Podcasts about associate editor

On this episode of the AMSSM Sports Medcast, host Dr. Devin McFadden, MD, is joined by Dr. Irfan Asif, MD, FAMSSM, and Dr. Jonathan Finnoff, DO, FAMSSM, to discuss the multi-faceted topic of Paralympic Sports Medicine. In this conversation, Dr. Asif and Dr. Finnoff discuss the following: How they first got involved in USOPC and Paralympic team sports The number of sports in Paralympic competition and the athlete classifications that aim to level the playing field for athletes of different abilities What it's like to take care of Paralympic athletes and their unique requirements The planning process for delivering medical services for Team USA during the Paralympic Games Current and future research efforts regarding Paralympic athletes Overcoming the perceived barriers to entry when providing care for Paralympic athletes and ways to get more involved Dr. Asif is the associate dean for primary care and rural health and professor and chair of the Department of Family and Community at the University of Alabama at Birmingham (UAB). He currently serves as the 2nd Vice President for AMSSM and is an Associate Editor for both the British Journal of Sports Medicine and Sports Health: A Multi-Disciplinary Approach. Dr. Finnoff is the Chief Medical Officer for the United States Olympic and Paralympic Committee, a Clinical Professor in the Department of Physical Medicine and Rehabilitation, University of Colorado, and a Professor in the Department of Physical Medicine and Rehabilitation at Mayo Clinic College of Medicine and Science. He currently serves as the 1st Vice President for AMSSM. Resources: 2025 USOPC Paralympic Sports Medicine Conference https://www.usopc.org/2025-paralympic-sports-medicine-conference PARA-Wise Registry Screening Survey: https://redcap.link/PARAWISE

In this 21WIRE LIVE midweek edition with host Patrick Henningsen talking to Associate Editor for Global Affairs at 21WIRE,Freddie Ponton, to discuss Trump's alleged "ceasefire" deal between Iran and Israel, which is increasingly looking like another classic fake negotiation by Trump and Israel who are more likely reloading and preparing for a long regime change war in Iran, on the road to confronting China in Asia. We also look at the IAEA's betrayal of Iran and the UN, and how Palantir was used to generate fake intel that Iran was building a nuclear bomb. All this and more.   Also, listen to the Sunday Wire every Sunday at 5pm UK Time/12pm EST: https://21stcenturywire.com/category/sunday-wire-radio-show/ *SUBSCRIBE/DONATE TO OUR MEDIA PLATFORM HERE: https://21w.co/support VISIT OUR AFFILIATE SPONSORS: Health Solutions - Shop at Clive de Carle: https://21w.co/shop-clive FOLLOW OUR TELEGRAM CHANNEL: https://t.me/My21wire OUR FEATURED MUSIC ARTISTS: Joseph Arthur: https://josepharthur.bandcamp.com/ Peyoti for President: https://peyoti.com/ Red Rumble: https://www.youtube.com/@RedRumbleBand Peter Conway: https://www.peterconway.net/ Countdown Music: Song: Cartoon, Jéja - On & On (feat. Daniel Levi) [NCS Release] - Music provided by NoCopyrightSounds Free Download/Stream: http://ncs.io/onandon Watch: http://youtu.be/K4DyBUG242c  

Microbiologist and Associate Professor at the University of Washington Dr. Olusegun Soge reviews six different ways that the microbiology of Neisseria gonorrhoeae contributes to its antimicrobrial resistance. Dr. Soge and National STD Curriculum Podcast Host Dr. Meena Ramchandani then explore how current overuse and misuse of antibiotics in the STI field might be part of the problem. View episode transcript at www.std.uw.edu.This podcast is dedicated to an STD [sexually transmitted disease] review for health care professionals who are interested in remaining up-to-date on the diagnosis, management, and prevention of STDs. Editor and host Dr. Meena Ramchandani is an Assistant Professor of Medicine at the University of Washington (UW), Program Director of the UW Infectious Diseases Fellowship Program, and Associate Editor of the National STD Curriculum.  

The residential property market is about to be split into very clear segments thanks to a wave of generous home loan incentives. For investors, there is a clear opportunity here: Competition will be slim and values will improve in the market categories just above the incentive thresholds. In fact, the government has usefully provided a guide to how and where the opportunities will arise. Cameron Kusher of Kusher Consulting joins Associate Editor, Wealth James Kirby. In today's episode, we cover: * The new opportunity for investors in a distorted market * Queensland takes the prize for loan incentives with a 2% deposit scheme* The bad news for those waiting for the apartment gap to narrow * Capital Gains and Land tax tipped as new tax targets See omnystudio.com/listener for privacy information.

The Author Events Series presents Jonathan Capehart  | Yet Here I Am: Lessons from a Black Man's Search for Home Tickets to the Montgomery Auditorium are now sold out, but you can still get tickets for the simulcast live screening in Room 108.  REGISTER In Conversation with David Brooks Pulitzer Prize-winning writer, editor, and TV host Jonathan Capehart on growing up, coming out, finding his voice, battles lost and won, and the path to a meaningful life Before meeting with success as a journalist, Jonathan Capehart struggled with his identity. Capehart grew up without his father and, as a child, lived with his mother in New Jersey and spent his summers living with relatives in North Carolina. Whether in the North or the South, Capehart had to contend with being told he was too smart or not smart enough, too black or not black enough. His was a struggle to identify and become. Yet Here I Am takes us along Capehart's journey, from his years at Carleton College, where he learns to embrace his identity as a gay, black man surrounded by a likeminded community; to his decision to come out to his family, risking rejection; and finally, his move to New York City and where he landed his first break in television news. Capehart, gaining confidence, eventually found his singular voice – as a writer, editor, and broadcaster – and used it to propel himself and the causes of others. Indeed, it was his voice that helped him find his place in the world, contemplating the complexities of race, place, reporting, and home. Honest and endearing, Yet Here I Am is an inspirational memoir of identity, opportunity, and purpose.  Pulitzer Prize-winning journalist Jonathan Capehart is anchor of The Saturday Show and The Sunday Show on MSNBC. In the spring, he will become a co-host of the morning edition of The Weekend on MSNBC. Capehart is Associate Editor at the Washington Post, where he is also an opinion writer. He is also an analyst on The PBS News Hour. Capehart was deputy editorial page editor of the New York Daily News (2002-2004) and served on its editorial board (1993-2000). His editorial campaign in 1999 to save the Apollo Theater earned the board the Pulitzer Prize for Editorial Writing. David Brooks is a columnist for The New York Times and a contributor to The Atlantic. He is a commentator on ''The PBS Newshour." His latest book is ''How To Know A Person: The Art of Seeing Others Deeply and Being Deeply Seen.'' His previous three books were ''The Second Mountain,'' ''The Road to Character,'' and ''The Social Animal: The Hidden Sources of Love, Character, and Achievement,'' all #1 New York Times bestsellers.  The 2024/25 Author Events Series is presented by Comcast. Because you love Author Events, please make a donation when you register for this event to ensure that this series continues to inspire Philadelphians. Books will be available for purchase at the library on event night! All tickets are non-refundable. (recorded 5/22/2025)

Central Asia's vast yet mostly untapped mineral wealth is garnering global attention at a moment of rising competition for critical minerals. The European Union and the United States are increasingly focusing on the raw materials of a region that has often been overlooked. Ellie Saklatvala, Senior Editor of Argus Non-Ferrous Markets, recently discussed the current state of mineral production in Central Asia with Cristina Belda, Argus' Associate Editor, and reporter Maeve Flaherty. They examined what the region needs to realise its full potential in the coming years and explored how these developments could alter the landscape of critical minerals. Covered this episode: • The mineral resources of Central Asian countries • Tajikistan's role as a supplier of antimony • Kazakhstan and the shifting trade flows of chrome metal • Challenges related to infrastructure, logistics, and geological data • The geopolitical dynamics of the region Speakers: • Ellie Saklatvala, Editorial Lead for non-ferrous metals at Argus • Cristina Belda, Associate Editor for metals at Argus • Maeve Flaherty, Reporter for metals at Argus

In this 21WIRE LIVE midweek edition with host Patrick Henningsen talking to guests, Associate Editor for Global Affairs at 21WIRE, Freddie Ponton, and author and international human rights lawyer, Arnaud Develay, to discuss the conspicuous White House fall-out and subsequent public disappearance of Trump's Director of National Intelligence (DNI), Tulsi Gabbard, as the world inches close to nuclear war following Israel's unprovoked war of aggression against Iran - and with Trump hinting the US will join in the illegal war this week. Gabbard had previously stated in March that Iran was NOT pursing a nuclear weapon - an assessment which Trump categorically dismissed this week. Considering we are now on the brink of WWIII, can she retain her integrity without resigning from her post? All this and more. Also, listen to the Sunday Wire every Sunday at 5pm UK Time/12pm EST: https://21stcenturywire.com/category/sunday-wire-radio-show/ *SUBSCRIBE/DONATE TO OUR MEDIA PLATFORM HERE: https://21w.co/support VISIT OUR AFFILIATE SPONSORS: Health Solutions - Shop at Clive de Carle: https://21w.co/shop-clive OUR FEATURED MUSIC ARTISTS: Joseph Arthur: https://josepharthur.bandcamp.com/ Peyoti for President: https://peyoti.com/ Red Rumble: https://www.youtube.com/@RedRumbleBand Peter Conway: https://www.peterconway.net/ Countdown Music: Song: Cartoon, Jéja - On & On (feat. Daniel Levi) [NCS Release] - Music provided by NoCopyrightSounds Free Download/Stream: http://ncs.io/onandon Watch: http://youtu.be/K4DyBUG242c  

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

Historically patients with alcohol-related liver disease have received poor quality of care during their admission. In 2014, a guidance bundle was released by the the British Society of Gastroenterology (BSG) and British Association for the Study of the Liver (BASL) to address this issue. This toolkit has recently received an update to incorporate recent advances in care and improve its usability as well as accessibility.  A panel of guests join the podcast to discuss the perils of "bundle fatigue", the importance of buy-in for implementing guidance, and QI strategies for bringing the updated bundle successfully to your practice. Dr Oliver Tavabie, Deputy Editor at FG and Hepatology Consultant at the Leeds Liver Unit along with Dr Kohilan Gananandan, Trainee Editor at FG and Hepatology Registrar Royal London Hospital, interview Professor Stuart McPherson and Drs Lynsey Corless and Giovanna McGinty. Professor Stuart McPherson is based at the Liver Unit at Newcastle Upon Tyne NHS Foundation Trust and is the deputy VP for Hepatology at the BSG. Dr Lynsey Corless is a Consultant Hepatologist at Hull Royal Infirmary and the NIHR Research Delivery Network National Specialty and Settings Lead for Hepatology. Dr Giovanna McGinty is a Specialist Gastroenterology Registrar at the North Bristol NHS Trust as well as an Associate Editor at FG. They are amongst the authors of the paper "Decompensated cirrhosis: an update of the BSG/BASL admission care bundle”, published online in Frontline Gastroenterology in April 2025.   We hope you enjoy the #FGPodcast. Please follow @‌FrontGastro_BMJ. Listen to our regular podcasts and subscribe in Apple Podcasts and Spotify. If you enjoy our podcast, please rate us on your chosen platform, and leave us a review on the Frontline Gastroenterology Podcast page on Apple Podcasts: https://podcasts.apple.com/gb/podcast/fg-podcast/id942944229

In this episode, I sit down with Dr. David Klurfeld—longtime USDA scientist and one of the few insiders to publicly challenge the WHO's classification of red meat as a carcinogen. We go deep into the flawed evidence behind the infamous 2015 IARC report, why nutritional epidemiology often fails to prove causality, and how a small group of researchers helped shape global policy with low-quality science. If you've ever felt confused about meat, saturated fat, or dietary guidelines, this conversation will help you think critically about what “counts” as evidence—and who gets to decide. We cover:Dr. Klurfeld's personal journey and lessons from a career in public healthWhy the 2015 IARC red meat classification was based on weak and inconsistent evidenceHow observational studies and “allegiance bias” mislead nutrition scienceThe politics of dietary guidelines and the role of the USDA and WHOWhat the media got wrong—and why red meat remains a nutrient-dense foodWhether you're a clinician, dietitian, or simply trying to make better nutrition decisions, this episode is a powerful reminder that bias, groupthink and weak data can distort science and mislead the public. We need to be discerning about the nutrition and health advice we follow. Who is Dr. David Klurfeld?Dr. David Klurfeld is a nutritional scientist and former National Program Leader for Human Nutrition at the USDA's Agricultural Research Service. He also served as Professor and Chair of Nutrition and Food Science at Wayne State University and Associate Editor of The American Journal of Clinical Nutrition. He has authored more than 200 scientific publications and was one of 22 experts invited to the 2015 IARC working group on red meat and cancer. He is a longtime advocate for scientific integrity in public health policy.This episode is brought to you by: LMNT- Free Sample Pack with any purchase, visit https://DrinkLMNT.com/DRLYONTimeline - Get 20% off your order of Mitopure - https://timeline.com/LYONMUDWTR - Use code DRLYON to get up to 43% off your starter kit - https://mudwtr.com/DRLYONNeeded - Use code DRLYON for 20% off your first order - https://thisisneeded.com Find Dr. David Klurfeld at: Indiana University Bloomington - https://publichealth.indiana.edu/about/directory/David-Klurfeld-dmklurfe.html Google Scholar - https://scholar.google.ca/citations?user=Ym5Og20AAAAJ&hl=en LinkedIn - https://www.linkedin.com/in/david-klurfeld-812845209/ Find me at:Instagram:@drgabriellelyon TikTok: @drgabriellelyonFacebook: facebook.com/doctorgabriellelyonYouTube:

Curtis Mitch, M.A., is the principal annotator and Associate Editor of the Ignatius Study Bible series. Mitch joined the Augustine Institute in 2022 as a Bible Projects Managing Editor and concurrent Associate Professor of Sacred Scripture. Curtis joins Keith to discuss his personal faith journey and his work with the Ignatius Study Bible, which he worked on for twenty-one years! https://ignatius.com/ignatius-catholi... This episode is sponsored by Brandon Grysko and Fausone & Grysko PLC/. Law firm. https://www.thefgfirm.law/attorneys/b... If you would like to sponsor an episode, please email keith@down2earthministry.org To support the channel and Keith's ministry: Become a supporter and part of Keith's locals community https://keithnester.locals.com We also have Patreon:   / keithnester   For more info about Keith visit: http://down2earthministry.org/ Social media links: https://x.com/KeithNester1    / keithnestercatholic     / keithnestercatholic    

Steven Ellis, Associate Editor and Prospect Analyst at DailyFaceoff joins the show to talk players in the 2025 NHL Draft Class.  From Matthew Schaefer to Justin Carbonneau, Steven covers a ton of ground on a wealth of prospects entering the 2025 NHL Draft.      Give us a follow and a like and please give us a 5-Star review on Apple Podcasts and Spotify You can submit questions to our mailbag anytime via our Discord Channel or Twitter. || FHFH Twitter || FHFH Discord || FHFH Patreon || FHFH YouTube ||  

THE TIM JONES AND CHRIS ARPS SHOW 0:00 SEG 1 The Speaker's Stump Speech is brought to you by https://www.hansenstree.com/ 18:04 SEG 2 Nick Fondacaro, Associate Editor at NewsBusters | TOPIC: ABC firing News Senior National Correspondent Terry Moran after his latest tweet attacking President Trump and Stephen Miller. NewsBusters has been tracking Moran’s biased reporting for years.newsbusters.org x.com/NickFondacaro 34:04 SEG 3 Joey V. reviews the new movie “Materialists”, starring Chris Evans, Pedro Pascal, and Dakota Johnson. https://newstalkstl.com/ FOLLOW TIM - https://twitter.com/SpeakerTimJones FOLLOW CHRIS - https://twitter.com/chris_arps 24/7 LIVESTREAM - http://bit.ly/NEWSTALKSTLSTREAMS RUMBLE - https://rumble.com/NewsTalkSTL See omnystudio.com/listener for privacy information.

THE TIM JONES AND CHRIS ARPS SHOW 0:00 SEG 1 The Speaker's Stump Speech is brought to you by https://www.hansenstree.com/ 18:04 SEG 2 Nick Fondacaro, Associate Editor at NewsBusters | TOPIC: ABC firing News Senior National Correspondent Terry Moran after his latest tweet attacking President Trump and Stephen Miller. NewsBusters has been tracking Moran’s biased reporting for years.newsbusters.org x.com/NickFondacaro 34:04 SEG 3 Joey V. reviews the new movie “Materialists”, starring Chris Evans, Pedro Pascal, and Dakota Johnson. https://newstalkstl.com/ FOLLOW TIM - https://twitter.com/SpeakerTimJones FOLLOW CHRIS - https://twitter.com/chris_arps 24/7 LIVESTREAM - http://bit.ly/NEWSTALKSTLSTREAMS RUMBLE - https://rumble.com/NewsTalkSTL See omnystudio.com/listener for privacy information.

Editor's Summary by Linda Brubaker, MD, Preeti Malani, MD, MSJ, Deputy Editors, and Christopher W. Seymour, MD, MSc, Associate Editor of JAMA, the Journal of the American Medical Association, for articles published from June 7-13, 2025.

In the final installment of the MacVoices Live! WWDC 2025 coverage, the panel explores Apple's latest innovations across Maps, Apple Music, live translation, and Vision Pro. Discussions include the practical benefits of pinned playlists and AutoMix, personalized navigation in Maps, and the long-awaited shared spatial experiences in Vision Pro. Chuck Joiner, Brittany Smith,Marty Jencius, Ben Roethig, Eric Bolden, and Brian Flanigan-Arthurs also touch on translation through AirPods, Continuity upgrades, and new input options for Vision Pro like styluses and VR controllers.  MacVoices is supported by Macstock Conference and Expo in Crystal Lake IL on July 11 - 13. Use the code “macvoices50” to save $50 on conference registration. Show Notes: Chapters: 00:09 Introduction to WWDC 2025 Highlights00:30 Features of the New Maps03:57 Guest Insights and Farewells05:15 Live Translation Possibilities07:49 Apple Music Innovations16:22 Continuity and Device Integration18:11 Vision Pro Updates and Features28:37 Wrapping Up the Discussion35:32 Macstock Conference Announcement Guests: Eric Bolden is into macOS, plants, sci-fi, food, and is a rural internet supporter. You can connect with him on Twitter, by email at embolden@mac.com, on Mastodon at @eabolden@techhub.social, on his blog, Trending At Work, and as co-host on The Vision ProFiles podcast. Brian Flanigan-Arthurs is an educator with a passion for providing results-driven, innovative learning strategies for all students, but particularly those who are at-risk. He is also a tech enthusiast who has a particular affinity for Apple since he first used the Apple IIGS as a student. You can contact Brian on twitter as @brian8944. He also recently opened a Mastodon account at @brian8944@mastodon.cloud. Dr. Marty Jencius has been an Associate Professor of Counseling at Kent State University since 2000. He has over 120 publications in books, chapters, journal articles, and others, along with 200 podcasts related to counseling, counselor education, and faculty life. His technology interest led him to develop the counseling profession ‘firsts,' including listservs, a web-based peer-reviewed journal, The Journal of Technology in Counseling, teaching and conferencing in virtual worlds as the founder of Counselor Education in Second Life, and podcast founder/producer of CounselorAudioSource.net and ThePodTalk.net. Currently, he produces a podcast about counseling and life questions, the Circular Firing Squad, and digital video interviews with legacies capturing the history of the counseling field. This is also co-host of The Vision ProFiles podcast. Generally, Marty is chasing the newest tech trends, which explains his interest in A.I. for teaching, research, and productivity. Marty is an active presenter and past president of the NorthEast Ohio Apple Corp (NEOAC). Ben Roethig has been in the Apple Ecosystem since the System 7 Days. He is the a former Associate Editor with Geek Beat, Co-Founder of The Tech Hangout and Deconstruct and currently shares his thoughts on RoethigTech. Contact him on  Twitter and Mastodon. Brittany Smith is a trained cognitive neuroscientist who provides ADD/ADHD, technology, and productivity coaching through her business, Devise and Conquer, along with companion video courses for folks with ADHD. She's also the cofounder of The ADHD Guild, a community for nerdy folks with ADHD. She, herself, is a self-designated “well-rounded geek”. She can be found on Twitter as @addliberator, on Mastodon as @addliberator@pdx.social, and on YouTube with tech tips.   Support:      Become a MacVoices Patron on Patreon     http://patreon.com/macvoices      Enjoy this episode? Make a one-time donation with PayPal Connect:      Web:     http://macvoices.com      Twitter:     http://www.twitter.com/chuckjoiner     http://www.twitter.com/macvoices      Mastodon:     https://mastodon.cloud/@chuckjoiner      Facebook:     http://www.facebook.com/chuck.joiner      MacVoices Page on Facebook:     http://www.facebook.com/macvoices/      MacVoices Group on Facebook:     http://www.facebook.com/groups/macvoice      LinkedIn:     https://www.linkedin.com/in/chuckjoiner/      Instagram:     https://www.instagram.com/chuckjoiner/ Subscribe:      Audio in iTunes     Video in iTunes      Subscribe manually via iTunes or any podcatcher:      Audio: http://www.macvoices.com/rss/macvoicesrss      Video: http://www.macvoices.com/rss/macvoicesvideorss

In the final installment of the MacVoices Live! WWDC 2025 coverage, the panel explores Apple's latest innovations across Maps, Apple Music, live translation, and Vision Pro. Discussions include the practical benefits of pinned playlists and AutoMix, personalized navigation in Maps, and the long-awaited shared spatial experiences in Vision Pro. Chuck Joiner, Brittany Smith,Marty Jencius, Ben Roethig, Eric Bolden, and Brian Flanigan-Arthurs also touch on translation through AirPods, Continuity upgrades, and new input options for Vision Pro like styluses and VR controllers.  http://traffic.libsyn.com/maclevelten/MV25166.mp3 MacVoices is supported by Macstock Conference and Expo in Crystal Lake IL on July 11 - 13. Use the code “macvoices50” to save $50 on conference registration. Show Notes: Chapters: 00:09 Introduction to WWDC 2025 Highlights 00:30 Features of the New Maps 03:57 Guest Insights and Farewells 05:15 Live Translation Possibilities 07:49 Apple Music Innovations 16:22 Continuity and Device Integration 18:11 Vision Pro Updates and Features 28:37 Wrapping Up the Discussion 35:32 Macstock Conference Announcement Guests: Eric Bolden is into macOS, plants, sci-fi, food, and is a rural internet supporter. You can connect with him on Twitter, by email at embolden@mac.com, on Mastodon at @eabolden@techhub.social, on his blog, Trending At Work, and as co-host on The Vision ProFiles podcast. Brian Flanigan-Arthurs is an educator with a passion for providing results-driven, innovative learning strategies for all students, but particularly those who are at-risk. He is also a tech enthusiast who has a particular affinity for Apple since he first used the Apple IIGS as a student. You can contact Brian on twitter as @brian8944. He also recently opened a Mastodon account at @brian8944@mastodon.cloud. Dr. Marty Jencius has been an Associate Professor of Counseling at Kent State University since 2000. He has over 120 publications in books, chapters, journal articles, and others, along with 200 podcasts related to counseling, counselor education, and faculty life. His technology interest led him to develop the counseling profession ‘firsts,' including listservs, a web-based peer-reviewed journal, The Journal of Technology in Counseling, teaching and conferencing in virtual worlds as the founder of Counselor Education in Second Life, and podcast founder/producer of CounselorAudioSource.net and ThePodTalk.net. Currently, he produces a podcast about counseling and life questions, the Circular Firing Squad, and digital video interviews with legacies capturing the history of the counseling field. This is also co-host of The Vision ProFiles podcast. Generally, Marty is chasing the newest tech trends, which explains his interest in A.I. for teaching, research, and productivity. Marty is an active presenter and past president of the NorthEast Ohio Apple Corp (NEOAC). Ben Roethig has been in the Apple Ecosystem since the System 7 Days. He is the a former Associate Editor with Geek Beat, Co-Founder of The Tech Hangout and Deconstruct and currently shares his thoughts on RoethigTech. Contact him on  Twitter and Mastodon. Brittany Smith is a trained cognitive neuroscientist who provides ADD/ADHD, technology, and productivity coaching through her business, Devise and Conquer, along with companion video courses for folks with ADHD. She's also the cofounder of The ADHD Guild, a community for nerdy folks with ADHD. She, herself, is a self-designated “well-rounded geek”. She can be found on Twitter as @addliberator, on Mastodon as @addliberator@pdx.social, and on YouTube with tech tips.   Support:      Become a MacVoices Patron on Patreon      http://patreon.com/macvoices      Enjoy this episode? Make a one-time donation with PayPal Connect:      Web:      http://macvoices.com      Twitter:      http://www.twitter.com/chuckjoiner      http://www.twitter.com/macvoices      Mastodon:      https://mastodon.cloud/@chuckjoiner      Facebook:      http://www.facebook.com/chuck.joiner      MacVoices Page on Facebook:      http://www.facebook.com/macvoices/      MacVoices Group on Facebook:      http://www.facebook.com/groups/macvoice      LinkedIn:      https://www.linkedin.com/in/chuckjoiner/      Instagram:      https://www.instagram.com/chuckjoiner/ Subscribe:      Audio in iTunes      Video in iTunes      Subscribe manually via iTunes or any podcatcher:      Audio: http://www.macvoices.com/rss/macvoicesrss      Video: http://www.macvoices.com/rss/macvoicesvideorss

In part two of the WWDC 2025 keynote discussion, the MacVoices Live! panel dives deeper into hands-on impressions of Apple's latest OS betas and features. Highlights include the enthusiasm around call screening and hold assist, improvements to multitasking and UI unification, and Apple Watch additions like Workout Buddy and wrist flick gestures. Chuck Joiner, David Ginsburg, Brittany Smith, Marty Jencius, Ben Roethig, Jeff Gamet, Eric Bolden, and Brian Flanigan-Arthurs also examine a new focus on gaming, privacy-focused on-device AI, and new Shortcuts automations on the Mac. (Part 2)  Today's MacVoices is supported by CleanMyMac by MacPaw, your ultimate solution for Mac control and care. Try CleanMyMac for 7 days free, then use the code “MacVoices20” for 20% off at CLNMY.com/MacVoices. Show Notes: Chapters: 00:09 Introduction to WWDC Keynote Insights 13:07 Call Screening and Hold Assist Innovations 27:00 Game Center's Comeback and Features 33:41 Automations and Shortcuts on Mac Guests: Eric Bolden is into macOS, plants, sci-fi, food, and is a rural internet supporter. You can connect with him on Twitter, by email at embolden@mac.com, on Mastodon at @eabolden@techhub.social, on his blog, Trending At Work, and as co-host on The Vision ProFiles podcast. Brian Flanigan-Arthurs is an educator with a passion for providing results-driven, innovative learning strategies for all students, but particularly those who are at-risk. He is also a tech enthusiast who has a particular affinity for Apple since he first used the Apple IIGS as a student. You can contact Brian on twitter as @brian8944. He also recently opened a Mastodon account at @brian8944@mastodon.cloud. Jeff Gamet is a technology blogger, podcaster, author, and public speaker. Previously, he was The Mac Observer's Managing Editor, and the TextExpander Evangelist for Smile. He has presented at Macworld Expo, RSA Conference, several WordCamp events, along with many other conferences. You can find him on several podcasts such as The Mac Show, The Big Show, MacVoices, Mac OS Ken, This Week in iOS, and more. Jeff is easy to find on social media as @jgamet on Twitter and Instagram, jeffgamet on LinkedIn., @jgamet@mastodon.social on Mastodon, and on his YouTube Channel at YouTube.com/jgamet. David Ginsburg is the host of the weekly podcast In Touch With iOS where he discusses all things iOS, iPhone, iPad, Apple TV, Apple Watch, and related technologies. He is an IT professional supporting Mac, iOS and Windows users. Visit his YouTube channel at https://youtube.com/daveg65 and find and follow him on Twitter @daveg65 and on Mastodon at @daveg65@mastodon.cloud. Dr. Marty Jencius has been an Associate Professor of Counseling at Kent State University since 2000. He has over 120 publications in books, chapters, journal articles, and others, along with 200 podcasts related to counseling, counselor education, and faculty life. His technology interest led him to develop the counseling profession ‘firsts,' including listservs, a web-based peer-reviewed journal, The Journal of Technology in Counseling, teaching and conferencing in virtual worlds as the founder of Counselor Education in Second Life, and podcast founder/producer of CounselorAudioSource.net and ThePodTalk.net. Currently, he produces a podcast about counseling and life questions, the Circular Firing Squad, and digital video interviews with legacies capturing the history of the counseling field. This is also co-host of The Vision ProFiles podcast. Generally, Marty is chasing the newest tech trends, which explains his interest in A.I. for teaching, research, and productivity. Marty is an active presenter and past president of the NorthEast Ohio Apple Corp (NEOAC). Ben Roethig has been in the Apple Ecosystem since the System 7 Days. He is the a former Associate Editor with Geek Beat, Co-Founder of The Tech Hangout and Deconstruct and currently shares his thoughts on RoethigTech. Contact him on  Twitter and Mastodon. Brittany Smith is a trained cognitive neuroscientist who provides ADD/ADHD, technology, and productivity coaching through her business, Devise and Conquer, along with companion video courses for folks with ADHD. She's also the cofounder of The ADHD Guild, a community for nerdy folks with ADHD. She, herself, is a self-designated “well-rounded geek”. She can be found on Twitter as @addliberator, on Mastodon as @addliberator@pdx.social, and on YouTube with tech tips. Support: Become a MacVoices Patron on Patreon      http://patreon.com/macvoices      Enjoy this episode? Make a one-time donation with PayPal Connect: Web:      http://macvoices.com Twitter: http://www.twitter.com/chuckjoiner      http://www.twitter.com/macvoices Mastodon:      https://mastodon.cloud/@chuckjoiner Facebook:      http://www.facebook.com/chuck.joiner MacVoices Page on Facebook:      http://www.facebook.com/macvoices/ MacVoices Group on Facebook:      http://www.facebook.com/groups/macvoice LinkedIn:      https://www.linkedin.com/in/chuckjoiner/ Instagram:      https://www.instagram.com/chuckjoiner/ Subscribe:      Audio in iTunes      Video in iTunes      Subscribe manually via iTunes or any podcatcher: Audio: http://www.macvoices.com/rss/macvoicesrss      Video: http://www.macvoices.com/rss/macvoicesvideorss

K. Giriprakash is a seasoned business journalist based in Bengaluru, with over three decades of experience covering key sectors of the Indian economy. Currently serving as the Business Editor at The Federal, he previously held prominent roles at The Hindu BusinessLine—including Chief of Bureau and Associate Editor—and contributed to Business Standard, Reuters, and The Pioneer.He is the author of The Vijay Mallya Story, published by Penguin Random House in 2014—a meticulously reported biography that charts Mallya's rise across liquor, aviation, and sports, and his subsequent fall from grace.In addition to his editorial work and authorship, Giriprakash shares his expertise as a faculty member teaching business journalism at the Indian Institute of Journalism & New Media (IIJNM) in Bengaluru.He holds an active presence on social media (e.g., X/platform-wide bylines) and maintains a robust portfolio with more than 300 articles spanning alcohol, IT, aviation, and economic policy.

In part two of the WWDC 2025 keynote discussion, the MacVoices Live! panel dives deeper into hands-on impressions of Apple's latest OS betas and features. Highlights include the enthusiasm around call screening and hold assist, improvements to multitasking and UI unification, and Apple Watch additions like Workout Buddy and wrist flick gestures. Chuck Joiner,  David Ginsburg, Brittany Smith, Marty Jencius, Ben Roethig, Jeff Gamet, Eric Bolden, and Brian Flanigan-Arthurs also examine a new focus on gaming, privacy-focused on-device AI, and new Shortcuts automations on the Mac. (Part 2)  http://traffic.libsyn.com/maclevelten/MV25165.mp3 Today's MacVoices is supported by CleanMyMac by MacPaw, your ultimate solution for Mac control and care. Try CleanMyMac for 7 days free, then use the code “MacVoices20” for 20% off at CLNMY.com/MacVoices. Show Notes: Chapters: 00:09 Introduction to WWDC Keynote Insights 13:07 Call Screening and Hold Assist Innovations 27:00 Game Center's Comeback and Features 33:41 Automations and Shortcuts on Mac Guests: Eric Bolden is into macOS, plants, sci-fi, food, and is a rural internet supporter. You can connect with him on Twitter, by email at embolden@mac.com, on Mastodon at @eabolden@techhub.social, on his blog, Trending At Work, and as co-host on The Vision ProFiles podcast. Brian Flanigan-Arthurs is an educator with a passion for providing results-driven, innovative learning strategies for all students, but particularly those who are at-risk. He is also a tech enthusiast who has a particular affinity for Apple since he first used the Apple IIGS as a student. You can contact Brian on twitter as @brian8944. He also recently opened a Mastodon account at @brian8944@mastodon.cloud. Jeff Gamet is a technology blogger, podcaster, author, and public speaker. Previously, he was The Mac Observer's Managing Editor, and the TextExpander Evangelist for Smile. He has presented at Macworld Expo, RSA Conference, several WordCamp events, along with many other conferences. You can find him on several podcasts such as The Mac Show, The Big Show, MacVoices, Mac OS Ken, This Week in iOS, and more. Jeff is easy to find on social media as @jgamet on Twitter and Instagram, jeffgamet on LinkedIn., @jgamet@mastodon.social on Mastodon, and on his YouTube Channel at YouTube.com/jgamet. David Ginsburg is the host of the weekly podcast In Touch With iOS where he discusses all things iOS, iPhone, iPad, Apple TV, Apple Watch, and related technologies. He is an IT professional supporting Mac, iOS and Windows users. Visit his YouTube channel at https://youtube.com/daveg65 and find and follow him on Twitter @daveg65 and on Mastodon at @daveg65@mastodon.cloud. Dr. Marty Jencius has been an Associate Professor of Counseling at Kent State University since 2000. He has over 120 publications in books, chapters, journal articles, and others, along with 200 podcasts related to counseling, counselor education, and faculty life. His technology interest led him to develop the counseling profession ‘firsts,' including listservs, a web-based peer-reviewed journal, The Journal of Technology in Counseling, teaching and conferencing in virtual worlds as the founder of Counselor Education in Second Life, and podcast founder/producer of CounselorAudioSource.net and ThePodTalk.net. Currently, he produces a podcast about counseling and life questions, the Circular Firing Squad, and digital video interviews with legacies capturing the history of the counseling field. This is also co-host of The Vision ProFiles podcast. Generally, Marty is chasing the newest tech trends, which explains his interest in A.I. for teaching, research, and productivity. Marty is an active presenter and past president of the NorthEast Ohio Apple Corp (NEOAC). Ben Roethig has been in the Apple Ecosystem since the System 7 Days. He is the a former Associate Editor with Geek Beat, Co-Founder of The Tech Hangout and Deconstruct and currently shares his thoughts on RoethigTech. Contact him on  Twitter and Mastodon. Brittany Smith is a trained cognitive neuroscientist who provides ADD/ADHD, technology, and productivity coaching through her business, Devise and Conquer, along with companion video courses for folks with ADHD. She's also the cofounder of The ADHD Guild, a community for nerdy folks with ADHD. She, herself, is a self-designated “well-rounded geek”. She can be found on Twitter as @addliberator, on Mastodon as @addliberator@pdx.social, and on YouTube with tech tips. Support:      Become a MacVoices Patron on Patreon      http://patreon.com/macvoices      Enjoy this episode? Make a one-time donation with PayPal Connect:      Web:      http://macvoices.com      Twitter:      http://www.twitter.com/chuckjoiner      http://www.twitter.com/macvoices      Mastodon:      https://mastodon.cloud/@chuckjoiner      Facebook:      http://www.facebook.com/chuck.joiner      MacVoices Page on Facebook:      http://www.facebook.com/macvoices/      MacVoices Group on Facebook:      http://www.facebook.com/groups/macvoice      LinkedIn:      https://www.linkedin.com/in/chuckjoiner/      Instagram:      https://www.instagram.com/chuckjoiner/ Subscribe:      Audio in iTunes      Video in iTunes      Subscribe manually via iTunes or any podcatcher:      Audio: http://www.macvoices.com/rss/macvoicesrss      Video: http://www.macvoices.com/rss/macvoicesvideorss

This week on the podcast we examine the government's spending review and what it means for higher education. How will the £86bn R&D commitment translate into real-terms funding, and why was higher education notably absent from the Chancellor's priorities?Plus we discuss the Post-18 Project's call to fundamentally reshape HE policy away from market competition, the startling new REF rules, and the striking rise in student term-time working revealed by the latest Student Academic Experience Survey.With Stephanie Harris, Director of Policy at Universities UK, Ben Vulliamy, Executive Director at the Association of Heads of University Administration, Jim Dickinson, Associate Editor at Wonkhe, Michael Salmon, News Editor at Wonkhe, and presented by Mark Leach, Editor-in-Chief at Wonkhe.Tooling up: Building a new economic mission for higher educationInvesting for the long term often loses out to pensioner powerWhat's in the spending review for higher educationThe student experience is beyond breaking pointHow to assess anxious, time-poor students in a mass ageREF is about institutions not individuals Hosted on Acast. See acast.com/privacy for more information.

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

The MacVoices Live! panel took on the task of analyzing Apple's WWDC 2025 keynote, focusing on meaningful updates across iPadOS, Vision Pro, macOS, and iOS. Discussions included the new Liquid Glass interface, cross-platform consistency, and practical enhancements driven by Apple Intelligence. Panelists Chuck Joiner, David Ginsbug, Brittany Smith, Marty Jencius, Ben Roethig, Jeff Gamet, Eric Bolden, and Brian Flanigan-Arthurs debated the usefulness of iPad improvements, praised the Preview app's arrival on more devices, and examined accessibility implications. Before all that, the group paid tribute to Bill Atkinson, recognizing his pivotal role in Apple's legacy.  Today's MacVoices is supported by CleanMyMac by MacPaw, your ultimate solution for Mac control and care. Try CleanMyMac for 7 days free, then use the code “MacVoices20” for 20% off at CLNMY.com/MacVoices. Show Notes: Chapters: 00:08 Introduction to WWDC 2025 Keynote04:03 Remembering Bill Atkinson06:55 Keynote Highlights Begin09:55 iPad and Vision Pro Features13:07 Unified Interface Across Devices16:00 Apple Intelligence Discussion18:15 Preview App Recognition21:15 General Impressions of the Keynote25:30 Liquid Glass Interface Explained30:26 Accessibility Concerns with Liquid Glass Links: MacVoices #1019: MacVoices at Macworld – Bill Atkinson Shows Off His New PhotoCard iPhone App, and Comments on the iPadhttps://macvoices.com/macvoices-1019-macvoices-at-macworld-bill-atkinson-shows-off-his-new-photocard-iphone-app-and-comments-on-the-ipad/ MacVoices #1019: MacVoices at Macworld – Bill Atkinson Shows Off His New PhotoCard iPhone App, and Comments on the iPadhttps://www.youtube.com/watch?v=0_DjDdfqtUE Guests: Eric Bolden is into macOS, plants, sci-fi, food, and is a rural internet supporter. You can connect with him on Twitter, by email at embolden@mac.com, on Mastodon at @eabolden@techhub.social, on his blog, Trending At Work, and as co-host on The Vision ProFiles podcast. Brian Flanigan-Arthurs is an educator with a passion for providing results-driven, innovative learning strategies for all students, but particularly those who are at-risk. He is also a tech enthusiast who has a particular affinity for Apple since he first used the Apple IIGS as a student. You can contact Brian on twitter as @brian8944. He also recently opened a Mastodon account at @brian8944@mastodon.cloud. Jeff Gamet is a technology blogger, podcaster, author, and public speaker. Previously, he was The Mac Observer's Managing Editor, and the TextExpander Evangelist for Smile. He has presented at Macworld Expo, RSA Conference, several WordCamp events, along with many other conferences. You can find him on several podcasts such as The Mac Show, The Big Show, MacVoices, Mac OS Ken, This Week in iOS, and more. Jeff is easy to find on social media as @jgamet on Twitter and Instagram, jeffgamet on LinkedIn., @jgamet@mastodon.social on Mastodon, and on his YouTube Channel at YouTube.com/jgamet. David Ginsburg is the host of the weekly podcast In Touch With iOS where he discusses all things iOS, iPhone, iPad, Apple TV, Apple Watch, and related technologies. He is an IT professional supporting Mac, iOS and Windows users. Visit his YouTube channel at https://youtube.com/daveg65 and find and follow him on Twitter @daveg65 and on Mastodon at @daveg65@mastodon.cloud. Dr. Marty Jencius has been an Associate Professor of Counseling at Kent State University since 2000. He has over 120 publications in books, chapters, journal articles, and others, along with 200 podcasts related to counseling, counselor education, and faculty life. His technology interest led him to develop the counseling profession ‘firsts,' including listservs, a web-based peer-reviewed journal, The Journal of Technology in Counseling, teaching and conferencing in virtual worlds as the founder of Counselor Education in Second Life, and podcast founder/producer of CounselorAudioSource.net and ThePodTalk.net. Currently, he produces a podcast about counseling and life questions, the Circular Firing Squad, and digital video interviews with legacies capturing the history of the counseling field. This is also co-host of The Vision ProFiles podcast. Generally, Marty is chasing the newest tech trends, which explains his interest in A.I. for teaching, research, and productivity. Marty is an active presenter and past president of the NorthEast Ohio Apple Corp (NEOAC). Ben Roethig has been in the Apple Ecosystem since the System 7 Days. He is the a former Associate Editor with Geek Beat, Co-Founder of The Tech Hangout and Deconstruct and currently shares his thoughts on RoethigTech. Contact him on  Twitter and Mastodon. Brittany Smith is a trained cognitive neuroscientist who provides ADD/ADHD, technology, and productivity coaching through her business, Devise and Conquer, along with companion video courses for folks with ADHD. She's also the cofounder of The ADHD Guild, a community for nerdy folks with ADHD. She, herself, is a self-designated “well-rounded geek”. She can be found on Twitter as @addliberator, on Mastodon as @addliberator@pdx.social, and on YouTube with tech tips.   Support:      Become a MacVoices Patron on Patreon     http://patreon.com/macvoices      Enjoy this episode? Make a one-time donation with PayPal Connect:      Web:     http://macvoices.com      Twitter:     http://www.twitter.com/chuckjoiner     http://www.twitter.com/macvoices      Mastodon:     https://mastodon.cloud/@chuckjoiner      Facebook:     http://www.facebook.com/chuck.joiner      MacVoices Page on Facebook:     http://www.facebook.com/macvoices/      MacVoices Group on Facebook:     http://www.facebook.com/groups/macvoice      LinkedIn:     https://www.linkedin.com/in/chuckjoiner/      Instagram:     https://www.instagram.com/chuckjoiner/ Subscribe:      Audio in iTunes     Video in iTunes      Subscribe manually via iTunes or any podcatcher:      Audio: http://www.macvoices.com/rss/macvoicesrss      Video: http://www.macvoices.com/rss/macvoicesvideorss

The MacVoices Live! panel took on the task of analyzing Apple's WWDC 2025 keynote, focusing on meaningful updates across iPadOS, Vision Pro, macOS, and iOS. Discussions included the new Liquid Glass interface, cross-platform consistency, and practical enhancements driven by Apple Intelligence. Panelists Chuck Joiner, David Ginsbug, Brittany Smith, Marty Jencius, Ben Roethig, Jeff Gamet, Eric Bolden, and Brian Flanigan-Arthurs debated the usefulness of iPad improvements, praised the Preview app's arrival on more devices, and examined accessibility implications. Before all that, the group paid tribute to Bill Atkinson, recognizing his pivotal role in Apple's legacy.  Today's MacVoices is supported by CleanMyMac by MacPaw, your ultimate solution for Mac control and care. Try CleanMyMac for 7 days free, then use the code “MacVoices20” for 20% off at CLNMY.com/MacVoices. Show Notes: Chapters: 00:08 Introduction to WWDC 2025 Keynote 04:03 Remembering Bill Atkinson 06:55 Keynote Highlights Begin 09:55 iPad and Vision Pro Features 13:07 Unified Interface Across Devices 16:00 Apple Intelligence Discussion 18:15 Preview App Recognition 21:15 General Impressions of the Keynote 25:30 Liquid Glass Interface Explained 30:26 Accessibility Concerns with Liquid Glass Links: MacVoices #1019: MacVoices at Macworld – Bill Atkinson Shows Off His New PhotoCard iPhone App, and Comments on the iPad https://macvoices.com/macvoices-1019-macvoices-at-macworld-bill-atkinson-shows-off-his-new-photocard-iphone-app-and-comments-on-the-ipad/ MacVoices #1019: MacVoices at Macworld – Bill Atkinson Shows Off His New PhotoCard iPhone App, and Comments on the iPad https://www.youtube.com/watch?v=0_DjDdfqtUE Guests: Eric Bolden is into macOS, plants, sci-fi, food, and is a rural internet supporter. You can connect with him on Twitter, by email at embolden@mac.com, on Mastodon at @eabolden@techhub.social, on his blog, Trending At Work, and as co-host on The Vision ProFiles podcast. Brian Flanigan-Arthurs is an educator with a passion for providing results-driven, innovative learning strategies for all students, but particularly those who are at-risk. He is also a tech enthusiast who has a particular affinity for Apple since he first used the Apple IIGS as a student. You can contact Brian on twitter as @brian8944. He also recently opened a Mastodon account at @brian8944@mastodon.cloud. Jeff Gamet is a technology blogger, podcaster, author, and public speaker. Previously, he was The Mac Observer's Managing Editor, and the TextExpander Evangelist for Smile. He has presented at Macworld Expo, RSA Conference, several WordCamp events, along with many other conferences. You can find him on several podcasts such as The Mac Show, The Big Show, MacVoices, Mac OS Ken, This Week in iOS, and more. Jeff is easy to find on social media as @jgamet on Twitter and Instagram, jeffgamet on LinkedIn., @jgamet@mastodon.social on Mastodon, and on his YouTube Channel at YouTube.com/jgamet. David Ginsburg is the host of the weekly podcast In Touch With iOS where he discusses all things iOS, iPhone, iPad, Apple TV, Apple Watch, and related technologies. He is an IT professional supporting Mac, iOS and Windows users. Visit his YouTube channel at https://youtube.com/daveg65 and find and follow him on Twitter @daveg65 and on Mastodon at @daveg65@mastodon.cloud. Dr. Marty Jencius has been an Associate Professor of Counseling at Kent State University since 2000. He has over 120 publications in books, chapters, journal articles, and others, along with 200 podcasts related to counseling, counselor education, and faculty life. His technology interest led him to develop the counseling profession ‘firsts,' including listservs, a web-based peer-reviewed journal, The Journal of Technology in Counseling, teaching and conferencing in virtual worlds as the founder of Counselor Education in Second Life, and podcast founder/producer of CounselorAudioSource.net and ThePodTalk.net. Currently, he produces a podcast about counseling and life questions, the Circular Firing Squad, and digital video interviews with legacies capturing the history of the counseling field. This is also co-host of The Vision ProFiles podcast. Generally, Marty is chasing the newest tech trends, which explains his interest in A.I. for teaching, research, and productivity. Marty is an active presenter and past president of the NorthEast Ohio Apple Corp (NEOAC). Ben Roethig has been in the Apple Ecosystem since the System 7 Days. He is the a former Associate Editor with Geek Beat, Co-Founder of The Tech Hangout and Deconstruct and currently shares his thoughts on RoethigTech. Contact him on  Twitter and Mastodon. Brittany Smith is a trained cognitive neuroscientist who provides ADD/ADHD, technology, and productivity coaching through her business, Devise and Conquer, along with companion video courses for folks with ADHD. She's also the cofounder of The ADHD Guild, a community for nerdy folks with ADHD. She, herself, is a self-designated “well-rounded geek”. She can be found on Twitter as @addliberator, on Mastodon as @addliberator@pdx.social, and on YouTube with tech tips.   Support:      Become a MacVoices Patron on Patreon      http://patreon.com/macvoices      Enjoy this episode? Make a one-time donation with PayPal Connect:      Web:      http://macvoices.com      Twitter:      http://www.twitter.com/chuckjoiner      http://www.twitter.com/macvoices      Mastodon:      https://mastodon.cloud/@chuckjoiner      Facebook:      http://www.facebook.com/chuck.joiner      MacVoices Page on Facebook:      http://www.facebook.com/macvoices/      MacVoices Group on Facebook:      http://www.facebook.com/groups/macvoice      LinkedIn:      https://www.linkedin.com/in/chuckjoiner/      Instagram:      https://www.instagram.com/chuckjoiner/ Subscribe:      Audio in iTunes      Video in iTunes      Subscribe manually via iTunes or any podcatcher:      Audio: http://www.macvoices.com/rss/macvoicesrss      Video: http://www.macvoices.com/rss/macvoicesvideorss

Simon and Rachel speak to the journalist and author Ben Macintyre. Ben is the bestselling author of books including "A Spy Among Friends", "Agent Sonya", "Agent Zigzag", "Colditz", "Operation Mincemeat", "SAS: Rogue Heroes" and "The Spy and the Traitor". He is a columnist and Associate Editor at The Times, and has worked as the newspaper's correspondent in New York, Paris and Washington. Several of his books have been made into films and television series, including "Operation Mincemeat", "A Spy Among Friends" and "SAS: Rogue Heroes". We spoke to Ben about his work as a journalist for The Times, his long journey to becoming a successful non-fiction author, and his latest book, "The Siege", about the Iranian embassy hostage crisis - and subsequent special-forces raid - in London in 1980. We've made another update for those ⁠⁠⁠⁠⁠⁠⁠⁠⁠who support the podcast on the crowdfunding site Patreon⁠⁠⁠⁠⁠⁠⁠⁠⁠. We've added 40 pages of new material to the package of successful article pitches that goes to anyone who supports the show with $5 per month or more, including new pitches to the New York Times, the Washington Post and the BBC. The whole compendium now runs to a whopping 160 pages. For Patreons who contribute $10/month we're now also releasing bonus mini-episodes. Thanks to our sponsor, Scrivener, the first ten new signs-ups at $10/month will receive a lifelong license to Scrivener worth £55/$59.99 (eight are left). This specialist word-processing software helps you organise long writing projects such as novels, academic papers and even scripts. Other Patreon rewards include signed copies of the podcast book and the opportunity to take part in a monthly call with Simon and Rachel.A new edition of “Always Take Notes: Advice From Some Of The World's Greatest Writers” - a book drawing on our podcast interviews - is available now. The updated version now includes insights from over 100 past guests on the podcast, with new contributions from Harlan Coben, Victoria Hislop, Lee Child, Megan Nolan, Jhumpa Lahiri, Philippa Gregory, Jo Nesbø, Paul Theroux, Hisham Matar and Bettany Hughes. You can order it via ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Amazon⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ or ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Waterstones⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠.You can find us online at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠alwaystakenotes.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠, on Twitter @takenotesalways and on Instagram @alwaystakenotes. Always Take Notes is presented by Simon Akam and Rachel Lloyd, and produced by Artemis Irvine. Our music is by Jessica Dannheisser and our logo was designed by James Edgar.

In this episode I'm interviewing a nuclear energy educator with a series of informative videos on LinkedIn. He works to address radiophobia and provides an evidence-based assessment of nuclear fission and the many polarized debates surrounding its safety.  Dr. Robert Hayes is an Associate Professor of Nuclear Engineering at North Carolina State University. He holds a joint faculty appointment with Savannah River National Laboratory and serves as an Associate Editor for the journal Radiation Physics and Chemistry.  Dr. Hayes is a licensed Professional Engineer in Nuclear Engineering, a Certified Health Physicist (CHP) through the American Board of Health Physics, and a Fellow of both the Health Physics Society (HPS) and the American Physical Society (APS). He has extensive experience in federal radiological emergency response, serving over a decade at the Waste Isolation Pilot Plant for the geological disposal of transuranic waste. Currently, Dr. Hayes is an advisor to the DOE-NNSA Advisory Committee on Nuclear Security and serves on the National Council of Examiners for Engineering and Surveying (NCEES) committee responsible for nuclear engineering licensure. In addition to his academic and research contributions, he is actively engaged in public communication on radiological risk, particularly in the realm of nuclear waste management.

Join Elevated GP: www.theelevatedgp.com Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram Dr. Markus B. Blatz is Professor of Restorative Dentistry, Chairman of the Department of Preventive and Restorative Sciences and Assistant Dean for Digital Innovation and Professional Development at the University of Pennsylvania School of Dental Medicine in Philadelphia, Pennsylvania, where he also founded the Penn Dental Medicine CAD/CAM Ceramic Center, an interdisciplinary venture to study emerging technologies and new ceramic materials while providing state-of-the-art esthetic clinical care. Dr. Blatz graduated from Albert-Ludwigs University in Freiburg, Germany, and was awarded additional Doctorate Degrees, a Postgraduate Certificate in Prosthodontics, and a Professorship from the same University. Dr. Blatz is co-founder and past President of the International Academy for Adhesive Dentistry (IAAD) and a founding member of the European Academy of Digital Dentistry (EADD). He is a board-certified Diplomat in the German Society for Prosthodontics and Biomaterials (DGPro) and a member of multiple other professional organizations, including the American Academy of Esthetic Dentistry, the European Academy of Esthetic Dentistry, the International College of Prosthodontists, the American College of Prosthodontists (honorary member), Academy of Osseointegration, and O.K.U. Honor Dental Society. He is the Editor-in-Chief of Compendium of Continuing Education in Dentistry, Associate Editor of the Journal of Esthetic and Restorative Dentistry and of Quintessence International, Section Editor for the International Journal of Prosthodontics, and serves on the editorial boards of numerous other recognized scientific dental journals. He is coauthor of the international bestseller “evolution – contemporary protocols for anterior single-tooth implants”, which has been translated on over 8 languages. Prior to joining Penn Dental Medicine as Chairperson of the Department of Preventive and Restorative Sciences in September 2006, Dr. Blatz was at Louisiana State University (LSU) Health Sciences Center School of Dentistry in New Orleans, where he served as Chairman of the Department of Comprehensive Dentistry and Biomaterials and Assistant Dean for Clinical Research. During his tenure at LSU, Dr. Blatz also directed the Masters of Science in Oral Biology Program and was a senior faculty member in the Department of Prosthodontics. From 1994 to 1998 he was an Assistant Professor and from 1998 to 1999 a senior faculty member in the Department of Prosthodontics at Albert Ludwigs University Freiburg School of Dentistry in Freiburg, Germany. A widely published and internationally respected lecturer, Dr. Blatz's main focus within clinical practice and research is esthetic dentistry with an emphasis on implantology and dental materials, particularly ceramics and adhesion. Dr. Blatz is the recipient of multiple teaching and research awards and has published and lectured extensively on dental esthetics, restorative materials, and implant dentistry. He was recently named one of the “World's Top 100 Doctors in Dentistry”.

What happens when the analytic setting—built on confidentiality and silence—meets the institutional demands of psychoanalytic training? Can the frame of supervision truly preserve the integrity of the analytic pact, or does it inevitably put it at risk? In this episode, Ellen Sparer explores a central paradox in psychoanalytic formation: the tension between the confidentiality of analytic work and the structural requirements of supervision. Drawing from her experience at the Paris Psychoanalytic Institute, she asks whether supervision risks undermining the very foundation of the analytic situation—what Freud, in An Outline of Psychoanalysis, described as a pact in which “the patient's sick ego promises us the most complete candour…” while “we, on the other hand, assure him of the strictest discretion.” Through reflections on André Green, José Bleger, and Freud's concept of disavowal, Sparer examines what she calls a “noisy contradiction”—a situation in which the analyst-in-formation becomes both observer and observed, and where the silence essential to the analytic space is disturbed by institutional structure. She invites us to consider the Institute's role as a symbolic third—present, structuring, yet potentially unsettling—and to ask whether we can live with this paradox without disavowing its presence. Rather than resolving the contradiction, this episode engages with it directly, as Ellen Sparer offers a nuanced and courageous inquiry into a space of ethical tension, institutional inheritance, and potential transformation at the core of analytic formation.   Ellen Sparer is a training analyst at the Paris Psychoanalytic Society and former Director of the Paris Institute of Psychoanalysis, a role she held until March 2025. She has served as co-chair of the Applicant Societies Committee of the IPA, where she contributed to the evaluation of emerging psychoanalytic groups seeking IPA recognition. She is also an Associate Editor of the International Journal of Psychoanalysis, where she's part of the Education Section, and a scientific advisor for the Jahrbuch of Psychoanalysis. From 2009 to 2019, she was on the editorial board of the Revue Française de Psychanalyse. Most recently, she was elected to the IPA Board as a European representative. Her scientific work and publications focus on the unconscious ego, supervision, training, the frame, and ethics. She has also written on countertransference phenomena, including the function of the analyst's dream in the treatment process.   This Podcast Series, published by the International Psychoanalytical Association, is part of the activities of the IPA Communication Committee and is produced by the IPA Podcast Editorial Team. Co-Editors: Gaetano Pellegrini and Nicolle Zapien. Editing and Post-Production: Massimiliano Guerrieri.

In hour 3, Mark is joined by David Strom, the Associate Editor with HotAir.com. They discuss everything involving President Trump and Elon Musk's fallout as well as Karine Jean Pierre's book release announcement. He is then joined by Neil Gellman from The Gellman Team. Neil discusses the local real estate market and more. They wrap up the show with the Audio Cut of the Day.

In this segment, Mark is joined by David Strom, the Associate Editor with HotAir.com. They discuss everything involving President Trump and Elon Musk's fallout as well as Karine Jean Pierre's book release announcement.

In hour 1 of The Mark Reardon Show, Mark breaks down the intense "head butting" occurring on social media between President Trump and Elon Musk. What's the cause of it? Where does each side go from here? He is then joined by Josh Hammer, a Newsweek Senior Editor at Large and the Host of the Josh Hammer Show. He shares his take on the social media war between Donald Trump and Elon Musk regarding the Big, Beautiful Bill and more. Mark spends the remainder of the hour continuing to discuss the discourse between Musk and Trump online as well as former White House Press Secretary Karine Jean Pierre's tell all book announcement. In hour 2, Mark is joined by Keith Kellogg. Kellogg is a retired general and a Special Presidential Envoy to Ukraine. They discuss his thoughts on Ukraine's drone attack on Russia that occurred over the weekend, Trump's latest comments on Russian President Putin and the peace efforts. Sue then hosts, "Sue's News" where she discusses the latest trending entertainment news, this day in history, the random fact of the day, and much more. He is later joined by Brian Ping, a News Anchor for KNX Radio in Los Angeles and a St Louis Native. Brian discusses the rapid minimum raise increase in Los Angeles and the potential impact that it could have on the 2028 Summer Olympics. They wrap up the hour by discussing the latest story of St Louis' Sherriff's unnecessary spending. In hour 3, Mark is joined by David Strom, the Associate Editor with HotAir.com. They discuss everything involving President Trump and Elon Musk's fallout as well as Karine Jean Pierre's book release announcement. He is then joined by Neil Gellman from The Gellman Team. Neil discusses the local real estate market and more. They wrap up the show with the Audio Cut of the Day.

This week on the podcast we examine Universities UK's efficiency and transformation taskforce report. What do shared back-office services, federation models and subject cold spots tell us about the sector's financial pressures?Plus we discuss Research England's new EDI action plan, and explore whether the UK's rapid three-year degree model is harming student wellbeing and learning outcomes.With Rille Raaper, Associate Professor in Sociology of Higher Education at Durham University, Jess Lister, Director (Education) at Public First, Mack Marshall, Community and Policy Officer at Wonkhe SUs, and presented by Jim Dickinson, Associate Editor at Wonkhe.Our drop-out and pace miracle is harming students' health and learningUniversities UK's new era of collaborationFixing the potholes in postgraduate fundingThe spending review is a critical moment for UK science and innovationThere are better politics, big ideas, and future trade-offs in Research England's new EDI action plan Hosted on Acast. See acast.com/privacy for more information.

The first of many rescission packages has found its way to Congress. The debate starts at its efficacy first, and to the chance of it being passed, second. Also in this episode: David Strom, Associate Editor of HotAir, joins to discuss the mental health ratings of conservatives versus liberals and much more. White House Sends Congress $9.4 Billion Rescissions Package https://dailycaller.com/2025/06/03/white-house-sends-congress-rescissions-package-trump-npr-pbs/ Trump's Justice Department examining pardons issued by Biden https://www.reuters.com/world/us/trumps-justice-department-examining-pardons-issued-by-biden-2025-06-02/ Murder Rates Plummet Under President Trump https://www.dailysignal.com/2025/06/03/murder-rates-plummet-under-president-trump/ Learn more about your ad choices. Visit podcastchoices.com/adchoices

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

CDC and the World Health Organization consider Neisseria gonorrhoeae an urgent antibiotic-resistant threat because it continuously develops resistance. Microbiologist and Associate Professor at the University of Washington Dr. Olusegun Soge provides a historical overview of past efforts, an update on the current situation, why global surveillance is so important, and a potential new treatment for uncomplicated gonorrhea. View episode transcript at www.std.uw.edu.This podcast is dedicated to an STD [sexually transmitted disease] review for health care professionals who are interested in remaining up-to-date on the diagnosis, management, and prevention of STDs. Editor and host Dr. Meena Ramchandani is an Assistant Professor of Medicine at the University of Washington (UW), Program Director of the UW Infectious Diseases Fellowship Program, and Associate Editor of the National STD Curriculum.  

Dr. Andrea J. Heuson has been on the Finance Faculty at the School of Business Administration at the University of Miami since 1982. She served as the Director of the International Finance and Marketing major from 1998 to 2008 and was appointed Academic Director of Real Estate Programs in 2009. Dr. Heuson has presented research at more than 100 academic conferences in her career and published articles on mortgage finance and other fixed-income markets in numerous academic journals while teaching valuation, international finance, management of financial institutions and real estate finance in undergraduate, graduate and executive level programs. Her research has appeared in Real Estate Economics, the Journal of Real Estate Finance and Economics, the Journal of Real Estate Research and the Journal of Housing Economics. In addition to her academic duties, Heuson serves as a consultant on all aspects of real estate brokerage and appraisal licensing for the State of Florida, including evaluation of licensing examinations and educational materials. In addition to her 2015 appointment as the Secretary of AREUEA, she is also the Treasurer of the Financial Management Association and is an Associate Editor of the Journal of Financial Research.

ABSTRACT To act rightly is to act in accordance with moral demands. But what grounds moral demands? Much contemporary moral philosophy tends to take a non-relational approach to answering this question. According to non-relational moral theories, to act rightly is to act in a way that honours or promotes the (non-relational) moral properties of individuals, for example their well-being or their rights. According to relational moral theories, by contrast, at least some moral demands are grounded in a relation between individuals. To act rightly, is to act in accordance with what our moral relations to other individuals demand from us. Within relational theories, there is a further distinction to be drawn. Most contemporary relational theories presuppose that moral relations are determined by relational moral properties of the individuals involved. Call this account of relational moral demands individuals-first relationalism. Radical relationalism, by contrast, rejects the normative priority of moral properties of individuals – whether they are relational or non-relational properties. Instead, it has a relations-first structure. My aim in this paper is to argue that some moral demands are radically relational. ABOUT Fabienne Peter is Professor of Philosophy at the University of Warwick, specialising in moral and political philosophy and in social epistemology, including political epistemology. She has published extensively on political legitimacy and democratic theory. Her current research is in meta-ethics. She served as Head of Department at Warwick from 2017 to 2020. Before joining Warwick, she was a postdoc at Harvard University and then an assistant professor at the University of Basel. She has also held visiting positions at the Research School of Social Sciences at ANU and the Murphy Institute at Tulane University. She has previously been an editor of Economics and Philosophy and is currently an Associate Editor of the Journal of Moral Philosophy.

This week on the podcast we examine the OfS penalty imposed on Leeds Trinity over subcontractual partnerships oversight. What does the £115,000 fine and a new proposed code of “ethical” governance tell us about decision-making at the top? Plus we discuss the government's decision to axe level 7 apprenticeships from levy funding, and explore incoming OfS chair Edward Peck's ten trends shaping the future of campus universities.With Alex Stanley, Vice President for Higher Education at the National Union of Students, Pam Macpherson Barrett, Head of Policy and Regulation at the University of Leeds, David Kernohan, Associate Editor at Wonkhe and presented by Mark Leach, Editor-in-Chief at Wonkhe.Poor quality teaching and student outcomes. But where?The new OfS chair identifies ten trendsA code of ethical university governance is overdueShould governance reform be horizontal or vertical? Hosted on Acast. See acast.com/privacy for more information.

It’s time for a rebroadcast of a wonderful interview with my old friend, Dr. Casey Means, where she talked about the launch of her book, Good Energy. It has been a year since we talked on the eve of her book launch, which was just about to go number one and become a New York Times bestseller, and in other news, Dr. Casey has just been appointed to become the Surgeon General of the United States of America. Amazing news, a bit controversial these days since everything in politics is controversial, but long time listeners know that I steer completely clear of politics on this show, however I did want to give a plug for Dr. Casey and encourage you to listen to this interview if you didn't hear it the first time around, as she now rises to the highest position in America for doctors. In this episode, you will learn all about Dr. Casey Means’ book Good Energy: The Surprising Connection Between Metabolism and Limitless Health, which she wrote with her brother, Calley Means, and hear her talk about the broken medical industrial complex—a subject that is of deep significance for her since (as she talked about in her first appearance on the show) she used to be a dutiful doctor, a highly trained throat surgeon who was just trying to do her best, until she realized how dysfunctional the whole system was. She had a realization: no one was really getting better. They were, however, coming in for more surgery, and this sparked her decision to pursue a career in the alternative health world instead, an issue that only became more important and personal to her after she experienced the deep pain and frustration of watching her mother die of a preventable disease. This is a great episode to listen to if you want to learn about all the nuances of our profit-driven medical system, the science and details of how mitochondrial function essentially represents the essence of our health, why mitochondrial dysfunction represents the whole cause of all disease, the scary statistic about Americans and metabolic syndrome risk factors that shocked me, and more! Casey Means, MD, Surgeon General of the United States of America, is a Stanford-trained physician, the Chief Medical Officer and Co-founder of metabolic health company Levels, and Associate Editor of the International Journal of Disease Reversal and Prevention. Her mission is to maximize human potential and reverse the epidemic of preventable chronic disease by empowering individuals with tech-enabled tools that can inform smart, personalized, and sustainable dietary and lifestyle choices. Check out her website and visit CaseyMeans.com/goodenergy to read her best-selling book, Good Energy. TIMESTAMPS: Sixty-eight percent of Americans are classified as metabolically unhealthy. [03:08] It's a totally unstainable path that we are on as a country. [09:04] After becoming a head and neck surgeon, Dr. Means realized that she was not improving people's health. She wanted to focus on prevention. [12:00] Cancer is a metabolic dysfunction. We are focusing on the wrong problem. [14:41] The health care industry is fast growing and it makes more money when you are sick than when you are well. [20:02] Everything in moderation is a very bad way to look at diet. [29:48] There is such a thing as bad food. [35:19] You need to understand your own body and read the signals your body sends to you. [36:23] We have normalized not feeling well, that we don't notice it. [41:55] When we eat processed foods, they are not benign. It's more than just calories. [46:53] The ingredients in the processed foods trigger your desire to overeat. The bigger the glucose spike, the bigger the crash [53:54] High fructose corn syrup is in so many foods and is very problematic. [58:39] There are five foods that you want to include to support your mitochondrial function. [01:01:36] In a few months, if you follow those suggestions, your markers on your blood tests will show a huge difference if you were pre-diabetic. [01:09:24] Why isn't the medical system focused more on prevention? [01:15:03] LINKS: Brad Kearns.com BradNutrition.com B.rad Whey Protein Superfuel - The Best Protein on The Planet! Brad’s Shopping Page BornToWalkBook.com B.rad Podcast – All Episodes Peluva Five-Toe Minimalist Shoes Good Energy Outlive Body by Science Podcast with Dr. Casey Means Casey Means Instagram Casey Means.com/GoodEnergy. Dr. Casey's Kitchen We appreciate all feedback, and questions for Q&A shows, emailed to podcast@bradventures.com. If you have a moment, please share an episode you like with a quick text message, or leave a review on your podcast app. Thank you! Check out each of these companies because they are absolutely awesome or they wouldn’t occupy this revered space. Seriously, I won’t promote anything that I don't absolutely love and use in daily life: B.rad Nutrition: Premium quality, all-natural supplements for peak performance, recovery, and longevity; including the world's highest quality whey protein! Peluva: Comfortable, functional, stylish five-toe minimalist shoe to reawaken optimal foot function. Use code BRADPODCAST for 15% off! Ketone-IQ Save 30% off your first subscription order & receive a free six-pack of Ketone-IQ! Get Stride: Advanced DNA, methylation profile, microbiome & blood at-home testing. Hit your stride the right way, with cutting-edge technology and customized programming. Save 10% with the code BRAD. 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Did you attend Workhuman Live 2025? The conference's theme this year put the spotlight on the fusion of AI and human intelligence. At its core, the event highlighted how artificial intelligence can be a partner in enhancing human decision-making, not a substitute for it. In this episode of the Inspirational Leadership Podcast, I invite Jackye Clayton to discuss each of our individual experiences at this year's Workhuman conference. Jackye is a strategic voice at the intersection of HR technology, AI, and talent innovation. As founder of People Puzzles™, she helps companies bridge the trust gap in HR tech, translating complex innovations into human-first, credible solutions. Known for her dynamic presence as a LinkedIn influencer, sought-after speaker, and Associate Editor at HR Gazette, Jackye's approach blends bold insights with authentic connection, empowering leaders to drive strategic, sustainable change in the workplace. Listen in to learn how AI should support strategy, not suppress humanity, and that modern workplaces must balance tech advancement with emotional intelligence and collaboration. You will also learn about the themes of conscious leadership, psychological safety, and the critical need to move beyond the outdated zero-sum game mindset in organizations. Key Takeaways: The importance of intentional AI use and employee experimentation. The role of data ethics, aggregation, and accurate storytelling in HR. Why there's a reinforcement that AI should serve people, not replace purpose-driven work. Why authentic human interaction, like appreciation and check-ins, is the true face of leadership. Understanding the challenges of creating real change in DEI work. The complexity of microcultures within organizations and how shifting company culture requires addressing these layers. How the Workhuman conference experience fosters deep community and belonging. The importance of expanding recognition beyond the workplace to family and other support systems. Standout Quotes: “Feedback is what we've already done and advice is forward-looking.”- Jackye [19:42] “Don't wait for confidence, action is what creates confidence, not the other way around.”- Kristen [21:32] “Humanity is not going anywhere; the importance of human skills is not going anywhere; we just need to integrate them with the AI.”- Kristen [38:11] ⇢ Get full show notes and more information here: https://bit.ly/Workhuman2025 If this episode inspired you, share it with a fellow leader or tag me on LinkedIn with your biggest takeaway! Be sure to subscribe so you never miss a dose of real, practical leadership wisdom. ➡️ Join the conversation on LinkedIn

As artificial intelligence (AI) tools become increasingly mainstream, they can potentially transform neurology clinical practice by improving patient care and reducing clinician workload. Critically evaluating these AI tools for clinical practice is important for successful implementation. In this episode, Katie Grouse, MD, FAAN speaks with Peter Hadar, MD, MS, coauthor of the article “Clinical Applications of Artificial Intelligence in Neurology Practice” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Hadar is an instructor of neurology at Harvard Medical School and an attending physician at the Massachusetts General Hospital in Boston, Massachusetts. Additional Resources Read the article: Clinical Applications of Artificial Intelligence in Neurology Practice Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Guest: @PeterNHadar Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Peter Hadar about his article on clinical applications of artificial intelligence in neurology practice, which he wrote with Dr Lydia Moura. This article appears in the April 2025 Continuum issue on neuro-ophthalmology. Welcome to the podcast, and please introduce yourself to our audience. Dr Hadar: Hi, thanks for having me on, Katie. My name is Dr Peter Hadar. I'm currently an instructor over at Mass General Hospital, Harvard Medical School, and I'm excited to talk more about AI and how it's going to change our world, hopefully for the better. Dr Grouse: We're so excited to have you. The application of AI in clinical practice is such an exciting and rapidly developing topic, and I'm so pleased to have you here to talk about your article, which I found to be absolutely fascinating. To start, I'd like to hear what you hope will be the key takeaway from your article with our listeners. Dr Hadar: Yeah, thank you. The main point of the article is that AI in medicine is a tool. It's a wonderful tool that we should be cautiously optimistic about. But the important thing is for doctors, providers to be advocates on their behalf and on behalf of their patients for the appropriate use of this tool, because there are promises and pitfalls just with any tool. And I think in the article we detail a couple ways that it can be used in diagnostics, in clinical documentation, in the workflow, all ways that can really help providers. But sometimes the devil is in the details. So, we get into that as well. Dr Grouse: How did you become interested in AI and its application, specifically in the practice of neurology? Dr Hadar: When I was a kid, as most neurologists are, I was- I nerded out on a lot of sci-fi books, and I was really into Isaac Asimov and some of his robotics, which kind of talks about the philosophy of AI and how AI will be integrated in the future. As I got into neurology, I started doing research neurology and a lot of folks, if you're familiar with AI and machine learning, statistics can overlap a lot with machine learning. So slowly but surely, I started using statistical methods, machine learning methods, in some of my neurology research and kind of what brought me to where I am today. Dr Grouse: And thinking about and talking about AI, could you briefly summarize a few important terms that we might be talking about, such as artificial intelligence, generative AI, machine learning, etcetera? Dr Hadar: It's a little difficult, because some of these terms are nebulous and some of these terms are used in the lay public differently than other folks would use it. But in general, artificial intelligence is kind of the ability of machines or computers to communicate independently. It's similar to as humans would do so. And there are kind of different levels of AI. There's this very hard AI where people are worried about with kind of terminator-full ability to replicate a human, effectively. And there are other forms of narrow AI, which are actually more of what we're talking about today, and where it's very kind of specific, task-based applications of machine learning in which even if it's very complex, the AI tools, the machine learning tools are able to give you a result. And just some other terms, I guess out there. You hear a lot about generative AI. There's a lot of these companies and different algorithms that incorporate generative AI, and that usually kind of creates something, kind of from scratch, based on a lot of data. So, it can create pictures, it can create new text if you just ask it. Other terms that can be used are natural language processing, which is a big part of some of the hospital records. When AI tools read hospital records and can summarize something, if it can translate things. So, it turns human speech into these results that you look for. And I guess other terms like large language models are something that also have come into prominence and they rely a lot on natural language processing, being able to understand human speech, interpret it and come up with the results that you want. Dr Grouse: Thank you, that's really helpful. Building on that, what are some of the current clinical applications of AI that we may already be using in our neurologic practice and may not even be aware that that's what that is? Dr Hadar: It depends on which medical record system you use, but a very common one are some of the clinical alerts that people might get, although some of them are pretty basic and they can say, you know, if the sodium is this level, you get an alert. But sometimes they do incorporate fancier machine learning tools to say, here's a red flag. You really should think about contacting the patient about this. And we can talk about it as well. It might encourage burnout with all the different flags. So, it's not a perfect tool. But these sorts of things, typically in the setting of alerts, are the most common use. Sorry, and another one is in folks who do stroke, there are a lot of stroke algorithms with imaging that can help detect where the strokes occur. And that's a heavy machine learning field of image processing, image analysis for rapid detection of stroke. Dr Grouse: That's really interesting. I think my understanding is that AI has been used specifically for radiology interpretation applications for some time now. Is that right? Dr Hadar: In some ways. Actually, my background is in neuroimaging analysis, and we've been doing a lot of it. I've been doing it for years. There's still a lot of room to go, but it's really getting there in some ways. My suspicion is that in the coming years, it's going to be similar to how anesthesiologists at one point were actively bagging people in the fifties, and then you develop machines that can kind of do it for you. At some point there's going to be a prelim radiology read that is not just done by the resident or fellow, but is done by the machine. And then another radiologist would double check it and make sure. And I think that's going to happen in our lifetime. Dr Grouse: Wow, that's absolutely fascinating. What are some potential applications of AI in neurologic practice that may be most high-yield to improve patient care, patient access, and even reduce physician burnout? Dr Hadar: These are separate sort of questions, but they're all sort of interlinked. I think one of the big aspects of patient care in the last few years, especially with the electronic medical record, is patients have become much more their own advocates and we focus a lot more on patient autonomy. So, they are reaching out to providers outside of appointments. This can kind of lead to physician burnout. You have to answer all these messages through the electronic medical record. And so having, effectively, digital twins of yourself, AI version of yourself, that can answer the questions for the patient on your off times is one of the things that can definitely help with patient care. In terms of access, I think another aspect is having integrated workflows. So, being able to schedule patients efficiently, effectively, where more difficult patients automatically get one-hour appointments, patients who have fewer medical difficulties might get shorter appointments. That's another big improvement. Then finally, in terms of physician burnout, having ambient intelligence where notes can be written on your behalf and you just need to double-check them after allows you to really have a much better relationship with the patients. You can actually talk with them one on one and just focus on kind of the holistic care of the patient. And I think that's- being less of a cog in the machine and focusing on your role as a healer would be actually very helpful with the implementation of some of these AI tools. Dr Grouse: You mentioned ambient technology and specifically ambient documentation. And certainly, this is an area that I feel a lot of excitement about from many physicians, a lot of anticipation to be able to have access to this technology. And you mentioned already some of the potential benefits. What are some of the potential… the big wins, but then also potential drawbacks of ambient documentation? Dr Hadar: Just to kind of summarize, the ambient intelligence idea is using kind of an environmental AI system that, without being very obtrusive, just is able to record, able to detect language and process it, usually into notes. So, effectively like an AI scribe that is not actually in the appointment. So, the clear one is that---and I've seen this as well in my practice---it's very difficult to really engage with the patient and truly listen to what they're saying and form that relationship when you're behind a computer and behind a desk. And having that one-on-one interaction where you just focus on the patient, learn everything, and basically someone else takes notes for you is a very helpful component of it. Some of the drawbacks, though, some of it has to do with the existing technology. It's still not at the stage where it can do everything. It can have errors in writing down the medication, writing down the exact doses. It can't really, at this point, detect some of the apprehensions and some of the nonverbal cues that patients and providers may kind of state. Then there's also the big one where a lot of these are still done by startups and other companies where privacy may be an issue, and a lot of patients may feel very uncomfortable with having ambient intelligence tools introduced into their clinical visit, having a machine basically come between the doctor and the patient. But I think that over time these apprehensions will lessen. A lot of the security will improve and be strengthened, and I think that it's going to be incorporated a lot more into clinical practice. Dr Grouse: Yeah, well, we'll all be really excited to see how that technology develops. It certainly seems like it has a lot of promise. You mentioned in your article a lot about how AI can be used to improve screening for patients for certain types of conditions, and that certainly seems like an obvious win. But as I was reading the article, I couldn't help but worry that, at least in the short term, these tools could translate into more work for busy neurologists and more demand for access, which is, you know, already, you know, big problems in our field. How can tools like these, such as, like, for instance, the AI fundoscopic screening for vascular cognitive risk factors help without adding to these existing burdens? Dr Hadar: It's a very good point. And I think it's one of the central points of why we wanted to write the article is that these AI in medicine, it's, it's a tool like any other. And just like when the electronic medical record came into being, a lot of folks thought that this was going to save a lot of time. And you know, some people would say that it actually worsened things in a way. And when you use these diagnostic screening tools, there is an improvement in efficiency, there is an improvement in patient care. But it's important that doctors, patients advocate for this to be value-based and not revenue-based, necessarily. And it doesn't mean that suddenly the appointments are shorter, that now physicians have to see twice as many patients and then patients just have less of a relationship with their provider. So, it's important to just be able to integrate these tools in an appropriate way in which the provider and the patient both benefit. Dr Grouse: You mentioned earlier about the digital twin. Certainly, in your article you mentioned, you know, that idea along with the idea of the potential of development of virtual chatbot visits or in-person visits with a robot neurologist. And I read all this with equal parts, I think excitement, but horror and and fear. Can you tell us more about what these concepts are, and how far are we from seeing technology like this in our clinics, and maybe even, what are the risks we need to be thinking about with these? Dr Hadar: Yeah. So, I mean, I definitely think that we will see implementation of some of these tools in our lifetime. I'm not sure if we're going to have a full walking, talking robot doing some of the clinical visits. But I do think that, especially as we start doing a lot more virtual visits, it is very easy to imagine that there will be some sort of video AI doctor that can serve as, effectively, a digital twin of me or someone else, that can see patients and diagnose them. The idea behind the digital twin is that it's kind of like an AI version of yourself. So, while you only see one patient, an AI twin can go and see two or three other patients. They could also, if the patients send you messages, can respond to those messages in a way that you would, based on your training and that sort of thing. So, it allows for the ability to be in multiple places at once. One of the risks of this is, I guess, overreliance on the technology, where if you just say, we're just going to have a chatbot do everything for us and then not look at the results, you really run the risk of the chatbot just recommending really bad things. And there is training to be had. Maybe in fifty years the chatbot will be at the same level as a physician, but there's still a lot of room for improvement. I personally, I think that my suspicion as to where things will go are for very simple visits in the future and in our lifetime. If someone is having a cold or something like that and it goes to their primary care physician, a chatbot or something like that may be of really beneficial use. And it'll help segment out the different groups of simple diagnosis, simple treatments can be seen by these robots, these AI, these machine learning tools; and some of the more complex ones, at least for the early implementation of this will be seen by more specialized providers like neurologists and subspecialist neurologists too. Dr Grouse: That certainly seems reasonable, and it does seem that the more simple algorithmic things are always where these technologies will start, but it'll be interesting to see where things can go with more complex areas. Now I wanted to switch gears a little bit in the article- and I thought this was really important because I see it as being certainly one of the bigger drawbacks of AI, is that despite the many benefits of artificial intelligence, AI can unfortunately perpetuate systemic bias. And I'm wondering if you could tell us a little bit more about how this happened? Dr Hadar: I know I'm beating a dead horse on this, but AI is a tool like any other. And the problem with it is that what you put in is very similar to what you get out. And there's this idea in computer science of “garbage in, garbage out”. If you include a lot of data that has a lot of systemic biases already in the data, you're going to get results that perpetuate these things. So, for instance, if in dermatologic practices, if you just had a data set that included people of one skin color or one race and you attempted to train a model that would be able to detect skin cancer lesions, that model may not be easily applicable to people of other races, other ethnicities, other skin colors. And that can be very damaging for care. And it can actually really, really hurt the treatments for a lot of the patients. So that is one of the, kind of, main components of the systemic biases in AI. The way we mitigate them is by being aware of it and actually implementing, I guess, really hard stops on a lot of these tools before they get into practice. Being sure, did your data set include this breakdown of sex and gender, of race and ethnicity? So that the stuff you have in the AI tool is not just a very narrow, focused application, but can be generalized to a large population, not just of one community, one ethnic group, racial group, one country, but can really be generalized throughout the world for many patients. Dr Grouse: The first step is being aware of it, and hopefully these models will be built thoughtfully to help mitigate this as much as possible. I wanted to ask as well, another concern about AI is the safety of private data. And I'm wondering, as we're starting to do things like use ambient documentation, AI scribe, and other types of technologies like this, what can we tell our patients who are concerned about the safety of their personal data collected via these programs, particularly when they're being stored or used with outside companies that aren't even in our own electronic medical records system? Dr Hadar: Yeah, it's a very good question, and I think it's one of the major limitations of the current implementation of AI into clinical practice, because we still don't really have great standards---medical standards, at least---for storing this data, how to analyze this data. And my suspicion is that at some point in the future, we're going to need to have a HIPAA compliance that's going to be updated for the 21st century, that will incorporate the appropriate use of these tools, the appropriate use of these data storage, of data storage beyond just PHI. Because there's a lot more that goes into it. I would say that the important thing for how to implement this, and for patients to be aware of, is being very clear and very open with informed consent. If you're using a company that isn't really transparent about their data security and their data sharing practices, that needs to be clearly stated to the patient. If their data is going to be shared with other people, reanalyzed in a different way, many patients will potentially consider not participating in an AI implementation in clinic. And I think the other key thing is that this should be, at least initially, an opt-in approach as opposed to an opt-out approach. So patients really have- can really decide and have an informed opinion about whether or not they want to participate in the AI implementation in medicine. Dr Grouse: Well, thank you so much for explaining that. And it does certainly sound like there's a lot of development that's going to happen in that space as we are learning more about this and the use of it becomes more prevalent. Now, I also wanted to ask, another good point that you made in your article---and I don't think comes up enough in this area, but likely will as we're using it more---AI has a cost, and some of that cost is just the high amount of data and computational processing needed to use it, as well as the effects on the environment from all this energy usage. Given this drawback of AI, how can we think about potential costs versus the benefits, the more widespread use of this technology? Or how should we be thinking about it? Dr Hadar: It's part of a balance of the costs and benefits, effectively, is that AI---and just to kind of name some of them, when you have these larger data centers that are storing all this data, it requires a lot of energy consumption. It requires actually a lot of water to cool these things because they get really hot. So, these are some of the key environmental factors. And at this point, it's not as extreme as it could be, but you can imagine, as the world transitions towards an AI future, these data centers will become huge, massive, require a lot of energy. And as long as we still use a lot of nonrenewable resources to power our world, our civilization, I think this is going to be very difficult. It's going to allow for more carbon in the atmosphere, potentially more climate change. So, being very clear about using sustainable practices for AI usage, whether it be having data centers specifically use renewable resources, have clear water management guidelines, that sort of thing will allow for AI to grow, but in a sustainable way that doesn't damage our planet. In terms of the financial costs… so, AI is not free. However, on a given computer, if you want to run some basic AI analysis, you can definitely do it on any laptop you have and sometimes even on your phone. But for some of these larger models, kind of the ones that we're talking about in the medical field, it really requires a lot of computational power. And this stuff can be very expensive and can get very expensive very quickly, as anyone who's used any of these web service providers can attest to. So, it's very important to be clear-eyed about problems with implementation because some of these costs can be very prohibitive. You can run thousands and you can quickly rack up a lot of money for some very basic analysis if you want to do it in a very rapid way, in a very effective way. Dr Grouse: That's a great overview. You know, something that I think we're all going to be having to think about a lot more as we're incorporating these technologies. So, important conversations I hope we're all having, and in our institutions as we're making these decisions. I wanted to ask, certainly, as some of our listeners who may be still in the training process are hearing you talk about this and are really excited about AI and implementation of technology in medicine, what would you recommend to people who want to pursue a career in this area as you have done? Dr Hadar: So, I think one of the important things for trainees to understand are, there are different ways that they can incorporate AI into their lives going forward as they become more seasoned doctors. There are clinical ways, there are research ways, there are educational ways. A lot of the research ways, I'm one of the researchers, you can definitely incorporate AI. You can learn online. You can learn through books about how to use machine learning tools to do your analysis, and it can be very helpful. But I think one of the things that is lacking is a clinician who can traverse both the AI and patient care fields and be able to introduce AI in a very effective way that really provides value to the patients and improves the care of patients. So that means if a hospital system that a trainee is eventually part of wants to implement ambient technology, it's important for physicians to understand the risks, the benefits, how they may need to adapt to this. And to really advocate and say, just because we have this ambient technology doesn't mean now we see fifty different patients, and then you're stuck with the same issue of a worse patient-provider relationship. One of the reasons I got into medicine was to have that patient-provider interaction to not only be kind of a cog in the hospital machine, but to really take on a role as a healer and a physician. And one of the benefits of these AI tools is that in putting the machine in medicine, you can also put the humanity back in medicine at times. And I think that's a key component that trainees need to take to heart. Dr Grouse: I really appreciate you going into that, and sounds like there's certainly need. Hoping some of our listeners today will consider careers in pursuing AI and other types of technologies in medicine. I really appreciate you coming to talk with us today. I think this is just such a fascinating topic and an area that everybody's really excited about, and hoping that we'll be seeing more of this in our lives and hopefully improving our clinical practice. Thank you so much for talking to us about your article on AI in clinical neurology. It was a fascinating topic and I learned a lot. Dr Hadar: Thank you very much. I really appreciate the conversation, and I hope that trainees, physicians, and others will gain a lot and really help our patients through this. Dr Grouse: So again, today I've been interviewing Dr Peter Hadar about his article on clinical applications of artificial intelligence in neurology practice, which he wrote with Dr Lydia Moura. This article appears in the most recent issue of Continuum on neuro-ophthalmology. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.

Editor's Summary by Kirsten Bibbins-Domingo, PhD, MD, MAS, Editor in Chief, Preeti Malani, MD, MSJ, Deputy Editor, and Christopher W. Seymour, MD, MSc, Associate Editor of JAMA, the Journal of the American Medical Association, for articles published from May 17-23, 2025.

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

From September 26, 2023: On August 21, the Human Rights Watch released a report detailing systematic abuses of Ethiopian migrants and asylum seekers at the Saudi Arabia-Yemen border. Researchers interviewed dozens of Ethiopian migrants and asylum seekers and found that Saudi border guards had used explosive weapons on them and shot migrants at close range.Lawfare's Associate Editor of Communications Anna Hickey sat down with Joey Shea, a researcher in the Middle East and North Africa Division of Human Rights Watch who investigates human rights abuses in Saudi Arabia and the United Arab Emirates. They discussed the Human Rights Watch recent report, how the international community has responded so far, and the human rights record of Prince Mohammed bin Salman since he ascended the throne in 2015. To receive ad-free podcasts, become a Lawfare Material Supporter at www.patreon.com/lawfare. You can also support Lawfare by making a one-time donation at https://givebutter.com/lawfare-institute.Support this show http://supporter.acast.com/lawfare. Hosted on Acast. See acast.com/privacy for more information.

Hour 1 of the Big Show + with Patrick Dumas is on demand! To open the hour Patrick and GVP are talking all things NHL Playoffs! They start with the strong play of the Edmonton Oilers in their series against the Vegas Golden Knights. Then they talk about the Toronto Maple Leafs somehow hitting a new low.(21:34) Later on, Patrick is joined by Associate Editor at sportsnet.ca, Zach Worden! They dive into the Blue Jays righting the ship of late and discuss the biggest reasons why that has happened. They then talk about some of the injury questions surrounding the team, and specifically it's pitching.The views and opinions expressed in this podcast are those of the hosts and guests and do not necessarily reflect the position of Rogers Media Inc. or any affiliate.

This episode of PedsCases will give you an approach to congenital hemangiomas. By the end of this podcast, listeners will be able to 1) define hemangiomas and congenital hemangiomas, 2) explain the genetics and environmental factors associated with congenital hemangiomas, 3) describe the pathogenesis of congenital hemangiomas, 4) classify congenital hemangiomas, and 5) discuss the diagnosis, differential diagnosis, and management strategies for congenital hemangiomas. Today's episode was created by Emilie Wang, a medical student at the University of British Columbia, in collaboration with Dr. Joseph Lam, a pediatric dermatologist at BC Children's Hospital. An author of this podcast has financial support and has received speaker bursaries from Johnson & Johnson, Pierre-Fabre, Pfizer, Valeant, Sanofi Genzyme, Incyte, La Roche Posay Canada, Beiersdorf Canada and serves on advisory committees for Johnson & Johnson, Pierre-Fabre, Pfizer, Valeant, Sanofi Genzyme. They also serve as Associate Editor of Pediatric Dermatology Journal, and have been contributors to UpToDate, Medscape, BMJ Updates, and Eczema Society of Canada.  

Dysfunction of the supranuclear ocular motor pathways typically causes highly localizable deficits. With sophisticated neuroimaging, it is critical to better understand structure-function relationships and precisely localize pathology within the brain. In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Gregory P. Van Stavern, MD, author of the article “Supranuclear Disorders of Eye Movements” in the Continuum® April 2025 Neuro-ophthalmology issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Van Stavern is the Robert C. Drews professor of ophthalmology and visual sciences at Washington University in St Louis, Missouri. Additional Resources Read the article: Internuclear and Supranuclear Disorders of Eye Movements Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Gregory Van Stavern, who recently authored an article on intranuclear and supranuclear disorders of eye movements for our latest Continuum issue on neuro-ophthalmology. Dr Van Stavern is the Robert C Drews professor of ophthalmology and visual sciences at Washington University in Saint Louis. Dr Van Stavern, welcome, and thank you for joining us today. Why don't you introduce yourself to our audience? Dr Van Stavern: Hi, my name is Gregory Van Stavern. I'm a neuro-ophthalmologist located in Saint Louis, and I'm pleased to be on this show today. Dr Jones: We appreciate you being here, and obviously, any discussion of the visual system is worthwhile. The visual system is important. It's how most of us and most of our patients navigate the world. Roughly 40% of the brain---you can correct me if I'm wrong---is in some way assigned to our visual system. But it's not just about the sensory experience, right? The afferent visual processing. We also have motor systems of control that align our vision and allow us to accurately direct our vision to visual targets of interest. The circuitry is complex, which I think is intimidating to many of us. It's much easier to see a diagram of that than to describe it on a podcast. But I think this is a good opportunity for us to talk about the ocular motor exam and how it helps us localize lesions and, and better understand diagnoses for certain disorders. So, let's get right to it, Dr Van Stavern. If you had from your article, which is outstanding, a single most important message for our listeners about recognizing or treating patients with ocular motor disorders, what would that message be? Dr Van Stavern: Well, I think if we can basically zoom out a little to the big picture, I think it really emphasizes the continuing importance of the examination. History as well, but the examination. I was reading an article the other day that was essentially downplaying the importance of the physical examination in the modern era with modern imaging techniques and technology. But for neurology, and especially neuro-ophthalmology, the history and the examination should still drive clinical decision-making. And doing a careful assessment of the ocular motor system should be able to tell you exactly where the lesion is located, because it's very easy to order a brain MRI, but the MRI is, like Forrest Gump might say, it's like a box of chocolates. You never know what you're going to find. You may find a lot of things, but because you've done the history and the examination, you can see if whatever lesion is uncovered by the MRI is the lesion that explains what's going on with the patient. So even today, even with the most modern imaging techniques we have, it is still really important to know what you're looking for. And that's where the oculomotor examination can be very helpful. Dr Jones: I did not have Forrest Gump on my bingo card today, Dr Van Stavern, but that's a really good analogy, right? If you order the MRI, you don't know what you're going to get. And then- and if you don't have a really well-formed question, then sometimes you get misleading information, right?  Dr Van Stavern: Exactly. Dr Jones: We'll get into some technology here in a minute, because I think that's relevant for this discussion. I think most of our listeners are going to agree with us that the exam is important in neuro-ophthalmology, and neurology broadly. So, I think you have some sympathetic listeners there. Again, the point of the exam is to localize and then lead to a diagnosis that we can help patients with. When you think about neurologic disorders where the ocular motor exam helps you get to the right diagnosis, obviously disorders of eye movements, but sometimes it's a clue to a broader neurologic syndrome. And you have some nice discussions in your article about the ocular motor clues to Parkinson disease or to progressive supranuclear palsy. Tell us a little more about that. In your practice, which neurologic disorders do you find the ocular motor exam being most helpful? Dr Van Stavern: Well, just a very brief digression. So, I started off being an ophthalmology resident, and I do two years of ophthalmology and then switch to neurology. And during neurology residency, I was debating which subspecialty to go into, and I realized that neuro-ophthalmology touches every other subspecialty in neurology. And it goes back to the fact that the visual system is so pervasive and widely distributed throughout the brain. So, if you have a neurologic disease, there is a very good chance it is going to affect vision, maybe in a minor way or a major way. That's why careful assessment of the visual system, and particularly the oculomotor system, is really helpful for many neurologic diseases. Neuromuscular disease, obviously, myasthenia gravis and certain myopathies affect the eye movements. Neurodegenerative diseases, in particular Parkinson's disease and parkinsonian conditions, often affect the eye movements. And in particular, when you're trying to differentiate, is this classic Parkinson's disease? Or is this progressive supranuclear palsy? Is it some broad spectrum multisystem atrophy? The differences between the eye movement disorders, even allowing for the fact that there's overlap, can really help point in one direction to the other, and again, prevent unnecessary testing, unnecessary treatment, and so on. Dr Jones: Very good. And I think, to follow on a thread from that concept with patients who have movement disorders, in my practice, seeing older patients who have a little bit of restriction of vertical gaze is not that uncommon. And it's more common in patients who have idiopathic Parkinson disease. And then we use that part of the exam to help us screen patients for other neurodegenerative syndromes like progressive nuclear- supranuclear palsy. So, do you have any tips for our listeners to- how to look at, maybe, vertical gaze and say, this is maybe a normal age-related degree of change. This is something that might suggest idiopathic Parkinson disease. Or maybe something a little more progressive and sinister like progressive super nuclear palsy? Dr Van Stavern: Well, I think part of the issue- and it's harder to do this without the visual aspect. One of my colleagues always likes to say for a neurologist, the eye movement exam begins and ends with the neurology benediction, just doing the sign of the cross and checking the eye movements. And that's a good place to start. But I think it's important to remember that all you're looking at is smooth pursuit and range of eye movements, and there's much more to the oculomotor examination than that. There's other aspects of eye movement. Looking at saccades can be really helpful; in particular, classically, saccadic movements are selectively abnormal in PSP versus Parkinson's with progressive supranuclear palsy. Saccades, which are essentially rapid movements of the eyes---up and down, in this case---are going to be affected in downward gaze. So, the patient is going to have more difficulty initiating downward saccades, slower saccades, and less range of movement of saccades in downgaze. Whereas in Parkinson's, it's classically upward eye movements and upgaze. So, I think that's something you won't be able to see if you're just doing, looking at, you know, your classic, look at your eye movements, which are just assessing, smooth pursuit. Looking carefully at the eye movements during fixation can be helpful. Another aspect of many parkinsonian conditions is saccadic intrusions, where there's quick movements or saccades of the eye that are interrupting fixation. Much, much more common in PSP than in Parkinson's disease. The saccadic intrusions are what we call square-wave jerks because of what they look like. Eye movement recordings are much larger amplitude in PSP and other multisystem atrophy diseases than with Parkinson's. And none of these are perfect differentiators, but the constellation of those findings, a patient with slow downwards saccades, very large amplitude, and frequent saccadic intrusions might point you more towards this being PSP rather than Parkinson's. Dr Jones: That's a great pearl, thinking about the saccades in addition to the smooth pursuit. So, thank you for that. And you mentioned eye movement measurements. I think it's simultaneously impressive and a little scary that my phone can tell when I'm looking at it within a few degrees of visual attention. So, I imagine there are automated tools to analyze eye movement. Tell us, what's the state of the art there, and what should our listeners be aware of in terms of tools that are available and what they can and can't do? Dr Van Stavern: Well, I could tell you, I mean, I see neuro-ophthalmic patients with eye movement disorders every day and we do not have any automated tools for eye movement. We have a ton of imaging techniques for imaging the optic nerve and the retina in different ways, but we don't routinely employ eye movement recording devices. The only time we usually do that is in somebody where we suspect they have a central or peripheral vestibular disease and we send them for vestibular testing, for eye movement recordings. There is interest in using- I know, again, sort of another digression, but if you're looking at the HINTS technique, which is described in the chapter to differentiate central from peripheral disease, which is a very easy, useful way to differentiate central from peripheral or peripheral vestibular disease. And again, in the acute setting, is this a stroke or not a stroke? Is it the brain or is it the inner ear? Part of the problem is that if you're deploying this widespread, the people who are doing it may not be sufficiently good enough at doing the test to differentiate, is a positive or negative test? And that's where some people have started introducing this into the emergency room, these eye movement recording devices, to give the- using, potentially, AI and algorithms to help the emergency room physicians say, all right, this looks like a stroke, we need to admit the patient, get an MRI and so on, versus, this is vestibular neuritis or an inner ear problem, treat them symptomatically, follow up as an outpatient. That has not yet been widely employed. It's a similar way that a lot of institutions are having fundus photography and OCT devices placed in the emergency room to aid the emergency room physician for patients who present with acute vision issues. So, I think that could be the future. It probably would be something that would be AI-assisted or AI-driven. But I can tell you at least at our institution and most of the ones I know of, it is not routinely employed yet. Dr Jones: So maybe on the horizon, AI kind of facilitated tools for eye movement disorder interpretation, but it's not ready for prime time yet. Is that a fair summary? Dr Van Stavern: In my opinion, yes. Dr Jones: Good to know. This has struck me every time I've read about ocular motor anatomy and ocular motor disorders, whether they're supranuclear or intranuclear disorders. The anatomy is complex, the circuitry is very complicated. Which means I learn it and then I forget it and then I relearn it. But some of the anatomy isn't even fully understood yet. This is a very complex real estate in the brainstem. Why do you think the neurophysiology and neuroanatomy is not fully clarified yet? And is there anything on the horizon that might clarify some of this anatomy? Dr Van Stavern: The very first time I encountered this topic as an ophthalmology resident and later as a neurology resident, I just couldn't understand how anyone could really understand all of the circuitry involved. And there is a lot of circuitry that is involved in us simply having clear, single binocular vision with the afferent and efferent system working in concert. Even in arch. In my chapter, when you look at the anatomy and physiology of the smooth pursuit system or the vertical gaze pathways, there's a lot of, I'll admit it, there's a lot of hand waving and we don't completely understand it. I think a lot of it has to do with, in the old days, a lot of the anatomy was based on lesions, you know, lesion this area either experimentally or clinically. And that's how you would determine, this is what this region of the brain is responsible for. Although we've gotten more sophisticated with better imaging, with functional connectivity MRI and so on, all of those have limitations. And that's why I still don't think we completely understand all the way this information is integrated and synthesized, and, to get even more big level and esoteric, how this makes its way into our conscious mind. And that has to do with self-awareness and consciousness, which is a whole other kettle of fish. It's just really complicated. I think when I'm at least talking to other neurologists and residents, I try to keep it as simple as possible from a clinical standpoint. If you see someone with an eye movement problem, try to see if you can localize it to which level you're dealing with. Is it a muscle problem? Is it neuromuscular junction? Is it nerve? Is it nucleus? Is it supranuclear? If you can put it at even one of those two levels, you have eliminated huge territories of neurologic real estate, and that will definitely help you target and tailor your workup. So, again, you're not costing the patient in the healthcare system hundreds of thousands of dollars. Dr Jones: Great points in there. And I think, you know, if we can't get it down to the rostral interstitial nucleus of the medial longitudinal fasciculus, if we can get it to the brainstem, I think that's obviously- that's helpful in its own right. And I imagine, Dr Van Stavern, managing patients with persistent ocular motor disorders is a challenge. We take foveation for granted, right, when we can create these single cortical images. And I imagine it's important for daily function and difficult for patients who lose that ability to maintain their ocular alignment. What are some of the clinical tools that you use in your practice that our listeners should be aware of to help patients that have a persistent supranuclear disorder of ocular movement? Dr Van Stavern: Well, I think you tailor your treatment to the symptoms, and if it's directly due to underlying condition, obviously you treat the underlying condition. If they have sixth nerve palsy because of a skull base tumor, obviously you treat the skull base tumor. But from a practical standpoint, I think it depends on what the symptom is, what's causing it, and how much it's affecting their quality of life. And everyone is really different. Some patients have higher levels of tolerance for blurred vision and double vision. For things- for patients who have double vision, depending upon the underlying cause we can sometimes use prisms and glasses. Prisms are simply- a lot of people just think prism is this, like, mystical word that means a lot. It's simply just an optical device that bends light. So, it essentially bends light to allow the eyes- basically, the image to fall on the fovea in both eyes. And whether the prisms help or not is partly dependent upon how large the misalignment is. If somebody has a large degree of misalignment, you're not going to fix that with prism. The amount of prism you'd need to bend the light enough to land on the fovea in both eyes would cause so much blur and distortion that it would essentially be a glorified patch. So, for small ranges of misalignment, prisms are often very helpful, that we can paste over glasses or grind into glasses. For larger degrees of misalignment that- let's say it is due to some skull base tumor or brain stem lesion that is not going to get better, then eye muscle surgery is a very effective option. We usually like to give people a long enough period of time to make sure there's no change before proceeding with eye muscle surgery. Dr Jones: Very helpful. So, prisms will help to a limited extent with misalignment, and then surgery is always an option if it's persistent. That's a good pearl for, I think, our listeners to take away. Dr Van Stavern: And even in those circumstances, even prisms and eye muscle surgery, the goal is primarily to cause single binocular vision and primary gaze at near. Even in those cases, even with the best results, patients are still going to have double vision, eccentric gaze. For most people, that's not a big issue, but we have had a few patients… I had a couple of patients who were truck drivers who were really bothered by the fact that when they look to the left, let's say because it's a 4th nerve palsy on the right, they have double vision. I had a patient who was a golfer who was really, really unhappy with that. Most people are okay with that, but it all depends upon the individual patient and what they use their vision for. Dr Jones: That's a great point. There's not enough neurologists in the world. I know for a fact there are not enough neuro-ophthalmologists in the world, right? There's just not many people that have that dual expertise. You mentioned that you started with ophthalmology and then did neurology training. What do you think the pipeline looks like for neuro-ophthalmology? Do you see growing interest in this among trainees, or unchanged? What are your thoughts about that? Dr Van Stavern: No, that's a continuing discussion we're having within our own field about how to attract more residents into neuro-ophthalmology. And there's been a huge shift. In the past, this was primarily ophthalmology-driven. Most neuro-ophthalmologists were trained in ophthalmology initially before doing a fellowship. The last twenty years, it switched. Now there's an almost 50/50 division between neurologists and ophthalmologists, as more neurologists have become more interested. This is probably a topic more for the ophthalmology equivalent of Continuum. One of the perceptions is this is not a surgical subspecialty, so a lot of ophthalmology residents are disincentivized to pursue it. So, we have tried to change that. You can do neuro-ophthalmology and do eye muscle surgery or general ophthalmology. I think it really depends upon whether you have exposure to a neuro-ophthalmologist during your neurology residency. If you do not have any exposure to neuro-ophthalmology, this field will always seem mysterious, a huge black box, something intimidating, and something that is not appealing to a neurologist. I and most of my colleagues make sure to include neurology residents in our clinic so they at least have exposure to it. Dr Jones: That's a great point. If you never see it, it's hard to envision yourself in that practice. So, a little bit of a self-fulfilling prophecy. If you don't have neuro-ophthalmologists, it's hard to expose that practice to trainees. Dr Van Stavern: And we're also trying; I mean, we make sure to include medical students, bring them to our meetings, present research to try to get them interested in this field at a very early stage. Dr Jones: Dr Van Stavern, great discussion, very helpful. I want to thank you for joining us today. I want to thank you for not just a great podcast, but also just a wonderful article on ocular motor disorders, supranuclear and intranuclear. I learned a lot, and hopefully our listeners did too. Dr Van Stavern: Well, thanks. I really appreciate doing this. And I love Continuum. I learn something new every time I get another issue. Dr Jones: Well, thanks for reading it. And I'll tell you as the editor of Continuum, I learn a lot reading these articles. So, it's really a joy to get to read, up to the minute, cutting-edge clinical content for neurology. Again, we've been speaking with Dr Gregory Van Stavern, author of a fantastic article on intranuclear and supranuclear disorders of eye movements in Continuum's most recent issue on neuro-ophthalmology. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Send us a textIn this encore edition, Beth and Lisa chat with Ivan Taurisano, Associate Editor at Abrams, who specializes in children's literature and intellectual properties. Ivan shares insider tips on creating standout submissions, navigating the acquisition process, and the evolving trends in middle-grade publishing.Guest BioIvan Taurisano is an Associate Editor at Abrams, specializing in children's licenses and intellectual property. His work includes novelty books, board books, graphic novels, and select MG and YA titles. He has collaborated on several successful series and brands, such as How to Catch, Little Heroes, Big Hearts, Sesame Street, Disney, Tokidoki, and Pokémon. His guiding principle is that a child whose life is transformed by a book is one step closer to becoming an adult who will change the world.Key Discussion PointsSubmission Essentials: Ivan emphasizes the importance of polished manuscripts, strategic research, and personalized query letters. Authors should highlight why their work fits the editor's preferences and demonstrate professionalism to make a strong first impression.Acquisition Process: Ivan demystifies the journey of a manuscript from editorial meetings to marketing evaluations, highlighting what makes or breaks a deal.Middle-Grade Trends: The market is leaning toward shorter, action-packed, and visually engaging middle-grade books. Writers are encouraged to innovate and break traditional molds to captivate readers.Social Media & Track Records: While a social media platform isn't a dealbreaker, it's a bonus for YA and middle-grade authors. Past sales numbers of debut books are discussed critically during acquisitions, with publishers investigating contributing factors to performance.Opportunities in Chapter Books: There's room for new voices in character-driven chapter books, with series potential being a key factor for success.ConclusionThis episode provides actionable advice for aspiring authors to refine their submissions and navigate publishing with confidence. Ivan's insights, grounded in industry expertise, offer a roadmap for writers seeking to make an impact in children's literature. Support the show Visit the WebsiteWriters with Wrinkles Link Tree for socials and more!

As the dust settles on the federal election, we're unpacking Australia's dramatically changed political landscape. From Labor's historic female majority caucus to tomorrow's Liberal leadership contest and the Greens searching for a new leader, this is your Australian politics update. AND IN HEADLINES TODAY: Labor will unveil their new leadership team today with two big names already ousted form the front bench; The Bondi stabbing inquest will hear from the doctor who weaned Joel Cauchi off his antipsychotic medication today; Ukraine President Volodymyr Zelensky has agreed to meet with Russian President Vladimir Putin in Turkey on Thursday; US President Donald Trump has reportedly accepted a jumbo jet as a gift from Qatari's ruling family; Bindi Irwin has missed her Dad's annual fundraiser after undergoing emergency surgery THE END BITSSupport independent women's mediaCheck out The Quicky Instagram here GET IN TOUCHShare your story, feedback, or dilemma! Send us a voice note or email us at thequicky@mamamia.com.au CREDITS Hosts: Taylah Strano & Claire Murphy Guest: Jenna Clarke, Associate Editor at The Australian Executive Producer: Taylah StranoBecome a Mamamia subscriber: https://www.mamamia.com.au/subscribeSee omnystudio.com/listener for privacy information.

By subjugating Ukraine, Putin hopes to reassert Russia's status as a great power, discourage other neighbours from pivoting west, and distract from domestic issues through nationalist fervour. Ultimately, Putin fears the erosion of Russia's imperial legacy and the contagion of democratic aspirations among his own people—making Ukraine not just a strategic interest, but an existential concern for his rule and survival. It's not about economic, territory or minerals, so why would Putin stop until he has erased Ukraine as a sovereign entity and a bulwark of democratisation? ----------Dominic Nicholls is Associate Editor for Defence) at the Telegraph and co-host of podcast ‘Ukraine: The Latest'. Dominic served for 23 years in the British Army with operational deployments in Iraq, Afghanistan, the Balkans and Northern Ireland. Originally a cavalry officer in The Royal Scots Dragoon Guards he later transferred to the Army Air Corps where he flew Gazelle helicopters. ----------LINKS: https://www.telegraph.co.uk/authors/d/dk-do/dominic-nicholls/https://domnicholls.com/https://www.linkedin.com/in/dominic-nicholls-54a14134https://x.com/domnicholls?lang=en-GB ----------Your support is massively appreciated! SILICON CURTAIN LIVE EVENTS - FUNDRAISER CAMPAIGN Events in 2025 - Advocacy for a Ukrainian victory with Silicon CurtainNEXT EVENTS - LVIV, KYIV AND ODESA THIS MAY.https://buymeacoffee.com/siliconcurtain/extrasOur first live events this year in Lviv and Kyiv were a huge success. Now we need to maintain this momentum, and change the tide towards a Ukrainian victory. The Silicon Curtain Roadshow is an ambitious campaign to run a minimum of 12 events in 2025, and potentially many more. We may add more venues to the program, depending on the success of the fundraising campaign. https://buymeacoffee.com/siliconcurtain/extrasWe need to scale up our support for Ukraine, and these events are designed to have a major impact. Your support in making it happen is greatly appreciated. All events will be recorded professionally and published for free on the Silicon Curtain channel. Where possible, we will also live-stream events.https://buymeacoffee.com/siliconcurtain/extras----------SILICON CURTAIN FILM FUNDRAISER - A project to make a documentary film in Ukraine, to raise awareness of Ukraine's struggle and in supporting a team running aid convoys to Ukraine's front-line towns.https://buymeacoffee.com/siliconcurtain/extras----------SUPPORT THE CHANNEL:https://www.buymeacoffee.com/siliconcurtainhttps://www.patreon.com/siliconcurtain----------TRUSTED CHARITIES ON THE GROUND:Save Ukrainehttps://www.saveukraineua.org/Superhumans - Hospital for war traumashttps://superhumans.com/en/UNBROKEN - Treatment. Prosthesis. Rehabilitation for Ukrainians in Ukrainehttps://unbroken.org.ua/Come Back Alivehttps://savelife.in.ua/en/Chefs For Ukraine - World Central Kitchenhttps://wck.org/relief/activation-chefs-for-ukraineUNITED24 - An initiative of President Zelenskyyhttps://u24.gov.ua/Serhiy Prytula Charity Foundationhttps://prytulafoundation.orgNGO “Herojam Slava”https://heroiamslava.org/kharpp - Reconstruction project supporting communities in Kharkiv and Przemyślhttps://kharpp.com/NOR DOG Animal Rescuehttps://www.nor-dog.org/home/----------PLATFORMS:Twitter: https://twitter.com/CurtainSiliconInstagram: https://www.instagram.com/siliconcurtain/Podcast: https://open.spotify.com/show/4thRZj6NO7y93zG11JMtqmLinkedin: https://www.linkedin.com/in/finkjonathan/Patreon: https://www.patreon.com/siliconcurtain----------Welcome to the Silicon Curtain podcast. Please like and subscribe if you like the content we produce. It will really help to increase the popularity of our content in YouTube's algorithm. Our material is now being made available on popular podcasting platforms as well, such as Spotify and Apple Podcasts.