Podcasts about associate editor

Play Episode Listen Later Oct 3, 2025 36:44

The MacVoices Live! panel talks brand genericization (“AirPods” for all earbuds), a quirky AirPods Max fix, and first-week impressions of new Apple gear. Chuck Joiner, Dave Ginsburg, Brian Flanigan-Arthurs, Ben Roethig, Jeff Gamet, Eric Bolden, Marty Jencius Jim Rea, and Web Bixby relate stories of iPhone 17 setup, camera zoom and landscape selfie tricks, store launch crowds, cases and scratch concerns, Liquid Glass readability, Apple Watch Ultra 3, AirPods Pro 3 translation limits, and an M3 iPad Air upgrade with education-store trade-in twists. http://traffic.libsyn.com/maclevelten/MV25252.mp3 This edition of MacVoices is brought to you by the MacVoices Dispatch, our weekly newsletter that keeps you up-to-date on any and all MacVoices-related information. Subscribe today and don't miss a thing. Show Notes: Chapters: [0:03] Newsletter plug [0:21] “AirPods” as a generic term [3:55] AirPods Max freezer fix success [6:36] New iPhone launch week check-in [11:42] Device migrations and methods [13:43] Apple Store pickup experiences [19:19] Hands-on with iPhone Air [20:04] Watch Ultra 3 and accessories [24:22] Purchase patterns and upgrades [25:50] M3 iPad Air trade-in journey [28:48] Liquid Glass readability; scratch worries| [33:25] Concert testing: 40× zoom results Links: iPhone 17 buyers pack Apple Stores worldwide https://appleinsider.com/articles/25/09/19/iphone-17-buyers-pack-apple-stores-worldwide Guests: Web Bixby has been in the insurance business for 40 years and has been an Apple user for longer than that.You can catch up with him on Facebook, Twitter, and LinkedIn, but prefers Bluesky. 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). Jim Rea built his own computer from scratch in 1975, started programming in 1977, and has been an independent Mac developer continuously since 1984. He is the founder of ProVUE Development, and the author of Panorama X, ProVUE's ultra fast RAM based database software for the macOS platform. He's been a speaker at MacTech, MacWorld Expo and other industry conferences. Follow Jim at provue.com and via @provuejim@techhub.social on Mastodon. 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. 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

MacVoices #25251: Live! - How The MacVoices Live! Panel Uses Tech…And What For

Play Episode Listen Later Oct 2, 2025 26:27

The panel of Chuck Joiner, Dave Ginsburg, Brian Flanigan-Arthurs, Ben Roethig, Jeff Gamet, Eric Bolden, Marty Jencius, Jim Rea, and Web Bixby share how they use technology across personal and professional projects — from AI tools like Teams Copilot and MacWhisper to collaborative Google Slides and automation. One panel member discusses managing a massive listserv and combating spam research posts, while others highlight advances in Apple silicon and side ventures like an eclectic food pursuit. The group shares evolving workflows, collaboration, and unexpected tech support moments. This edition of MacVoices is supported by The MacVoices Slack. Available all Patrons of MacVoices. Sign up at Patreon.com/macvoices. Show Notes: Chapters: [0:00] Introductions and panel greetings [5:22] Exploring personal tech projects and AI tools [7:09] Using Google Slides across platforms for collaboration [9:02] Teams Premium and AI transcription in corporate settings [11:35] Managing large listservs and research spam challenges [15:06] MacWhisper performance comparisons and Apple Silicon speed [19:42] Creative projects: black walnut syrup and tech integration [22:08] Real-world client support and unexpected tech help [24:51] Closing reflections and community engagement Web Bixby has been in the insurance business for 40 years and has been an Apple user for longer than that.You can catch up with him on Facebook, Twitter, and LinkedIn, but prefers Bluesky. 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). Jim Rea built his own computer from scratch in 1975, started programming in 1977, and has been an independent Mac developer continuously since 1984. He is the founder of ProVUE Development, and the author of Panorama X, ProVUE's ultra fast RAM based database software for the macOS platform. He's been a speaker at MacTech, MacWorld Expo and other industry conferences. Follow Jim at provue.com and via @provuejim@techhub.social on Mastodon. 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. Guests: 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

Multidisciplinary Treatment for Functional Movement Disorder With Dr. Jon Stone

Easy Reider: A Conversation with Bruce Reider, MD

Play Episode Listen Later Oct 1, 2025 28:17

Functional movement disorders are a common clinical concern for neurologists. The principle of “rule-in” diagnosis, which involves demonstrating the difference between voluntary and automatic movement, can be carried through to explanation, triage, and evidence-based multidisciplinary rehabilitation therapy. In this episode, Gordon Smith, MD, FAAN speaks Jon Stone, PhD, MB, ChB, FRCP, an author of the article “Multidisciplinary Treatment for Functional Movement Disorder” in the Continuum® August 2025 Movement Disorders 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. Stone is a consultant neurologist and honorary professor of neurology at the Centre for Clinical Brain Sciences at the University of Edinburgh in Edinburgh, United Kingdom. Additional Resources Read the article: Multidisciplinary Treatment for Functional Movement Disorder 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 Host: @gordonsmithMD Guest: @jonstoneneuro Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. This exclusive Continuum Audio interview is available only to you, our subscribers. We hope you enjoy it. Thank you for listening. Dr Smith: Hello, this is Dr Gordon Smith. Today I've got the great pleasure of interviewing Dr Johnstone about his article on the multidisciplinary treatment for functional neurologic disorder, which he wrote with Dr Alan Carson. This article will appear in the August 2025 Continuum issue on movement disorders. I will say, Jon, that as a Continuum Audio interviewer, I usually take the interviews that come my way, and I'm happy about it. I learn something every time. They're all a lot of fun. But there have been two instances where I go out and actively seek to interview someone, and you are one of them. So, I'm super excited that they allowed me to talk with you today. For those of our listeners who understand or are familiar with FND, Dr Stone is a true luminary and a leader in this, both in clinical care and research. He's also a true humanist. And I have a bit of a bias here, but he was the first awardee of the Ted Burns Humanism in Neurology award, which is a real honor and reflective of your great work. So welcome to the podcast, Jon. Maybe you can introduce yourself to our audience. Dr Stone: Well, thank you so much, Gordon. It was such a pleasure to get that award, the Ted Burns Award, because Ted was such a great character. I think the spirit of his podcasts is seen in the spirit of these podcasts as well. So, I'm a neurologist in Edinburgh in Scotland. I'm from England originally. I'm very much a general neurologist still. I still work full-time. I do general neurology, acute neurology, and I do two FND clinics a week. I have a research group with Alan Carson, who you mentioned; a very clinical research group, and we've been doing that for about 25 years. Dr Smith: I really want to hear more about your clinical approach and how you run the clinic, but I wonder if it would be helpful for you to maybe provide a definition. What's the definition of a functional movement disorder? I mean, I think all of us see these patients, but it's actually nice to have a definition. Dr Stone: You know, that's one of the hardest things to do in any paper on FND. And I'm involved with the FND society, and we're trying to get together a definition. It's very hard to get an overarching definition. But from a movement disorder point of view, I think you're looking at a disorder where there is an impairment of voluntary movement, where you can demonstrate that there is an automatic movement, which is normal in the same movement. I mean, that's a very clumsy way of saying it. Ultimately, it's a disorder that's defined by the clinical features it has; a bit like saying, what is migraine? You know? Or, what is MS? You know, it's very hard to actually say that in a sentence. I think these are disorders of brain function at a very broad level, and particularly with FND disorders, of a sort of higher control of voluntary movement, I would say. Dr Smith: There's so many pearls in this article and others that you've written. One that I really like is that this isn't a diagnosis of exclusion, that this is an affirmative diagnosis that have clear diagnostic signs. And I wonder if you can talk a little bit about the diagnostic process, arriving at an FND diagnosis for a patient. Dr Stone: I think this is probably the most important sort of “switch-around” in the last fifteen, twenty years since I've been involved. It's not new information. You know, all of these diagnostic signs were well known in the 19th century; and in fact, many of them were described then as well. But they were kind of lost knowledge, so that by the time we got to the late nineties, this area---which was called conversion disorder then---it was written down. This is a diagnosis of exclusion that you make when you've ruled everything out. But in fact, we have lots of rule in signs, which I hope most listeners are familiar with. So, if you've got someone with a functional tremor, you would do a tremor entrainment test where you do rhythmic movements of your thumb and forefinger, ask the patient to copy them. It's very important that they copy you rather than make their own movements. And see if their tremor stops briefly, or perhaps entrains to the same rhythm that you're making, or perhaps they just can't make the movement. That might be one example. There's many examples for limb weakness and dystonia. There's a whole lot of stuff to learn there, basically, clinical skills. Dr Smith: You make a really interesting point early on in your article about the importance of the neurological assessment as part of the treatment of the patient. I wonder if you could talk to our listeners about that. Dr Stone: So, I think, you know, there's a perception that- certainly, there was a perception that that the neurologist is there to make a diagnosis. When I was training, the neurologist was there to tell the patient that they didn't have the kind of neurological problem and to go somewhere else. But in fact, that treatment process, when it goes well, I think begins from the moment you greet the patient in the waiting room, shake their hand, look at them. Things like asking the patient about all their symptoms, being the first doctor who's ever been interested in their, you know, horrendous exhaustion or their dizziness. You know, questions that many patients are aware that doctors often aren't very interested in. These are therapeutic opportunities, you know, as well as just taking the history that enable the patient to feel relaxed. They start thinking, oh, this person's actually interested in me. They're more likely to listen to what you've got to say if they get that feeling off you. So, I'd spend a lot of time going through physical symptoms. I go through time asking the patient what they do, and the patients will often tell you what they don't do. They say, I used to do this, I used to go running. Okay, you need to know that, but what do they actually do? Because that's such valuable information for their treatment plan. You know, they list a whole lot of TV shows that they really enjoy, they're probably not depressed. So that's kind of useful information. I also spend a lot of time talking to them about what they think is wrong. Be careful, that they can annoy patients, you know. Well, I've come to you because you're going to tell me what's wrong. But what sort of ideas had you had about what was wrong? I need to know so that I can deal with those ideas that you've had. Is there a particular reason that you're in my clinic today? Were you sent here? Was it your idea? Are there particular treatments that you think would really help you? These all set the scene for what's going to come later in terms of your explanation. And, more importantly, your triaging of the patient. Is this somebody where it's the right time to be embarking on treatment, which is a question we don't always ask yourself, I think. Dr Smith: That's a really great point and kind of segues to my next question, which is- you talked a little bit about this, right? Generally speaking, we have come up with this is a likely diagnosis earlier, midway through the encounter. And you talked a little bit about how to frame the encounter, knowing what's coming up. And then what's coming up is sharing with the patient our opinion. In your article, you point out this should be no different than telling someone they have Parkinson's disease, for instance. What pearls do you have and what pitfalls do you have in how to give the diagnosis? And, you know, a lot of us really weren't trained to do this. What's the right way, and what are the most common land mines that folks step on when they're trying to share this information with patients? Dr Stone: I've been thinking about this for a long time, and I've come to the conclusion that all we need to do with this disorder is stop being weird. What goes wrong? The main pitfall is that people think, oh God, this is FND, this is something a bit weird. It's in a different box to all of the other things and I have to do something weird. And people end up blurting out things like, well, your scan was normal or, you haven't got epilepsy or, you haven't got Parkinson's disease. That's not what you normally do. It's weird. What you normally do is you take a deep breath and you say, I'm sorry to tell you've got Parkinson's disease or, you have this type of dystonia. That's what you normally say. If you follow the normal- what goes wrong is that people don't follow the normal rules. The patient picks up on this. What's going on here? This doctor's telling me what I don't have and then they're starting to talk about some reason why I've got this, like stress, even though I don't- haven't been told what it is yet. You do the normal rules, give it a name, a name that you're comfortable with, preferably as specific as possible: functional tremor, functional dystonia. And then do what you normally do, which is explain to the patient why you think it's this. So, if someone's got Parkinson's, you say, I think you've got Parkinson's because I noticed that you're walking very slowly and you've got a tremor. And these are typical features of Parkinson. And so, you're talking about the features. This is where I think it's the most useful thing that you can do. And the thing that I do when it goes really well and it's gone badly somewhere else, the thing I probably do best, what was most useful, is showing the patient their signs. I don't know if you do that, Gordon, but it's maybe not something that we're used to doing. Dr Smith: Wait, maybe you can talk more about that, and maybe, perhaps, give an example? Talk about how that impacts treatment. I was really impressed about the approach to physical therapy, and treatment of patients really leverages the physical examination findings that we're all well-trained to look for. So maybe explore that a little bit. Dr Stone: Yeah, I think absolutely it does. And I think we've been evolving these thoughts over the last ten or fifteen years. But I started, you know, maybe about twenty years ago, started to show people their tremor entrainment tests. Or their Hoover sign, for example; if you don't know Hoover sign, weakness of hip extension, that comes back to normal when the person's flexing their normal leg, their normal hip. These are sort of diagnostic tricks that we had. Ahen I started writing articles about FND, various senior neurologists said to me, are you sure you should write this stuff down? Patients will find out. I wrote an article with Marc Edwards called “Trick or Treat in Neurology” about fifteen years ago to say that actually, although they're they might seem like tricks, there really are treats for patients because you're bringing the diagnosis into the clinic room. It's not about the normal scan. You can have FND and MS. It's not about the normal scan. It's about what you're seeing in front of you. If you show that patient, yes, you can't move your leg. The more you try, the worse it gets. I can see that. But look, lift up your other leg. Let me show you. Can you see now how strong your leg is? It's such a powerful way of communicating to the patient what's wrong with them diagnostically, giving them that confidence. What it's also doing is showing them the potential for improvement. It's giving them some hope, which they badly need. And, as we'll perhaps talk about, the physio treatment uses that as well because we have to use a different kind of physio for many forms of functional movement disorder, which relies on just glimpsing these little moments of normal function and promoting them, promoting the automatic movement, squashing down that abnormal pattern of voluntary movement that people have got with FND. Dr Smith: So, maybe we can talk about that now. You know, I've got a bunch of other questions to ask you about mechanism and stuff, but let's talk about the approach to physical therapy because it's such a good lead-in and I always worry that our physical therapists aren't knowledgeable about this. So, maybe some examples, you have some really great ones in the article. And then words of wisdom for us as we're engaging physical therapists who may not be familiar with FND, how to kind of build that competency and relationship with the therapist with whom you work. Dr Stone: Some of the stuff is the same. Some of the rehabilitation ideas are similar, thinking about boom and bust activity, which is very common in these patients, or grading activity. That's similar, but some of them are really different. So, if you have a patient with a stroke, the physiotherapist might be very used to getting that person to think and look at their leg to try and help them move, which is part of their rehabilitation. In FND, that makes things worse. That's what's happening in Hoover sign and tremor entrainment sign. Attention towards the limb is making it worse. But if the patient's on board with the diagnosis and understands it, they'll also see what you need to do, then, in the physio is actively use distraction in a very transparent way and say to the patient, look, I think if I get you to do that movement, and I'll film you, I think your movement's going to look better. Wouldn't that be great if we could demonstrate that? And the patient says, yeah, that would be great. We're kind of actively using distraction. We're doing things that would seem a bit strange for someone with other forms of movement disorder. So, the patients, for example, with functional gait disorders who you discover can jog quite well on a treadmill. In fact, that's another diagnostic test. Or they can walk backwards, or they can dance or pretend that they're ice skating, and they have much more fluid movements because their ice skating program in their brain is not corrupted, but their normal walking program is. So, can you then turn ice skating or jogging into normal walking? It's not that complicated, I think. The basic ideas are pretty simple, but it does require some creativity from whoever's doing the therapy because you have to use what the patient's into. So, if the patient used to be a dancer- we had a patient who was a, she was really into ballet dancing. Her ballet was great, but her walking was terrible. So, they used ballet to help her walk again. And that's incredibly satisfying for the therapist as well. So, if you have a therapist who's not sure, there are consensus recommendations. There are videos. One really good success often makes a therapist want to do that again and think, oh, that's interesting. I really helped that patient get better. Dr Smith: For a long time, this has been framed as a mental health issue, conversion disorder, and maybe we can talk a little bit about early life of trauma as a risk factor. But, you know, listening to you talk, it sounds like a brain network problem. Even the word “functional”, to me, it seems a little judgmental. I don't know if this is the best term, but is this really a network problem? Dr Stone: The word “functional”, for most neurologists, sounds judgmental because of what you associate it with. If you think about what the word actually is, it's- it does what it says on the tin. There's a disordered brain function. I mean, it's not a great word. It's the least worst term, in my view. And yes, of course it's a brain network problem, because what other organ is it going to be? You know, that's gone wrong? When software brains go wrong, they go wrong in networks. But I think we have to be careful not to swing that pendulum too far to the other side because the problem here, when we say asking the question, is this a mental health problem or a neurological one, we're just asking the wrong question. We're asking a question that makes no sense. However you try and answer that, you're going to get a stupid answer because the question doesn't make sense. We shouldn't have those categories. It's one organ. And what's so fascinating about FND---and I hope what can incite your sort of curiosity about it---is this disorder which defies this categorization. You see some patients with it, they say, oh, they've got a brain network disorder. Then you meet another patient who was sexually abused for five years by their uncle when they were nine, between nine and fourteen; they developed an incredibly strong dissociative threat response into that experience. They have crippling anxiety, PTSD, interpersonal problems, and their FND is sort of somehow a part of that; part of that experience that they've had. So, to ignore that or to deny or dismiss psychological, psychiatric aspects, is just as bad and just as much a mistake as to dismiss the kind of neurological aspects as well. Dr Smith: I wonder if this would be a good time to go back and talk a little bit about a concept that I found really interesting, and that is FND as a prodromal syndrome before a different neurological problem. So, for instance, FND prodromal to Parkinson's disease. Can you talk to us a little bit about that? I mean, obviously I was familiar with the fact that patients who have nonepileptic seizurelike events often have epileptic seizures, but the idea of FND ahead of Parkinson's was new to me. Dr Stone: So, this is definitely a thing that happens. It's interesting because previously, perhaps, if you saw someone who was referred with a functional tremor---this has happened to me and my colleagues. They send me some with a functional tremor. By the time I see them, it's obvious they've got Parkinson's because it's been a little gap. But it turns out that the diagnosis of functional tremor was wrong. It was just that they've developed that in the prodrome of Parkinson's disease. And if you think about it, it's what you'd expect, really, especially with Parkinson's disease. We know people develop anxiety in the prodrome of Parkinson's for ten, fifteen years before it's part of the prodrome. Anxiety is a very strong risk factor for FND, and they're already developing abnormalities in their brain predisposing them to tremor. So, you put those two things together, why wouldn't people get FND? It is interesting to think about how that's the opposite of seizures, because most people with comorbidity of functional seizures and epilepsy, 99% of the time the epilepsy came first. They had the experience of an epileptic seizure, which is frightening, which evokes strong threat response and has somehow then led to a recapitulation of that experience in a functional seizure. So yeah, it's really interesting how these disorders overlap. We're seeing something similar in early MS where, I think, there's a slight excess of functional symptoms; but as the disease progresses, they often become less, actually. Dr Smith: What is the prognosis with the types of physical therapy? And we haven't really talked about psychological therapy, but what's the success rate? And then what's the relapse rate or risk? Dr Stone: Well, it does depend who they're seeing, because I think---as you said---you're finding difficult to get people in your institution who you feel are comfortable with this. Well, that's a real problem. You know, you want your therapists to know about this condition, so that matters. But I think with a team with a multidisciplinary approach, which might include psychological therapy, physio, OT, I think the message is you can get really good outcomes. You don't want to oversell this to patients, because these treatments are not that good yet. You can get spectacular outcomes. And of course, people always show the videos of those. But in published studies, what you're seeing is that most studies of- case series of rehabilitation, people generally improve. And I think it's reasonable to say to a patient, that we have these treatments, there's a good chance it's going to help you. I can't guarantee it's going to help you. It's going to take a lot of work and this is something we have to do together. So, this is not something you're going to do to the patient, they're going to do it with you. Which is why it's so important to find out, hey, do they agree with you with the diagnosis? And check they do. And is it the right time? It's like when someone needs to lose weight or change any sort of behavior that they've just become ingrained. It's not easy to do. So, I don't know if that helps answer the question. Dr Smith: No, that's great. And you actually got right where I was wanting to go next, which is the idea of timing and acceptance. You brought this up earlier on, right? So, sometimes patients are excited and accepting of having an affirmative diagnosis, but sometimes there's some resistance. How do you manage the situation where you're making this diagnosis, but a patient's resistant to it? Maybe they're fixating on a different disease they think they have, or for whatever reason. How do you handle that in terms of initiating therapy of the overall diagnostic process? Dr Stone: We should, you know, respect people's rights to have whatever views they want about what's wrong with them. And I don't see my job as- I'm not there to change everyone's mind, but I think my job is to present the information to them in a kind of neutral way and say, look, here it is. This is what I think. My experience is, if you do that, most people are willing to listen. There are a few who are not, but most people are. And most of the time when it goes wrong, I have to say it's us and not the patients. But I think you do need to find out if they can have some hope. You can't do rehabilitation without hope, really. That's what you're looking for. I sometimes say to patients, where are you at with this? You know, I know this is a really hard thing to get your head around, you've never heard of it before. It's your own brain going wrong. I know that's weird. How much do you agree with it on a scale of naught to ten? Are you ten like completely agreeing, zero definitely don't? I might say, are you about a three? You know, just to make it easy for them to say, no, I really don't agree with you. Patients are often reluctant to tell you exactly what they're thinking. So, make it easy for them to disagree and then see where they're at. If they're about seven, say, that's good. But you know, it'd be great if you were nine or ten because this is going to be hard. It's painful and difficult, and you need to know that you're not damaging your body. Those sort of conversations are helpful. And even more importantly, is it the right time? Because again, if you explore that with people, if a single mother with four kids and, you know, huge debts and- you know, it's going to be very difficult for them to engage with rehab. So, you have to be realistic about whether it's the right time, too; but keep that hope going regardless. Dr Smith: So, Jon, there's so many things I want to talk to you about, but maybe rather than let me drive it, let me ask you, what's the most important thing that our listeners need to know that I haven't asked you about? Dr Stone: Oh God. I think when people come and visit me, they sometimes, let's go and see this guy who does a lot of FND, and surely, it'll be so easy for him, you know? And I think some of the feedback I've had from visitors is, it's been helpful to watch, to see that it's difficult for me too. You know, this is quite hard work. Patients have lots of things to talk about. Often you don't have enough time to do it in. It's a complicated scenario that you're unravelling. So, it's okay if you find it difficult work. Personally, I think it's very rewarding work, and it's worth doing. It's worth spending the time. I think you only need to have a few patients where they've improved. And sometimes that encounter with the neurologist made a huge difference. Think about whether that is worth it. You know, if you do that with five patients and one or two of them have that amazing, really good response, well, that's probably worth it. It's worth getting out of bed in the morning. I think reflecting on, is this something you want to do and put time and effort into, is worthwhile because I recognize it is challenging at times, and that's okay. Dr Smith: That's a great number needed to treat, five or six. Dr Stone: Exactly. I think it's probably less than that, but… Dr Smith: You're being conservative. Dr Stone: I think deliberately pessimistic; but I think it's more like two or three, yeah. Dr Smith: Let me ask one other question. There's so much more for our listeners in the article. This should be required reading, in my opinion. I think that of most Continuum, but this, I really truly mean it. But I think you've probably inspired a lot of listeners, right? What's the next step? We have a general or comprehensive neurologist working in a community practice who's inspired and wants to engage in the proactive care of the FND patients they see. What's the next step or advice you have for them as they embark on this? It strikes me, like- and I think you said this in the article, it's hard work and it's hard to do by yourself. So, what's the advice for someone to kind of get started? Dr Stone: Yeah, find some friends pretty quick. Though, yeah, your own enthusiasm can take you a long way, you know, especially with we've got much better resources than we have. But it can only take you so far. It's really particularly important, I think, to find somebody, a psychiatrist or psychologist, you can share patients with and have help with. In Edinburgh, that's been very important. I've done all this work with the neuropsychiatrist, Alan Carson. It might be difficult to do that, but just find someone, send them an easy patient, talk to them, teach them some of this stuff about how to manage FND. It turns out it's not that different to what they're already doing. You know, the management of functional seizures, for example, is- or episodic functional movement disorders is very close to managing panic disorder in terms of the principles. If you know a bit about that, you can encourage people around you. And then therapists just love seeing these patients. So, yeah, you can build up slowly, but don't- try not to do it all on your own, I would say. There's a risk of burnout there. Dr Smith: Well, Dr Stone, thank you. You don't disappoint. This has really been a fantastic conversation. I really very much appreciate it. Dr Stone: That's great, Gordon. Thanks so much for your time, yeah. Dr Smith: Well, listeners, again, today I've had the great pleasure of interviewing Dr Jon Stone about his article on the multidisciplinary treatment for functional neurologic disorder, which he wrote with Dr Alan Carson. This article appears in the August 2025 Continuum issue on movement disorders. Please be sure to check out Continuum Audio episodes from this and other issues. And listeners, thank you once again for joining us today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. We hope you've enjoyed this subscriber-exclusive interview. Thank you for listening.

Brett Owens, MD, and Miho Tanaka, MD, PhD

Play Episode Listen Later Oct 1, 2025 43:31

Brett Owens, MD, Professor of Orthopaedic Surgery at the Brown University Alpert Medical School in Providence, Rhode Island and Editor-in-Chief of the American Journal of Sports Medicine, and Miho Tanaka, MD, PhD, Director of the Women's Sports Medicine Program at the Massachusetts General Hospital, Associate Professor of Orthopaedic Surgery at Harvard Medical School, and Associate Editor at the American Journal of Sports Medicine, discuss the exciting future of AJSM, challenges in patellofemoral care, women's sports medicine, their secret and not-so-secret talents, and more.

women director phd professor md associate professor providence rhode island harvard medical school sports medicine associate editor american journal massachusetts general hospital md phd tanaka orthopaedic surgery miho brett owens sports medicine program

BASL Special Edition of Frontline Gastroenterology

FG podcast

Play Episode Listen Later Oct 1, 2025 51:28

This special edition has been made to celebrate BASL's affiliation with Frontline Gastroenterology - listen to the team discuss the papers in this recent special edition. Read the issue: https://fg.bmj.com/content/16/e1 Participants: Dr Oliver Tavabie - Deputy Editor at Frontline Gastroenterology and Consultant Hepatologist at the Leeds Liver Unit Dr Louise China - Lead Associate Editor at Frontline Gastroenterology and Consultant Hepatologist at the Royal Free Dr Tim Cross - BASL President, Associate Editor at Frontline Gastroenterology and Consultant Hepatologist at the Royal Liverpool Hospital 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

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What ‘TrumpTok' means for TikTok users

The Signal

Play Episode Listen Later Sep 29, 2025 14:33

Donald Trump wants TikTok to be American owned and now a group of billionaire Trump supporters is buying it. But how will an American version of the popular Chinese app work, and what kind of influence could its new owners have on the videos its algorithm serves up? Today, tech expert and Crikey's Associate Editor Cam Wilson on the deal and what it might mean for TikTok's eight million Australian users.Featured:Cam Wilson, Tech expert and Crikey's Associate Editor

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Trump's Big Announcement Seeking Peace in Middle East, Change of ERA for Cardinals, Political Violence Concerns & More (9/29/25) Full Show

Play Episode Listen Later Sep 29, 2025 117:15

In hour 1 of The Mark Reardon Show, the crew discusses Bad Bunny getting announced as the Super Bowl Halftime Show performer. Mark is then joined by Josh Hammer, the Newsweek Senior Editor at Large and the Host of The Josh Hammer Show. Hammer shares his thoughts on President Trump and Israel President Netanyahu's plan to end the war with Hamas. Will the plan work? He's later joined by Jennifer Sey, the Founder and CEO of XX-XY Athletics, a USA Champion Gymnast and the Producer of Athlete A on Netflix. She discusses JK Rowling calling out Emma Watson on her support of trans rights as well as Jimmy Kimmel's non apology. In hour 2, the crew shares their weekend recaps. 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. Mark is then joined by Joel Kurtinitis, a Political Commentator in Iowa. He shares the latest on the Des Moines Public School Super Intendent that was arrested by ICE recently. He's later joined by KSDK Sports Director Frank Cusumano who recaps John Mozeliak's final press conference following the conclusion of his tenure as the St Louis Cardinals President of Baseball Operations. Frank also gives an early preview of Mizzou vs Alabama. In hour 3, Mark is joined by David Strom, an Associate Editor with Hot Air. He discusses the recent political violence witnessed and other trending political topics. Mark then shares the latest information on the shooting and burning of a Mormon church in Michigan. He is then joined by FanDuel Sports Midwest Network Studio Host Scott Warmann. Warmann discusses the new ERA of Cardinals baseball with Chaim Bloom taking over for John Mozeliak as the President of Baseball Operations. Dan Reardon then recaps the Ryder Cup and Mark wraps up the show with the Audio Cut of the Day.

David Strom Reacts to the Recent Political Violence

news reacts associate editor political violence hot air david strom

Play Episode Listen Later Sep 29, 2025 17:53

In this segment, Mark is joined by David Strom, an Associate Editor with Hot Air. He discusses the recent political violence witnessed and other trending political topics.

Hour 3: Audio Cut of the Day - Rory McIlroy Proves Why He's a Pro's Pro at Ryder Cup

president news michigan era cardinals mormon proves ryder cup associate editor rory mcilroy hot air baseball operations chaim bloom john mozeliak dan reardon david strom

Play Episode Listen Later Sep 29, 2025 39:47

In hour 3, Mark is joined by David Strom, an Associate Editor with Hot Air. He discusses the recent political violence witnessed and other trending political topics. Mark then shares the latest information on the shooting and burning of a Mormon church in Michigan. He is then joined by FanDuel Sports Midwest Network Studio Host Scott Warmann. Warmann discusses the new ERA of Cardinals baseball with Chaim Bloom taking over for John Mozeliak as the President of Baseball Operations. Dan Reardon then recaps the Ryder Cup and Mark wraps up the show with the Audio Cut of the Day.

Doom Spending vs. FIRE: Can a Kid Pension Fix Retirement?

The Lonely Office

Play Episode Listen Later Sep 19, 2025 23:29

From vending machines to van life, today's money plans feel unhinged. On this episode, we welcome special guest Orianna Rosa Royle —award-winning journalist and Associate Editor at the Success Desk at Fortune. She helps us break down Germany's “start at age six” pension idea, why Social Security fears are fueling bad choices, and the $32 investing habit that could change your future. Reference Article by Orianna Rosa Royle As boomers are forced to ‘unretire' because they've not saved enough, 6-year-olds in Germany could soon have retirement accounts Hosts: Matt Sunbulli ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.linkedin.com/in/sunbulli/⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠https://www.firstdraft.vc⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Aaron Calafato ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Listen to Aaron's 7 Minute Stories Podcast ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Leah Ova ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Follow Leah on TikTok ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ Editorial: Brooks Borden Matt Sunbulli Ken Wendt Senior Audio Engineer: Ken Wendt Research: Zaid Safe Matt Sunbulli Aaron Calafato

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Quality reforms, duty of candour, skills

The Wonkhe Show - the higher education podcast

Play Episode Listen Later Sep 18, 2025 41:33

This week on the podcast we examine the Office for Students' proposed overhaul of England's quality system, as radical reforms seek to integrate the Teaching Excellence Framework with minimum standards and give TEF some serious teeth.Plus we discuss the government's long-awaited "Hillsborough law" as the Public Office (Accountability) Bill imposes new duties of candour on universities, and examine the machinery of government changes that have seen apprenticeships policy and Skills England transferred from the Department for Education to Pat McFadden's expanded Department for Work and Pensions.With Andrea Turley, Partner at KPMG, Shane Chowen, Editor at FE Week, Debbie McVitty, Editor at Wonkhe and presented by Jim Dickinson, Associate Editor at Wonkhe.TEF6: the incredible machine takes over quality assurance regulationReputation versus sunlight – universities and the new duty of candourWhat Ofsted inspections reveal about university leadership and cultureA machinery of government muddle over skillsThe former student leaders entering Parliament Hosted on Acast. See acast.com/privacy for more information.

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Tourette Syndrome and Tic Disorders With Dr. Jessica Frey

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Play Episode Listen Later Sep 17, 2025 24:04

Tics are movements or sounds that are quick, recurrent, and nonrhythmic. They fluctuate over time and can be involuntary or semivoluntary. Although behavioral therapy remains the first-line treatment, modifications to comprehensive behavioral intervention have been developed to make treatment more accessible. In this episode, Casey Albin, MD, speaks with Jessica Frey, MD, author of the article “Tourette Syndrome and Tic Disorders” in the Continuum® August 2025 Movement Disorders issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Frey is an assistant professor of neurology, Movement Disorders Fellowship Program Director, and Neurology Student Clerkship Director at the Rockefeller Neuroscience Institute in the department of neurology at West Virginia University in Morgantown, West Virginia. Additional Resources Read the article: Tourette Syndrome and Tic Disorders Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Transcript 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 Albin: Hi all, this is Dr Casey Albin. Today I'm interviewing Dr Jessica Frey about her article Tourette Syndrome and Tic Disorders, which appears in the August 2025 Continuum issue on movement disorders. Dr Frey, thank you so much for being here, and welcome to the podcast. I'd love for you to briefly introduce yourself to our audience. Dr Frey: Thank you for having me here today. My name is Jessica Frey, and I am a movement disorder specialist at West Virginia University. I'm also the movement disorder fellowship director, as well as the neurology clerkship student director. Dr Albin: Dr. Frey, I feel like this was one of the things I actually had no exposure to as a resident. For trainees that kind of want to get a better understanding of how these are managed, what kind of counseling you do, what kind of interventions you're using, how can they get a little bit more exposure? Dr Frey: That's a great question, and I actually had a similar experience to you. I did not see that many patients with Tourette syndrome while I was in my residency training. I got a lot more exposure during my fellowship training, and that's when I actually fell in love with that patient population, caring for them, seeing them be successful. I think it depends on the program that you're in. During the pediatric neurology rotation might be your best bet to getting exposure to patients with Tourette syndrome, since a lot of them are going to be diagnosed when they're quite young, and sometimes they'll even continue to follow through young adulthood in the pediatric neurology clinic. However, up to 20% of patients with Tourette syndrome will have persistent tics during adulthood. And so, I think it is important for neurology trainees to understand how to manage them, understand what resources are out there. So, if you have an interest in that, absolutely try to follow either in the pediatric neurology department, or if you have a movement disorder program that has a Tourette clinic or has a movement disorder specialist who has an interest in Tourette syndrome, definitely try to hang out with them. Get to know that patient population, and educate yourself as much as you're able to educate the patients as well. Dr Albin: Yeah, I think that's fantastic advice. You wrote a fantastic article, and it covers a lot of ground. And I think let's start at some of the basics. When I think of Tourette syndrome and tics, I think of Tourette syndrome having tics, but maybe not all patients who have tics have Tourette syndrome. And so, I was wondering, A, if you could confirm that's true; and then could you tell us a little bit about some of the diagnostic criteria for each of these conditions? Dr Frey: Sure. So, a tic is a phenomenological description. So basically, what you're seeing is a description of a motor or phonic tic, which is a particular type of movement disorder. Tourette syndrome is a very specific diagnosis, and the diagnostic criteria for Tourette syndrome at this point in time is that you need to have had at least one phonic tic and two or more motor tics over the course of at least a year before the age of eighteen. Dr Albin: Got it. So, there's certainly more specific and a lot more criteria for having Tourette syndrome. I was struck in reading your article how many myths there are surrounding Tourette syndrome and tic disorders kind of in general. What's known about the pathophysiology of Tourette syndrome, and what are some common misconceptions about patients who have this disorder? Dr Frey: Yeah, so I think that's a really excellent question because for so many years, Tourette syndrome and tic disorders in general were thought to be psychogenic in origin, even dating back to when they were first described. The history of Tourette syndrome is quite interesting in that, when Tourette---who, you know, it's named after---was working with Charcot, a lot of the initial descriptors were of actual case reports of patients who had more psychogenic descriptions, and eventually they became known as tic disorders as well. It wasn't until the discovery of Haldol and using Haldol as a treatment for tic disorders that people started to change their perception and say, okay, maybe there is actually a neurologic basis for Tourette syndrome. So, in terms of the pathophysiology, it's not completely known, but what we do know about it, we think that there is some sort of hyperactivity in the corticostriatal-thalamocortical circuits. And we think that because of this hyperactivity, it leads to the hyperactive movement disorder. We think similar circuitry is involved in conditions like OCD, or obsessive compulsive disorder; as well as ADHD, or attention deficit hyperactivity disorder. And because of that, we actually do tend to see an overlap between all three of these conditions in both individuals and families. Dr Albin: And hearing all of that, does this all come back to, sort of, dopamine and, sort of, behavioral motivation, or is it different than that? Dr Frey: It's probably more complex than just dopamine, but there is the thought that dopamine does play a role. And even one of the hypotheses regarding the pathophysiology is actually that these tics might start as habits, and then when the habits become more common, they actually reshape the dopaminergic pathways. And each time a tic occurs, there's a little bit of a dopaminergic reward. And so over time, that reshapes those hyperactive pathways and changes the actual circuitry of the brain, leading it to be not just a habit but part of their neurologic makeup. Dr Albin: It's fascinating to hear how that actually might play into our neural circuitry and, over time, rewire our brain. Fascinating. I mean, this is just so interesting how movement disorders play into such behavioral regulation and some comorbid conditions like ADHD and OCD. I thought it would be really helpful, maybe, to our listeners to kind of think through a case that I suspect is becoming more common. So, if it's okay with you, I'll present sort of a hypothetical. Dr Frey: Absolutely. Dr Albin: This is a father bringing in his seventeen-year-old daughter. She's coming into the clinic because she's been demonstrating, over the past four to six weeks, some jerking movement in her right arm. And it's happened multiple times a day. And it was a pretty sudden onset. She had not had any movement like this before, and then several weeks ago, started moving the right hand. And then it became even more disruptive: her right leg was involved, she had some scrunching her face. This is all happening at a time where she was dealing with some stress, maybe a little bit of applications around college that she was having a lot of anxiety about. How do you sort of approach this case if this is someone who comes to your office? Dr Frey: Sure. So, I think the first thing that you want to get is a good solid history, trying to understand, what is the origin of these abnormal movements and what led to the abnormal movements. Now, a key thing here is that in Tourette syndrome, and most physiologic tic syndromes, there's a pretty early onset. So, in Tourette syndrome, the expected age of onset is between the ages of five and seven years old. So, to have kind of acute new abnormal movements as a seventeen-year-old would be very unusual for a new-onset diagnosis of Tourette syndrome. However, there's a couple of things from the history that could help you. One would be, were there ever tics in the past? Because sometimes, when you think retrospectively, a lot of these patients might have had a simple eye-blinking tic or a coughing tic when they were a child. And perhaps they did have Tourette syndrome, a very mild case of it. But because the tics were never that pronounced, they never went to see anyone about it and it was never known that they had Tourette syndrome in the first place. If there is no history like that and the movements are completely new, out of the blue, of course you want to rule out anything acute that could be going on that could be causing that. Looking at the phenomenology of the movements can also be very helpful. When you're looking at abnormal tic movements, you would expect most cases of something like Tourette syndrome to occur first in the midline and go in a rostrocoidal distribution. So, you mostly see things happening with eye blinking, throat clearing, sniffling, neck snapping. These are some of the immediate tics that start to happen. We also usually start to see simple tics, as opposed to complex tics, at the beginning. Now, over the course of time, many patients do develop more complex tics that might involve the arms or the extremities, but that would be unusual to see this as a presenting feature of new-onset Tourette syndrome. Dr Albin: Got it. So, I'm hearing that the history really matters and that sometimes, like those, like, first-onset seizures, I imagine as a neurointensivist, we see a lot of patients who've had seizures who think that they're presenting the first time. And then we go back and we say, well, actually they have had some abnormal movements at night. Sounds like it's very similar with these movement disorders where you have to really go back and ask, well, was there some sniffling? Did they go through a phase where they were grunting frequently? Because I can imagine that many children make those behaviors, and that it may not have registered as something that was cause for concern. Dr Frey: Absolutely. Dr Albin: And then the other thing I heard from you was that the phenomenology really matters and that there is a typical presentation, starting from sort of the face and working the way down. And that can be really helpful. But in this case, the family is quite clear. No, no, no. She's never had movements like this before. This is- nothing like this. We promise you, did not go through a phase where she was coughing or blinking, or, this is all totally new. And the phenomenology, they say, no, no, she did not start with blinking. It definitely started in the arm and then progressed in its complex movements. So, knowing that about her, how does that sort of shape how you move forward with the diagnosis? Dr Frey: Yeah. So, really good question. And this is something that I think really peaked during the Covid-19 pandemic. We saw an influx of patients, especially teenage girls or young adult girls, who basically would come in and have these new, acute-onset, abnormal movements. We weren't sure what to call them initially. There was some discussion of calling them “explosive tic disorder” and things like that. A lot of these actually looked very similar to psychogenic nonepileptic seizures, where they would come into the emergency department and have many abnormal movements that were so severe, that they were having a “tic attack” and couldn't stop the abnormal movements from occurring. And we saw so many of these cases during the Covid-19 pandemic that it eventually became known as a distinctive diagnostic criteria with the name of “functional ticlike behavior”, or FTLB. When we think about functional ticlike behavior, we think that these tics are driven more by anxiety and stress. A lot of times, the backstory of these patients, they were in a very stressful situation, and that's when the abnormal movement started. So, a very similar kind of backstory to patients that might develop psychogenic nonepileptic seizures. These tics were popularized, for lack of a better term, via social media during the Covid-19 pandemic. One article is out there that even has called these functional ticlike behaviors as “a pandemic within a pandemic”, because there was such a strong showing of ticlike behavior in the clinics during the Covid-19 pandemic. Although social media was thought to play a big role in these functional ticlike behaviors, we think that there's probably a little bit more complexity and nuance to why these functional ticlike behaviors develop. There is probably a little bit of a genetic predisposition. There's probably some other psychosocial factors at play. And when we see cases like this, the best thing that you can do is educate your patients about the differences between functional ticlike behaviors and tics that we see associated with conditions like Tourette syndrome. And then the best types of treatments that we have seen thus far are treating any underlying stressors, if any of those exist, as well as cognitive behavioral therapy has been shown to be somewhat helpful. As the Covid-19 pandemic has wound down, we have actually seen a lot less cases in our clinic. And one reason we think is less stressors, less uncertainty for the future, which we think was a driving precipitant of some of these cases. But it also is not as popularized in the media as well. There were a lot of TikTok users in particular, which lent itself to the name “TikTok tic”. These videos are not as viewed or not as popular as they were during the Covid-19 pandemic. One reason being that because we are not all relegated to our homes, constantly looking to online sources of information---just in general, we have kind of not been on the Internet as much as we were during the Covid-19 pandemic---as a society as a whole. Dr Albin: This is really fascinating how the environmental milieu, for lack of a better word, like, really influenced how patients were experiencing, sort of, functional neurologic disorders. In your article you describe really these three baskets of primary tic---which can then be a part of Tourette syndrome---,functional ticlike behaviors---which really were a unique manifestation of stress and anxiety specifically during the Covid-19 pandemic---, and then tics as a manifestation of some either different underlying etiology or medication side effect. So, when do you get concerned about that secondary etiology? Dr Frey: So secondary tics can occur in a variety of instances. I think some of the more common examples would be in genetic disorders. So, Huntington's disease is a really good example. I think we all associate chorea with Huntington's disease. That's probably the most commonly associated phenomenology that we see with Huntington's disease. But we can see a variety of movement disorders in Huntington's, and one of them is tics. So, when we see tics in association with other types of movement disorders, we should be thinking about a possible genetic etiology. If we see tics in association with other neurologic symptoms, such as seizures or cognitive changes, we should be thinking that this is something besides a primary tic disorder. You also mentioned medication use, and it's really important to think about tardive tics. I know we often think about tardive dyskinesia, and the first kind of phenomenology that jumps into our brain is usually chorea because it's those abnormal lip movements, finger movements, toe movements that we see after a patient has been on, for example, an antipsychotic or an antiemetic that has antidopaminergic properties. However, we can see a variety of abnormal movement disorders that occur secondary to antidopaminergic medications, especially after abrupt withdrawal of these antidopaminergic medications. And tics are one of them. There have been cases reported where people that have tardive tics will still report that they have a premonitory urge, as well as a sense of relief after their tics. So, it actually can seem very similar to Tourette syndrome and the tics that people with Tourette syndrome experience on a regular basis. The key here is that the treatment might differ because if it's due to an antidopaminergic medication or abrupt withdrawal of that antidopaminergic medication, you might need to treat it a little bit differently than you would otherwise. Dr Albin: I love that you bring in, it's not just looking at their specific movement disorder that they may be coming to clinic with, that tic disorder, but are there other movement disorders? Has there been a change in their medication history? Have they had cognitive changes? So really emphasizing the importance of that complete and comprehensive neurologic history, neurologic physical exam, to really get the complete picture so that it's not honing in on, oh, this is a primary tic. That's all there is to it, because it could be so much more. I know we're getting close to sort of the end of our time together, but I really wanted to switch to end on talking about treatment. And your article does such a beautiful job of talking about behavioral interventions and really exciting new medical interventions. But I would like to, if you don't mind, have you focus on, what behavioral counseling and what education do you provide for patients and their families? Because I imagine that the neurologist plays a really important role in educating the patient and their family about these disorders. Dr Frey: Absolutely. When we think about treatment, one of the most important things you can do for patients with Tourette syndrome or other primary tic disorders is educate them. This remains true whether it's a primary tic disorder that we see in Tourette syndrome or the functional ticlike behavior that we've discussed here. A lot of times, because there is such a stigma against people with tic disorders and Tourette syndrome, when they hear that they have Tourette syndrome or they are diagnosed with that, sometimes that can be an upsetting diagnosis. And sometimes you have to take time explaining what exactly that means and debunking a lot of the myths that go along with the stigmas associated with Tourette syndrome. I think a lot of times people are under the false assumption that people with Tourette syndrome cannot lead normal lives and cannot hold down jobs and cannot be productive members of society. None of that is true. Most of my patients have great lives, good quality of life, and are able to go about their day-to-day life without any major issues. And one of the reasons for that is we do have a lot of great treatment options available. Another important stigma to break down is that people with tic disorders are doing this for attention or doing this because they are trying to get something from someone else. That is absolutely false. We do think that the tics themselves are semivolitional because people with Tourette syndrome have some degree of control over their tics. They can suppress them for a period of time. But a lot of people with tic disorders and Tourette syndrome will describe their tics as if you're trying to hold onto a sneeze. And you can imagine how uncomfortable it is to hold in a sneeze. We're all able to do it for a period of time, but it's much easier to just allow that sneeze to occur. And a lot of times that's what they are experiencing, too. So, although there is some degree of control, it's not complete control, and they're certainly not doing these tics on purpose or for attention. So that's another important myth to debunk when you're counseling patients and their families. I think the dynamic between young patients that are presenting with their parents or guardians, sometimes that dynamic is a little bit challenging because another faulty assumption is that parents feel they are responsible for having this happen to their child. There used to be a really strong sense that parents were responsible for the tics that occurred in their children, and that is also absolutely not true. Parenting has nothing to do with having the tics or not. We know that this is a neurodevelopmental disorder. The brain is indeed wired differently and it's important to counsel that with the parents, too, so that they understand what tools they need to be successful for their children as well. Dr Albin: I love that. So, it's a lot of partnership with patients and their families. I really like that this is just a wire different, and I hope over time that working together we as neurologists can help break down some of that stigmatization for these patients. This has been an absolutely phenomenal discussion. I have so enjoyed learning from your article. For the listeners out there, there are some really phenomenal tables that go into sort of how to approach this from the office perspective, how to approach it from the treatment perspective. So, thank you again, Dr Jessica Frey, for your article on Tourette syndrome and tic disorders, which appears in the August 2025 Continuum issue on movement disorders. Be sure to check out Continuum Audio episodes from this and other issues, and thank you so much to our listeners for joining us today. Dr Frey: Thank you for having me. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

E54 -How to Negotiate with Matt Notowidigdo

The Hidden Curriculum

Play Episode Listen Later Sep 16, 2025 62:15

In this episode we talk with Matt Notowidigdo about negotiating. Matt is a Professor of Economics at Chicago Booth. He holds a BS in economics, a BS in computer engineering, a MEng in computer science, and a PhD in economics. He is currently a Research Associate at the National Bureau of Economics Research, and he is a co-editor at American Economic Journal - Economic Policy Notowidigdo and an Associate Editor at the Quarterly Journal of Economics.Sebastian Tello-Trillo is an Associate Professor of Public Policy and Economics at the Frank Batten School of Leadership and Public Policy at the University of Virginia.Alex Hollingsworth is an Associate Professor of Economics at the Ohio State University.Henry Morris is our main editor. He is a student at the University of Virginia studying computer science and mathematics. or of Economics at the O'Neill School of Public and Environmental Affairs in Indiana University.In this episode we discussed:Matt's structured approach to managing no more than six projects at a timeTime management with kids and boundaries after tenureInstitutional differences in how research and teaching loads are supportedWhy lunchtime culture matters for faculty communityA crash course on academic job market negotiations

HPV & Anogenital Warts

National STD Curriculum

Play Episode Listen Later Sep 16, 2025 33:40 Transcription Available

Dr. Helen Stankiewicz Karita, Associate Professor at UCSF and a national expert on human papillomavirus (HPV)-related diseases in the anal canal, and National STD Curriculum Podcast Editor Dr. Meena Ramchandani discuss how to screen, diagnose, and treat HPV-related warts in the anal area. View episode transcript and references 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.

Pomp and Politics: Trump is heading to Britain

Today with Claire Byrne

Play Episode Listen Later Sep 16, 2025 15:07

Adam Boulton, Broadcaster & Political Journalist and Lydia Starbuck, Associate Editor for Royal Central

donald trump britain heading broadcaster associate editor pomp politics trump adam boulton royal central

David Strom Discusses the Death of Charlie Kirk, the Radical Left's Horrible Response & More

death news horrible charlie kirk associate editor hot air radical left david strom

Play Episode Listen Later Sep 15, 2025 17:10

In this segment, Mark is joined by David Strom, an Associate Editor with HotAir. He discusses the assassination of Charlie Kirk and the radical left's horrible response to it.

Hour 3: Audio Cut of the Day - Updates on Kirk's Killer

news killers charlie kirk jennings associate editor hot air david strom

Play Episode Listen Later Sep 15, 2025 38:52

In hour 3, Mark is joined by David Strom, an Associate Editor with HotAir. He discusses the assassination of Charlie Kirk and the radical left's horrible response to it. He's later joined by CNN Political Contributor Scott Jennings. Jennings remembers his friend, Charlie Kirk who was assassinated last week. Jennings shares his frustration with the radical left's ideology and how it has caused political violence. He wraps up the show with the Audio Cut of the Day.

The Media's Twist of Who Charlie Kirk Was & the Justification of His Death (9/15/25) Full Show

death nfl media news large emmy awards college football twist charlie kirk justification jennings associate editor this day in history special session hot air josh hammer fm talk david strom

Play Episode Listen Later Sep 15, 2025 108:28

In hour 1 of The Mark Reardon Show, Mark recaps his weekend and discusses the latest updates on the assassination of Charlie Kirk. Mark is then joined by Josh Hammer, a Newsweek Senior Editor at Large and the Host of The Josh Hammer Show (Saturday's at 1PM on 97.1 FM Talk). Josh remembers his good friend, Charlie Kirk following his assassination. He discusses how good of a person he was, the impact his death will have on society, and how the media is responding to his death. He's later joined by Missouri State Senator Nick Schroer. State Senator Schroer discusses Governor Kehoe's second Special Session ending this past Friday, the Congressional Redistricting and an addressing of the Initiative Petition Reform. In hour 2, Sue 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. Mark then discusses last night's Emmy Award winners. He's later joined by KSDK Sports Director Frank Cusumano who discusses some of the notable NFL and College Football games from over the weekend. In hour 3, Mark is joined by David Strom, an Associate Editor with HotAir. He discusses the assassination of Charlie Kirk and the radical left's horrible response to it. He's later joined by CNN Political Contributor Scott Jennings. Jennings remembers his friend, Charlie Kirk who was assassinated last week. Jennings shares his frustration with the radical left's ideology and how it has caused political violence. He wraps up the show with the Audio Cut of the Day.

Seth Harp EXPOSES American Military Drug Ring & Murder Cover-Ups at Largest Army Base

The Katie Halper Show

Play Episode Listen Later Sep 11, 2025 100:53

Journalist Seth Harp talks about his hit book, which has just been picked up by HBO, investigating the drug cartels and string of murders plaguing the Fort Bragg U.S. Army military installation located in North Carolina. He also discusses his own time in the military as well as what he saw in Ukraine. Then we're joined by student organizer Hadeeqa Arzoo Malik, who was recently suspended by CUNY City College and adjunct professor Dr. Corinna Mullin who was recently fired by John Jay and Brooklyn College for pro-Palestine activism. To see the full discussion, please join us on Patreon at - https://www.patreon.com/posts/patreon-full-dr-138556252 Seth Harp is an investigative reporter and foreign correspondent who writes about the intersection of armed conflict and organized crime. A contributing editor at Rolling Stone, he has reported from countries including Iraq, Syria, Mexico, Ukraine, and elsewhere for Harper's, the New Yorker, The Intercept, and Columbia Journalism Review. He has also written for the New York Times and the Texas Observer. He is currently working on a book for Viking Press about drug-trafficking in the U.S. Army Special Forces and a series of unsolved murders at Fort Bragg, North Carolina. Before becoming a journalist, Harp practiced law for five years, and was an Assistant Attorney General for the state of Texas. During college and law school, he served in the U.S. Army Reserve and did one tour of duty in Iraq. He lives in Austin, Texas, where he was born and raised. Hadeeqa Arzoo Malik is a 21 year-old organizer, student, poet, and Student Leader of the Tamkeen Movement, which aims to uplift the Muslim community through education and social organization. She is a double major in Political Science, International Relations, and minors in Human Rights. She was recently suspended from CUNY City College for pro -Palestine activism. Dr. Corinna Mullin is an anti-imperialist academic who was recently fired from her job as adjunct faculty at The City University of New York for Palestine solidarity. Corinna is a member of the Anti-Imperialist Scholars Collective. She is a delegate in the PSC-CUNY's delegate assembly and serves on the Steering Committee of the PSC-CUNY's International Committee. Corinna organizes with CUNY for Palestine and Labor for Palestine. She is an Associate Editor for Middle East Critique and Science & Society. ***Please support The Katie Halper Show *** For bonus content, exclusive interviews, to support independent media & to help make this program possible, please join us on Patreon - https://www.patreon.com/thekatiehalpershow Get your Katie Halper Show Merch here! https://katiehalper.myspreadshop.com/all Follow Katie on Twitter: https://x.com/kthalps Follow Katie on Instagram: https://www.instagram.com/kthalps Follow Katie on TikTok: https://tiktok.com/@kthalps

Ataxia With Dr. Theresa Zesiewicz

SLU International Business Now: Conversations That Matter

Play Episode Listen Later Sep 10, 2025 20:31

Ataxia is a neurologic symptom that refers to incoordination of voluntary movement, typically causing gait dysfunction and imbalance. Genetic testing and counseling can be used to identify the type of ataxia and to assess the risk for unaffected family members. In this episode, Katie Grouse, MD, FAAN, speaks with Theresa A. Zesiewicz, MD, FAAN, author of the article “Ataxia” in the Continuum® August 2025 Movement Disorders 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. Zesiewicz is a professor of neurology and director at the University of South Florida Ataxia Research Center, and the medical director at the University of South Florida Movement Disorders Neuromodulation Center at the University of South Florida and at the James A. Haley Veteran's Hospital in Tampa, Florida. Additional Resources Read the article: Ataxia 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 Theresa Zesiewicz about her article on ataxia, which appears in the August 2025 Continuum issue on movement disorders. Welcome to the podcast, and please introduce yourself to our audience. Dr Zesiewicz: Well, thank you, Dr Grouse. I'm Dr Theresa Zesiewicz, otherwise known as Dr Z, and I'm happy to be here. Dr Grouse: I have to say, I really enjoyed reading your article. It was a really great refresher for myself as a general neurologist on the topic of ataxia and a really great reminder on a great framework to approach diagnosis and management. But I wanted to start off by asking what you feel is the key message that you hope our listeners will take away from reading your article. Dr Zesiewicz: Yes, so, thanks. I think one of the key messages is that there has been an explosion and renaissance of genetic testing in the past 10 years that has really revolutionized the field of ataxia and has made diagnosis easier for us, more manageable, and hopefully will lead to treatments in the future. So, I think that's a major step forward for our field in terms of genetic techniques over the last 10 years, and even over the last 30 years. There's just been so many diseases that have been identified genetically. So, I think that's a really important take-home message. The other take-home message is that the first drug to treat Friedreich's ataxia, called omaveloxolone, came about about two years ago. This was also a really landmark discovery. As you know, a lot of these ataxias are very difficult to treat. Dr Grouse: Now pivoting back to thinking about the approach to diagnosis of ataxia, how does the timeline of the onset of ataxia symptoms inform your approach? Dr Zesiewicz: The timeline is important because ataxia can be acute, subacute or chronic in nature. And the timeline is important because, if it's acute, it may mean that the ataxia took place over seconds to hours. This may mean a toxic problem or a hypoxic problem. Whereas a chronic ataxia can occur over many years, and that can inform more of a neurodegenerative or more of a genetic etiology. So, taking a very detailed history on the patient is very important. Sometimes I ask them, what is the last time you remember that you walked normal? And that can be a wedding, that can be a graduation. Just some timeline, some point, that the patient actually walked correctly before they remember having to hold onto a railing or taking extra steps to make sure that they didn't fall down, that they didn't have imbalance. That sometimes that's a good way to ask the patient when is the last time they had a problem. And they can help you to try to figure out how long these symptoms have been going on. Dr Grouse: I really appreciate that advice. I will say that I agree, it can sometimes be really hard to get patients to really think back to when they really started to notice something was different. So, I like the idea of referencing back to a big event that may be more memorable to them. Now, given that framework of, you know, thinking through the timeline, could you walk us through your approach to the evaluation of a patient who presents to your clinic with that balance difficulties once you've established that? Dr Zesiewicz: Sure. So, the first thing is to determine whether the patient truly has ataxia. So, do they have imbalance? Do they have a wide base gait? That's very important because patients come in frequently to your clinic and they'll have balance problems, but they can have knee issues or hip issues, neuropathy, something like that. And sometimes what we say to the residents and the students is, usually ataxia or cerebellar symptoms go together with other problems, like ocular problems are really common in cerebellar syndromes. Or dysmetria, pass pointing, speech disorder like dysarthria. So, not only do you need to look at the gait, but you should look at the other symptoms surrounding the gait to see if you think that the patient actually has a cerebellar syndrome. Or do they have something like a vestibular ataxia which would have more vertigo? Or do they have a sensory ataxia, which would occur if a person closes his eyes or has more ataxia when he or she is in the dark? So, you have to think about what you're looking at is the cerebellar syndrome. And then once we look to see if the patient truly has a cerebellar syndrome, then we look at the age, we look at---as you said before, the timeline. Is this acute, subacute, or chronic? And usually I think of ataxia as falling into three categories. It's either acquired, it's either hereditary, or it's neurodegenerative. It can be hereditary. And if it's not hereditary, is it acquired, or is it something like a multiple system atrophy or a parkinsonism or something like that? So, we try to put that together and start to narrow down on the diagnosis, thinking about those parameters. Dr Grouse: That's really a helpful way to think through it. And it is true, it can get very complex when patients come in with balance difficulties. There's so many things you need to think about, but that is a great way to think about it. Of course, we know that most people who come in to the Movements Disorders clinic are getting MRI scans of their brains. But I'm curious, in which cases of patients with cerebellar ataxia do you find the MRI to be particularly helpful in the diagnosis? Dr Zesiewicz: So, an MRI can be very important. Not always, but- so, something like multiple system atrophy type C where you may see a hot cross bun sign or a pontine hyperintensity on the T2-weighted image, that would be helpful. But of course, that doesn't make the diagnosis. It's something that may help you with the diagnosis. In FXTAS, which is fragile X tremor/ataxia syndrome, the patient may have the middle cerebellar peduncle sign or the symmetric hyperintensity in the middle cerebellar peduncles, which is often visible but not always. Something like Wernicke's, where you see an abnormality of the mammillary bodies. Wilson's disease, which is quite rare, T2-weighted image may show hyperintensities in the putamen in something like Wilson's disease. Those are the main MRI abnormalities, I think, with ataxia. And then we look at the cerebellum itself. I mean, that seems self-evident, but if you look at a sagittal section of the MRI and you see just a really significant atrophy of the cerebellum, that's going to help you determine whether you really have a cerebellar syndrome. Dr Grouse: That's really encouraging to hear a good message for all of us who sometimes feel like maybe we're missing something. It's good to know that information can always come up down the line to make things more clear. Your article does a great review of spinal cerebellar ataxia, but I found it interesting learning about the more recently described syndrome of SCA 27B. Would you mind telling us more about that and other really common forms of SCA that's good to keep in mind? Dr Zesiewicz: Sure. So, there are now 49 types of spinal cerebellar ataxia that have been identified. The most common are the polyglutamine repeat diseases: so, spinocerebellar ataxia type 3 or type 2, type 6, are probably the most common. One of the most recent spinocerebellar ataxias to be genetically identified and clinically identified is spinocerebellar ataxia 27B. This is caused by a GAA expansion repeat in the first intron of the fibroblast growth factor on chromosome 13. And the symptoms do include ataxia, eye problems, downbeat nystagmus, other nystagmus, vertical, and diplopia. It appears to be a more common form of adult-onset ataxia, and probably more common than was originally thought. It may account for a substantial number of ataxias, like, a substantial percentage of ataxias that we didn't know about. So, this was really a amazing discovery on SCA 27B. Dr Grouse: Now a lot of us I think feel a little anxious when we think about genetic testing for ataxia simply because there's so many forms, things are changing quickly. Do you have a rule of thumb or a kind of a framework that we can think of as we approach how we should be thinking about getting genetic testing for the subset of patients? Dr Zesiewicz: Sure. And I think that this is where age comes into play a lot. So, if you have a child who's 10, 11, or 12 who's having balance problems in the schoolyard, does not have a history of ataxia in the family, the teachers are telling you that the child is not running correctly, they're having problems with physical education, that is someone who you would think about testing for Friedreich's ataxia. A preteen or a child, that would be one thing that would be important to test. When you talk to your patient, it's important to really take a detailed family history. Not just mom or dad, but ethnicity, grandparents, etc. And sometimes, once in a while, you come up with a known spinal cerebellar ataxia. Then you can just test for that. So, if a person is from Portugal or has Portugal background and they have ataxia and the parents had ataxia, you would think of spinal cerebellar ataxia type 3. Or if they're Brazilian, or if the person is from a certain area of Cuba and mom and dad had ataxia and that person has ataxia, you would think of spinal cerebellar ataxia type 2. Or if a person has ataxia and their parent had blindness or visual problems, you may be more likely to think of spinal cerebellar ataxia type 7, for example. If they have that---either they have a known genetic cause in in the family, first degree family, or they come from an area of the world in which we can pinpoint what type we think it is---you can go ahead and get those tests. If not, you can take an ataxia comprehensive panel. Many times now, if you take the panel and the panel is negative, it will reflex to the whole exome gene sequencing, where we're finding really unusual and more rare types of ataxia, which are very interesting. Spinal cerebellar ataxia type 32, spinal cerebellar ataxia type 36, I had a spinal cerebellar ataxia type 15. So, I think you should start with the age, then the family history, then where the person is from. And then, if none of those work out, you can get a comprehensive panel, and then go on to whole exome gene sequencing. Dr Grouse: That's really, really useful. Thank you so much for breaking that down in a really simple way that a lot of us can take with us. Pivoting a little bit now back towards different types of acquired ataxias, what are some typical lab tests that you recommend for that type of workup? Dr Zesiewicz: Again, if there's no genetic history and the person does not appear to have a neurodegenerative disease, we do test for acquired ataxias. Acquired ataxias can be complex. Many times, they are in the autoimmune family. So, what we start with are just basic labs like a CBC or a CMP, but then we tried to look at some of the other abnormalities that could cause ataxia. So, celiac disease, stiff person syndrome. So, you would look at anti-glutamic acid decarboxylase antibodies, Hashimoto's---so, antithyroglobulin antibodies or antithyroperoxidase antibodies would be helpful. You know, in a case of where the patients may have an underlying neoplasm, maybe even a paraneoplastic workup, such as an anti-Hu, anti-Yo, anti-Ri. A person has breast cancer, for example, you may want to take a paraneoplastic panel. I've been getting more of the anti-autoimmune encephalitis panels in some cases, that were- that are very interesting. And then, you know, things that sometimes we forget now like the syphilis test, thyroid-stimulating test, take a B12 and folate, for example. That would be important. Those are some of the labs. We just have on our electronic chart a group of acquired labs for ataxia. If we can't find any other reason, we just go ahead and try to get those. Dr Grouse: Now, I'm curious what you think is the most challenging aspect of diagnosing a patient with cerebellar ataxia? Dr Zesiewicz: So, for those of us who see many of these patients a day, some of the hardest patients are the ones that---regardless of the workup that we do, we've narrowed it down, it's not hereditary. You know, they've been through the whole exome gene sequencing and we've done the acquired ataxia workup. It doesn't appear to be that. And then we've looked for parkinsonism and neurodegenerative diseases, and it doesn't appear to be that either; like, the alpha-synuclein will be negative. Those are the toughest patients, where we think we've done everything and we still don't have the answer. So, I've had patients in whom I've taken care of family members years and years ago, they had a presumed diagnosis, and later on I've seen their children or other family members. And with the advent of the genetic tests that we have, like whole exome gene sequencing, we have now been able to give the patient and the family a definitive diagnosis that they didn't have 25 years ago. So, I would say don't give up hope. Retesting is important, and as science continues and we get more information and we make more landmark discoveries in genetics, you may be better able to diagnose the patient. Dr Grouse: I was wondering if you had any recommendations regarding either some tips and tricks, some pearls of wisdom you can impart to us regarding the work of ataxia, or conversely, any big pitfalls that you can help us avoid? I would love to hear about it. Dr Zesiewicz: Yeah, there's no easy way to treat or diagnose ataxia patients. I've always felt that the more patients you see- and sounds easy, but the more patients you see, the better you're going to become at it, and eventually things are going to fall into place. You'll begin to see similarities in patients, etc. I think it's important not only to make sure that a person has ataxia, but again, look at the other signs and symptoms that may point to ataxia that you'll see in a cerebellar syndrome. I think it's important to do a full neuroexam. If a person has spasticity, that may point you more towards a certain type of ataxia than if a person has no reflexes, for example, that we see in Friedreich's ataxia. Some of the ocular findings are very interesting as well. It's important to know if a person has a tremor. I've seen several Wilson's disease cases in my life with ataxia. They're very important. I think a full neuroexam and also a very detailed history would be very helpful. Dr Grouse: Tell us about some promising developments in the diagnosis and management of ataxia that we should be on the lookout for. Dr Zesiewicz: The first drug for Friedreich's ataxia was FDA-approved two years ago, which was an NRF2 activator, which was extremely exciting and promising. There are also several medications that are now in front of the FDA that may also be very promising and have gone through long clinical trials. There's a medication that's related to riluzole, which is a medication used for amyotrophic lateral sclerosis, that has been through about seven years of testing. That is before the FDA as well for spinal cerebellar ataxia. Friedreich's ataxia has now completed the first cardiac gene therapy program with AAV vectors, which- we're waiting for full results, but that's a cardiac test. But I would assume that in the future, neurological gene therapy is not far behind if we've already done cardiac gene therapy and Friedreich's ataxia. So, you know, some of these AAV vector-based genetic therapies may be very helpful, as well as ASO, antisense oligonucleotides, for example. And I think in the future, other things to think about are the CRISPR/Cas9 technology for potential treatment of ataxia. It is a very exciting time, and some major promising therapies have been realized in the past 2 to 3 years. Dr Grouse: Well, that's really exciting, and we'll all look forward to seeing these becoming more clinically applicable in the future. So, thank you so much for coming to talk with us today. Dr Zesiewicz: Thank you. Dr Grouse: Again, today I've been interviewing Dr Theresa Zesiewicz about her article on ataxia, which appears in the August 2025 Continuum issue on movement disorders. 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.

Episode 36: Real International Business Challenges from Real Companies

Play Episode Listen Later Sep 9, 2025 25:13

Featuring X-Culture Program Founder and Coordinator, Dr. Vas TarasJoin host Chris Carril and guest Dr. Vas Taras, founder and coordinator of the X-Culture Project, as they discuss the X-Culture and its mission. X-Culture is a large-scale international experiential learning project that involves over 6,500 MBA and business students from 150 universities from 70 countries on six continents every semester. As of 2024, over 115,000 students have completed the X-Culture Program. The students are placed in global virtual teams of about seven, each student coming from a different country. Working with people from around the globe and dealing with cultural differences, time-zone dispersion, and global communication challenges, the teams complete a consulting project for a multi-national company. Dr. Vas Taras is an Associate Professor of International Business at the University of North Carolina at Greensboro. He is the founder and coordinator of the X-Culture Project which he launched in 2010. He received his PhD in Human Resource Management and Organizational Dynamics from the University of Calgary, Canada and his Master's in Political Economy from the University of Texas at Dallas. He teaches International Business at the Bryan School of Business and Economics at the University of North Carolina at Greensboro. His research revolves around cross-cultural and global virtual teams and experiential approaches to international business education. His research team is particularly interested in the potential of large and diverse crowds of amateurs in solving complex business problems. He is an Associate Editor of the International Journal of Cross-Cultural Management, and the Editorial Board member of Journal of International Business Studies, Journal of World Business, Journal of International Management, and Management Research Review. He is a recipient of numerous research and teaching awards for his work in International Business. He has lived, worked and studied in half a dozen countries and has experience as a manager, businessman, and business consultant.Visit Guest Dr. Vas Taras' LinkedIn Profile

Trump's latest Russia sanction threat and US Open boos

Afternoon Drive with John Maytham

Play Episode Listen Later Sep 9, 2025 8:12 Transcription Available

Amy Maciver speaks to Brooks Spector, Associate Editor at the Daily Maverick and a former US diplomat to discusss Donald Trump’s readiness to put sanctions on Russia. Presenter John Maytham is an actor and author-turned-talk radio veteran and seasoned journalist. His show serves a round-up of local and international news coupled with the latest in business, sport, traffic and weather. The host’s eclectic interests mean the program often surprises the audience with intriguing book reviews and inspiring interviews profiling artists. A daily highlight is Rapid Fire, just after 5:30pm. CapeTalk fans call in, to stump the presenter with their general knowledge questions. Another firm favourite is the humorous Thursday crossing with award-winning journalist Rebecca Davis, called “Plan B”. Thank you for listening to a podcast from Afternoon Drive with John Maytham Listen live on Primedia+ weekdays from 15:00 and 18:00 (SA Time) to Afternoon Drive with John Maytham broadcast on CapeTalk https://buff.ly/NnFM3Nk For more from the show go to https://buff.ly/BSFy4Cn or find all the catch-up podcasts here https://buff.ly/n8nWt4x Subscribe to the CapeTalk Daily and Weekly Newsletters https://buff.ly/sbvVZD5 Follow us on social media: CapeTalk on Facebook: https://www.facebook.com/CapeTalk CapeTalk on TikTok: https://www.tiktok.com/@capetalk CapeTalk on Instagram: https://www.instagram.com/ CapeTalk on X: https://x.com/CapeTalk CapeTalk on YouTube: https://www.youtube.com/@CapeTalk567 See omnystudio.com/listener for privacy information.

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MacVoices #25232: Live! - Replacing Facebook

MacVoices Video

Play Episode Listen Later Sep 8, 2025 24:33

The MacVoices panel of Chuck Joiner, David Ginsburg, Marty Jencius, Brian Flanigan-Arthurs, Ben Roethig, Jeff Gamet, Eric Bolden, Web Bixby, and Jim Rea debates whether alternatives like Discord, Reddit, Mastodon, or Blue Sky could replace Facebook for groups and community interaction. They discuss ease of adoption, generational barriers, and what it takes for platforms to go mainstream, comparing them to Zoom's rise during the pandemic. The conversation wraps with thoughts on Apple's upcoming September event and closing connections. Get Tidy Today with Cloud Cleanup and CleanMyMac! Try 7 days free and use my code MACVOICES20 for 20% off at clnmy.com/MACVOICES. Show Notes: Chapters: 0:00 – Introduction and sponsor message 1:05 – The Facebook dilemma and community reliance 2:05 – Could Reddit or Discord replace Facebook groups? 3:10 – Community platforms and user responsibilities 4:46 – The “grandparents test” and tech adoption 6:59 – Why Mastodon struggles with mainstream adoption 7:44 – Barriers to new platforms and Facebook's simplicity 8:50 – Lessons from Zoom's forced adoption during COVID 9:59 – CleanMyMac Cloud Cleanup ad read 11:33 – Connections and closing plugs from the panel 21:10 – Apple's September event announcement and predictions 23:14 – Closing thoughts and sign-off Links: The first known AI wrongful death lawsuit accuses OpenAI of enabling a teen's suicide https://www.engadget.com/ai/the-first-known-ai-wrongful-death-lawsuit-accuses-openai-of-enabling-a-teens-suicide-212058548.html Microsoft Copilot is now a talking blob on Samsung TVs https://www.engadget.com/ai/microsoft-copilot-is-now-a-talking-blob-on-samsung-tvs-204115199.html Clippy is back—this time as a mascot for Big Tech protesthttps://www.fastcompany.com/91387927/clippy-is-back-as-a-mascot-for-big-tech-protests Guests: Web Bixby has been in the insurance business for 40 years and has been an Apple user for longer than that.You can catch up with him on Facebook, Twitter, and LinkedIn, but prefers Bluesky. 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). Jim Rea built his own computer from scratch in 1975, started programming in 1977, and has been an independent Mac developer continuously since 1984. He is the founder of ProVUE Development, and the author of Panorama X, ProVUE's ultra fast RAM based database software for the macOS platform. He's been a speaker at MacTech, MacWorld Expo and other industry conferences. Follow Jim at provue.com and via @provuejim@techhub.social on Mastodon. 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. 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

MacVoices #25232: Live! - Replacing Facebook

The Wonkhe Show - the higher education podcast

Play Episode Listen Later Sep 8, 2025 24:34

Podcast: Year ahead, International, Governance

Play Episode Listen Later Sep 5, 2025 48:21

This week on the podcast we examine the challenges facing UK higher education as another tough academic year begins with government finances stretched and the sector languishing at the bottom of political priorities.With the post-16 education white paper still pending and rumours swirling about tuition fee increases and international student levies, what does the year ahead hold for universities already struggling with funding pressures?Plus we discuss the latest crackdown on international students as 130,000 are warned about visa overstaying and further restrictions on dependants loom, and ask whether new governance recommendations – from paying board members to live-streaming meetings – can restore confidence in university leadership after high-profile failures.With Anton Muscatelli, Principal at University of Glasgow, Dani Payne, Head of Education and Social Mobility at the Social Market Foundation, James Coe, Associate Editor at Wonkhe, and presented by Jim Dickinson, Associate Editor at Wonkhe.Retry Hosted on Acast. See acast.com/privacy for more information.

university head uk education international principal acast glasgow governance associate editor year ahead social mobility podcast year jim dickinson

MacVoices #25230: Live! - Intel Investment Debate and Bluesky's Mississippi Exit

MacVoices Video

Play Episode Listen Later Sep 4, 2025 27:01

The panel examines the U.S. government's $8.9 billion investment in Intel, debating whether it strengthens national security or sets a risky precedent for government ownership in private companies. Chuck Joiner, David Ginsburg, Marty Jencius, Brian Flanigan-Arthurs, Ben Roethig, Jeff Gamet, Eric Bolden, Web Bixby, and Jim Rea discuss Intel's challenges, the role of the CHIPS Act, and political optics. The session also examined Bluesky's withdrawal from Mississippi over strict age-verification laws, and the implications for other states and services. Today's MacVoices is supported by Insta360 and their new GO Ultra, the tiny 4K camera that goes everywhere with you. Visit store.Insta360.com and use the code “MacVoices” for a free set of Sticky Tabs. Show Notes: Chapters: [0:10] Government investment in Intel [1:30] Concerns about state-owned enterprise [3:49] Intel's struggles and future outlook [5:43] Comparing Intel to past bailouts [7:19] Differences between subsidies and bailouts [7:57] Perspectives on government involvement [9:16] International vs U.S. approaches [11:29] Stratechery analysis on Intel [11:59] CHIPS Act and Intel's funding shift [15:17] Breakdown of grants and obligations [16:40] Political optics of Intel investment [20:30] Bluesky exits Mississippi [21:28] Age-verification law challenges [23:58] Privacy, Facebook, and data security [24:58] Broader implications of restrictive laws Links: Trump confirms US government's 10% stake in Intel, stock climbs https://9to5mac.com/2025/08/22/trump-confirms-us-governments-10-stake-in-intel-stock-climbs/ U.S. Intel https://stratechery.com/2025/u-s-intel/ Bluesky blocks service in Mississippi over age assurance law https://techcrunch.com/2025/08/24/bluesky-blocks-service-in-mississippi-over-age-assurance-law/ Guests: Web Bixby has been in the insurance business for 40 years and has been an Apple user for longer than that.You can catch up with him on Facebook, Twitter, and LinkedIn, but prefers Bluesky. 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). Jim Rea built his own computer from scratch in 1975, started programming in 1977, and has been an independent Mac developer continuously since 1984. He is the founder of ProVUE Development, and the author of Panorama X, ProVUE's ultra fast RAM based database software for the macOS platform. He's been a speaker at MacTech, MacWorld Expo and other industry conferences. Follow Jim at provue.com and via @provuejim@techhub.social on Mastodon. 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. 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

Blue Ribbon College Basketball Podcast, Ep. 153: Blue Ribbon Yearbook is at the printer! Talking with associate editor Patrick Stevens and saying farewell to a giant of the game.

Blue Ribbon College Basketball Podcasts

Play Episode Listen Later Sep 4, 2025 49:23

In the newest episode of the Blue Ribbon College Basketball Podcast, hosts Chris Dortch—editor and publisher of Blue Ribbon College Basketball Yearbook—and Kevin Ingram—the radio voice of Vanderbilt men's basketball—discuss a variety of college basketball (and other) topics:• Blue Ribbon College Basketball Yearbook has been delivered to the printer! We will ship printed copies in early October, and our digital edition drops next week! Order at blueribbonyearbook.com.• Patrick Stevens recounts the many conversations he had with college coaches while performing his annual yeoman's work for Blue Ribbon. NIL, the portal, retention, and building a culture were hot topics.• Saying farewell to George Raveling—coach, announcer, Nike ambassador, and mentor to countless young coaches and many others, including some guy named Michael.• Rick Barnes, 71, signs a lifetime contract with Tennessee. But it isn't money that keeps on the sidelines. It's the joy of helping his players succeed.All Blue Ribbon college basketball podcasts are available on Apple Podcasts and Spotify.You can also listen in your email client or click on the “Listen In Podcast App” link above to listen in your podcast player of choice. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit blueribbon.substack.com

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MacVoices #25230: Live! - Intel Investment Debate and Bluesky's Mississippi Exit

The Classical Ideas Podcast

Play Episode Listen Later Sep 4, 2025 27:02

EP 333: Salvadoran-Middle Eastern Resistance and Shafiq Handal w/Dr. Amy Fallas

Play Episode Listen Later Sep 3, 2025 37:25

Dr. Amy Fallas is a PhD in History at UC Santa Barbara. She holds an MA in History from Yale and her research examines religious difference, charitable networks, and historical memory in the Middle East. Her work has been supported by the American Research Center in Egypt, the American Society for Church History, the Orthodox Christian Studies Center among others. She is the Associate Editor of the Arab Studies Journal and serves on the steering committees of the History of Christianity and Middle Eastern Christianity units of the American Academy of Religion. Her scholarship appears in History Compass and Islam and Christian–Muslim Relations and her essays are published in the Washington Post, Jadaliyya, Mada Masr, the Revealer, Sojourners and more. On this episode, we mostly discuss her article Brothers in the Resistance, research in Lebanon about connections between Latin America and the Middle East, titled Hermanos fi al-Muqawama, She is based in Beirut. Visit Sacred Writes: https://www.sacred-writes.org/carpenter-cohort-2025-jan Visit Amy Fallas: https://www.amyfallas.com/

MacVoices #25229: Live! - Gemini and Siri, The FTC's Encryption Demands, Y Combinator and Epic

Play Episode Listen Later Sep 3, 2025 38:09

The MacVoices Live! panel debate reports that Apple may tap Google's Gemini for Siri, weighing multi-model AI, privacy, and sandboxed partnerships. Chuck Joiner, David Ginsburg, Marty Jencius, Brian Flanigan-Arthurs, Ben Roethig, Jeff Gamet, Eric Bolden, Web Bixby, and Jim Rea review the FTC's warning not to weaken encryption at governments' request, then examine Y Combinator's brief backing Epic against App Store fees. The discussion wraps up with claims that Meta inflated ad outcomes and evaded Apple's tracking rules, and the often uncomfortable trade-offs of still using Facebook. Today's MacVoices is supported by Insta360 and their new GO Ultra, the tiny 4K camera that goes everywhere with you. Visit store.Insta360.com and use the code “MacVoices” for a free set of Sticky Tabs. Show Notes: Chapters: [0:00] Intro and sponsor mention (Insta360 Go Ultra) [0:27] Apple considering Gemini for Siri: pros, cons, privacy [3:51] Multi-model approach, sandboxing, and user transparency [10:11] Sponsor read: Insta360 Go Ultra [11:36] FTC warns tech firms not to weaken encryption for governments [13:52] Legal conflicts across regions and disclosure dilemmas [16:01] Y Combinator backs Epic: App Store fees and innovation “tax” [21:14] Developer frustrations, big-app exceptions, and fairness [26:30] Meta accused of inflating ad results, dodging ATT tracking rules [33:28] The dilemma of using Facebook despite privacy concerns[36:35] Wrap-up Links: Apple is reportedly considering using Gemini to power the new Siri https://www.engadget.com/ai/apple-is-reportedly-considering-using-gemini-to-power-the-new-siri-184528449.html FTC warns Apple it must not weaken data encryption at behest of rogue governments https://www.applemust.com/ftc-warns-apple-it-must-not-weaken-data-encryption-at-behest-of-rogue-governments/ Y Combinator backs Epic in Apple appeal, calls App Store fee a ‘tax on innovation' https://9to5mac.com/2025/08/21/y-combinator-backs-epic-in-apple-appeal-calls-app-store-fee-a-tax-on-innovation/ Meta accused of inflating ad results & dodging Apple privacy rules https://appleinsider.com/articles/25/08/21/meta-accused-of-inflating-ad-results-dodging-apple-privacy-rules Guests: Web Bixby has been in the insurance business for 40 years and has been an Apple user for longer than that.You can catch up with him on Facebook, Twitter, and LinkedIn, but prefers Bluesky. 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). Jim Rea built his own computer from scratch in 1975, started programming in 1977, and has been an independent Mac developer continuously since 1984. He is the founder of ProVUE Development, and the author of Panorama X, ProVUE's ultra fast RAM based database software for the macOS platform. He's been a speaker at MacTech, MacWorld Expo and other industry conferences. Follow Jim at provue.com and via @provuejim@techhub.social on Mastodon. 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. 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

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MacVoices #25228: Live! - xAI Sues Apple and Apple Watch Secrets Stolen

MacVoices Video

Play Episode Listen Later Sep 2, 2025 31:30

Elon Musk's xAI launches a lawsuit against Apple and OpenAI over app chart favoritism, sparking debate on App Store algorithms and competition. The panel digs into whether Grok is being unfairly excluded and how rankings work. Then, Chuck Joiner, David Ginsburg, Marty Jencius, Brian Flanigan-Arthurs, Ben Roethig, Jeff Gamet, Eric Bolden, Web Bixby, and Jim Rea turn to alleged Apple Watch trade secret theft linked to Oppo, raising questions about corporate espionage and its impact. Today's MacVoices is supported by Insta360 and their new GO Ultra, the tiny 4K camera that goes everywhere with you. Visit store.Insta360.com and use the code “MacVoices” for a free set of Sticky Tabs. Show Notes: Chapters: [0:00] Introduction and panel check-in [5:12] Chickens, gardens, and offbeat free associations [6:33] Elon Musk's XAI lawsuit against Apple and OpenAI [8:57] App Store rankings, Grok's role, and competitive fairness [13:13] Media cycles, legal timelines, and possible motives [17:09] Why app chart positions matter to users and developers [21:04] How Apple's app ranking algorithm may actually work [23:08] Broader implications of lawsuits and App Store transparency [25:27] Apple Watch trade secrets allegedly stolen for Oppo [28:46] Apple's legal strategy and corporate security concerns [30:39] Closing thoughts and show wrap-up Links: Elon Musk's xAI sues Apple and OpenAI over Siri partnership, App Store charts   https://9to5mac.com/2025/08/25/elon-musks-xai-sues-apple-and-openai-over-siri-partnership-app-store-charts/ Apple moves to block Oppo from using stolen Apple Watch designs https://appleinsider.com/articles/25/08/22/apple-watch-designs-allegedly-stolen-and-provided-to-oppo Guests: Web Bixby has been in the insurance business for 40 years and has been an Apple user for longer than that.You can catch up with him on Facebook, Twitter, and LinkedIn, but prefers Bluesky. 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). Jim Rea built his own computer from scratch in 1975, started programming in 1977, and has been an independent Mac developer continuously since 1984. He is the founder of ProVUE Development, and the author of Panorama X, ProVUE's ultra fast RAM based database software for the macOS platform. He's been a speaker at MacTech, MacWorld Expo and other industry conferences. Follow Jim at provue.com and via @provuejim@techhub.social on Mastodon. 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. 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

MacVoices #25228: Live! - xAI Sues Apple and Apple Watch Secrets Stolen

Play Episode Listen Later Sep 2, 2025 31:31

Elon Musk's xAI launches a lawsuit against Apple and OpenAI over app chart favoritism, sparking debate on App Store algorithms and competition. The panel digs into whether Grok is being unfairly excluded and how rankings work. Then, Chuck Joiner, David Ginsburg, Marty Jencius, Brian Flanigan-Arthurs, Ben Roethig, Jeff Gamet, Eric Bolden, Web Bixby, and Jim Rea turn to alleged Apple Watch trade secret theft linked to Oppo, raising questions about corporate espionage and its impact. Today's MacVoices is supported by Insta360 and their new GO Ultra, the tiny 4K camera that goes everywhere with you. Visit store.Insta360.com and use the code “MacVoices” for a free set of Sticky Tabs. Show Notes: Chapters: [0:00] Introduction and panel check-in [5:12] Chickens, gardens, and offbeat free associations [6:33] Elon Musk's XAI lawsuit against Apple and OpenAI [8:57] App Store rankings, Grok's role, and competitive fairness [13:13] Media cycles, legal timelines, and possible motives [17:09] Why app chart positions matter to users and developers [21:04] How Apple's app ranking algorithm may actually work [23:08] Broader implications of lawsuits and App Store transparency [25:27] Apple Watch trade secrets allegedly stolen for Oppo [28:46] Apple's legal strategy and corporate security concerns [30:39] Closing thoughts and show wrap-up Links: Elon Musk's xAI sues Apple and OpenAI over Siri partnership, App Store charts  https://9to5mac.com/2025/08/25/elon-musks-xai-sues-apple-and-openai-over-siri-partnership-app-store-charts/ Apple moves to block Oppo from using stolen Apple Watch designs https://appleinsider.com/articles/25/08/22/apple-watch-designs-allegedly-stolen-and-provided-to-oppo Guests: Web Bixby has been in the insurance business for 40 years and has been an Apple user for longer than that.You can catch up with him on Facebook, Twitter, and LinkedIn, but prefers Bluesky. 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). Jim Rea built his own computer from scratch in 1975, started programming in 1977, and has been an independent Mac developer continuously since 1984. He is the founder of ProVUE Development, and the author of Panorama X, ProVUE's ultra fast RAM based database software for the macOS platform. He's been a speaker at MacTech, MacWorld Expo and other industry conferences. Follow Jim at provue.com and via @provuejim@techhub.social on Mastodon. 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. 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

china apple technology media secrets video co founders system elon musk iphone journal chicken mac associate professor smile ios ipads windows apple tv ram counseling stolen lawsuit siri openai app store blue sky generally apple watches 4k sues managing editors mastodon macos big show patents associate editor second life grok broader kent state university oppo xai deconstruct counselor education rsa conference insta360 wordcamp corporate espionage apple ecosystem macworld expo jeff gamet david ginsburg apple iigs mac observer chuck joiner macvoices mactech mac os ken in touch with ios macvoices group provue macvoices page

Why Britain's Left is radicalising

Stories of our times

Play Episode Listen Later Sep 1, 2025 26:44

Tomorrow, the Greens announce their new leader, and one contender has been borrowing from the Farage playbook in his campaign. Meanwhile, Jeremy Corbyn's new populist party is getting hundreds of thousands of sign-ups since its launch. Are the days of gradualism - and our two-party system dominance - over?This podcast was brought to you thanks to the support of readers of The Times and The Sunday Times. Subscribe today: http://thetimes.com/thestoryGuests: Aubrey Allegretti, Chief Political Correspondent, The Times.Josh Glancy, Associate Editor, The Sunday Times.Host: Manveen Rana.Producer: Olivia Case.Clips: YouTube / Break Through News, Sky, YouTube / @zakpolanskigreen, Novara Media, The Telegraph, ITV, YouTube / Ellie and Adrian 2025.Photo: Getty Images.Get in touch: thestory@thetimes.com. Hosted on Acast. See acast.com/privacy for more information.

left britain acast greens itv telegraph sunday times associate editor jeremy corbyn farage chief political correspondent novara media host manveen rana

BONUS: Highest 2 Lowest feat. Robert Daniels TEASER

Hit Factory

Play Episode Listen Later Aug 29, 2025 11:33

Get access to this entire episode as well as all of our premium episodes and bonus content by becoming a Hit Factory Patron for just $5/month.Associate Editor at Roger Ebert Robert Daniels joins to discuss the latest Spike Lee joint Highest 2 Lowest, a loose reimagining of Akira Kurosawa's 1963 procedural masterpiece High & Low that marks the fifth collaborationg between Lee and the inimitable Denzel Washington. Thematically rich, unabashedly confrontational and occasionally baffling, Highest 2 Lowest is everything you would hope for from a late period Spike Lee picture, as Lee grapples with personal concerns about masculinity, the contradictions of Black capitalism, and the generational divide around the nature of authenticity in art when success has finally come your way.We begin with a discussion of the bold formal choices of Highest 2 Lowest, including the stylistic gambit of dividing the film firmly into two aesthetic halves; the first half marked by an austere, antiseptic, and artificial atmosphere that finally gives way to a more daring, brash and musical rhythm when the film descends on the streets of Spike's native New York, escaping the Dumbo high rise apartment of the film's early chapters. Then, we explore the film as autocritique, with Lee and Washington examining their positions as elder statesmen of Black artistry, and the push-pull of working within systems of capital built upon racialized heirarchies. Finally, we tackle the film's thorny political propositions, its conservative tendencies, and the thrill of trying to parse where exactly an artist like Spike Lee stands on the issues and questions he presents within the text.Read Robert Daniels on Highest 2 Lowest at Roger EbertRead Alphonse Pierre on Highest 2 Lowest at PitchforkFollow Robert Daniels on Twitter.....Our theme song is "Mirror" by Chris Fish

Progressive Supranuclear Palsy and Corticobasal Syndrome With Dr. Nikolaus McFarland

university medicine associate professor assistant professor program directors anal std hpv associate editor stds ucsf cancer screenings hra dysplasia washington uw

Play Episode Listen Later Aug 27, 2025 23:51

Progressive supranuclear palsy and corticobasal syndrome are closely related neurodegenerative disorders that present with progressive parkinsonism and multiple other features that overlap clinically and neuropathologically. Early recognition is critical to provide appropriate treatment and supportive care. In this episode, Teshamae Monteith, MD, FAAN speaks with Nikolaus R. McFarland, MD, PhD, FAAN, author of the article “Progressive Supranuclear Palsy and Corticobasal Syndrome” in the Continuum® August 2025 Movement Disorders 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. McFarland is an associate professor of neurology at the University of Florida College of Medicine at the Norman Fixel Institute for Neurological Diseases in Gainesville, Florida. Additional Resources Read the article: Progressive Supranuclear Palsy and Corticobasal Syndrome 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 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 Nikolaus McFarland about his article on progressive supranuclear palsy and cortical basilar syndrome, which appears in the August 2025 Continuum issue on movement disorders. Welcome, how are you? Dr Farland: I'm great. Thank you for inviting me to do this. This is a great opportunity. I had fun putting this article together, and it's part of my passion. Dr Monteith: Yes, I know that. You sit on the board with me in the Florida Society of Neurology and I've seen your lectures. You're very passionate about this. And so why don't you first start off with introducing yourself, and then tell us just a little bit about what got you interested in this field. Dr Farland: I'm Dr Nicholas McFarlane. I'm an associate professor at the University of Florida, and I work at the Norman Fixel Institute for Neurological Diseases. I am a director of a number of different centers. So, I actually direct the cure PSP Center of Care and the MSA Center of Excellence at the University of Florida; I also direct the Huntington's clinic there as well. But for many years my focus has been on atypical parkinsonisms. And, you know, I've treated these patients for years, and one of my focuses is actually these patients who suffer from progressive supranuclear palsy and corticobasal syndrome. So that's kind of what this review is all about. Dr Monteith: You probably were born excited, but I want to know what got you interested in this in particular? Dr Farland: So, what got me interested in this in particular was really the disease and the challenges that's involved in it. So, Parkinson's disease is pretty common, and we see a lot of that in our clinic. Yet many times, roughly about 10 to 15% of my patients present with these atypical disorders. And they're quite fascinating. They present in different ways. They're fairly uncommon. They're complex disorders that progress fairly rapidly, and they have multiple different features. They're sort of exciting to see clinically as a neurologist. I think they're really interesting from an academic standpoint, but also in the standpoint of really trying to bring together sort of a team. We have built a multidisciplinary team here at the University of Florida to take care of these patients. They require a number of folks on that team to take care of them. And so, what's exciting, really, is the challenge of treating these patients. There are very limited numbers of therapies that are available, and the current therapies that we have often really aren't great and over time they fail. And so, part of the challenge is actually doing research. And so, there's actually a lot of new research that's been going on in this field. Recently, there's been some revisions to the clinical criteria to help diagnose these disorders. So, that's really what's exciting. The field is really moving forward fairly rapidly with a number of new diagnostics, therapeutics coming out. And hopefully we can make a real difference for these patients. And so that's what really got me into this field, the challenge of trying to treat these patients, help them, advocate for them and make them better. Dr Monteith: And so, tell me what the essential points of this article. Dr Farland: So, the essential points, really, of this article is: number one, you know, just to recognize the new clinical criteria for both PSP and corticobasal syndrome, the diagnosis for these disorders or the phenotypic spectrum has really expanded over the years. So, we now recognize many different phenotypes of these disorders, and the diagnosis has gotten fairly complicated. And so, one of the goals of this article was to review those new diagnostic criteria and the different phenotypic ways these diseases present. I wanted to discuss, also, some of the neuropathology and clinicopathological overlap that's occurred in these diseases as well as some of the new diagnostic tests that are available. That's definitely growing. Some of the new studies that are out, in terms of research and clinical trials. And then wanted to review some of the approaches for treatment for neurologists. Particularly, we're hoping that, you know, this article educates folks. If you're a general neurologist, we're hoping that recognizing these diseases early on will prompt you to refer these patients to specialty clinics or movement disorder specialists early on so they can get appropriate care, confirm your diagnosis, as well as get them involved in trials if they are available. Dr Monteith: And how has the clinical criteria for PSP and cortical basilar syndrome changed? Dr Farland: I think I already mentioned there's been an evolution of the clinical criteria for PSP. There's new diagnostic criteria that were recently published, and it recognizes the multiple clinical phenotypes and the spectrum of the disease that's out there, which is much broader than we thought about. Corticobasal clinical criteria are the Dr Armstrong criteria from 2013. They have not been updated, but they are in the works of being updated. But it does recognize the classic presentation of corticobasal syndrome, plus a frontal executive predominant and then a variant that actually overlaps with PSP. So, there's a lot more overlap in these two diseases than we originally recognized. Dr Monteith: And so, you spoke a bit about FTD spectrum. So why don't you tell us a little bit about what that is? I know you mentioned multiple phenotypes. Dr Farland: What I really want to say is that both PSP and corticobasal syndrome, they're relatively rare, and what- sort of as to common features, they both are progressive Parkinson disorders, but they have variable features. While they're commonly associated with Parkinson's, they also fit within this frontotemporal lobar spectrum, having features that overlap both clinically and neuropathologically. I just want folks to understand that overlap. One of this pathological overlap here is the predominant Tau pathology in the brain, an increasing recognology- recognition of sort of the pathological heterogeneity within these disorders. So, there's an initial description, a classic of PSP, as Richardson syndrome. But now we recognize there are lots of different features to it and there are different ways it presents, and there's definitely a lot of clinical pathological overlap. Dr Monteith: Why don't we just talk about some red flags for PSP? Dr Farland: Yeah, sure. So, some of the red flags for PSP and even corticobasal syndrome are: number one is rapid progression with early onset of falls, gait difficulty, falling typically backwards, early speech and swallow problems that are more prominent than you see in Parkinson's disease, as well as eye gaze issues. So, ocular motor features, particularly vertical gaze palsy. In particular what we talk about is the supranuclear gaze palsy, and one of the most sensitive features that we've seen with these is downgaze limitation or slowed downgaze, and eventually a full vertical gaze palsy and followed supranuclear gaze palsy. So, there's some of the red flags that we see. So, while we think about the lack of response to levodopa frequently as something that's a red flag for Parkinson's, there are many times that we see Parkinson's patients, and about a quarter of them don't really respond. There's some features that don't respond to levodopa that may not be so specific, but also can be helpful in this disease. Dr Monteith: And what about the red flags for cortical basilar syndrome? Dr Farland: So, for cortical basilar syndrome, some of the red flags again are this rapidly depressive syndrome tends to be, at least in its classical present presentation, more asymmetric in its presentation of parkinsonism, with features including things like dystonic features, okay? For limb dystonia and apraxias---so, inability to do a learned behavior. One of those red flags is a patient who comes in and says, my hand doesn't work anymore, which is something extremely uncommon that you hear in Parkinson's disease. Most of those patients will present, say, I might have a tremor, but they very rarely will tell you that I can't use my hand. So look out for that sign. Dr Monteith: And let's talk a little bit about some of the advances in the fields you mentioned, evolving biomarker and imaging capacities. So, how are these advances useful in helping us understand these conditions, especially when there's so much heterogeneity? Dr Farland: I might start by talking a little bit about some of the clinical criteria that have advanced. Why don't we start there and just discuss some of the advances? I think in PSP, I think, originally we had both probable and possible diagnoses of PSP, and the diagnostic criteria were basically focused on what was what's called “classical PSP” or “Richardson syndrome”. But now we recognize that there are multiple phenotypes. There's an overlap with Parkinsonism that's slower in progression and morphs into PSP, the classical form. There's a frontal behavioral variant where patients present with that frontal behavioral kind of thing. There's a speech-language variant that can overlap with PSP. So they have prominent speech language, potentially even apraxia speech. So, recognition of these different phenotypes is sort of a new thing in this field. There's even overlap with cortical basal syndrome and PSP, and we note that the pathology can overlap as well. So, I think that's one of the things that have changed over time. And these were- recently came out in 2017 in a new publication in the Movement Disorders Society. So, in terms of diagnostic tests as well---and there's been quite a bit of evolution---really still to date, our best diagnostic test is imaging. MRI is really one of our best tests currently. Currently blood tests, spinal fluid, there's new biomarkers in terms of skin… they're still in the research phase and not necessarily very specific yet. So, we rely heavily on imaging still; and for PSP, what we're looking for largely are changes in the brain stem, and particularly focused on the midbrain. So disproportionate midbrain atrophy compared to the pons and the rest of the midbrain is a fairly specific intensive sign for PSP. Whereas in MSA we see more of a pontine atrophy compared to the midbrain. So that can be really helpful, and there are lots of different new measurements that can be done. PET scans are also being used as well. And there are new PET markers, but they still remain kind of research-based, but are becoming more and more prevalent and may be available soon for potential use. Although there's some overlap with PET tracers with Alzheimer's disease and different Tau isoforms. So, something to be wary about, but we will be seeing some of these soon coming out as well. More kind of up-to-date things include things like the spinal fluid as well as even some of the skin biopsies. And I think we've heard some word of recent studies that have come out that potentially in the very near future we might actually have some Tau protein tests that we can look at Tau either in spinal fluid or even in a skin biopsy. But again, still remains research-based and, we still need more information as to whether these tests can be reproducible and how sensitive or specific they are. Dr Monteith: It sounds like, when really approaching these patients, still, it's a lot of back to the history, back to the clinical and some basic imaging that we should be able to identify to distinguish these types of patients, and we're not quite where we need to be yet for biomarker. Dr Farland: I totally agree with you. I think it starts, really, with the clinical exam and that's our main focus here; and understanding some of the new clinical criteria which are more sensitive, but also specific, too. And they're really useful to look at. So, I think reviewing those; patients do progress, following them over time can be really useful. And then for diagnosis, getting imaging if you suspect a patient has an atypical presentation of parkinsonism, to look for signs or features that might be specific for these different disorders. Dr Monteith: Why don't we take a typical case, a typical patient that you would see in clinic, and walk us through the thought process---especially, maybe they presented somewhat early---and the different treatment approaches to helping the patient, and of course their family. Dr Farland: Yeah, sure. So, a typical patient might be someone who comes in with, like, a three year history of progressive gait problems and falling. And let's say the patient says, I'm falling backwards frequently. They may have had, like, a rib fracture, or they hit their head once, and they're describing some speech issues as well. Now they're relying on a walker and family members saying they rarely let them be by themselves. And there may be some slowing of their cognitive function and maybe a bit of withdrawal. So that's a typical patient. So, the approach here is really, what are some of the red flags? I think already you hear a red flag of a rapidly progressive disease. So, Parkinson's disease patients rarely have frequent falls within the first five years. So, this is within three years or less. You're already hearing early onset of gait problems and falling, and particularly falling backwards rather than forwards as often Parkinson's disease patients do. You're hearing early speech problems and maybe a subtle hint of cognitive slowing and some withdrawal. So, a lot of things that sort of are red flags. So, our approach really would be examining this patient really closely. Okay? We'd be listening to the history, looking at the patient. One thing is that some of these patients come in, they may be in a wheelchair already. That's a red flag for us. If they're wearing sunglasses---sometimes we see that patients, they have photosensitivity and they're in a chair and they're wearing sunglasses---you take the glasses off and you look at their face and they have that sort of a facial stare to them---not just the masked face, but the stare---and their eyes really aren't moving. So, another kind of clue, maybe this is probably something atypical, particularly PSP is what I'm thinking about. So, the approach is really, do a thorough exam. I always recommend looking at eye movements and starting with volitional saccades, not giving them a target necessarily, but asking them to look up and then look down. And then particularly look at the speed of downgaze and whether they actually have full versions down, are able to do that. That's probably your most sensitive test for a patient who has PSP. Not the upgaze, which can be- upgaze impairment in older patients can be nonspecific. So, look for that down gaze. So, if I can get out one message, that's one thing that can be easily done and examined fairly quickly for diagnosis of these patients. And then just look for signs of rigidity, bradykinesia, maybe even some myelopraxia, and then look at their gait carefully so that there's a high suspicion. Again, if there's some atypical features, imaging is really important. So, my next step would be probably getting an MRI to evaluate whether- do they have brain somatrophy or other widespread atrophy or other signs? You need to think about your differential diagnosis for some of these patients as well. So, common things are common; vascular disease, you can't have vascular parkinsonism or even signs of NPH. Both of those can present with progressive gait difficulty and falls. So, the gait may look more like Parkinson's rather than ataxic gait that we see in classic PSP, but still they have early gait issues, and that can be a mimicker of PSP, So looking for both of those things in your imaging. Think about sort of autoimmune potentially causes. So, if they have a really rapid progressive cause, there are some rare autoimmune things. There have been recent reports of things like IgLON5, although there's limited cases, but we're doing more screening for some of those autoimmune causes. And then even some infectious causes like Whipples, that are rarely present like this. Okay? And have other signs and features. Dr Monteith: So, let's say you diagnose this patient with PSP and you're assessing the patients to see how you can improve their quality of life. So, what are some potential symptomatic managements that will help our patient? Dr Farland: I recommend for most all of these patients… while the literature indicates that many patients with PSP, and especially corticobasal syndrome, don't respond well to levodopa. So, the classic treatment for parkinsonism. However, we all recommend a trial of levodopa. These patients may respond partially to doses of levodopa, and we try to push the doses a bit higher. So, the recommended trial is usually a dose up to roughly 1000 milligrams of levodopa per day. And give it some time, at least two, if not actually three months of a trial. If not well-tolerated, you can back off. If there's no response at all or no improvement, then slowly back off and taper patients off and ask them to tell you whether they feel like they're actually worsening. So, many patients, sometimes, don't recognize the improvements, or family members don't recognize it until we actually taper them back off. And they may end up saying there are some other things that even recognize. Even some nonmotor benefits can be seen with levodopa. In some cases, we do keep them on levodopa, but levodopa's our best therapy for this. Dopamine agonists, MAO inhibitors, have all been sort of tried and they've been studied, but often don't really help or fail to help benefit these patients and could be fraught with some other side effects. I think many people do also turn to Amantadine as a treatment for Parkinson's, gait problems, freezing, if you see it in these disorders. Yet Amantadine is fraught with issues of side effects, including cognitive issues, and I think is not well-tolerated. But there are the rare patient who actually does respond to this or claims they respond to this. By and large, these patients relentlessly progress, unfortunately. So, beside treatment of other symptoms, I think it's really important to recognize that they require supportive cares and therapy. So, starting those early on and getting your allied healthcares kind of involved. So that includes people like physical, occupational therapy for the gait issues, the falls, occupational therapy for doing daily activities. Speech language pathology can be really a critical player for these because of the early speech and language issues, as well as swallow difficulties. Swallow is compared quickly in these patients. And so, we do recommend the screening evaluation, then often following patients either every six- or even annually, at least, with a swallow evaluation. And we recommend the fluoroscopic-guided kind of modified barium swallow for these patients. Dr Monteith: And how does that differ if, let's say, the patient had cortical basilar syndrome? What are some of the symptomatic treatments that would be high on your consideration? Dr Farland: So actually, these patients also have a very similar approach, and they often have some overlapping features. Maybe a little bit of difference in terms of the level of apraxia and some dystonic features that you see in corticobasal syndrome. So, as I mentioned earlier that these patients have a more typ- when they present, typically have a more asymmetric presentation. And one of the biggest issues is this limb apraxia. They may have abnormal movements as well as, like, the alien limb-type phenomena as well. So, the focus of therapy, while similar in the sense we focus on the parkinsonism, I do always try levodopa and try to ramp up the doses to see if it benefits. It does often fail, but it's definitely worth trying. The other focus of these patients is trying to treat symptoms. Dystonia, those features… in some cases, we can help; if it's painful or uncomfortable, muscle relaxants can be used. If it's vocal, things like Botox can be really helpful. Often times it is more palliative than actually restorative in terms of function, but still can be really helpful for patients who ask about pain and discomfort and trying to treat. And then of course, again, the focus on our supportive care. We need to build that network and build that team of folks, the therapists, the physical, occupational, and the speech therapist to help them. If they have language problems---like either in PSP or corticobasal---I'll also include my request to a speech language pathologist to work on cognitive function. That's a special, additional thing you have to ask for and then specifically request when you make a referral to a speech language pathologist. Dr Monteith: That is so important. I think keeping the simulation, keeping the social support, and I would probably guess that you would also include screening for sleep and mood disorder. Dr Farland: Absolutely. Mood disorders are really big in these diseases. Patients are suffering terribly. You do hear about labile mood in both of these diseases, particularly PSP; and even what's called pseudobulbar palsy, where the mood is not always congruent with the affect. So they may laugh or cry inappropriately, and particularly the crying can be very disturbing to family and caregivers to see that. And so, treating those things can be really important. So always asking about the mood issues. Depression in particular is something that we're very sensitive about, and there is a higher incidence of suicidal ideations. Asking about that and feeling and making sure that they are in a safe environment can be really important. Dr Monteith: Thank you so much. Dr Farland: Thank you. Dr Monteith: Today I've been interviewing Dr Nikolaus McFarland about his article on progressive supranuclear palsy and cortical basilar syndrome, which appears in the August 2025 Continuum issue on movement disorders. 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.

Tribute to Tshidi Madia

The Aubrey Masango Show

Play Episode Listen Later Aug 27, 2025 49:05 Transcription Available

Aubrey Masango is joined by Dr Matlhogonolo Malebane, Life Coach and Zikhona Miso, Nokukhanya Mntambo, Alpha Ramushwana all from EWN reflecting on the life and work of Tshidi Madia the Associate Politics Editor of EWN. They are joined by listeners who also pay tribute to the now late Tshidi Madia. Tags: 702, The Aubrey Masango Show, Aubrey Masango, Tribute, Tshidi Madia, Associate Editor, Politics, EWN, Journalist, Grief, Pain, Death The Aubrey Masango Show is presented by late night radio broadcaster Aubrey Masango. Aubrey hosts in-depth interviews on controversial political issues and chats to experts offering life advice and guidance in areas of psychology, personal finance and more. All Aubrey’s interviews are podcasted for you to catch-up and listen. Thank you for listening to this podcast from The Aubrey Masango Show. Listen live on weekdays between 20:00 and 24:00 (SA Time) to The Aubrey Masango Show broadcast on 702 https://buff.ly/gk3y0Kj and on CapeTalk between 20:00 and 21:00 (SA Time) https://buff.ly/NnFM3Nk Find out more about the show here https://buff.ly/lzyKCv0 and get all the catch-up podcasts https://buff.ly/rT6znsn Subscribe to the 702 and CapeTalk Daily and Weekly Newsletters https://buff.ly/v5mfet Follow us on social media: 702 on Facebook: https://www.facebook.com/TalkRadio702 702 on TikTok: https://www.tiktok.com/@talkradio702 702 on Instagram: https://www.instagram.com/talkradio702/ 702 on X: https://x.com/Radio702 702 on YouTube: https://www.youtube.com/@radio702 CapeTalk on Facebook: https://www.facebook.com/CapeTalk CapeTalk on TikTok: https://www.tiktok.com/@capetalk CapeTalk on Instagram: https://www.instagram.com/ CapeTalk on X: https://x.com/CapeTalk CapeTalk on YouTube: https://www.youtube.com/@CapeTalk567 See omnystudio.com/listener for privacy information.

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HPV & Anal Cancer Screening

National STD Curriculum

Play Episode Listen Later Aug 26, 2025 33:44 Transcription Available

Dr. Helen Stankiewicz Karita, Associate Professor at UCSF and a national expert on human papillomavirus (HPV)-related diseases in the anal canal, and National STD Curriculum Podcast Editor Dr. Meena Ramchandani discuss screening tools for anal dysplasia and anal cancer. View episode transcript and reference 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.

A Stoic Conversation with Dr. John Sellars: Stoicism Rediscovered Beyond the Buzzword

Street Stoics

Play Episode Listen Later Aug 25, 2025 57:43

Welcome to the Via Stoica Podcast, The Podcast on Stoicism.In this episode of The Via Stoica Podcast, Benny speaks with Dr. John Sellars, one of today's leading scholars of Stoicism and the history of philosophy. Dr. Sellars is Reader in the History of Philosophy at Royal Holloway, University of London, Associate Editor for the Ancient Commentators on Aristotle series at King's College London, and a founding member of both Modern Stoicism and the Aurelius Foundation. He has authored and edited numerous works, including Stoicism (recently revised), Stoicism and Emotion, and The Cambridge Companion to Marcus Aurelius.Our conversation traces Dr. Sellars' journey from his early fascination with science and politics to his lifelong study of ancient philosophy. We explore how the Stoics carried forward the legacy of Socrates in a way that feels both practical and deeply human, and why their materialist, empiricist outlook resonated more with him than Plato's metaphysical idealism. Dr. Sellars reflects on how philosophy has shaped his own life, from changing his views on free will to cultivating a “big picture” perspective that keeps ego and ambition in check.The discussion ranges widely: from common misconceptions about Stoicism, such as that it is unemotional, politically disengaged, or only for men, to the role of community in mental health, and the tension between Stoic determinism and ideas of God, providence, and nature. We also dive into Marcus Aurelius' Meditations, examining why the book endures, how Marcus grappled with death and difficult people, and why we should see him not as a perfect sage but as a flawed human being struggling to live well.Dr. Sellars also shares insights into his ongoing projects, including new research on Stoicism and leadership (with Justin Stead of the Aurelius Foundation), and his work with psychologists at Royal Holloway testing Stoic practices in peer-reviewed studies on resilience, anxiety, and anger.Whether you are new to Stoicism or looking to go deeper into its history and modern applications, this episode offers both scholarly depth and practical wisdom for living a good life.You can find Dr. Sellars' books, including the revised edition of Stoicism and The Cambridge Companion to Marcus Aurelius, through major booksellers. To learn more, visit the Aurelius Foundation or the Center for the Study and Application of Stoicism at Royal Holloway.Support the show⁠https://viastoica.com⁠https://viastoica.com/stoic-life-coaching⁠https://viastoica.com/benny-voncken⁠https://viastoica.com/brendan-hogle⁠https://x.com/ViaStoica⁠info@viastoica.com⁠Produced by: ⁠http://badmic.com

Jonathan Capehart on his Terrific New Memoir and Leaving the Washington Post

The Back Room with Andy Ostroy

Play Episode Listen Later Aug 23, 2025 55:52

Pulitzer Prize-winning journalist Jonathan Capehart is a co-host of the morning edition of The Weekend on MSNBC. From 2020 until 2025 he was anchor of The Saturday Show and The Sunday Show on MSNBC. He is also an analyst on The PBS News Hour. He is a former Associate Editor at the Washington Post, where he was an opinion writer for nearly two decades.He was also deputy editorial page editor of the New York Daily News and served on its editorial board. His editorial campaign in 1999 to save the Apollo Theater earned the board the Pulitzer Prize for Editorial Writing. His new memoir, “Yet Here I Am: Lessons from A Black Man's Search for Home,”, is a NY Times bestseller. Jonathan discusses his terrific new book about his life and career, and shares why after nearly two decades he left The Washington Post this Summer. Got somethin' to say?! Email us at BackroomAndy@gmail.com Leave us a message: 845-307-7446 Twitter: @AndyOstroy Produced by Andy Ostroy, Matty Rosenberg, and Jennifer Hammoud @ Radio Free Rhiniecliff Design by Cricket Lengyel

new york times home search leaving washington post memoir msnbc pulitzer prize black man associate editor terrific new york daily news pbs newshour apollo theater sunday show saturday show jonathan capehart

Multiple System Atrophy With Dr. Tao Xie

tiktok donald trump british acast cnbc jd vance sunday times associate editor tories cotswolds

Play Episode Listen Later Aug 20, 2025 22:25

Multiple system atrophy is a rare, sporadic, adult-onset, progressive, and fatal neurodegenerative disease. Accurate and early diagnosis remains challenging because it presents with a variable combination of symptoms across the autonomic, extrapyramidal, cerebellar, and pyramidal systems. Advances in brain imaging, molecular biomarker research, and efforts to develop disease-modifying agents have shown promise to improve diagnosis and treatment. In this episode, Casey Albin, MD speaks with Tao Xie, MD, PhD, author of the article “Multiple System Atrophy” in the Continuum® August 2025 Movement Disorders issue. Dr. Albin is a Continuum® Audio interviewer, associate editor of media engagement, and an assistant professor of neurology and neurosurgery at Emory University School of Medicine in Atlanta, Georgia. Dr. Xie is director of the Movement Disorder Program, chief of the Neurodegenerative Disease Section in the department of neurology at the University of Chicago Medicine in Chicago, Illinois. Additional Resources Read the article: Multiple System Atrophy Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @caseyalbin Full episode transcript available here Dr. Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast. Dr Albin: Hello everyone, this is Dr Casey Albin. Today I'm interviewing Dr Tao Xie about his article on diagnosis and management of multiple system atrophy, which appears in the August 2025 Continuum issue on movement disorders. Welcome to the podcast, and please introduce yourself to our audience. Dr Xie: Thank you so much, Dr Albin. My name is Tao Xie, and sometimes people also call me Tao Z. I'm a mood disorder neurologist, professor of neurology at the University of Chicago. I'm also in charge of the mood disorder program here, and I'm the section chief in the neurodegenerative disease in the Department of Neurology at the University of Chicago Medicine. Thank you for having me, Dr Albin and Dr Okun and the American Academy of Neurology. This is a great honor and pleasure to be involved in this education session. Dr Albin: We are delighted to have you, and thank you so much for the thoughtful approach to the diagnosis and management. I really want to encourage our listeners to check out this article. You know, one of the things that you emphasize is multiple system atrophy is a fairly rare condition. And I suspect that clinicians and trainees who even have a fair amount of exposure to movement disorders may not have encountered that many cases. And so, I was hoping that you could just start us off and walk us through what defines multiple system atrophy, and then maybe a little bit about how it's different from some of the more commonly encountered movement disorders. Dr Xie: This is a really good question, Dr Albin. Indeed, MSA---multisystem atrophy----is a rare disease. It is sporadic, adult-onset, progressive, fatal neurodegenerative disease. By the name MSA, multisystem atrophy. Clinically, it will present with multiple symptoms and signs involving multiple systems, including symptoms of autonomic dysfunction and symptoms of parkinsonism, which is polyresponsive to the levodopa treatment; and the symptom of cerebellar ataxia, and symptom of spasticity and other motor and nonmotor symptoms. And you may be wondering, what is the cause- underlying cause of these symptoms? Anatomically, we can find the area in the basal ganglia striatonigral system, particularly in the putamen and also in the cerebellar pontine inferior, all of the nuclear area and the specific area involved in the autonomic system in the brain stem and spinal cord: all become smaller. We call it atrophy. Because of the atrophy in this area, they are responsible for the symptom of parkinsonism if it is involved in the putamen and the cerebral ataxia, if it's involved in the pons and cerebral peduncle and the cerebellum. And all other area, if it's involved in the autonomic system can cause autonomic symptoms as well. So that's why we call it multisystem atrophy. And then what's the underlying cellular and subcellular pathological, a hallmark that is in fact caused by misfolded alpha-synuclein aggregate in the oligodontia site known as GCI---glial cytoplasmic increasing bodies---in the cells, and sometimes it can also be found in the neuronal cell as well in those areas, as mentioned, which causes the symptom. But clinically, the patient may not present all the symptoms at the same time. So, based on the predominant clinical symptom, if it's mainly levodopa, polyresponsive parkinsonism, then we call it MSAP. If it's mainly cerebellar ataxia, then we call it MSAC. But whether we call it MSP or MSC, they all got to have autonomic dysfunction. And also as the disease progresses, they can also present both phenotypes together. We call that mixed cerebellar ataxia and parkinsonism in the advanced stage of the disease. So, it is really a complicated disease. The complexity and the similarity to other mood disorders, including parkinsonism and the cerebellar ataxia, make it really difficult sometimes, particularly at the early stages of disease, to differentiate one from the other. So, that was challenging not only for other professionals, general neurologists and even for some movement disorder specialists, that could be difficult particularly if you aim to make an accurate and early diagnosis. Dr Albin: Absolutely. That is such a wealth of knowledge here. And I'm going to distill it just a little bit just to make sure that I understand this right. There is alpha-synuclein depositions, and it's really more widespread than one would see maybe in just Parkinson's disease. And with this, you are having patients present with maybe one of two subtypes of their clinical manifestations, either with a Parkinson's-predominant movement disorder pattern or a cerebellar ataxia type movement disorder pattern. Or maybe even mixed, which really, you know, we have to make things quite complicated, but they are all unified and having this shared importance of autonomic features to the diagnosis. Have I got that all sort of correct? Dr Xie: Correct. You really summarize well. Dr Albin: Fantastic. I mean, this is quite a complicated disease. I would pose to you sort of a case, and I imagine this is quite common to what you see in your clinic. And let's say, you know, a seventy-year-old woman comes to your clinic because she has had rigidity and poor balance. And she's had several falls already, almost always from ground level. And her family tells you she's quite woozy whenever she gets up from the chair and she tends to kind of fall over. But they noticed that she's been stiff,and they've actually brought her to their primary care doctor and he thought that she had Parkinson's disease. So, she started levodopa, but they're coming to you because they think that she probably needs a higher dose. It's just not working out very well for her. So how would you sort of take that history and sort of comb through some of the features that might make you more concerned that the patient actually has undiagnosed multiple systems atrophy? Dr Xie: This is a great case, because we oftentimes can encounter similar cases like this in the clinic. First of all, based on the history you described, it sounds like an atypical parkinsonism based on the slowness, rigidity, stiffness; and particularly the early onset of falls, which is very unusual for typical Parkinson disease. It occurs too early. If its loss of balance, postural instability, and fall occurred within three years of disease onset---usually the motor symptom onset---then it raises a red flag to suspect this must be some atypical Parkinson disorders, including multiple system atrophy. Particularly, pou also mentioned that the patient is poorly responsive to their levodopa therapy, which is very unusual because for Parkinson disease, idiopathic Parkinson disease, we typically expect patients would have a great response to the levodopa, particularly in the first 5 to 7 years. So to put it all together, this could be atypical parkinsonism, and I could not rule out the possibility of MSA. Then I need to check more about other symptoms including autonomic dysfunction, such as orthostatic hypertension, which is a blood pressure drop when the patient stands up from a lying-down position, or other autonomic dysfunctions such as urinary incontinence or severe urinary retention. So, in the meantime, I also have to put the other atypical Parkinson disorder on the differential diagnosis, such as PSP---progressive supranuclear palsy---and the DLBD---dementia with Lewy body disease.---Bear this in mind. So, I want to get more history and more thorough bedside assessment to rule in or rule out my diagnosis and differential diagnosis. Dr Albin: That's super helpful. So, looking for early falls, the prominence of autonomic dysfunction, and then that poor levodopa responsiveness while continuing to sort of keep a very broad differential diagnosis? Dr Xie: Correct. Dr Albin: One of the things that I just have to ask, because I so taken by this, is that you say in the article that some of these patients actually have preservation of smell. In medical school, we always learn that our Parkinson's disease patients kind of had that early loss of smell. Do you find that to be clinically relevant? Is that- does that anecdotally help? Dr Xie: This is a very interesting point because we know that the loss of smelling function is a risk effect, a prodromal effect, for the future development of Parkinson disease. But it is not the case for MSA. Strange enough, based on the literature and the studies, it is not common for the patient with MSA to present with anosmia. Some of the patients may have mild to moderate hyposmia, but not to the degree of anosmia. So, this is why even in the more recent diagnosis criteria, the MDS criteria published 2022, it even put the presence of anosmia in the exclusion criteria. So, highlight the importance of the smell function, which is well-preserved for the majority in MSA, into that category. So, this is a really interesting point and very important for us, particularly clinicians, to know the difference in the hyposmia, anosmia between the- we call it the PD, and the dementia Lewy bodies versus MSA. Dr Albin: Fascinating. And just such a cool little tidbit to take with us. So, the family, you know, you're talking to them and they say, oh yes, she has had several fainting episodes and we keep taking her to the primary care doctor because she's had urinary incontinence, and they thought maybe she had urinary tract infections. We've been dealing with that. And you're sort of thinking, hm, this is all kind of coming together, but I imagine it is still quite difficult to make this diagnosis based on history and physical alone. Walk our listeners through sort of how you're using MRI and DAT scan and maybe even some other biomarkers to help sort of solidify that diagnosis. Dr Xie: Yeah, that's a wonderful question. Yeah. First of all, UTI is very common for patients with MSA because of urinary retention, which puts them into a high risk of developing frequent UTI. That, for some patients, could be the very initial presentation of symptoms. In this case, if we check, we say UTI is not present or UTI is present but we treat it, then we check the blood pressure and we do find also hypertension---according to new diagnosis criteria, starting drop is 20mm mercury, but that's- the blood pressure drop is ten within three minutes. And also, in the meantime the patients present persistent urinary incontinence even after UTI was treated. And then the suspicion for MS is really high right at this point. But if you want increased certainty and a comfortable level on your diagnosis, then we also need to look at the brain MRI mark. This is a required according to the most recent MDS diagnosis criteria. The presence of the MRI marker typical for MSA is needed for the diagnosis of clinically established MSA, which holds the highest specificity in the clinical diagnosis. So then, we have- we're back to your question. We do need to look at the brain MRI to see whether evidence suggestive of atrophy around the putamen area, around the cerebellar pontine inferior olive area, is present or not. Dr Albin: Absolutely. That's super helpful. And I think clinicians will really take that to sort of helping to build a case and maybe recognizing some of this atypical Parkinson's disease as a different disease entity. Are there any other biomarkers in the pipeline that you're excited about that may give us even more clarity on this diagnosis? Dr Xie: Oh, yeah. This is a very exciting area. In terms of biomarker for the brain imaging, particularly brain MRI, in fact, today there's a landmark paper just published in the Java Neurology using AI, artificial intelligence or machine learning aid, diagnoses a patient with parkinsonism including Parkinson's disease, MSA, and PSP, with very high diagnostic accuracy ranging from 96% to 98%. And some of the cases even were standard for autopsy, with pathological verification at a very high accurate rate of 93.9%. This is quite amazing and can really open new diagnosis tools for us to diagnose this difficult disease; not only in an area with a bunch of mood disorder experts, but also in the rural area, in the area really in need of mood disorder experts. They can provide tremendous help to provide accurate, early diagnosis. Dr Albin: That's fantastic and I love that, increasing the access to this accurate diagnosis. What can't artificial intelligence do for us? That's just incredible. Dr Xie: And also, you know, this is just one example of how the brain biomarker can help us. Theres other---a fluid biomarker, molecular diagnostic tools, is also available. Just to give you an example, one thing we know over the past couple years is skin biopsy. Through the immunofluorescent reaction, we can detect whether the hallmark of abnormally folded, misfolded, and the phosphorate, the alpha-synuclein aggregate can be found just by this little pinch of skin biopsy. Even more advanced, there's another diagnosis tool we call the SAA, we call the seizure amplification assay, that can even help us to differentiate MSA from other alpha-synucleinopathy, including Parkinson disease and dementia with Lewy bodies. If we get a little sample from CSF, spinal cerebral fluids, even though this is probably still at the early stage, a lot of developments still ongoing, but this, this really shows you how exciting this area is now. We're really in a fast forward-moving path now. Dr Albin: It's really incredible. So, lots coming down the track in, sort of, MRI, but also with CSF diagnosis and skin biopsies. Really hoping that we can hone in some of those tools as they become more and more validated to make this diagnosis. Is that right? Dr Xie: Correct. Dr Albin: Amazing. We can talk all day about how you manage these in the clinic, and I really am going to direct our listeners to go and read your fantastic article, because you do such an elegant job talking about how this takes place in a multidisciplinary setting, if at all possible. But as a neurointensivist, I was telling you, we have so much trouble in the hospital. We have A-lines, and we have the ability to get rapid KUBs to look at Ilias, and we can have many people as lots of diagnosis, and we still have a lot of trouble treating autonomiclike symptoms. Really, really difficult. And so, I just wanted to kind of pick your brain, and I'll start with just the one of orthostatic hypotension. What are some of the tips that you have for, you know, clinicians that are dealing with this? Because I imagine that this is quite difficult to do without patients. Dr Xie: Exactly. This is indeed a very difficult symptom to deal with, particularly at an outpatient setting. But nowadays with the availability of more medication---to give an example, to treat patients with orthostatic hypertension, we have not only midodrine for the cortisol, we also have droxidopa and several others as well. And so, we have more tools at hand to treat the patient with orthostatic hypertension. But I think the key thing here, particularly for us to the patient at the outpatient setting: we need to educate the patient's family well about the natural history of the disease course. And we also need to tell them what's the indication and the potential side effect profile of any medication we prescribe to them so that they can understand what to expect and what to watch for. And in the meantime, we also need to keep really effective and timely communication channels, make sure that the treating physician and our team can be reached at any time when the patient and family need us so that we can be closely monitoring, their response, and also monitoring potential side effects as well to keep up the quality of care in that way. Dr Albin: Yeah, I imagine that that open communication plays a huge role in just making sure that patients are adapting to their symptoms, understanding that they can reach out if they have refractory symptoms, and that- I imagine this takes a lot of fine tuning over time. Dr Xie: Correct. Dr Albin: Well, this has just been such a delight to get to talk to you. I really feel like we could dive even deeper, but I know for the sake of time we have to kind of close out. Are there any final points that you wanted to share with our listeners before we end the interview? Dr Xie: I think for the patients, I want them to know that nowadays with advances in science and technology, particularly given a sample of rapid development in the diagnostic tools and the multidisciplinary and multisystemic approach to treatment, nowadays we can make an early and accurate diagnosis of the MSA, and also, we can provide better treatment. Even though so far it is still symptomatically, mainly, but in the near future we hope we can also discover disease-modifying treatment which can slow down, even pause or prevent the disease from happening. And for the treating physician and care team professionals, I just want them to know that you can make a difference and greatly help the patient and the family through your dedicated care and also through your active learning and innovative research. You can make a difference. Dr Albin: That's amazing and lots of hope for these patients. Right now, you can provide really great care to take care of them, make an early and accurate diagnosis; but on the horizon, there are really several things that are going to move the field forward, which is just so exciting. Again today, I've been really greatly honored and privileged to be able to talk to Dr Tao Xie about his article on diagnosis and management of multiple system atrophy, which appears in the August 2025 Continuum issue on movement disorders. Be sure to check out Continuum Audio episodes for this and other issues. And thank you again to our listeners for joining us today. Dr Xie: Thank you so much for having me. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

JD Vance comes to the Cotswolds

Stories of our times

Play Episode Listen Later Aug 14, 2025 25:28

The US vice-president JD Vance is holidaying with his family in the Cotswold village of Dean. But on the side, he's meeting a phalanx of British politicians. Who's on the roll-call? And what does this tell us about where Trump's possible successor sees the future of British politics?This podcast was brought to you thanks to the support of readers of The Times and The Sunday Times. Subscribe today: http://thetimes.com/thestoryGuest: Josh Glancy, Associate Editor, The Sunday Times.Host: Luke Jones.Producer: Olivia Case.Read more: JD Vance holds court with top Tories in Cotswolds thanks to George OsborneClips: The Guardian, CNBC, The Jaipur Dialogues, TikTok / iamtomskinner, Sky.Photo: Getty Images.Get in touch: thestory@thetimes.com Hosted on Acast. See acast.com/privacy for more information.

Essential Tremor With Dr. Ludy Shih