already been doing that. Now we have some data on how much it can impact the benefit. But there was some discussion about what the actual degree of impact was. There was a drop-off rate in terms of how long folks were able to stick with this exercise regimen. But you've seen this in clinic when someone have their surgery, they have their chemotherapy, they've been so intimately involved with the oncology world, with the oncology practice, and they somehow feel that they're being let loose into this mean, angry world without any guidance and they're looking for something to do. “What more can I do in terms of my lifestyle?” And then here we have very solid data, as solid as can be for an intervention like exercise, showing that there is an impact and you can give a prescription for exercise when someone wraps up their chemotherapy for colon cancer, thanks to the study. Dr. Kristen Ciombor: Yeah. It was a great study. Dr. Shaalan Beg: Moving to gastroesophageal cancer, another late-breaking abstract. This is LBA5. The MATTERHORN trial was a phase 3 trial of durvalumab plus FLOT for resectable GE junction and gastric cancer. And again, another area where immunotherapy has made an impact, and here we're seeing it move closer for earlier-stage disease. What was your take-home for the MATTERHORN trial? Dr. Kristen Ciombor: Yeah, so this study looked at neoadjuvant perioperative durvalumab plus our current standard chemotherapy of FLOT versus placebo plus FLOT. And this was a large study, almost 1,000 patients were randomized. And the primary endpoint was event-free survival, and it was definitely met in favor of the D + FLOT arm, as Dr. Klempner discussed after Dr Janjigian's presentation. I do think there are still some unanswered questions here. Overall survival is not yet mature, so we do have to wait and see how that shakes out. But it's very interesting and kind of is reflective of what, as you said, we're looking at earlier and earlier lines of therapy, particularly with immunotherapy, in these GI cancer spaces. So it makes a lot of sense to test this and and to look at this. So the toxicity was pretty similar to what we would expect. Primary endpoint was met, but again, we'll have to wait and see what the survival data looks like. Dr. Shaalan Beg: Yeah, and in oncology, we know, especially for treatment that does add additional cost, it does add additional potential toxicity that we want to see that overall survival nudged. I did see some polls on social media asking folks whether their practices changed from this, and I think the results were favoring adding durvalumab for this group of patients but understanding that there are caveats to the addition of treatments and the eventual FDA approval in that indication as well. Dr. Kristen Ciombor: Exactly. I completely agree with that. Dr. Shaalan Beg: All right. How about we stick with gastroesophageal cancer? LBA4002 was trastuzumab deruxtecan versus ramucirumab plus paclitaxel for second-line treatment in HER2-positive unresectable or metastatic gastric cancer or GE junction cancer. This was the DESTINY-Gastric04 study. And again, antibody-drug conjugates making a big impact across different diseases. And here we have more data in the HER2-positive gastric cancer space. Your thoughts on this study? Dr. Kristen Ciombor: Yeah, so this is a really important space in gastroesophageal cancer because the HER2 positivity rate is fairly high as compared to some of our other tumor types. So, I do think one of the important things was that patients did have biopsy confirmation of HER2 status, which was very important, and then they were randomized to either T-DXd versus the kind of second-line standard of ramucirumab-paclitaxel. So this was a great practical study and really answers a question that we had for a while in terms of does anti-HER2 therapy in the second-line really impact and improve survival. So we did see a statistically significant improvement favoring T-DXd. I do think it's always important to look at toxicity, though, too. And there was about almost 14% rate of interstitial lung disease, which of course is the most feared toxicity from some of these antibody-drug conjugates, especially T-DXd. So I do think it's important to keep that in mind, but this is definitely a great addition to the armamentarium for these HER2-positive patients. Dr. Shaalan Beg: And pancreas cancer was on the stage after a very long time with a positive clinical trial. This is Abstract 4006. These were preliminary results from a phase 2 study of elraglusib in combination with gemcitabine/nab-paclitaxel versus gemcitabine/nab-paclitaxel alone for previously untreated metastatic pancreas cancer. This is a frontline clinical trial of gemcitabine/nab-paclitaxel plus/minus the study drug. There were other cohorts in this study as well, but they reported the results of their part 3B arm. And great to see some activity in the pancreas space. And your thoughts? Dr. Kristen Ciombor: Yeah, we definitely need better treatments in pancreas cancer. This was a very welcome presentation to see. The elraglusib is an inhibitor of GSK-3beta, and it's thought that that mediates drug resistance and EMT. And so this is, I think, a perfect setting to test this drug. So patients basically were randomized. Patients with metastatic pancreas cancer were randomized 2: 1 to gemcitabine/nab-paclitaxel plus or minus this elraglusib. So, what we saw was that overall survival was better with the addition of this new drug. And overall, not only the 1-year overall survival, but also median overall survival.  The thing that was interesting, though, was that we saw that the overall survival rates were 9.3 months with the combination versus 7.2 months with just gemcitabine/nab-paclitaxel. And that's a little bit lower than we've seen in other studies. So, not sure what was going on there. Was it the patients that were a bit sicker? Was it a patient selection, you know, thing? I'm not really sure how to explain that so much. Also, the toxicity profile was much higher in terms of visual impairment, with over 60% of patients being treated with the combination versus 9% with gemcitabine/nab-paclitaxel. So these were mild, grade 1 and 2, but still something to be cautious about. Dr. Shaalan Beg: And especially with this being a phase 2 trial, making sure that in a larger study we're able to better evaluate the toxicity and see if the control arm in the larger confirmatory study performs differently will be really important before this compound makes it to the clinic in our space. But very exciting to see these kinds of results for pancreas adenocarcinoma. Dr. Kristen Ciombor: Yeah. Dr. Shaalan Beg: We've talked, it seems, a couple of times on this podcast about the BREAKWATER clinical trial. We did hear PFS and updated OS data, updated overall survival data on first-line encorafenib plus cetuximab plus modified FOLFOX6 for BRAF-mutated colorectal cancer. This was LBA3500. And eagerly anticipated results – we have all previously heard the progression-free survival results – but here we heard updated overall survival results, and very well-received study it seemed from the audience that time. So what are your takeaways on the updated results for BREAKWATER? Dr. Kristen Ciombor: In my opinion, this was one of the most practice-confirming studies. As you mentioned, we've already seen some of the preliminary data of BREAKWATER at prior meetings. But really what was particularly impactful for me was the median overall survival with the BREAKWATER regimen. So, again, patients received FOLFOX, encorafenib cetuximab in the first line if they had BRAF-mutated V600E-mutated colorectal cancer. And the median PFS was 12.8 months, which was actually really remarkable in this traditionally very aggressive, poor prognosis subtype of tumors. So, by seeing a median overall survival of 30.3 months was just incredible, in my opinion. Just a few years ago, that was considered the median overall survival for all comers for metastatic colorectal cancer. And we know the median overall survival was more in the less than 12 months range for BRAF. So this was incredibly impactful, and I think should be absolutely practice-changing for anyone who is eligible for this regimen.  I think again, where the practice meets the study is what's kind of important to think about too, how long did patients get FOLFOX, and certainly it adds toxicity to add a BRAF-targeted regimen on top of FOLFOX already. So, one of the other interesting things about the study, though, was that even though it didn't complete treatment, they actually did look at encorafenib/cetuximab alone and in the first line without chemotherapy. And those preliminary results actually looked okay, especially for patients who might not be able to tolerate chemotherapy, which we certainly see in practice. So, overall, definitely more data. And I agree that it's certainly practice-changing. Dr. Shaalan Beg: And it completely, as you mentioned, changes the outlook for a person who's diagnosed with BRAF-mutated metastatic colon cancer today versus even 7 or 8 years ago. Dr. Kristen Ciombor: And we're seeing this over and over in other subtypes too, but how you choose to treat the patient up front really matters. So really giving the right regimen up front is the key here. Dr. Shaalan Beg: And along the same lines, Abstract 3501 wanted to answer the question on whether people with MSI-high metastatic colorectal cancer need double checkpoint inhibitor therapy or is single therapy enough. So this [CheckMate-8HW] study compared nivo plus ipi with nivo alone, nivo monotherapy for MSI-high metastatic colorectal cancer. And we've known that both of these are fairly active regimens, but we also know the chance of immune-related adverse events is significantly higher with combination therapy. So this was a much-needed study for this group of patients. And what were your takeaways here? Dr. Kristen Ciombor: This, of course, has been really nivo-ipi in the first-line MSI-high metastatic colorectal cancer is now a standard of care. And not everybody is eligible for it, and there could be reasons, toxicity reasons, and other things too. But as we've been seeing for the last couple of years, immunotherapy clearly beats chemo in this space. And now looking at doublet versus single immunotherapy treatment in the first line, I think really nivo-ipi does beat out monotherapy. I will say, however, there is a caveat in that we still haven't seen the nivo-ipi versus nivo in the first line. So what has been presented thus far has been across all lines of therapy, and that does muddy the waters a little bit. So definitely looking forward and and we've asked this many times and based on the statistical plan and and what not, you know, we just haven't seen that data yet. But I do think it's becoming increasingly important to consider doublet immunotherapy for these patients as long as there are no contraindications. With the again, with the caveat that we have to have these toxicity discussions in the clinic with patients because many patients can tolerate it, you know, this regimen fairly well, but there can be very severe toxicities. So, I think an informed discussion should really be had with each patient before moving forward. Dr. Shaalan Beg: Yeah, informed decision, making them aware of the potential of real significant toxicities, immune-related toxicities with double therapy. But I am curious in your practice, how often do you see people choosing doublet therapy as frontline? Dr. Kristen Ciombor: So patients are really savvy, and a lot of times they've heard this data before or have come across it in patient advocacy groups and other things, and it's really nice to be able to have that conversation of the risk versus benefit. So I will say not all of my patients choose doublet, and many of them are still cured with immunotherapy monotherapy. So the big question there is, will we ever understand who actually needs the doublet versus who can still be cured or have very good long-term outcomes with just the single agent? And that has not been answered yet. Dr. Shaalan Beg: What a great point. So the last abstract I was hoping we could talk about is POD1UM-303 or the INTERAACT2 subgroup analysis and impact of delayed retifanlimab treatment for patients with squamous cell carcinoma of the anal canal. What were your thoughts here? Dr. Kristen Ciombor: This was a study, actually we saw at ESMO, we saw the primary data at ESMO last year, and this was an update with some exploratory analyses. But this was really an important study because once again, we're looking at immunotherapy in later lines of therapy. That's how we started looking at and investigating immunotherapy, and now we're moving it up and up in the treatment course. So this was a study of carboplatin/paclitaxel plus or minus retifanlimab. Actually it was retifanlimab versus placebo. And it was a positive study, as we heard last year. This actually led to FDA approval of this regimen last month, just before ASCO, and it has now been incorporated in the NCCN guidelines as the preferred first-line option.  So what I thought was important from the additional data presented at ASCO was looking at the different subgroups, it did not appear that patients with liver mets or not had different outcomes. So that was really good to see because sometimes in colon cancer we see that immunotherapy doesn't work as well when patients have liver mets. And interestingly, because we use immunotherapy in anal cancer without any biomarkers, unlike with colon cancer or some of the other tumor types, also the authors looked at PD-L1 status, and it did look like maybe patients did a little bit better if they had higher PD-L1 expression, but patients still could benefit even if they were PD-L1 negative. So that was important, I think, and we will continue to see further data come out from this study. I want to mention also that EA2176 just completed accrual, so that was carbo-taxol plus or minus nivolumab. And so we should be seeing that data sometime soon, which will hopefully also confirm the ongoing role for immunotherapy in the first-line setting for anal cancer. Dr. Shaalan Beg: That was a fantastic review. Thank you, Dr Ciombor. Thanks for sharing your valuable insights with us today on the ASCO Daily News Podcast. Dr. Kristen Ciombor: Thanks for having me here. Dr. Shaalan Beg: And thank you to our listeners for your time today. You will find links to the abstracts discussed today in the transcript of this episode. And if you value the insights that you hear on the podcast, please take a moment to rate, review, and subscribe, wherever you get your podcasts. Disclaimer: The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. More on today's speakers:   Dr. Shaalan Beg  @ShaalanBeg  Dr. Kristen Ciombor @KristenCiombor Follow ASCO on social media:    @ASCO on Twitter   @ASCO on BlueSky  ASCO on Facebook    ASCO on LinkedIn    Disclosures:   Dr. Shaalan Beg:   Consulting or Advisory Role: Ipsen, Cancer Commons, Foundation Medicine, Science37, Nant Health, Lindus Health Speakers' Bureau: Sirtex Research Funding (Inst.): Delfi Diagnostics, Universal Diagnostics, Freenome Dr. Kristen Ciombor: Consulting or Advisory Role: Pfizer, Incyte, Exelixis, Bayer, ALX Oncology, Tempus, Agenus, Taiho Oncology, Merck, BeiGene Research Funding (Inst.): Pfizer, Boston Biomedical, MedImmune, Onyx, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Merck, Novartis, Incyte, Amgen, Sanofi, Bristol-Myers Squibb, Array BioPharma, Incyte, Daiichi Sankyo, Nucana, Abbvie, Merck, Pfizer/Calthera, Genentech, Seagen, Syndax Travel, Accommodations, Expenses: Incyte, Tempus

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Following our recent episode, Accuracy in Accommodations, we wanted to revisit an episode that plays a crucial role in creating accurate accommodation. Enjoy this revisit to our previous Practice in Action episode: Problem? SolvedProblem solving is an integral part of our everyday lives and a critical skill that every mental health professional must be aware of. But what is good problem solving, and how do we use it in the therapy setting. This is exactly what Ray and Paul seek to answer in their conversation today. They break down the process of problem solving, and develop guiding principles that allow us to help our clients with this crucial skill. We hope you enjoy this Practice in Action episode: Problem?… SolvedTo 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

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What are commonly requested accommodations in the workplace? How can employers successfully hire and train neurodiverse staff? Maxwell Huffman and Jen Goubeaud of Aspiritech, Aspiritech, a quality-assurance company with over 90% of autistic employees, share their insights on these topics. Maxwell is Autistic himself and oversees operations across Aspiritech's program lines, including software quality assurance, accessibility, and data services. And Jen, who has ADHD, is the program manager for the company's accessibility program line. Welcome to Autism Tips & Tools, where we highlight the best practical guidance from previous episodes of Autism Knows No Borders. Whether you're a self-advocate, a family member, or a service provider, there's something here for you! The following clip is from our conversation with Maxwell Huffman and Jen Goubeaud, originally released on February 15, 2024.  Would you like to hear Jen and Maxwell talk about accessibility in digital spaces and how to create opportunities for neurodivergent employees to thrive? Click the link below for the full conversation and be sure to subscribe to hear more from people connected to autism inspiring change and building community.  How to Increase Neurodiversity in the Workplace | Part 1 with Maxwell Huffman and Jen Goubeaud Let's work together to transform how the world relates to autism. ----more---- We appreciate your time. If you enjoy this podcast and you'd like to support our mission, please take just a few seconds to share it with one person who you think will find value in it too. Follow us on Instagram: @autismpodcast Join our community on Mighty Networks: Global Autism Community Subscribe to our YouTube channel: Global Autism Project We would love to hear your feedback about the show. Please fill out this short survey to let us know your thoughts: Listener Survey

This episode is your ultimate guide to dominating law school, from pre-1L prep to acing orientation and beyond. Whether you're gearing up for the LSAT or stepping into law school for the first time, these strategies from Shana Ginsburg (Founder, Ginsburg Advanced) and Trudel Pare (Yale Law '25) will set you apart and ensure you enter with confidence.Law school is a marathon, and staying physically active helps maintain energy and focus through long study sessions. Prioritizing rest is just as crucial—avoid burnout by balancing your workload smartly. Case briefing mastery is a must, and getting ahead on reading techniques with 1-1 JD skill development resources like the Pre-1L Boss makes a difference.Accommodations matter—if you need LSAT or law school adjustments, advocate for them early to optimize your learning environment. And when orientation arrives, tune in, take notes, and pay attention—insider tips can shape your bar prep, internships, and legal career path.Created by Shana Ginsburg, founder and CEO of Ginsburg Advanced Tutoring, this episode is packed with empowering insights to shape your law school journey. What will they say about you after law school? Let this episode help you craft your story and make your mark.

1 Corinthians 9:19-23

What's it really like to walk a long-distance trail in rural France? In this episode of Join Us in France, titled Hiking Chemin du Puy and Célé Valley, host Annie Sargent talks with Rowena Sjovall, a solo traveler from the U.S. walking the GR65 and the scenic Célé Valley route. Get the podcast ad-free Rowena shares her detailed experience hiking the Chemin du Puy, one of France's most popular pilgrimage trails. She talks about trail conditions, signage, and the variety of landscapes—rolling hills, deep river valleys, and charming medieval towns. If you've wondered about hiking from Le Puy-en-Velay toward Cahors or incorporating the lesser-known Célé Valley variant, Rowena offers honest insights. The conversation covers practical tips too. What kind of gear should you bring? How easy is it to find food and lodging? What's the vibe among other hikers? Annie asks all the right questions to help listeners decide if this kind of trip is for them. Whether you're planning a Camino in France or just curious about rural walking holidays, this episode delivers both inspiration and real-world advice. Don't forget to subscribe to Join Us in France for more episodes like this, where travel dreams and logistics meet. Perfect for slow travel lovers, Francophiles, and adventure-seekers! Table of Contents for this Episode [00:00:15] Introduction and Greetings [00:00:31] Today on the podcast [00:00:59] Podcast supporters [00:01:32] The Magazine segment [00:02:25] Annie and Rowena [00:03:11] The Crazy Adventure Begins [00:06:27] Planning the Journey [00:08:41] Navigating the Trail [00:12:45] Challenges and Perseverance [00:18:48] Starting point [00:27:14] Navigating Through Cornfields [00:27:51] Rainy Day Lunch and Milka Chocolate [00:28:44] Challenges of Finding Food and Shelter [00:29:43] Reaching the Hilltop and Meeting Fellow Travelers [00:32:48] Exploring Troglodyte Houses [00:34:07] Communal Dinners and Accommodations [00:34:51] Comfort Level at the Accommodations in the Célé Valley [00:41:14] Advice for Future Travelers [00:44:15] Planning the Next Journey [00:47:41] The hardest day [00:48:17] Concluding Thoughts and Farewell [00:48:45] Thank you Patrons [00:49:40] Tour Reviews [00:50:40] Discount for Podcast Listeners [00:51:54] Swimming in the Seine [00:56:21] Next week on the podcast [00:56:58] Copyright   More episodes about active vacations in France

ReferencesLangmuir 2019 35.30 9944-53Beethoven, LV. 1806. Violin Concerto in D major Op.61https://music.youtube.com/watch?v=0Cg_0jepxow&si=vq1V1ikaX2caa5Z_Loggins, K. 1970. "Danny's Song" Loggins and Messinahttps://music.youtube.com/watch?v=51rYIKv6e3I&si=QxORQll3XlVXZ8r7

ReferencesBiophys J. 2012 Mar 7;102(5):1079–1087Langmuir 2019 35.30 9944-9953.Guerra, DJ. 2025 Unpublished Lectures: Biochemical ThermodynamicsWinwood,S. 1969. Had to Cry Today. Blind Faith.https://music.youtube.com/watch?v=Z4Yo_VbGdMg&si=4SXRCJ3kT6YgU52ZClapton, E. and Gordon, J. 1970. Layla. Derek and the Dominoeshttps://music.youtube.com/watch?v=TngViNw2pOo&si=Z1gNnH-XwpXYMFCX

In this episode of Psyched to Practice, Paul and Ray take on a conversation that hits home for educators, therapists, and parents alike—how do we know when an accommodation is actually helping? And when is it holding someone back? With clinical insight, personal stories, and a bit of humor, they break down how to tell the difference between under-accommodating, over-accommodating, and finding that “just right” fit. From executive functioning to anxiety support to college roommates, they explore how to scaffold success without doing the work for someone. Whether you're helping a student, a client, or your own child, this episode offers the clarity and strategies to make accommodations meaningful—not just habitual.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

Send us a textIf you have a child with dyslexia, or if you're starting to investigate this possibility, you've probably come across the term “accommodations.” In this video, we demystify this term and go through the various accommodations that you and your child might want to consider.Explanation of accommodations from the International Dyslexia Association of https://dyslexiaida.org/accommodations-for-students-with-dyslexia/Dyslexia Journey has conversations and explorations to help you support the dyslexic child in your life. Content includes approaches, tips, and interviews with a range of guests from psychologists to educators to people with dyslexia. Increase your understanding and connection with your child as you help them embrace their uniqueness and thrive on this challenging journey!Send us your questions, comments, and guest suggestions to parentingdyslexiajourney@gmail.comAlso check out our YouTube channel! https://www.youtube.com/@ParentingDyslexiaJourney

ReferencesACS Omega 2021, 6, 17, 11122–11130Biophys J. 2012 Mar 7;102(5):1079–1087.Bruce/Clapton/Baker, 1970. Live Cream I.https://open.spotify.com/album/3y9gLoczbAcmoFyvlcDY5d?si=lw-0inZ7RnGP3YSi-wtJOgBrahms, J. 1885.Symphony 4 in E Minor. Op 98.https://open.spotify.com/album/400aRtO2ZI3oMBqQdgC9UY?si=l7A7vjTPSjSDveCchHhCUg

ReferencesKant. I 1781 /1787. Ist and 2nd eds. of "Critique of Pure Reason"J Mol Biol. 2020 Aug 15;433(12):166624. Guerra, DJ. 2025 Unpublished lectures in biochemical thermodynamics.Mozart, WA. 1791 Requiem in D Minor Unfinished.https://music.youtube.com/playlist?list=OLAK5uy_nSNY0VtEjG1DYcoE6gg9tibETknwAWeLY&si=RDyroCqgeGIAMBHILennon/McCartney.1969. Golden Slumbers/Carry That Weight/The End Medley. Abbey Road lp. Beatles.https://music.youtube.com/watch?v=LjOl0fG72ZE&si=erY_gDZE0q0u441t

Celebrate National Rivers Month with this enchanting episode of Big Blend Radio's “Travel with Terri” Podcast. Terri takes us on a romantic journey to Niagara Falls, Canada—one of the world's most awe-inspiring natural wonders. Known as the Honeymoon Capital, Niagara Falls offers more than just breathtaking views. Terri shares her personal experiences and insider tips on how to fully enjoy this magical destination—from thrilling boat rides and behind-the-falls tours to stunning aerial perspectives. You'll also hear about delicious local dining, charming wineries, and cozy accommodations that fit every travel style. Whether you're planning a romantic getaway or a scenic escape, discover why Niagara Falls is a year-round destination packed with beauty, adventure, and charm. Takeaways: • Niagara Falls is a top romantic getaway • Multiple ways to experience the falls: boat, tunnels, and sky • Enjoy local farm-to-table dining and regional wineries • Accommodations for all budgets • Fireworks and floral displays enhance the scene • Stunning in all seasons—from summer rainbows to winter wonderlands • Ideal for couples and nature lovers alike

Joining us this week is returning guest Eric Endlich, Ph.D. Dr. Endlich is a clinical psychologist and founder of Top College Consultants®, which specializes in guiding neurodivergent students through the college application process. An advocate and expert in the field and a neurodivergent adult himself, he co-teaches a UC Irvine course for educational consultants, manages a large Facebook group for parents of neurodivergent students, and serves on advisory boards related to autism and neurodiversity. Dr. Endlich joins us this week to discuss the far too often overlooked challenges that neurodivergent students face when transitioning from high school to college. While gaining admission is one big challenge, the real challenge is succeeding once on campus, and Dr. Endlich sheds some light on some of the key differences between being college-capable and college-ready, highlighting the fact that students with learning and thinking differences are typically at much higher risk of not completing their degrees. We also explore some practical strategies to help students prepare for the increased independence and self-advocacy required in college life, with topics including building executive functioning skills in high school, the value of gap years, and how parents can gradually transition from being advocates to coaches.  Dr. Endlich even talks about how to find the right college fit and make the most of on-campus resources, especially for students needing accommodations and support programs. Whether your teen is just starting high school or gearing up for college in the upcoming fall season, this episode of the podcast truly provides some practical insights into how to foster independence! Show Notes: [2:39] - Dr. Endlich asserts that too many students focus too much on getting into college rather than graduating from it. [4:43] - Success in college requires more than just academic capability; independence and self-management skills are also important. [6:36] - College demands greater self-organization and disability accommodation compared to high school. [8:57] - Dr. Endlich argues that parents should shift from advocating for their child to empowering their independence. [10:26] - Gradually transferring daily responsibilities helps students build independence before college. [13:02] - Taking a gap year can improve college preparedness and help prevent academic burnout. [15:10] - Dr. Endlich adds that gap years can strengthen a student's portfolio and develop valuable life skills. [18:02] - Consider the long-term value of a degree and explore financial aid options. [19:51] - Dr. Endlich points out how skill development can happen during high school, gap years, or throughout college. [22:44] - Even if colleges lack support, external programs can provide assistance and guidance. [25:26] - Visiting various colleges helps students identify their preferences and find the right fit. [28:09] - It's also important to make visits to dining halls and have meetings with support staff, helping to reveal the college's suitability. [31:02] - Even without campus visits, virtual tours and accepted-student events can also offer some valuable insights. [34:58] - Bridge programs help students acclimate to college life before the official start. [36:28] - Dr. Endlich states that carefully managing the application process and having backup plans can help reduce anxiety.   Links and Related Resources: Episode 83: What Students with Disabilities Should Do When Starting College with Eric Endlich, Ph.D Episode 126: Why Self-Awareness and Self-Determination are Important for College Success with Elizabeth Hamblet Episode 156: To Test or Not to Test (ACT/SAT) in the Test-Optional Era with Annika Guy Episode 190: Should Your Teen Take a Gap Year? with Julia Rogers Top College Consultants® - Getting Into College Is the Easy Part Top College Consultants® - 6 Reasons to Consider a Gap Year   Connect with Us: Get on our Email List Book a Consultation Get Support and Connect with a ChildNEXUS Provider Register for Our Self-Paced Mini Courses: Support for Parents Who Have Children with ADHD, Anxiety, or Dyslexia    Connect with Eric Endlich, Ph.D: Eric Endlich, Ph.D's LinkedIn Page Top College Consultants® Email: eric@topcollegeconsultants.com  Phone: (833) WE-APPLY (toll free)  

In this episode: Jen talks about how ADHD shows up at work — from time blindness to burnout — and breaks down what your rights are under the Americans with Disabilities Act (ADA). She walks you through real-world accommodations that can make a huge difference (including remote work), how to actually ask for them without overexplaining, and also rethinks the whole concept of why we even have to ask for things like this on our own in the first place. SHOW NOTES: For bonus episodes, transcripts, video classes, AMA's, a private chat community and more - go GET A LOT in the “You Are a LOT” podcast Patreon community. Start with a 7-day-free-trial at any level, and when you join take 15% off if you subscribe annually. Link to Bearaby for Knot Pillow, Lounger Warmable, Weighted Blankets 30 FREE DAYS to BRAIN FM Wire Your Brain For Focus! Visit the “You Are A Lot” (an ADHD/AuDHD Podcast) webpage Subscribe to the “This Is A Lot” Newsletter 15% Off HUGIMALS weighted stuffed animals 15% off APPOINTED planners & notebooks 20% off UnHide Weighted Blankets & Pillows Send an email to the podcast at alotadhdpod at gmail dot com Call The “A Lot” Line at (347) 674-2201   SOURCES USED FOR THIS EPISODE: Why “Workplace Accommodations” Are Archaic - Lindsey Mackereth How People Can Ask For Accommodations At Work - ChADD How Protected Are People Under The ADA? - ADDitude Magazine The Trump Admin Demands Returning To Office Profile Of The 2023 Workforce Rights Under the ADA Explained - ACLU Signs Of A Neurodivergent Inclusive Workplace - ADDitude Magazine ADHD Accommodations At Work - The ADDA The ADHD Guide To Asserting Yourself Head Heart Hands Check-In Method

Welcome back to Blended!   Today, we're talking about inclusion – one of our favorite topics here on the show! But we're thinking about it from a different angle. Not from the team we build or the people we hire, but the environment around us. We're talking about inclusive spaces.   This might be familiar to you, or maybe it's a concept that's fairly new but, guaranteed, you'll be hearing about it more and more.   As awareness of neurodiversity grows, designing spaces that cater to the needs of individuals with diverse cognitive and sensory processing styles is becoming increasingly important. By integrating neurodiversity into design, we can create environments that are not only more inclusive but also enhance the wellbeing and productivity of all individuals, fostering greater creativity and collaboration in both work and community spaces.   And it's not just neurodiversity we have to consider. More than a quarter of Americans have a disability, which is often intersectional with other areas of diversity as well, like race or age. So accessibility in all its forms is incredibly important to make sure we're creating environments where people with all types of diverse needs can thrive.   Today, our panel are talking all about formal diagnoses – the challenges, barriers and interplay with work – the basics of inclusive spaces, and some of the ways leaders and organizations can make changes to improve cultures and create more equitable working environments for everyone.   IN THIS EPISODE:   [01.26] Introductions to our Blended panelists.   ·       Dan Roth– Strategic People Operations Executive  ·        Dr. Tiffany Jameson– Organizational Psychologist and Founder and Managing Partner at grit & flow  [07.15] The group explore diagnoses for neurodivergence – how people are diagnosed, the varied reasons for the recent increase in diagnoses, the barriers to achieving a formal diagnosis, and the importance of gaining a diagnosis for access to help. “The criteria that were used for ADHD and autism were very white, boy centered. Girls don't present like a boy in school, and so they were being missed… There's now a lot more awareness by pediatricians… And, as more kids are being diagnosed, their parents are going: ‘Oh my goodness, this is very familiar!' And they go after a diagnosis for themselves.” Tiffany   “A lot of people fake it till they make it – and they don't make it. It's called masking, where you're pretending to be what society calls normal, and it's hard to keep that front up.” Tiffany “From a diversity, equity and inclusion standpoint, let's not beat around the bush – that term has been weaponized.” Dan   ·       Increase in diagnoses o   Increased awareness o   Updated criteria o   Child-parent knock-on effect  ·       Burnout ·       Masking ·       Barriers to diagnosis o   Cost o   School system o   Limited accessibility resources o   Stigma ·       Societal expectations ·       Bias ·       Requirement to get a formal diagnosis to access help ·       Cultural impact ·       Generational trauma ·       Parental projection ·       Insecurity/fear ·       Parental grieving process – expectations “A lot of parents will reject diagnoses, not understanding the proactive measures it allows for.” Dan    [32.42] The panel discuss the basics of inclusive spaces – what they are, what they can look like, and why we need them. ·       Inclusive spaces look different for different people o   Sensory impacts o   Lighting o   Clothing o   Movement ·       Self-awareness ·       Pace of change for US vs global ·       Advanced communication methods ·       Triggers ·       Rejecting ego ·       I vs we ·       Building psychological safety ·       Knowing/understanding what you need ·       Self-advocacy ·       Asking/listening ·       Ongoing conversation/process ·       Accommodations in hiring processes and potential biased impacts of using them ·       Social anxiety in working environments ·       Education ·       Change management ·       Step-by-step improvements ·       Work from home/work from office ·       Companies ticking boxes/policies ‘for show' ·       Compromise/finding the middle ground   ·       Issues with general education – setting kids up for success/failure ·       Unique point in time o   Different generations working together o   Different perspectives and concepts coming together    o   Different levels of understanding/acceptance o   Difference in communication styles ·       Overwhelm ·       Grace ·       Empathy ·       Looking at people holistically   “An inclusive space is something that's individualized, it's person-centered. So what's inclusive for me isn't necessarily inclusive for you. So that's where it can get confusing – how do we generalize inclusion? But there are some best practices, so we think about places where people can get what they need to enjoy the experience, like they belong and have a right to be there.” Tiffany “The reality is that no one has conquered this idea of the inclusive space, especially in corporations… There's so much that goes into it, I don't believe we're at a point where it's possible. For us to be truly inclusive, we each need to de-colonize ourselves and understand at a very visceral level what makes us tick, what our fears and triggers are, and we need to be able to express and explain those to others where ego doesn't come into play.” Dan “Neurodivergent people, disabled people – people in general! – don't know what they need to do their best work.” Tiffany   “It doesn't matter if you change process if you're not changing behavior – this is all a change management process.” Tiffany “I need to be comfortable, and to work in the situation I feel best. And companies with a return to office mandate are basically saying they don't want me at my best. They want me to be a number, a figure, to fall into line with what some white guy in an ivory tower thought was the right way to be. Who created this baseline we all have to live up to? The return to work mandate does not create equity.” Dan   [01.07.02] The group explore some of the easy ways organizations and leaders can create more inclusive spaces and develop more equitable workplace cultures.     ·       Hiring processes o   Job descriptions o   Reasonable accommodations o   Educating hiring managers o   Being person-centered o   Language o   Diverse interviewers ·       Retention processes o   ERGs o   External support o   Funding o   Giving people time to process/prepare o   Providing information in multiple mediums o   Changing working practices/methods of communication  o   Approach to meetings o   Management support ·       Impact of current administration ·       Gap in services between childhood and adulthood   [1.27.39] The panel share final resources and sum up their thoughts from today's discussion.  ·       Culture City ·       Fear of ‘doing it wrong' ·       Feel the emotion   RESOURCES AND LINKS MENTIONED: You can connect with Tiffany and Dan over on LinkedIn.  

Should you make special accommodations for someone with a special diet? Isha Sesay Talks Motherhood, Rebranding AreyaSee omnystudio.com/listener for privacy information.

In this episode, Eva and Chloe discuss why and how to set up a disability accommodation policy if your farm employee manual. We get into why and how to use your employee manual to communicate about disability accommodations effectively and equitably with all of your farm employees to promote a healthy workplace while protecting against the risk of a discrimination claim. Recommended Resources:Episode 77: Accommodating Employee Disabilities on the Farm and RanchModel Farm Employee ManualThat's Unreasonable! Making Sense of the ADA on the FarmThis material is based upon work supported by USDA/NIFA under Award Number 2023-70027-40444.

AP's Lisa Dwyer reports on a new ruling over the requirement on abortion coverage for pregnant workers.

Go to https://cozyearth.com and use code HUMANHR for 40% off their best-selling sheets, pajamas, towels, and more. And if you get a post-purchase survey? Let them know you heard about Cozy Earth right here.In this episode of the Bringing the Human Back to Human Resources podcast, Traci Chernoff and Bryan Driscoll discuss recent updates in HR policies, focusing on independent contractor enforcement, employee classification, and the implications of automation and AI on the workforce. They explore the political fluctuations affecting HR regulations, the importance of understanding state laws, and the risks associated with misclassification. The conversation also highlights a recent SHRM data brief on automation displacement, emphasizing the need for upskilling and the potential biases in AI hiring practices. The episode concludes with a discussion on the legal responsibilities of employers in accommodating candidates and the necessity of regular audits of hiring tools.Chapters00:00 Introduction to Policy Pulse and Independent Contractor Enforcement03:01 Understanding Employee Classification and Political Whiplash05:49 Private Lawsuits and State Laws on Misclassification09:13 Recommendations for HR on Classification and Compliance12:07 SHRM Data Brief on Automation Displacement14:55 Implications of Automation on Workforce and Upskilling17:56 AI Bias and Discrimination in Hiring Practices20:54 Legal Responsibilities and Accommodations in Hiring24:00 Conclusion and Future Insights on Employment LawDon't forget to rate, review, and subscribe! Plus, leave a comment if you're catching this episode on Spotify or YouTube.We hope you enjoyed this month's Policy Pulse episode. If you found our discussion insightful, we'd like you to take a moment to rate our podcast. Your feedback helps us grow and reach more listeners who are passionate about these topics. You can also leave a review and tell us what you loved or what you'd like to hear more of - we're all ears!Connect with Traci here: ⁠https://linktr.ee/HRTraci⁠Connect with Bryan: Website: https://bryanjdriscoll.com/ LinkedIn: https://www.linkedin.com/in/bryanjohndriscoll/ Disclaimer: Thoughts, opinions, and statements made on this podcast are not a reflection of the thoughts, opinions, and statements of the Company by whom Traci Chernoff is actively employed.Please note that this episode may contain paid endorsements and advertisements for products or services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode.

Mary J. Goodwin-Oquendo, Esq., discusses how the dismantling of the U.S. Department of Education (DoE) may impact students with ADHD and learning disabilities who receive special education services and accommodations through IEPs and 504 Plans. ADHD Accommodations and Educational Rights: Additional Resources Free Download: Your Child's Legal Rights at School Read: “Is My Child's IEP in Danger?” Read: When Schools Resist Evaluating & Addressing Learning Disabilities eBook: The Complete IEP/504 Guide Access the video and slides for podcast episode #554 here: https://www.additudemag.com/webinar/adhd-accommodations-department-of-education-iep-504/ Thank you for listening to ADDitude's ADHD Experts podcast. Please consider subscribing to the magazine (additu.de/subscribe) to support our mission of providing ADHD education and support.

In this episode, Hailey ventures to the beautiful and exciting Town of Brookfield, nestled on the outskirts of Milwaukee. This little town has become the shopping center of the area with the Corners of Brookfield right in the heart! Not only that, but the Town of Brookfield has many activities, events, and plenty of foodie options to check out while you're in the area. Let's dive into how you can plan your next Wisconsin mini-cation in the Town of Brookfield!The Bobber is brought to you by Something Special from Wisconsin: https://www.somethingspecialwi.com/Read the blog here: https://discoverwisconsin.com/plan-your-mini-cation-in-the-town-of-brookfield/The Corners of Brookfield: https://thecornersofbrookfield.com/; Twigs: https://shoptwigs.com/; Silverspot Cinema: https://silverspot.net/town-of-brookfield; Cafe Hollander: https://cafehollander.com/; Belair Cantina: https://belaircantina.com/; Fresh Fin Poke: https://www.freshfinpoke.com/; Indulgence Chocolatiers: https://indulgencechocolatiers.com/; Town Food Truck Festival: https://discoverbrookfield.com/events/town-food-truck-festival/; Hotels: https://discoverbrookfield.com/stay/; Mimosa: https://www.mimosabreakfast.com/menuThe Bobber: https://discoverwisconsin.com/the-bobber-blog/The Cabin Podcast: https://the-cabin.simplecast.com. Follow on social @thecabinpodShop Discover Wisconsin: shop.discoverwisconsin.com. Follow on social @shopdiscoverwisconsinDiscover Wisconsin: https://discoverwisconsin.com/. Follow on social @discoverwisconsinDiscover Mediaworks: https://discovermediaworks.com/. Follow on social @discovermediaworksTown of Brookfield: https://townofbrookfield.com/

If Hawai'i is on your bucket list, you need to listen to this episode with Hawaii travel expert Marcie Cheung. Marcie is a family travel blogger and mom of two who's been to Hawaii more than 40 times, staying everywhere from luxury resorts to budget-friendly condos. She helps parents plan unforgettable Hawaii vacations with kids by sharing expert tips, honest reviews, and stress-free itineraries. You can learn more on her website hawaiitravelwithkids.com or follow Marcie on Facebook and Instagram. You can also listen to her podcast, Hawaii Travel Made Easy. Episode Highlights: The most popular tourist islands are: Oahu, Maui, Kauai, and Hawaii (The Big Island) Oahu is best if you can only visit one island and are looking for a mix of experiences and attractions from Pearl Harbor to the Dole Plantation and also city life, nightlife and beaches on the North Shore or Waikiki Maui is also popular for luxury resorts, a quieter vacation, the famous Road to Hana, and also great restaurants and activities Kauai is even more laid back The Big Island is good for those that are looking to be adventurous and take road trips, plus this is where you will find Volcanoes National Park A first time visitor coming from the U.S. should look at least one week and spend it on Oahu because it has such a range of experiences. If you have two weeks, then you can island hop from Oahu to Maui or Kauai. Be active on Oahu and then relax on Maui or Kauai. Keep in mind that when you island hop you still need to fly and deal with all of the airport security, rental car lines, etc. that eats up a lot of a day in travel. The Big Island is really large and you need at least five to seven days. It takes several hours to drive from the beach area to the Hawaii Volcanoes National Park. Expect to spend about $12,000 or more for a family vacation to Hawaii. Airfare from the West Coast is about $500 and closer to $900 from the East Coast. You can use a Southwest Companion Pass or Alaska Companion Pass if you have them. Accommodations keep getting more and more expensive. Midrange hotels are $350-500 and luxury resorts can easily go over $1000 per night. You need to beware about vacation rentals because they are being closely regulated in Honolulu and often they will be cancelled last minute as there are a lot of illegal vacation rentals. If you go with a vacation rental, go with something reputable. Food is also expensive because so much needs to be shipped in on the islands. Plan on spending about $100 a day on food if you are able to mix up going to restaurants and buying groceries or eating at food trucks. Rental car prices are high and you need a rental car for at least a few days on each island. Keep in mind that hotel parking can be $40-60 per night. Activities are also quite pricey, at $300-500 per person. Luaus are at least $200-350 per person. Narrow down your wish list to 2-3 activities and have beach or pool days or exploring on your own for the rest of the time. Minimum stays during winter break can be 7-14 days and this is the most expensive time to visit. When planning road trips or hikes, be sure to map them out to see how far they are and how long it will take to get there. Don't overpack your itinerary. Related Episodes: Insider tips for visiting the Disney Aulani Planning a Hawaiian vacation

Did you know picking the wrong week for your family's Hawaii vacation could double your costs and leave you battling crowds?If you've ever been frustrated by packed beaches or wondered why some trips seem so much smoother—and more affordable—than others, this episode is for you. Get the practical tips on how timing your trip to Hawaii can turn a stressful getaway into a relaxing adventure.In this episode of our travel podcast, we break down exactly when to visit Hawaii for the lowest prices and quietest beaches, and share which three weeks families should skip to avoid crowds and high costs.

See your choice of a room or bed as part of the experience. Save money and maximize the memories by knowing your options. Watch the full talk at https://www.ricksteves.com/watch-read-listen/video/tv-show/experiencing-europe For European travel information, visit https://www.ricksteves.com.

Comment on the Show by Sending Mark a Text Message.This episode is part of my initiative to provide access to important court decisions  impacting employees in an easy to understand conversational format using AI.  The speakers in the episode are AI generated and frankly sound great to listen to.  Enjoy!Beneath the sterile drapes and surgical masks lies a devastating truth: surgeons have the highest suicide rate among all physicians. A staggering 15% report having contemplated ending their lives at some point in their careers, with 6% having such thoughts within just a single year.The juxtaposition is jarring – these talented professionals represent the pinnacle of medical achievement, yet many battle profound personal demons in silence. Through Dr. Carrie Cunningham's courageous presidential address to the Association for Academic Surgery, we witness this paradox firsthand. Despite her Harvard professorship, research grants, and leadership positions, she openly shared her struggles with depression, anxiety, and substance use disorder. Her vulnerability challenges our assumptions that external success guarantees internal well-being.The factors driving this crisis run deep. Medical training itself plants the seeds, with studies showing one-third of interns develop clinical depression. The surgical culture's emphasis on perfectionism, combined with sleep deprivation and high-stakes decision-making, creates tremendous pressure. Add to this the startling revelation that 45% of physicians experienced serious trauma before even entering medicine, and we begin to understand the perfect storm threatening our healers.Most concerning is the pervasive fear preventing surgeons from seeking help. Many go to extraordinary lengths – paying cash for therapy, traveling to distant cities for treatment, self-medicating – all to avoid potential career repercussions. Physician Health Programs exist in every state with impressive 90% success rates, yet many doctors don't know about these resources until they're in crisis.True progress requires fundamental shifts: moving beyond superficial "wellness" initiatives to address genuine mental health conditions, fostering cultures where vulnerability is seen as strength rather than weakness, and creating environments where seeking help doesn't jeopardize careers. The Dr. Lorna Breen Act represents a step forward, named for an emergency physician who died by suicide after working on the pandemic frontlines.Have you noticed signs of struggle in a colleague or friend? Reaching out could save a life. What small step might you take today to create a more supportive environment for those battling silently around you?National Suicide Prevention Lifeline If you enjoyed this episode of the Employee Survival Guide please like us on Facebook, Twitter and LinkedIn. We would really appreciate if you could leave a review of this podcast on your favorite podcast player such as Apple Podcasts. Leaving a review will inform other listeners you found the content on this podcast is important in the area of employment law in the United States. For more information, please contact our employment attorneys at Carey & Associates, P.C. at 203-255-4150, www.capclaw.com.Disclaimer: For educational use only, not intended to be legal advice.

In this episode I spoke with Chris Wegner - AKA "Speech Dude" - a speech language pathologist with extensive experience accommodating PDA teens in a public school. I loved our conversation, and I hope you will too!We talked about:Practical ways to communicate about PDA in a public school setting (in this case a high school).How to write PDA-specific goals/supports in an IEP (Institutional Educational Plan here in the United States).Supporting PDA teens to feel safe, engage in learning, and make social connections in creative ways that don't feel demanding.The role that autonomy plays in PDA teens' success.Here is more about Chris!Chris Wenger is a neurodivergent high school speech-language pathologist of over 20 years, international speaker, and creator of the Dynamic Assessment of Social Emotional Learning, a strengths-based assessment for autistic students. He is also the founder of NeuroAffirm, a first-of-its-kind worldwide interactive directory connecting providers and families. Globally known as Speech Dude, he has amassed nearly one million social media followers, sharing inspiring and educational content, always with a humorous twist.Mentioned in this episode:Paradigm Shift ProgramWant me to coach you as you learn and practice the skills and mindsets I talk about in my podcast? I'd love to work with you in my proven-effective Paradigm Shift Program. Click the link to learn more and join the program interest list. Paradigm Shift Program

Anna is an educator who has developed an incredible approach with accommodations at the core (for the student AND herself!). It makes sense pedagogically, and it's working! With a core of psychological safety, students are able to explore writing and language with their own goals in mind.We've also known each other since I was 15... so we talk a bit about the mysterious backstory of living in a Christian sorority ;)Resources Anna mentioned:Workshopping: Liz Lerman's Critical Response ProcessAll My Relations podcastLove Your Brain course info & live round updateResources:Transcript DocEmail Newsletter: Nothing Wrong With UsLike Your Brain community space (Patreon) Hosted on Acast. See acast.com/privacy for more information.

Struggling to make your business more inclusive? In this episode of Play Big Faster, accessibility expert Angela Fowler reveals how businesses can tap into the $2.1 trillion buying power of people with disabilities.  Angela shares her unique perspective as a blind business owner who focuses on opportunity rather than compliance. You'll learn: how designing for accessibility creates better experiences for everyone, simple cost-effective solutions to implement immediately, and why 25% of Americans have some form of disability—many invisible. Perfect for entrepreneurs seeking untapped market opportunities.  Angela's coaching approach transforms business mindsets instead of just fixing technical issues, building lasting accessibility practices that boost customer loyalty and reduce cart abandonment. Listen now to unlock profitable inclusion strategies that benefit all customers.

In this episode of Nine to Thrive HR, host Cindi Koetzle is joined by Seth Turner, Founder and Senior Advisor at AbsenceSoft, to explore the growing complexities of leave and accommodation in the workplace. They break down the biggest insights from our 2025 State of Leave and Accommodations Report, based on a survey of 2,400 employees and HR managers. Leave requests are rising, increased demand for mental health support is a growing factor, and compliance remains a challenge—so what does this mean for HR? We'll share findings leading to why leave and accommodations requests are increasing, how employers can balance compliance with employee support, and the biggest FMLA mistakes to avoid. Plus, we'll explore the importance of manager training and how technology can streamline processes while preserving a positive employee experience.

In this episode, we dive into the often-overlooked art of writing clear, measurable goals for executive functioning. Unlike other academic or functional goals, executive functioning focuses on internal processes—making it harder to quantify and observe. Whether you're a teacher, therapist, or part of a school team, this episode will give you actionable tools to create meaningful IEP and therapy plan goals that truly support student growth.What You'll Learn in This Episode:✔️ Why executive functioning is all about the process—and why that's tricky for traditional SMART goals.✔️ Examples of goal formats that keep things simple, specific, and actionable.✔️ How to differentiate between goals that focus on behavior versus those emphasizing strategies.✔️ A sample list of accommodations to support executive functioning without over-accommodating.✔️ Tips to ensure students build independence with their accommodations over time.

Tomi Lahren sounds off on the proxy voting battle in the House. "The Grace Curley Show" Host, Grace Curley, takes that on, MAGA raging against Justice Barrett, Elon Musk turning on tariffs, and more. Then, Trump plans to fine migrants $998 a day if they fail to leave after being given a deportation order and Tomi has some Final Thoughts. Learn more about your ad choices. Visit podcastchoices.com/adchoices

Accommodation requests for mental health issues are on the rise. Even though these types of disabilities might not be outwardly apparent, employers must address requests for mental health accommodations in the same way they would evaluate— and potentially accommodate—any disability as legally required. Chapters 00:00 Introduction to Mental Health Accommodations 03:08 The Interactive Process in Mental Health Accommodations 06:00 Challenges in Recognizing Mental Health Disabilities 08:53 The Role of Service Animals in the Workplace 12:12 Customizing the Interactive Process 15:11 Conclusion and Key Takeaways

A Note from James:Is it possible to travel around the world, live around the world, do remote work anywhere you want, and spend just $75 a day or less? When I was younger, I wish I'd tried this. Back then, you probably could have done it for even less, maybe $30 a day! Today's guest, Matt Kepnes—better known as Nomadic Matt—has spent decades traveling the globe on a budget. Ten years ago, he wrote How to Travel the World on $50 a Day, and he's just updated it with How to Travel the World on $75 a Day or Less. It's definitely possible. I'm even sharing this episode with my daughters because there's a perception that travel is too expensive. Matt has tips on everything from finding cheap flights and accommodations to securing remote work opportunities. Travel opens your mind without the stress that comes with age and responsibility. If you travel cheaply, you'll not only have amazing experiences but also become more successful and open-minded. I wish I had traveled more when I was younger—I didn't think I could afford it, but as Matt explains, you certainly can.Episode Description:Matt Kepnes, aka Nomadic Matt, returns to discuss the realities of traveling the world cheaply in 2025. With inflation and changes since COVID-19 dramatically affecting costs, Matt explains how traveling on just $75 a day is not only possible but easier than you think. You'll learn practical tips for finding cheap flights, affordable accommodations, and even ways to make money while traveling. Matt also shares personal insights into how decades of constant travel impacted his life, friendships, and perspectives.What You'll Learn:How flexibility with travel dates and destinations can drastically reduce your expenses.Practical tips for securing international flights at a fraction of typical costs.Simple strategies for reducing daily living expenses abroad (accommodations, meals, transportation).Realistic job ideas and online resources to help you earn money while traveling.How long-term travel impacts relationships, personal growth, and life decisions.Chapters:[00:00] Introduction: Traveling the World on a Budget[02:00] The Impact of Inflation and COVID on Travel Costs[04:00] The Rise of the Digital Nomad Lifestyle[07:00] Money-Saving Travel Tips[08:00] Finding Cheap Flights and Accommodations[14:00] Living Cheaply in Different Countries[19:00] Matt's Journey: From Corporate Job to World Traveler[27:00] Making Money While Traveling[31:00] Easiest Job for Travelers[32:00] Journey to Becoming a Travel Writer[34:00] Advice for New Travelers[36:00] Favorite Travel Destinations[37:00] Impact of Sharing Economy on Travel[39:00] Challenges of Long-Term Travel[43:00] Global Perceptions of American Travelers[49:00] Why America Leads in Innovation[51:00] Top Countries to Move to in Europe[53:00] Resources for Aspiring Travelers[55:00] Conclusion and Final ThoughtsAdditional Resources:How to Travel the World on $75 a Day by Matt KepnesGoing.com (Flight Deals)Workaway.info (Work Exchange Opportunities)Blablacar (Ride Sharing)Travel Ladies App (For Female Travelers)Nomadic Matt's WebsiteDie with Zero by Bill PerkinsSee Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Listen in as they discuss:Loan automations.Loan modification requests.Changing contracts for a fee. Upholding what was agreed upon. Mark also discussed the art of lending.  TIP OF THE WEEKLandon: Explore AppSumo to find cost-effective alternatives for essential business tools. This platform offers lifetime deals on various apps, helping entrepreneurs save on recurring software costs while enhancing their workflows. Check it out at appsumo.com. WANT TO LISTEN MORE?Did you like this episode? If so, listen to another AOPI episode to hear more about land investing tips that can help grow your land business."Are you ready to learn more about land investing? Just click HERE to schedule a call.""Isn't it time to create passive income so you can work where you want when you want, and with whomever you want?"

Etiquette, manners, and beyond! In this episode, Nick and Leah answer listener questions about bailing on bad accommodations, attending virtual housewarming parties, moving meetings "up," and much more. Please follow us! (We'd send you a hand-written thank you note if we could.) Have a question for us? Call or text (267) CALL-RBW or visit ask.wyrbw.com QUESTIONS FROM THE WILDERNESS: What is the proper etiquette when your deli order is more than you wanted? How to I bail as a houseguest when the accommodations aren't comfortable? Should I attend a "virtual" housewarming? How to I stop my mother-in-law from bringing over food that needs to be prepared in our kitchen? What does moving a meeting “up” or “back” mean? THINGS MENTIONED DURING THE SHOW Lining up at Costco YOU ARE CORDIALLY INVITED TO... Support our show through Patreon Subscribe and rate us 5 stars on Apple Podcasts Call, text, or email us your questions Follow us on Instagram, Facebook, and Twitter Visit our official website Sign up for our newsletter Buy some fabulous official merchandise CREDITS Hosts: Nick Leighton & Leah Bonnema Producer & Editor: Nick Leighton Theme Music: Rob Paravonian ADVERTISE ON OUR SHOW Click here for details TRANSCRIPT Episode 259 Learn more about your ad choices. Visit megaphone.fm/adchoices

Big Al didn't get do a whole lot of research before booking his AirBNB. Learn more about your ad choices. Visit megaphone.fm/adchoices

Ryan Poles' draft board is wide open, Spiegs & Laurence learn that they share the same favorite MLB player & Chris Collins is mad about Northwestern's hotel accommodations (Hour 4) full 1314 Fri, 14 Mar 2025 23:01:50 +0000 kUwHnOxHuzJsiMYTDZM0NTN2PbKSxTeW sports Spiegel & Holmes Show sports Ryan Poles' draft board is wide open, Spiegs & Laurence learn that they share the same favorite MLB player & Chris Collins is mad about Northwestern's hotel accommodations (Hour 4) Matt Spiegel and Laurence Holmes bring you Chicago sports talk with great opinions, guests and fun. Join Spiegel and Holmes as they discuss the Bears, Blackhawks, Bulls, Cubs and White Sox and delve into the biggest sports storylines of the day. Recurring guests include Bears cornerback Jaylon Johnson, former Bears coach Dave Wannstedt, former Bears center Olin Kreutz, Cubs manager Craig Counsell, Cubs second baseman Nico Hoerner and MLB Network personality Jon Morosi. Catch the show live Monday through Friday (2 p.m. - 6 p.m. CT) on 670 The Score, the exclusive audio home of the Cubs and the Bulls, or on the Audacy app. 2024 © 2021 Audacy, Inc.