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Glycopyrrolate is an anticholinergic medication commonly used to reduce excessive secretions, particularly in palliative care, postoperative settings, and certain neurologic conditions. It works by blocking acetylcholine at muscarinic receptors, which decreases salivary and respiratory secretions. Clinically, glycopyrrolate is often used to manage terminal respiratory secretions (“death rattle”). Adverse effects of glycopyrrolate are primarily related to its anticholinergic properties. These may include dry mouth, constipation, urinary retention, blurred vision, tachycardia, and decreased sweating. While it has fewer central effects than agents like scopolamine, caution is still warranted in patients with glaucoma, gastrointestinal obstruction, or significant urinary retention risk. Monitoring hydration and bowel function is important, especially in elderly or frail patients. Dosing strategies depend on the clinical need. In palliative care, low doses may be given subcutaneously or intravenously every 4–6 hours as needed, while oral dosing is common for chronic sialorrhea. Clinicians should consider the patient's overall medication burden, as cumulative anticholinergic load can worsen cognitive impairment and contribute to falls or constipation. I discuss drug interactions and other commonly used medications that may contribute to anticholinergic burden.

People who have been clinically dead and came back, how was the other side likeBecome a supporter of this podcast: https://www.spreaker.com/podcast/darkest-mysteries-online-the-strange-and-unusual-podcast-2025--5684156/support.Darkest Mysteries Online

Are wine, cheese, and chocolate really sabotaging your glow—or is it time to stop feeling guilty about what's on your plate? In this episode, Maggie and Ella break down food myths, facts, and what really matters for healthy skin. ASCP Esty Talk with hosts Ella Cressman and Maggie Staszcuk   Produced by Associated Skin Care Professionals (ASCP) for licensed estheticians, ASCP Esty Talk is a weekly podcast, hosted by licensed estheticians, Ella Cressman, ASCP Skin Deep Magazine contributor, and Maggie Staszcuk, ASCP Program Director. We see your passion, innovation, and hard work and are here to support you by providing a platform for networking, advocacy, camaraderie, and education. We aim to inspire you to ask the right questions, find your motivation, and give you the courage to have the professional skin care career you desire.  About Ella Cressman:  Ella Cressman is a licensed esthetician, certified organic formulator, business owner, ingredient junkie, and esthetic cheerleader! As an educator, she enjoys empowering other estheticians and industry professionals to understand skin care from an ingredient standpoint rather than a product-specific view.  In addition to running a skin care practice, Cressman founded a comprehensive consulting group, the HHP Collective, and has consulted for several successful skin care brands.    Connect with Ella Cressman:  Website: www.hhpcollective.com  LinkedIn: linkedin.com/in/ella-cressman-62aa46a    About Maggie Staszcuk:  Maggie Staszcuk serves as the Program Director for ASCP and is the cohost of ASCP Esty Talk podcast. With over 18 years' experience in the esthetics industry, her diverse background includes roles in spa management, spa and med-spa services, and esthetics education. Since becoming a licensed esthetician in 2006, she carries a range of certifications in basic and advanced esthetics. Maggie is dedicated to equipping estheticians with the knowledge and resources they need to thrive in their careers.   Connect with Maggie Staszcuk:  P: 800.789.0411 EXT 1636  E: MStaszcuk@ascpskincare.com    About our Sponsors:   Comfort Zone – The Italian, multi-awarded science-led, longevity-focused skincare trusted by professionals worldwide. Founded by Dr Bollati, a pharmacist, and powered by over 60 in-house chemists and skin care experts. Clinically tested formulations blend clinical precision, regenerative botanicals, and biotechnology research to transform skin with intention. Part of The Davines Group, certified B Corp since 2016.   Website: https://us.comfortzoneskin.com/   Instagram: https://www.instagram.com/comfortzoneskin_official/   Massage Envy is a national franchisor and does not independently own or operate any of the Massage Envy franchised locations nationwide. The Massage Envy franchise network, through its franchise locations, is the leading provider of massage services. Founded in 2002, Massage Envy now has approximately 1,100 franchise locations in 49 states that have together delivered more than 200 million massages and skin care services. Website: www.massageenvy.com/careers/career-areas/esthetician  Facebook: @MassageEnvyCareers LinkedIn: @MassageEnvy   About Associated Skin Care Professionals (ASCP):    Associated Skin Care Professionals (ASCP) is the nation's largest association for skin care professionals and your ONLY all-inclusive source for professional liability insurance, education, community, and career support. For estheticians at every stage of the journey, ASCP is your essential partner. Get in touch with us today if you have any questions or would like to join and become an ASCP member.  Connect with ASCP:  Website: www.ascpskincare.com  Email: getconnected@ascpskincare.com  Phone: 800-789-0411  Facebook: facebook.com/ASCPskincare  Instagram: @ascpskincare   

Co-hosts Ryan Piansky, a graduate student and patient advocate living with eosinophilic esophagitis (EoE) and eosinophilic asthma, and Holly Knotowicz, a speech-language pathologist living with EoE who serves on APFED's Health Sciences Advisory Council, interview Evan S. Dellon, MD, and Elizabeth T. Jensen, PhD, about a paper they published on predictors of patients receiving no medication for treatment of eosinophilic esophagitis. Disclaimer: The information provided in this podcast is designed to support, not replace, the relationship between listeners and their healthcare providers. Opinions, information, and recommendations shared in this podcast are not a substitute for medical advice. Decisions related to medical care should be made with your healthcare provider. Opinions and views of guests and co-hosts are their own.   Key Takeaways: [:52] Co-host Ryan Piansky introduces the episode, brought to you thanks to the support of Education Partners GSK, Sanofi, Regeneron, and Takeda. Ryan introduces co-host Holly Knotowicz.   [1:14] Holly introduces today's topic, predictors of not using medication for EoE, and today's guests, Dr. Evan Dellon and Dr. Elizabeth Jensen.   [1:29] Dr. Dellon is an Adjunct Professor of Epidemiology at the University of North Carolina School of Medicine in Chapel Hill. He is also the Director of the UNC Center for Esophageal Diseases and Swallowing.   [1:42] Dr. Dellon's main research interest is in the epidemiology, pathogenesis, diagnosis, treatment, and outcomes of eosinophilic esophagitis (EoE) and eosinophilic GI diseases (EGIDs).   [1:55] Dr. Jensen is a Professor of Epidemiology with a specific expertise in reproductive, perinatal, and pediatric epidemiology. She has appointments at both Wake Forest University School of Medicine and the University of North Carolina at Chapel Hill.   [2:07] Her research primarily focuses on etiologic factors in the development of pediatric immune-mediated chronic diseases, including understanding factors contributing to disparities in health outcomes.   [2:19] Both Dr. Dellon and Dr. Jensen also serve on the Steering Committee for EGID Partners Registry.   [2:24] Ryan thanks Dr. Dellon and Dr. Jensen for joining the podcast today.   [2:29] Dr. Dellon was the first guest on this podcast. It is wonderful to have him back for the 50th episode! Dr. Dellon is one of Ryan's GI specialists. Ryan recently went to North Carolina to get a scope with him.   [3:03] Dr. Dellon is an adult gastroenterologist at the University of North Carolina at Chapel Hill. He directs the Center for Esophageal Diseases and Swallowing. Clinically and research-wise, he is focused on EoE and other eosinophilic GI diseases.   [3:19] His research interests span the entire field, from epidemiology, diagnosis, biomarkers, risk factors, outcomes, and a lot of work, more recently, on treatments.   [3:33] Dr. Jensen has been on the podcast before, on Episode 27. Holly invites Dr. Jensen to tell the listeners more about herself and her work with eosinophilic diseases.   [3:46] Dr. Jensen has been working on eosinophilic gastrointestinal diseases for about 15 years. She started some of the early work around understanding possible risk factors for the development of disease.   [4:04] She has gone on to support lots of other research projects, including some with Dr. Dellon, where they're looking at gene-environment interactions in relation to developing EoE.   [4:15] She is also looking at reproductive factors as they relate to EoE, disparities in diagnosis, and more. It's been an exciting research trajectory, starting with what we knew very little about and building to an increasing understanding of why EoE develops.   [5:00] Dr. Dellon explains that EoE stands for eosinophilic esophagitis, a chronic allergic condition of the esophagus.   [5:08] You can think of EoE as asthma of the esophagus or eczema of the esophagus, although in general, people don't grow out of EoE, like they might grow out of eczema or asthma. When people have EoE, it is a long-term condition.   [5:24] Eosinophils are a type of white blood cell, specializing in allergy responses. Normally, they are not in the esophagus. When we see them there, we worry about an allergic process. When that happens, that's EoE.   [5:40] Over time, the inflammation seen in EoE and other allergic cell activity causes swelling and irritation in the esophagus. Early on, this often leads to a range of upper GI symptoms — including poor growth or failure to thrive in young children, abdominal pain, nausea, and symptoms that can mimic reflux.   [5:58] In older kids, symptoms are more about trouble swallowing. That's because the swelling that happens initially, over time, may turn into scar tissue. So the esophagus can narrow and cause swallowing symptoms like food impaction.   [6:16] Ryan speaks of living with EoE for decades and trying the full range of treatment options: food elimination, PPIs, steroids, and, more recently, biologics.   [6:36] Dr. Dellon says Ryan's history is a good overview of how EoE is treated. There are two general approaches to treating the underlying condition: using medicines and/or eliminating foods that we think may trigger EoE from the diet.   [6:57] For a lot of people, EoE is a food-triggered allergic condition.   [7:01] The other thing that has to happen in parallel is surveying for scar tissue in the esophagus. If that's present and people have trouble swallowing, sometimes stretching the esophagus is needed through esophageal dilation.   [7:14] There are three categories of medicines used for treatment. Proton pump inhibitors are reflux meds, but they also have an anti-allergy effect in the esophagus.   [7:29] Topical steroids are used to coat the esophagus and produce an anti-inflammatory effect. The FDA has approved a budesonide oral suspension for that.   [7:39] Biologics, which are generally systemic medications, often injectable, can target different allergic factors. Dupilumab is approved now, and there are other biologics that are being researched as potential treatments.   [7:51] Even though EoE is considered an allergic condition, we don't have a test to tell people what they are allergic to. If it's a food allergy, we do an empiric elimination diet because allergy tests aren't accurate enough to tell us what the EoE triggers are.   [8:10] People will eliminate foods that we know are the most common triggers, like milk protein, dairy, wheat, egg, soy, and other top allergens. You can create a diet like that and then have a response to the diet elimination.   [8:31] Dr. Jensen and Dr. Dellon recently published an abstract in the American Journal of Gastroenterology about people with EoE who are not taking any medicine for it. Dr. Jensen calls it a real-world data study, leveraging electronic health record patient data.   [8:51] It gives you an impression of what is actually happening, in terms of treatments for patients, as opposed to a randomized control trial, which is a fairly selected patient population. This is everybody who has been diagnosed, and then what happens with them.   [9:10] Because of that, it gives you a wide spectrum of patients. Some patients are going to be relatively asymptomatic. It may be that we arrived at their diagnosis while working them up for other potential diagnoses.   [9:28] Other patients are going to have rather significant impacts from the disease. We wanted to get an idea of what is actually happening out there with the full breadth of the patient population that is getting diagnosed with EoE.   [9:45] Dr. Jensen was not surprised to learn that there are patients who had no pharmacologic treatment.   [9:58] Some patients are relatively asymptomatic, and others are not interested in pursuing medications initially or are early in their disease process and still exploring dietary treatment options.   [10:28] Holly sees patients from infancy to geriatrics, and if they're not having symptoms, they wonder why bother treating it.   [10:42] Dr. Jensen says it's a point of debate on the implications of somebody who has the disease and goes untreated. What does that look like long-term? Are they going to develop more of that fibrostenotic pattern in their esophagus without treatment?   [11:07] This is a question we're still trying to answer. There is some suggestion that for some patients who don't manage their disease, we very well may be looking at a food impaction in the future.   [11:19] Dr. Dellon says we know overall for the population of EoE patients, but it's hard to know for a specific patient. We have a bunch of studies now that look at how long people have symptoms before they're diagnosed. There's a wide range.   [11:39] Some people get symptoms and get diagnosed right away. Others might have symptoms for 20 or 30 years that they ignore, or don't have access to healthcare, or the diagnosis is missed.   [11:51] What we see consistently is that people who may be diagnosed within a year or two may only have a 10 or 20% chance of having that stricture and scar tissue in the esophagus, whereas people who go 20 years, it might be 80% or more.   [12:06] It's not everybody who has EoE who might end up with that scar tissue, but certainly, it's suggested that it's a large majority.   [12:16] That's before diagnosis. We have data that shows that after diagnosis, if people go a long time without treatment or without being seen in care, they also have an increasing rate of developing strictures.    [12:29] In general, the idea is yes, you should treat EoE, because on average, people are going to develop scar tissue and more symptoms. For the patient in front of you with EoE but no symptoms, what are the chances it's going to get worse? You don't know.   [13:04] There are two caveats with that. The first is what we mean by symptoms. Kids may have vomiting and growth problems. Adults can eat carefully, avoiding foods that hang up in the esophagus, like breads and overcooked meats, sticky rice, and other foods.   [13:24] Adults can eat slowly, drink a lot of liquid, and not perceive they have symptoms. When someone tells Dr. Dellon they don't have symptoms, he will quiz them about that. He'll even ask about swallowing pills.    [13:40] Often, you can pick up symptoms that maybe the person didn't even realize they were having. In that case, that can give you some impetus to treat.   [13:48] If there really are no symptoms, Dr. Dellon thinks we're at a point where we don't really know what to do.   [13:54] Dr. Dellon just saw a patient who had a lot of eosinophils in their small bowel with absolutely no GI symptoms. He said, "I can't diagnose you with eosinophilic enteritis, but you may develop symptoms." People like that, he will monitor in the clinic.   [14:14] Dr. Dellon will discuss it with them each time they come back for a clinic visit.   [14:19] Holly is a speech pathologist, but also sees people for feeding and swallowing. The local gastroenterologist refers patients who choose not to treat their EoE to her. Holly teaches them things they should be looking out for.   [14:39] If your pills get stuck or if you're downing 18 ounces during a mealtime, maybe it's time to treat it. People don't see these coping mechanisms they use that are impacting their quality of life. They've normalized it.   [15:30] Dr. Dellon says, of these people who aren't treated, there's probably a subset who appropriately are being observed and don't have a medicine treatment or are on a diet elimination.   [15:43] There's also probably a subset who are inappropriately not on treatment. It especially can happen with students who were under good control with their pediatric provider, but moved away to college and didn't transfer to adult care.   [16:08] They ultimately come back with a lot of symptoms that have progressed over six to eight years.   [16:18] Ryan meets newly diagnosed adult patients at APFED's conferences, who say they have no symptoms, but chicken gets caught in their throat. They got diagnosed when they went to the ER with a food impaction.   [16:38] Ryan says you have to wonder at what point that starts to get reflected in patient charts. Are those cases documented where someone is untreated and now has EoE?   [16:49] Ryan asks in the study, "What is the target EGID Cohort and why was it selected to study EoE? What sort of patients were captured as part of that data set?"   [16:58] Dr. Jensen said they identified patients with the ICD-10 code for a diagnosis of EoE. Then they looked to see if there was evidence of symptoms or complications in relation to EoE. This was hard; some of these are relatively non-specific symptoms.   [17:23] These patients may have been seeking care and may have been experiencing some symptoms that may or may not have made it into the chart. That's one of the challenges with real-world data analyses.   [17:38] Dr. Jensen says they are using data that was collected for documenting clinical care and for billing for clinical care, not for research, so it comes with some caveats when doing research with this data.   [18:08] Research using electronic health records gives a real-world perspective on patients who are seeking care or have a diagnosis of EoE, as opposed to a study trying to enroll a patient population that potentially isn't representative of the breadth of individuals living with EoE.   [18:39] Dr. Dellon says another advantage of real-world data is the number of patients. The largest randomized controlled trials in EoE might have 400 patients, and they are incredibly expensive to do.   [18:52] A study of electronic health records (EHR) is reporting on the analysis of just under 1,000. The cohort, combined from three different centers, has more than 1,400 people, a more representative, larger population.    [19:16] Dr. Dellon says when you read the results, understand the limitations and strengths of a study of health records, to help contextualize the information.   [19:41] Dr. Dellon says it's always easier to recognize the typical presentations. Materials about EoE and studies he has done that led to medicine approvals have focused on trouble swallowing. That can be relatively easily measured.   [20:01] Patients often come to receive care with a food impaction, which can be impactful on life, and somewhat public, if in a restaurant or at work. Typical symptoms are also the ones that get you diagnosed and may be easier to treat.   [20:26] Dr. Dellon wonders if maybe people don't treat some of the atypical symptoms because it's not appreciated that they can be related to EoE.   [20:42] Holly was diagnosed as an adult. Ryan was diagnosed as a toddler. Holly asks what are some of the challenges people face in getting an EoE diagnosis.   [20:56] Dr. Jensen says symptoms can sometimes be fairly non-specific. There's some ongoing work by the CEGIR Consortium trying to understand what happens when patients come into the emergency department with a food bolus impaction.   [21:28] Dr. Jensen explains that we see there's quite a bit of variation in how that gets managed, and if they get a biopsy. You have to have a biopsy of the esophagus to get a diagnosis of EoE.   [21:45] If you think about the steps that need to happen to get a diagnosis of EoE, that can present barriers for some groups to ultimately get that diagnosis.   [21:56] There's also been some literature around a potential assumption about which patients are more likely to be at risk. Some of that is still ongoing. We know that EoE occurs more commonly in males in roughly a two-to-one ratio. Not exclusively in males, obviously, but a little more often in males.   [22:20] We don't know anything about other groups of patients that may be at higher risk. That's ongoing work that we're still trying to understand. That in itself can also be a barrier when there are assumptions about who is or isn't likely to have EoE.   [23:02] Dr. Dellon says that in adolescents and adults, the typical symptoms are trouble swallowing and food sticking, which have many causes besides EoE, some of which are more common.   [23:18] In that population, heartburn is common. Patients may report terrible reflux that, on questioning, sounds more like trouble swallowing than GERD. Sometimes, with EoE, you may have reflux that doesn't improve. Is it EoE, reflux, or both?   [24:05] Some people will have chest discomfort. There are some reports of worsening symptoms with exercise, which brings up cardiac questions that have to be ruled out first.   [24:19] Dr. Dellon mentions some more atypical symptoms. An adult having pain in the upper abdomen could have EoE. In children, the symptoms could be anything in the GI tract. Some women might have atypical symptoms with less trouble swallowing.   [24:58] Some racial minorities may have those kinds of symptoms, as well. If you're not thinking of the condition, it's hard to make the diagnosis.   [25:08] Dr. Jensen notes that there are different cultural norms around expressing symptoms and dietary patterns, which may make it difficult to parse out a diagnosis.   [25:27] Ryan cites a past episode where access to a GI specialist played a role in diagnosing patients with EoE. Do white males have more EoE, or are their concerns just listened to more seriously?   [25:57] Ryan's parents were told when he was two that he was throwing up for attention. He believes that these days, he'd have a much easier time convincing a doctor to listen to him. From speaking to physicians, Ryan believes access is a wide issue in the field.   [26:23] Dr. Dellon tells of working with researchers at Mayo in Arizona and the Children's Hospital of Phoenix. They have a large population of Hispanic children with EoE, much larger than has been reported elsewhere. They're working on characterizing that.   [26:49] Dr. Dellon describes an experience with a visiting trainee from Mexico City, where there was not a lot of EoE reported. The trainee went back and looked at the biopsies there, and it turned out they were not performing biopsies on patients with dysphagia in Mexico City.   [27:13] When he looked at the patients who ended up getting biopsies, they found EoE in 10% of patients. That's similar to what's reported out of centers in the developed world. As people are thinking about it more, we will see more detection of it.   [27:30] Dr. Dellon believes those kinds of papers will be out in the next couple of months, to a year.   [27:36] Holly has had licensure in Arizona for about 11 years. She has had nine referrals recently of children with EoE from Arizona. Normally, it's been one or two that she met at a conference.   [28:00] Ryan asks about the research on patients not having their EoE treated pharmacologically. Some treat it with food avoidance and dietary therapy. Ryan notes that he can't have applesauce, as it is a trigger for his EoE.   [28:54] Dr. Jensen says that's one of the challenges in using the EHR data. That kind of information is only available to the researchers through free text. That's a limitation of the study, assessing the use of dietary elimination approaches.   [29:11] Holly says some of her patients have things listed as allergies that are food sensitivities. Ryan says it's helpful for the patients to have their food sensitivities listed along with their food allergies, but it makes records more difficult to parse for research.   [30:14] Dr. Dellon says they identify EoE by billing code, but the codes are not always used accurately. Natural Language Processing can train a computer system to find important phrases. Their collaborators working on the real-world data are using it.   [30:59] Dr. Dellon hopes that this will be a future direction for this research to find anything in the text related to diet elimination.   [31:32] Dr. Jensen says that older patients were less likely to seek medication therapy. She says it's probably for a couple of reasons. First, older patients may have been living with the disease for a long time and have had compensatory mechanisms in place.   [32:03] The other reason may be senescence or burnout of the disease, long-term. Patients may be less symptomatic as they get older. That's a question that remains to be answered for EoE. It has been seen in some other disease processes.   [32:32] Dr. Dellon says there's not much data specifically looking at EoE in the older population. Dr. Dellon did work years ago with another doctor, and they found that older patients had a better response to some treatments, particularly topical steroids.   [32:54] It wasn't clear whether it was a milder aspect of the disease, easier to treat, or because they were older and more responsible, taking their medicines as prescribed, and having a better response rate. It's the flip side of work in the pediatric population.   [33:16] There is an increasingly aging population with EoE. Young EoE patients will someday be over 65. Dr. Dellon hopes there will be a cure by that point, but it's an expanding population now.   [33:38] Dr. Jensen says only a few sites are contributing data, so they hope to add additional sites to the study. For some of the less common outcomes, they need a pretty large patient sample to ask some of those kinds of questions.   [33:55] They will continue to follow up on some of the work that this abstract touched on and try to understand some of these issues more deeply.   [34:06] Dr. Dellon mentions other work within the cohort. Using Natural Language Processing, they are looking at characterizing endoscopy information and reporting it without a manual review of reports and codes. You can't get that from billing data.   [34:29] Similarly, they are trying to classify patient severity by the Index of Severity with EoE, and layer that on looking at treatments and outcomes based on disease severity. Those are a couple of other directions where this cohort is going.   [34:43] Holly mentions that this is one of many research projects Dr. Jensen and Dr. Dellon have collaborated on together. They also collaborate through EGID Partners. Holly asks them to share a little bit about that.   [34:53] Dr. Jensen says EGID Partners is an online registry where individuals, caregivers, and parents of children affected with EGIDs can join.   [35:07] EGID Partners also needs people who don't live with an EGID to join, as controls. That gives the ability to compare those who are experiencing an EGID relative to those who aren't.   [35:22] When you join EGID Partners, they provide you with a set of questionnaires to complete. Periodically, they push out a few more questionnaires.   [35:33] EGID Partners has provided some really great information about patient experience and answered questions that patients want to know about, like joint pain and symptoms outside the GI tract.   [36:04] To date, there are close to 900 participants in the registry from all over the world. As it continues to grow, it will give the ability to look at the patient experience in different geographical areas.   [36:26] Dr. Dellon says we try to have it be interactive, because it is a collaboration with patients. The Steering Committee works with APFED and other patient advocacy groups from around the world.    [36:41] The EGID Partners website shows general patient locations anonymously. It shows the breakdown of adults with the condition and caregivers of children with the condition, the symptom distribution, and the treatment distribution.   [37:03] As papers get published and abstracts are presented, EGID Partners puts them on the website. Once someone joins, they can suggest a research idea. Many of the studies they have done have come from patient suggestions.   [37:20] If there's an interesting idea for a survey, EGID Partners can push out a survey to everybody in the group and answer questions relatively quickly.   [37:57] Dr. Dellon says a paper came out recently about telehealth. EoE care, in particular, is a good model for telehealth because it can expand access for patients who don't have providers in their area.   [38:22] EoE is a condition where care involves a lot of discussion but not a lot of need for physical exams and direct contact, so telehealth can make things very efficient.    [38:52] EGID Partners surveyed patients about telehealth. They thought it was efficient and saved time, and they had the same kind of interactions as in person. In general, in-state insurance covered it. Patients were happy to do those kinds of visits again.   [39:27] Holly says Dr. Furuta, herself, and others were published in the Gastroenterology journal in 2019 about starting to do telehealth because patients coming to the Children's Hospital of Colorado from out of state had no local access to feeding therapy.   [39:50] Holly went to the board, and they allowed her to get licensure in different states. She started with some of the most impacted patients in Texas and Florida in 2011 and 2012. They collected data. They published in 2019 about telehealth's positive impact.   [40:13] When 2020 rolled around, Holly had trained a bunch of people on how to do feeding therapy via telehealth. You have to do all kinds of things, like make yourself disappear, to keep the kids engaged and in their chairs!   [40:25] Now it is Holly's primary practice. She has licenses in nine states. She sees people all over the country. With her diagnosis, her physicians at Mass General have telehealth licensure in Maine. She gets to do telehealth with them instead of driving two hours.   [40:53] Dr. Jensen tells of two of the things they hope to do at EGID Partners. One is trying to understand more about reproductive health for patients with an EGID diagnosis. Only a few studies have looked at this question, and with very small samples.   [41:15] As more people register for EGID Partners, Dr. Jensen is hoping to be able to ask some questions related to reproductive health outcomes.   [41:27] The second goal is a survey suggested by the Student Advisory Committee, asking questions related to the burden of disease specific to the teen population.   [41:48] This diagnosis can hit that population particularly hard, at a time when they are trying to build and sustain friendships and are transitioning to adult care and moving away from home. This patient population has a unique perspective we wanted to hear.   [42:11] Dr. Jensen and Dr. Dellon work on all kinds of other projects, too.   [42:22] Dr. Dellon says they have done a lot of work on the early-life factors that may predispose to EoE. They are working on a large epidemiologic study to get some insight into early-life factors, including factors that can be measured in baby teeth.   [42:42] That's outside of EGID Partners. It's been ongoing, and they're getting close, maybe over the next couple of years, to having some results.   [43:03] Ryan says all of those projects sound so interesting. We need to have you guys back to dive into those results when you have something finalized.   [43:15] For our listeners who want to learn more about eosinophilic disorders, we encourage you to visit apfed.org and check out the links in the show notes below.   [43:22] If you're looking to find specialists who treat eosinophilic disorders, we encourage you to use APFED's Specialist Finder at apfed.org/specialist.   [43:31] If you'd like to connect with others impacted by eosinophilic diseases, please join APFED's online community on the Inspire Network at apfed.org/connections.   [43:41] Ryan thanks Dr. Dellon and Dr. Jensen for joining us today. This was a fantastic conversation. Holly also thanks APFED's Education Partners GSK, Sanofi, Regeneron, and Takeda for supporting this episode.   Mentioned in This Episode: Evan S. Dellon, MD, MPH, Academic Gastroenterologist, University of North Carolina School of Medicine   Elizabeth T. Jensen, MPH, PhD, Epidemiologist, Wake Forest University School of Medicine, University of North Carolina at Chapel Hill   Predictors of Patients Receiving No Medication for Treatment of Eosinophilic Esophagitis in the United States: Data from the TARGET-EGIDS Cohort   Episode 15: Access to Specialty Care for Eosinophilic Esophagitis (EoE)   APFED on YouTube, Twitter, Facebook, Pinterest, Instagram Real Talk: Eosinophilic Diseases Podcast apfed.org/specialist apfed.org/connections apfed.org/research/clinical-trials   Education Partners: This episode of APFED's podcast is brought to you thanks to the support of GSK, Sanofi, Regeneron, and Takeda.   Tweetables:   "I've been working on eosinophilic gastrointestinal diseases for about 15 years. I started some of the early work around understanding possible risk factors for the development of disease. I've gone on to support lots of other research projects." — Elizabeth T. Jensen, MPH, PhD   "You can think of EoE as asthma of the esophagus or eczema of the esophagus, although in general, people don't grow out of EoE, like they might grow out of eczema or asthma. When people have it, it really is a long-term condition." — Evan S. Dellon, MD, MPH   "There are two general approaches to treating the underlying condition, … using medicines and/or eliminating foods from the diet that we think may trigger EoE. I should say, for a lot of people, EoE is a food-triggered allergic condition." — Evan S. Dellon, MD, MPH   "I didn't find it that surprising [that there are patients who had no treatment]. Some patients are relatively asymptomatic, and others are not interested in pursuing medications initially or are … still exploring dietary treatment options." — Elizabeth T. Jensen, MPH, PhD   "We have a bunch of studies now that look at how long people have symptoms before they're diagnosed. There's a wide range. Some people get symptoms and are diagnosed right away. Other people might have symptoms for 20 or 30 years." — Evan S. Dellon, MD, MPH   "EGID Partners is an online registry where individuals, caregivers, and parents of children affected with EGIDs can join. EGID Partners also needs people who don't live with an EGID to join, as controls." — Elizabeth T. Jensen, MPH, PhD

People who have been clinically dead and came back, how was the other side likeBecome a supporter of this podcast: https://www.spreaker.com/podcast/darkest-mysteries-online-the-strange-and-unusual-podcast-2025--5684156/support.Darkest Mysteries Online

This week on Inspire Change...Gunter  #InspireChange #Philosophy #Science #Reflection #Contemplation #SelfDevelopment #Masculinity #MakingGoodMenGreat #stoicism We have now partnered with sponsors that promote well-being, wellness and mental health.So it's that time of the year again! Yes, you heard me, THE HOLIDAYS are fast approaching and we all know what that means…parties, gatherings, work and business socials.  Science has evolved and there is no reason to waste time trying to recover from a night of celebrating. You may know what I mean if you have EVER had a few too many, that dreaded next morning where your head is pounding and you can't fathom the thought of getting up to use the rest room. Horrible! That's why we  believe in the scientific triumph that is Morning Recovery. It's scientifically formulated to help you bounce back after a night of drinking. It's made with ingredients like Milk Thistle and ginseng to help you recover from last night's festivities. Plus it's loaded with electrolytes and B Vitamins that replenish lost nutrients. It is seriously a game changer, your new “drink one before having a good time”, and wake up ready for anything drink!More Labs' Morning Recovery is the #1 alcohol recovery supplement that helps you wake up clear-headed and refreshed. Clinically proven and trusted by thousands, with 20M+ bottles sold and a 4.9-star rating, it works. Try it risk-free! Enjoy an exclusive discount with our promo code https://www.morelabs.com/discount/INSPIRECHANGE Our code will be applied to your cart and you get a discount at any of the products at MoreLabs.com Their products are loaded with super ingredients—Milk Thistle, Prickly Pear, Red Ginseng, Electrolytes, and B Vitamins. It is Developed with top scientists—including Dr. Fu Chen, a former FDA expert in supplement absorption. MoreLabs products work better than sports drinks—targets toxin buildup and nutrient loss, not just dehydration. Their products are a clean formula—no artificial colors, sweeteners, or preservatives.  It is also portable & TSA-friendly—perfect for travel, work, or big nights out.This week we would like to express our gratitude to those of you listening in Alaska. Your continued support has brought Alaska to #8 on the Top 10 Listeners List, for the first time EVER! CONGRATULATIONS!!!  and Thank you to  all our listeners in Anchorage for bringing your state to #8 and our deepest gratitude for promoting positive social change. We now take a list at the Global Listeners, and want to give a big CONGRATULATIONS to Trinidad and Tobago for entering the top 25 Global Listeners List!  We cannot express how grateful we are for your continued support around the world!  Thank you to all of our listeners for tuning in & supporting Positive Global Social Change.   This makes you a part of Gunter's efforts in transforming not only men's lives but lives in general and we are grateful you have joined us.  I, DeVonna Prinzi the Co-Exec Producer and our Showrunner Miranda Spigener-Sapon sincerely thank you and ask that you please take the time to like, follow, subscribe, and share as your efforts make a difference to everyone here at Inspire Change with Gunter.   Please remember If you want to share your story of social change, feel free to reach out  to the show directly. Please see the show-notes for our contact information.  As always thank you to each and every one of our listeners, and most importantly please keep Inspiring positive social change.Become a supporter of this podcast: https://www.spreaker.com/podcast/inspire-change-with-gunter--3633478/support.Gunter Swoboda and Lorin Josephson's neo-noir/supernatural thriller novel Amulets of Power, Book I A Brian Poole Mystery is officially ON SALE EVERYWHERE you like to get book, but if you want a discount please consider ording direct. ANY LISTENER who order's direct will get a surprise gift. https://shop.ingramspark.com/b/084?params=3RoOA6kVQ7ZgmqSK9LdnvNyDAZZFsg9IMaLUaprPgXKMake sure you LIKE SUBSCRIBE & FOLLOW our new Official YouTube Channel of Video Shorts series: https://www.youtube.com/@InspireChangewithGunterSwoboda/videos where we will be adding new videos and content every week from Gunter and our guests.  https://www.youtube.com/@InspireChangewithGunterSwoboda/videos

Full article: PI-RADS Version 2.1 for Prostate MRI Interpretation: Associations of Study Quality and Cancer Detection Metrics—A Systematic Review and Meta-Analysis Research quality can influence the results of studies evaluating PI-RADS performance. Tobi Folami, MD, discusses this AJR article by Nedelcu et al. reporting a meta-analysis of PI-RADS v2.1 performance, with attention to the impact of study quality.

Jillian Michaels addresses the pressing issue of cowardice in American politics, arguing that the real problem isn't extremism but the lack of courage to confront it. She discusses how both Democrats and Republicans avoid holding their own extremists accountable, resulting in a more mainstream presence of fringe ideologies. Jillian also calls for responsible leadership, emphasizing the need to marginalize actual hatred and promote a shared standard of decency and accountability.See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

Send us a textThis keynote episode features Dr. Jennifer Sucre (Vanderbilt University Medical Center), whose research bridges bedside observation and molecular biology to uncover why some preterm infants develop severe bronchopulmonary dysplasia (BPD) while others recover. Through innovative live imaging of lung development and mouse and human tissue models, her lab discovered that capillary “guidance” signals—semaphorins—are crucial for lung repair and resilience. Loss of these pathways marks irreversible injury. Dr. Sucre emphasizes “bedside-to-bench” science, finding lessons from resilient infants to inform therapy. Clinically, she urges providers to recognize individual resilience, foster hopeful communication with families, and envision a future where BPD is preventable—not inevitable.Support the showAs always, feel free to send us questions, comments, or suggestions to our email: nicupodcast@gmail.com. You can also contact the show through Instagram or Twitter, @nicupodcast. Or contact Ben and Daphna directly via their Twitter profiles: @drnicu and @doctordaphnamd. The papers discussed in today's episode are listed and timestamped on the webpage linked below. Enjoy!

Think before you post! Maggie and Ella dive into the fine line between authentic and unfiltered on social media. From oversharing and online debates to digital etiquette, they explore how estheticians can protect their reputation and their community—one post at a time.   ASCP Esty Talk with hosts Ella Cressman and Maggie Staszcuk   Produced by Associated Skin Care Professionals (ASCP) for licensed estheticians, ASCP Esty Talk is a weekly podcast, hosted by licensed estheticians, Ella Cressman, ASCP Skin Deep Magazine contributor, and Maggie Staszcuk, ASCP Program Director. We see your passion, innovation, and hard work and are here to support you by providing a platform for networking, advocacy, camaraderie, and education. We aim to inspire you to ask the right questions, find your motivation, and give you the courage to have the professional skin care career you desire.  About Ella Cressman:  Ella Cressman is a licensed esthetician, certified organic formulator, business owner, ingredient junkie, and esthetic cheerleader! As an educator, she enjoys empowering other estheticians and industry professionals to understand skin care from an ingredient standpoint rather than a product-specific view.  In addition to running a skin care practice, Cressman founded a comprehensive consulting group, the HHP Collective, and has consulted for several successful skin care brands.    Connect with Ella Cressman:  Website: www.hhpcollective.com  LinkedIn: linkedin.com/in/ella-cressman-62aa46a    About Maggie Staszcuk:  Maggie Staszcuk serves as the Program Director for ASCP and is the cohost of ASCP Esty Talk podcast. With over 18 years' experience in the esthetics industry, her diverse background includes roles in spa management, spa and med-spa services, and esthetics education. Since becoming a licensed esthetician in 2006, she carries a range of certifications in basic and advanced esthetics. Maggie is dedicated to equipping estheticians with the knowledge and resources they need to thrive in their careers.   Connect with Maggie Staszcuk:  P: 800.789.0411 EXT 1636  E: MStaszcuk@ascpskincare.com    About our Sponsors:   Comfort Zone – The Italian, multi-awarded science-led, longevity-focused skincare trusted by professionals worldwide. Founded by Dr Bollati, a pharmacist, and powered by over 60 in-house chemists and skin care experts. Clinically tested formulations blend clinical precision, regenerative botanicals, and biotechnology research to transform skin with intention. Part of The Davines Group, certified B Corp since 2016.   Website: https://us.comfortzoneskin.com/   Instagram: https://www.instagram.com/comfortzoneskin_official/   Massage Envy is a national franchisor and does not independently own or operate any of the Massage Envy franchised locations nationwide. The Massage Envy franchise network, through its franchise locations, is the leading provider of massage services. Founded in 2002, Massage Envy now has approximately 1,100 franchise locations in 49 states that have together delivered more than 200 million massages and skin care services. Website: www.massageenvy.com/careers/career-areas/esthetician  Facebook: @MassageEnvyCareers LinkedIn: @MassageEnvy   About Associated Skin Care Professionals (ASCP):    Associated Skin Care Professionals (ASCP) is the nation's largest association for skin care professionals and your ONLY all-inclusive source for professional liability insurance, education, community, and career support. For estheticians at every stage of the journey, ASCP is your essential partner. Get in touch with us today if you have any questions or would like to join and become an ASCP member.  Connect with ASCP:  Website: www.ascpskincare.com  Email: getconnected@ascpskincare.com  Phone: 800-789-0411  Facebook: facebook.com/ASCPskincare  Instagram: @ascpskincare   

This episode of the Atomic Anesthesia Podcast unpacks the real clinical risk of adrenal suppression after a single dose of etomidate, challenging common debates every anesthesia resident faces. Drawing on the latest studies, listeners will discover exactly which patient groups—cardiac, septic, trauma, pediatric, and elective—are actually vulnerable to etomidate's effects, and when transient adrenal suppression matters for outcomes. The discussion highlights the drug's unique origins, why its hemodynamic stability often outweighs risks in routine cases, and why infusions are off the table. Tune in for practical guidance on using etomidate safely, tips for steroid coverage in critically ill patients, and a sneak peek at promising new etomidate analogs. Whether you're prepping for exams or your next high-stakes induction, this episode helps you make smarter, evidence-based choices in the OR..Want to learn more? Create a FREE account at www.atomicanesthesia.com⚛️ CONNECT:

This week on Inspire Change...Gunter opens the conversation on Why Go Back to University Now? His journey going back to the university for his PhD. #InspireChange #Philosophy #Science #Reflection #Contemplation #SelfDevelopment #Masculinity #MakingGoodMenGreat #stoicism This week we are launching some partnerships with some ad sponsors that promote well-being, wellness and natural products. This week we would like to introduce you to More Labs.  More Labs' Morning Recovery is the #1 alcohol recovery supplement that helps you wake up clear-headed and refreshed. Clinically proven and trusted by thousands, with 20M+ bottles sold and a 4.9-star rating, it works. Try it risk-free! Enjoy an exclusive discount with our promo code https://www.morelabs.com/discount/INSPIRECHANGE Our code will be applied to your cart and you get a discount at any of the products at MoreLabs.com Their products are loaded with super ingredients—Milk Thistle, Prickly Pear, Red Ginseng, Electrolytes, and B Vitamins. It is Developed with top scientists—including Dr. Fu Chen, a former FDA expert in supplement absorption. MoreLabs products work better than sports drinks—targets toxin buildup and nutrient loss, not just dehydration. Their products are a clean formula—no artificial colors, sweeteners, or preservatives.  It is also portable & TSA-friendly—perfect for travel, work, or big nights out.Hello to all our listeners, We thank YOU for tuning in and promoting positive social change.  This makes you a part of Gunter's efforts in transforming not only men's lives but lives in general and we are grateful you have joined us.   This week we are thrilled to announce that Ethiopia was #20 on our global listeners list, specifically in Addis Ababa (a-duhs-ah-buuh-baa)! CONGRATULATIONS!!! We appreciate your efforts to support positive social change! Thank you for joining Africa's efforts of inspiring Positive Social Change.  Next we take a look at the USA, lets congratulate our listeners in Magee (muh-GHEE), Mississippi for bringing your state to #10 on the USA Top listeners list. CONGRATULATIONS!!!  I, DeVonna Prinzi the Co-Exec Producer and our Show-runner Miranda Spigener-Sapon sincerely thank you and ask that you please take the time to like, follow, subscribe, and share as your efforts make a difference to everyone here at Inspire Change with Gunter.Please remember If you want to share your story of social change, feel free to reach out  to the show directly. Please see the show-notes for our contact information. As always thank you to each and every one of our listeners, and most importantly please keep Inspiring positive social change.Become a supporter of this podcast: https://www.spreaker.com/podcast/inspire-change-with-gunter--3633478/support.Gunter Swoboda and Lorin Josephson's neo-noir/supernatural thriller novel Amulets of Power, Book I A Brian Poole Mystery is officially ON SALE EVERYWHERE you like to get book, but if you want a discount please consider ording direct. ANY LISTENER who order's direct will get a surprise gift. https://shop.ingramspark.com/b/084?params=3RoOA6kVQ7ZgmqSK9LdnvNyDAZZFsg9IMaLUaprPgXKMake sure you LIKE SUBSCRIBE & FOLLOW our new Official YouTube Channel of Video Shorts series: https://www.youtube.com/@InspireChangewithGunterSwoboda/videos where we will be adding new videos and content every week from Gunter and our guests.  https://www.youtube.com/@InspireChangewithGunterSwoboda/videos

Partners in PROMISE is a nonprofit organization whose mission is to Protect the Rights of Military children in Special Education and disability communities to ensure they receive equal access to an education.  Listen as Dr. Jenna Kremkow and Carla Wyrsch discuss how the PROMISE advocates for military children with special and exceptional needs.   This podcast is made possible by generous funding from the Luke Spouses' Club. To learn more, visit https://www.lukespousesclub.org/.   Audio mixing by Concentus Media, Inc., Temple, Texas.   Show Notes:   Resources:   Partners in PROMISE https://thepromiseact.org/   Partners in PROMISE Special Education & EFMP Binder  https://thepromiseact.org/binder/   Educator Report https://thepromiseact.org/educators-report-partners-in-promise-2022-research-findings/   Bio: Jenna Kremkow is an associate professor in the Department of Communication Sciences and Disorders at Elmhurst University. She completed her MS and PhD at The Pennsylvania State University with an emphasis in autism, augmentative and alternative communication, child language disorders, and stakeholder training and perspectives. Clinically, Jenna has worked as a speech-language pathologist in elementary schools, outpatient clinics, and early intervention settings. Jenna teaches courses in augmentative and alternative communication, autism, language disorders in children, and research methods. One of her research areas focuses on the experiences of military families with children with autism and the use of technology to improve communication outcomes and quality of life for children with autism and their families. Her goal is to use research to support data-driven recommendations and policy changes to improve special education services for military families.     Carla Wyrsch is the spouse of a retired United States Marine and mother of two. She has devoted her career to educating and advocating for children with disABILITIES. Her experience spans a variety of settings, including residential treatment facilities, military bases, public schools, and the Lerner School for Autism at the Cleveland Clinic. Currently, she is a School Operations Director with MIYO Health. In addition to her work with MIYO Health, Carla enjoys volunteering with Best Buddies of Greater Memphis, the Organization for Autism Research, and Partners in PROMISE as a content creator and advisory board member.

Christi Thompson from StretchLab shares a story of a nurse who gets back pain relief from one-on-one assisted stretching. Christi Thompson Master Instructor | Area Education Manager | Member, Master Trainer Advisory Council 2025 Christi Thompson is a dedicated Master Instructor at StretchLab and a member of the 2025 Master Trainer Advisory Council. Since joining the StretchLab team in 2019 as a Flexologist in Dilworth (Charlotte, NC), Christi has demonstrated a clear trajectory of growth—progressing to Lead Flexologist in Fort Mill, SC, and achieving the title of Master Instructor in 2022. She currently serves as the Area Education Manager for her local franchise, where she oversees the onboarding and continued education of Flexologists, equipping them with the skills and support necessary to thrive in their roles. Christi holds a Bachelor's degree in Athletic Training from the University of Delaware and a Master's degree in Athletic Training from the University of North Carolina at Chapel Hill. Her academic research focused on functional fatigue and its impact on body mechanics and injury risk. Clinically, she has worked with top-tier Division I athletics programs at UNC-Chapel Hill, including baseball and field hockey. After graduate school, she continued her career at Raleigh Orthopedic's Athletic Performance Center, where she worked with professional and youth athletes, including those affiliated with the Carolina Hurricanes NHL team. Before joining StretchLab, Christi also spent time as a high school teacher in biology and earth and environmental science. She earned her teaching certificate from North Carolina State University, where she studied teaching theory and psychology—skills she applies daily in her current leadership and education roles. Outside of her professional life, Christi is passionate about horseback riding and ultramarathon running. Having grown up in an equestrian household, she has been riding since childhood and currently leases and cares for a quarter horse named Luna. Christi is also a committed endurance athlete, with several ultramarathon finishes—including 50K and 50-mile distances—and plans to pursue 100K and 100-mile races. She values the mental resilience, strategic training, and love of the outdoors that the sport fosters.   Resources: Christi Thompson | Area Education Manager - StretchLab Charlotte & Columbia C: 302.530.0321  - call or text W: stretchlab.com Show sponsor: Haven Medical  

What happens when skin care stops being about "what's in it" and starts being about "what it does?". In this episode of ASCP Esty Talk, Maggie and Ella dive into the industry's shift from ingredient obsession to outcomes, exploring skin health as part of overall wellness and health span. ASCP Esty Talk with hosts Ella Cressman and Maggie Staszcuk   Produced by Associated Skin Care Professionals (ASCP) for licensed estheticians, ASCP Esty Talk is a weekly podcast, hosted by licensed estheticians, Ella Cressman, ASCP Skin Deep Magazine contributor, and Maggie Staszcuk, ASCP Program Director. We see your passion, innovation, and hard work and are here to support you by providing a platform for networking, advocacy, camaraderie, and education. We aim to inspire you to ask the right questions, find your motivation, and give you the courage to have the professional skin care career you desire.  About Ella Cressman:  Ella Cressman is a licensed esthetician, certified organic formulator, business owner, ingredient junkie, and esthetic cheerleader! As an educator, she enjoys empowering other estheticians and industry professionals to understand skin care from an ingredient standpoint rather than a product-specific view.  In addition to running a skin care practice, Cressman founded a comprehensive consulting group, the HHP Collective, and has consulted for several successful skin care brands.    Connect with Ella Cressman:  Website: www.hhpcollective.com  LinkedIn: linkedin.com/in/ella-cressman-62aa46a    About Maggie Staszcuk:  Maggie Staszcuk serves as the Program Director for ASCP and is the cohost of ASCP Esty Talk podcast. With over 18 years' experience in the esthetics industry, her diverse background includes roles in spa management, spa and med-spa services, and esthetics education. Since becoming a licensed esthetician in 2006, she carries a range of certifications in basic and advanced esthetics. Maggie is dedicated to equipping estheticians with the knowledge and resources they need to thrive in their careers.   Connect with Maggie Staszcuk:  P: 800.789.0411 EXT 1636  E: MStaszcuk@ascpskincare.com    About our Sponsors:   Comfort Zone – The Italian, multi-awarded science-led, longevity-focused skincare trusted by professionals worldwide. Founded by Dr Bollati, a pharmacist, and powered by over 60 in-house chemists and skin care experts. Clinically tested formulations blend clinical precision, regenerative botanicals, and biotechnology research to transform skin with intention. Part of The Davines Group, certified B Corp since 2016.   Website: https://us.comfortzoneskin.com/   Instagram: https://www.instagram.com/comfortzoneskin_official/   Massage Envy is a national franchisor and does not independently own or operate any of the Massage Envy franchised locations nationwide. The Massage Envy franchise network, through its franchise locations, is the leading provider of massage services. Founded in 2002, Massage Envy now has approximately 1,100 franchise locations in 49 states that have together delivered more than 200 million massages and skin care services. Website: www.massageenvy.com/careers/career-areas/esthetician  Facebook: @MassageEnvyCareers LinkedIn: @MassageEnvy   About Associated Skin Care Professionals (ASCP):    Associated Skin Care Professionals (ASCP) is the nation's largest association for skin care professionals and your ONLY all-inclusive source for professional liability insurance, education, community, and career support. For estheticians at every stage of the journey, ASCP is your essential partner. Get in touch with us today if you have any questions or would like to join and become an ASCP member.  Connect with ASCP:  Website: www.ascpskincare.com  Email: getconnected@ascpskincare.com  Phone: 800-789-0411  Facebook: facebook.com/ASCPskincare  Instagram: @ascpskincare   

This week on Inspire Change...Gunter   #InspireChange #Philosophy #Science #Reflection #Contemplation #SelfDevelopment #Masculinity #MakingGoodMenGreat #stoicism This week we are launching some partnerships with some ad sponsors that promote well-being, wellness and natural products. This week we would like to introduce you to More Labs.  More Labs' Morning Recovery is the #1 alcohol recovery supplement that helps you wake up clear-headed and refreshed. Clinically proven and trusted by thousands, with 20M+ bottles sold and a 4.9-star rating, it works. Try it risk-free! Enjoy an exclusive discount with our promo code https://www.morelabs.com/discount/INSPIRECHANGE Our code will be applied to your cart and you get a discount at any of the products at MoreLabs.com Their products are loaded with super ingredients—Milk Thistle, Prickly Pear, Red Ginseng, Electrolytes, and B Vitamins. It is Developed with top scientists—including Dr. Fu Chen, a former FDA expert in supplement absorption. MoreLabs products work better than sports drinks—targets toxin buildup and nutrient loss, not just dehydration. Their products are a clean formula—no artificial colors, sweeteners, or preservatives.  It is also portable & TSA-friendly—perfect for travel, work, or big nights out.Hello to all our listeners, We thank YOU for tuning in and promoting positive social change.  This makes you a part of Gunter's efforts in transforming not only men's lives but lives in general and we are grateful you have joined us.  This week we are taking a look at the Global Listeners List and for the FIRST time we would like to share our gratitude with our listeners in Pakistan. You were  #15 on our Global Listeners List! CONGRATULATIONS!!!  And thank you so much for your continued support. We appreciate your efforts to support positive social change!  I, DeVonna Prinzi the Co-Exec Producer and our Show-runner Miranda Spigener-Sapon sincerely thank you and ask that you please take the time to like, follow, subscribe, and share as your efforts make a difference to everyone here at Inspire Change with Gunter.   Please remember If you want to share your story of social change, feel free to reach out  to the show directly. Please see the show-notes for our contact information.As always thank you to each and every one of our listeners, and most importantly please keep Inspiring positive social change.Become a supporter of this podcast: https://www.spreaker.com/podcast/inspire-change-with-gunter--3633478/support.Gunter Swoboda and Lorin Josephson's neo-noir/supernatural thriller novel Amulets of Power, Book I A Brian Poole Mystery is officially ON SALE EVERYWHERE you like to get book, but if you want a discount please consider ording direct. ANY LISTENER who order's direct will get a surprise gift. https://shop.ingramspark.com/b/084?params=3RoOA6kVQ7ZgmqSK9LdnvNyDAZZFsg9IMaLUaprPgXKMake sure you LIKE SUBSCRIBE & FOLLOW our new Official YouTube Channel of Video Shorts series: https://www.youtube.com/@InspireChangewithGunterSwoboda/videos where we will be adding new videos and content every week from Gunter and our guests.  https://www.youtube.com/@InspireChangewithGunterSwoboda/videos

Have you heard of sulforaphane? Want to know how to harness the benefits of this powerful compound? Tune in to learn all about sulforaphane—a powerhouse phytonutrient that activates detox and antioxidant pathways to protect your cells.  In this episode, we will unpack how this potent compound supports the body's natural defense systems, working through the NRF2 pathway to reduce oxidative stress, enhance cellular detoxification, and promote resilience against modern day toxin exposure. We also discuss how food preparation impacts sulforaphane yield, why gut health matters for its conversion, and how to maximize levels through broccoli sprouts, seed extracts, and targeted supplementation.  We also unveil the exciting reformulation of Cellular Antiox, featuring clinically validated broccoli seed extract for enhanced cellular protection alongside glutathione support! Also in this episode:  Shop NEW Cellular Antiox with code CELLULAR15 Naturally Nourished Academy - Now Enrolling with Early Bird Pricing!  What is sulforaphane? Who can benefit from sulforaphane? Sulforaphane in the research Randomized Phase II Clinical Trial of Sulforaphane in Former Smokers at High Risk for Lung Cancer - PubMed Rapid and Sustainable Detoxication of Airborne Pollutants by Broccoli Sprout Beverage: Results of a Randomized Clinical Trial in China - PMC Sulforaphane-rich broccoli sprout extract improves hepatic abnormalities in male subjects - PubMed Effects of broccoli sprout supplements enriched in glucoraphanin on liver functions in healthy middle-aged adults with high-normal serum hepatic biomarkers: A randomized controlled trial Long-lasting beneficial effects of maternal intake of sulforaphane glucosinolate on gut microbiota in adult offspring - ScienceDirect Broccoli or Sulforaphane: Is It the Source or Dose That Matters? - PMC Sulforaphane treatment of autism spectrum disorder (ASD) | PNAS Prep and cooking to maximize sulforaphane Why the gut microbiome matters Probiotic Challenge Protocol How to get sulforaphane in the diet Considerations for BroccoDetox New Cellular Antiox Formulation Setria® Glutathione (250 mg): Clinically studied, reduced form, ready to use N-Acetylcysteine (1,000 mg): A powerful precursor, provides cysteine to fuel internal glutathione production Broccoli Seed Extract 40mg (2mg glucoraphanin): Activates Nrf2 pathway, upregulates endogenous antioxidant production, including glutathione Vitamin B6 (5 mg): Essential cofactor for amino acid metabolism and methylation, supports efficient detox and glutathione recycling New bovine gelatin capsule with silica as an added feature!   Sponsors for this episode:  This episode is sponsored by FOND Bone Broth, your sous chef in a jar. FOND's bone broths and tallows are produced in small batches with premium ingredients from verified regenerative ranches. Their ingredients are synergistically paired for maximum absorption, nutritional benefit, and flavor. Use code NATURALLY to save at fondbonebroth.com 

ADHD medication can be a controversial topic online. Is it safe? Does it change who you are? What does the science actually say?In this episode, Skye talks with Dr. Ryan Sultan, psychiatrist, researcher, and founder of Integrative Psychiatry in NYC, about what medication does in the brain and what decades of studies reveal about its effects. This is not medical advice - it's a clear, evidence-based conversation to help you understand your options.What we cover:How ADHD medication affects dopamine and focusThe difference between stimulant and non-stimulant medicationsWhy safety and addiction concerns often get misunderstoodHow to approach treatment decisions from an informed placeHow to know if your treatment plan needs adjustmentThe role of therapy, structure, and lifestyle alongside medicationDr. Ryan Sultan, MD is a double board-certified psychiatrist, Assistant Professor of Clinical Psychiatry at Columbia, and the Founder & Medical Director of Integrative Psychiatry in Chelsea, NYC, and Miami, FL. He leads NIH-funded research on ADHD and comorbidities and has published in JAMA, The Journal of Adolescent Health, and JAACAP. Clinically, he works with children and adults navigating conditions like anxiety, depression, and substance use.Medical Disclaimer:This episode is for educational purposes only and does not constitute medical advice.Skye Waterson is not a medical doctor and does not make treatment recommendations.Always consult a qualified healthcare professional before making any decisions about diagnosis, medication, or treatment for ADHD or any other condition.P.S. If you feel like the bottleneck in your business and life feels like chaos, click here to apply for a call with me. We'll discuss your struggles and explore systems to support you in growing without the overwhelm.

Chapter 1 – “Lumps, Not Bugs: Cracking the ‘Sterile' Case” 03:22 – John welcomes Dr Laura Buckley back for part two on brachycephalic skin disease and tees up two topics: Sterile Granuloma/Pyogranuloma Syndrome (SGPS) and Muzzle Folliculitis/Furunculosis, plus how to manage comorbidities. Laura explains it's an uncommon, immune‑mediated nodular skin disease of dogs involving histiocytic cells (macrophages). No infectious agent is found and it responds to immunomodulatory therapy. 04:43 – Sue asks which brachy breeds are most affected and typical ages. Laura most often sees Boxers, British Bulldogs, some Mastiffs and (in her clinic) many Staffordshire Bull Terriers. Usual onset is middle‑aged, though younger dogs can be affected. 05:21 – Sue asks what it looks like. Laura: papules, nodules or plaques (mm to several cm), localised or generalised; often on trunk, but head/limbs too. Typically non‑painful and non‑pruritic; may be erythematous, haired or alopecic; sometimes eroded/ulcerated with crusting - the key is a nodular process. 07:20 – Sue asks for key differentials. Laura highlights superficial bacterial folliculitis as the big rule‑out in short‑coated brachys (tufted hairs). Cytology helps: infection shows neutrophils with intracellular cocci (staphylococci); a sterile process shows inflammatory cells without bacteria. 07:49 – Laura notes most SGPS nodules are intact, so fine‑needle aspirates (multiple nodules) are preferred over impression smears. Expect many neutrophils and macrophages; bacteria should be absent. 08:23 – Sue asks about deep fungal disease and other infections. Laura: you can't reliably exclude on cytology alone—next step is biopsy. Remove a whole nodule if possible so histopathology can section through it and use special stains for atypical organisms (bacteria, deep fungi, parasites, protozoa). This thorough exclusion is critical before immunosuppression. 10:11 – Sue asks how to submit samples. Laura often splits: submit an entire nodule (or half) in formalin for histopathology and keep a second small sample (e.g., 4 mm punch from another lesion) chilled/frozen pending culture. Direct to bacteriology or mycology depending on histopath hints. 11:01 – John asks about treatment and prognosis. Laura finds most dogs do well: disease may wax and wane but responds to therapy; rare spontaneous resolution reported. Start with glucocorticoids (prednisolone). Typical immunosuppressive dose 2–4 mg/kg (sometimes 1–1.5 mg/kg suffices; she often starts at 2 mg/kg). If response is poor or steroid side effects are problematic, add cyclosporine at 5 mg/kg once daily; azathioprine has been used. For localised lesions, topical hydrocortisone aceponate spray can help. 13:24 – Sue asks for a prednisolone protocol. Laura: baseline haematology/biochemistry/urinalysis before starting. Recheck at 2–3 weeks for tolerance and early response; continue same dose another 2–3 weeks to resolution, then taper by ~20% every couple of weeks. Once down to ~0.5 mg/kg, move to alternate‑day dosing. Add cyclosporine if lesions recur on taper to avoid long‑term steroid adverse effects (PU/PD/PP, lethargy/weight gain; long‑term risk: calcinosis cutis). With dual therapy or cytotoxics, schedule regular bloods (after 1 month, then every 2–3 months). Chapter 2 – “Chins Up: Muzzle Mayhem, Managed” 17:05 – John pivots to Muzzle Folliculitis/Furunculosis: what is it and who gets it? Laura: a bacterial follicular disease confined to the muzzle skin, common in coarse/bristly‑coated brachys—British & French Bulldogs, Pugs, Shar‑Pei, Boxers. 18:04 – John asks what drives it. Laura: often linked to allergic skin disease; facial folds create many “mini‑intertrigo” sites. Pruritus → rubbing/trauma to bristly follicles. She suspects a sterile inflammatory start that quickly progresses to secondary bacterial folliculitis. 20:13 – Sue asks if this is the same as acne. Laura: no - acne is a keratinisation disorder (e.g., plugged follicles; classic in cat chins). Muzzle folliculitis/furunculosis is follicular inflammation progressing to follicle rupture (furunculosis) with foreign‑body reaction. Clinically it's more diffuse over chin/muzzle with erythema, alopecia, papules/pustules, erosions/ulcers/crusts; severe cases show haemorrhagic bullae‑like lesions—“an interdigital cyst on the chin.” 23:24 – John asks about diagnosis and first‑line management. Laura: clinical pattern + cytology to confirm/grade infection. Prioritise topical antiseptics; address primary disease and contributing behaviours (chewing cages/toys, environment). Systemic antibiotics only if deep/severe infection and ideally based on culture. 25:02 – Sue asks preferred topicals. Laura: chlorhexidine‑containing products are mainstay; ethyl lactate also helpful. Choose gentle vehicles (mousses/wipes) for faces; shampoos are good for debris removal but impractical on muzzles. Educate owners to avoid mechanical trauma. Benzoyl peroxide was useful historically but isn't currently available in the UK. Topical clindamycin/fusidic acid can work, but antiseptics usually outperform; always control inflammation alongside antimicrobials. Chapter 3 – More than a twofold problem: Comorbidities Without Chaos 29:52 – Sue asks about juggling comorbidities (e.g., SGPS plus history of demodicosis). Laura: set expectations with owners; if on isoxazoline preventatives, relapse of demodex during immunosuppression is unlikely but monitor closely. Risk is higher during combination immunosuppression (e.g., pred + cyclosporine) and lower on single‑agent maintenance. 32:15 – Sue asks about surveillance. Laura: in addition to haematology/biochemistry and urine checks, perform periodic hair plucks/skin scrapes to rule out demodex whenever new alopecic lesions appear or during ongoing therapy. Any follicular disease (including muzzle furunculosis) warrants demodex checks. 33:18 – Closing remarks. Sue and John thank Laura; they note the focus on common, real‑world brachy problems (intertrigo, muzzle folliculitis, seasonal flank alopecia, SGPS) and the importance of pragmatic, owner‑friendly routines.

This week on Inspire Change...Gunter is opening up the discussion about healing as a lifelong journey navigating setbacks and growth.  #InspireChange #Philosophy #Science #Reflection #Contemplation #SelfDevelopment #Masculinity #MakingGoodMenGreat #stoicism This week we are launching some partnerships with some ad sponsors that promote well-being, wellness and natural products. This week we would like to introduce you to More Labs.  More Labs' Morning Recovery is the #1 alcohol recovery supplement that helps you wake up clear-headed and refreshed. Clinically proven and trusted by thousands, with 20M+ bottles sold and a 4.9-star rating, it works. Try it risk-free! Enjoy an exclusive discount with our promo code https://www.morelabs.com/discount/INSPIRECHANGE Our code will be applied to your cart and you get a discount at any of the products at MoreLabs.com Their products are loaded with super ingredients—Milk Thistle, Prickly Pear, Red Ginseng, Electrolytes, and B Vitamins. It is Developed with top scientists—including Dr. Fu Chen, a former FDA expert in supplement absorption. MoreLabs products work better than sports drinks—targets toxin buildup and nutrient loss, not just dehydration. Their products are a clean formula—no artificial colors, sweeteners, or preservatives.  It is also portable & TSA-friendly—perfect for travel, work, or big nights out.Our gratitude this week goes out to our  listeners, We thank YOU for tuning in and promoting positive social change.  This makes you a part of Gunter's efforts in transforming not only men's lives but lives in general and we are grateful you have joined us.  This week we are taking a look at the Global Listeners List and for the FIRST time we would like to share our gratitude with our listeners in Iraq.  Thankyou  Baghdad & Nineveh (Nin-uh-vuh) for bringing Iraq on to the list at #10. CONGRATULATIONS!!!  We appreciate your efforts of supporting positive social change!I, DeVonna Prinzi the Co-Exec Producer and our Show-runner Miranda Spigener-Sapon sincerely thank you and ask that you please take the time to like, follow, subscribe, and share as your efforts make a difference to everyone here at Inspire Change with Gunter.   Please remember If you want to share your story of social change, feel free to reach out  to the show directly. Please see the show-notes for our contact information.  As always thank you to each and every one of our listeners, and most importantly please keep Inspiring positive social change.Become a supporter of this podcast: https://www.spreaker.com/podcast/inspire-change-with-gunter--3633478/support.Gunter Swoboda and Lorin Josephson's neo-noir/supernatural thriller novel Amulets of Power, Book I A Brian Poole Mystery is officially ON SALE EVERYWHERE you like to get book, but if you want a discount please consider ording direct. ANY LISTENER who order's direct will get a surprise gift. https://shop.ingramspark.com/b/084?params=3RoOA6kVQ7ZgmqSK9LdnvNyDAZZFsg9IMaLUaprPgXKMake sure you LIKE SUBSCRIBE & FOLLOW our new Official YouTube Channel of Video Shorts series: https://www.youtube.com/@InspireChangewithGunterSwoboda/videos where we will be adding new videos and content every week from Gunter and our guests.  https://www.youtube.com/@InspireChangewithGunterSwoboda/videos

Dr Lindsey Sinclair narrates her blog written for Dementia Researcher. In this blog, Lindsey reflects on the role of kindness in academia, questioning whether success and empathy can coexist. Drawing from personal experience as a psychiatrist and researcher, she shows how kindness, towards oneself and others, builds healthier teams, fosters trust, and strengthens research culture. From small gestures like a smile or a thank you to mentoring and supporting colleagues, her message is clear: kindness is not a weakness but a foundation for effective, ethical, and fulfilling academic life. Find the original text, and narration here on our website. https://www.dementiaresearcher.nihr.ac.uk/blog-is-kindness-key-in-academic-life/ -- Dr Lindsey Sinclair is an Honorary Senior Clinical Research Fellow at the University of Bristol and a Locum Consultant in Old Age Psychiatry. Her research explores the relationship between depression and dementia, combining lab work with epidemiology and genetics. Clinically, she works with older adults experiencing a wide range of mental health problems. Outside of work, she's a keen baker and runner, and has a particular talent for creating ambitious birthday cakes. Find Lindsey on LinkedIn -- Enjoy listening? We're always looking for new bloggers, drop us a line. http://www.dementiaresearcher.nihr.ac.uk This podcast is brought to you in association with Alzheimer's Association, Alzheimer's Research UK, Alzheimer's Society and Race Against Dementia, who we thank for their ongoing support. -- Follow us on Social Media: https://www.instagram.com/dementia_researcher/ https://www.facebook.com/Dementia.Researcher/ https://x.com/demrescommunity https://bsky.app/profile/dementiaresearcher.bsky.social https://www.linkedin.com/company/dementia-researcher Join our community: https://onelink.to/dementiaresearcher

Are you low in glutathione? Feeling sluggish, inflamed, or more sensitive to toxins than you used to be? Maybe you're catching every bug that goes around or noticing your recovery just isn't what it used to be. Today on the Naturally Nourished Podcast, we're talking about the body's master antioxidant, glutathione, and why it's essential for immune resilience, detoxification, energy, and longevity. We'll unpack what glutathione is, why modern life so easily depletes it, and how low levels have been linked to everything from fatigue and joint pain to accelerated aging and chronic disease. Plus, we'll share simple strategies to help you raise your levels naturally and introduce our newly reformulated Cellular Antiox, now featuring NAC, Setria® glutathione, and broccoli seed extract for enhanced cellular protection and glutathione production. Use the code CELLULAR15 to save 15% off our exciting reformulation of Cellular Antiox! Also in this episode:  What is glutathione and what does it do? Episode 325 All About Glutathione Trends of deficiency Micronutrient Panel How the body produces glutathione Cysteine Whey Protect Glycine Pure Collagen Relax and Regulate Glutamate GI Lining Support Do we store glutathione and does it need to be replenished? How to increase glutathione  Sulfur rich veggies Modulation of plasma antioxidant levels, glutathione S‐transferase activity and DNA damage in smokers following a single portion of broccoli: a pilot study Bone broth FOND Bone Broth use code ALIMILLERRD When to supplement with glutathione Will supplementation make my body stop producing it on its own? NEW Cellular Antiox reformulation A 2015 randomized, double-blind, placebo-controlled study published in the European Journal of Nutrition showed that 250–1000 mg of Setria daily for 6 months significantly increased glutathione levels in whole blood, red blood cells, and lymphocytes. Per 2 Capsules: Setria® Glutathione (250 mg): Clinically studied, reduced form, ready to use N-Acetylcysteine (1,000 mg): A powerful precursor, provides cysteine to fuel internal glutathione production Broccoli Seed Extract 40mg (2mg glucoraphanin): Activates Nrf2 pathway, upregulates endogenous antioxidant production, including glutathione Vitamin B6 (5 mg): Essential cofactor for amino acid metabolism and methylation, supports efficient detox and glutathione recyclingNew bovine gelatin capsule with silica as an added feature! Comparison to liposomal and IV glutathione How to dose 1 capsule twice daily for wellness 2 capsules 2-3 times daily for illness or infection Making Medicinal Honey   This episode is sponsored by: This episode is sponsored by Wild Foods, a company that puts quality, sustainability, and health first in all of their products. They have everything from coffee to turmeric to medicinal mushrooms, and every single product is painstakingly sourced from small farms around the globe. They take their mission seriously to fix the broken food system, and believe real food is medicine. They've partnered with us to give you guys an exclusive discount, so use the code ALIMILLERRD for 12% off your order at WildFoods.co! 

Catholics. During a near-death experience in 2017, Susan merged with an unnamable “God” and has mentored awakening women since.She graduated from Hamilton College with a Bachelor of Arts in Cultural Anthropology. Her work has appeared in Dance Magazine, FOLIO, Burningword, and Evening Street Review.Become a supporter of this podcast: https://www.spreaker.com/podcast/next-level-soul-podcast-with-alex-ferrari--4858435/support.

Airsupra is a combination inhaler that contains albuterol and budesonide, approved for as-needed use in adults with asthma. It represents the first rescue inhaler to combine a short-acting beta-2 agonist (SABA) with an inhaled corticosteroid (ICS) in a single device. The albuterol component provides rapid bronchodilation by relaxing airway smooth muscle, while budesonide works to reduce airway inflammation and mucus production. This dual mechanism allows Airsupra to not only relieve acute bronchoconstriction but also address the underlying inflammatory process that contributes to asthma exacerbations. Clinically, Airsupra is indicated for as-needed treatment or prevention of bronchoconstriction in adults with asthma, but it is not approved for COPD. The typical dosing is two inhalations as needed, with a maximum of six doses (12 inhalations) in a 24-hour period. The rationale for its use aligns with recent asthma guideline updates, which emphasize minimizing SABA-only use because it fails to address inflammation and may contribute to worse outcomes over time. Common adverse effects include tremor, nervousness, tachycardia, and hypokalemia from albuterol, as well as oral thrush and hoarseness from budesonide. Patients should rinse and spit after each use to reduce the risk of oral candidiasis. Drug interactions can occur with non-selective beta-blockers, which may blunt albuterol's effects. CYP3A4 also plays a role in budesonide metabolism. Systemic absorption typically isn't too much of an issue with infrequent use.

This week on Inspire Change...Gunter is ad-libbing as we wrap up the year. #InspireChange #Philosophy #Science #Reflection #Contemplation #SelfDevelopment #Masculinity #MakingGoodMenGreat #stoicism This week we are launching some partnerships with some ad sponsors that promote well-being, wellness and natural products. This week we would like to introduce you to More Labs.  More Labs' Morning Recovery is the #1 alcohol recovery supplement that helps you wake up clear-headed and refreshed. Clinically proven and trusted by thousands, with 20M+ bottles sold and a 4.9-star rating, it works. Try it risk-free! Enjoy an exclusive discount with our promo code https://www.morelabs.com/discount/INSPIRECHANGE Our code will be applied to your cart and you get a discount at any of the products at MoreLabs.com Their products are loaded with super ingredients—Milk Thistle, Prickly Pear, Red Ginseng, Electrolytes, and B Vitamins. It is Developed with top scientists—including Dr. Fu Chen, a former FDA expert in supplement absorption. MoreLabs products work better than sports drinks—targets toxin buildup and nutrient loss, not just dehydration. Their products are a clean formula—no artificial colors, sweeteners, or preservatives.  It is also portable & TSA-friendly—perfect for travel, work, or big nights out.Our gratitude this week goes out to our  listeners, We thank YOU for tuning in and promoting positive social change.  This makes you a part of Gunter's efforts in transforming not only men's lives but lives in general and we are grateful you have joined us.   This week we are taking a look at the USA's Top Ten Listeners List and would like to share our gratitude with our listeners in Atlanta for bringing Georgia  all the way to the top at #1, as you have have been steadily climbing the chart in your efforts of supporting positive social change. CONGRATULATIONS!!!  you made it to #1! I, DeVonna Prinzi the Co-Exec Producer and our Show-runner Miranda Spigener-Sapon sincerely thank you and ask that you please take the time to like, follow, subscribe, and share as your efforts make a difference to everyone here at Inspire Change with Gunter.    Please remember If you want to share your story of social change, feel free to reach out  to the show directly. Please see the show-notes for our contact information.  As always thank you to each and every one of our listeners, and most importantly keep Inspiring positive social change.Become a supporter of this podcast: https://www.spreaker.com/podcast/inspire-change-with-gunter--3633478/support.Gunter Swoboda and Lorin Josephson's neo-noir/supernatural thriller novel Amulets of Power, Book I A Brian Poole Mystery is officially ON SALE EVERYWHERE you like to get book, but if you want a discount please consider ording direct. ANY LISTENER who order's direct will get a surprise gift. https://shop.ingramspark.com/b/084?params=3RoOA6kVQ7ZgmqSK9LdnvNyDAZZFsg9IMaLUaprPgXKMake sure you LIKE SUBSCRIBE & FOLLOW our new Official YouTube Channel of Video Shorts series: https://www.youtube.com/@InspireChangewithGunterSwoboda/videos where we will be adding new videos and content every week from Gunter and our guests.  https://www.youtube.com/@InspireChangewithGunterSwoboda/videos

Erik Meira joined Noah for the second time on Forward Physio to discuss the principles of early rehab for Achilles rupture repairs.Erik is a physical therapist and educator who is well known for being the first person to start a podcast related to physical therapy back in 2011. Clinically, Erik mainly works with collegiate and professional level athletes. He has authored several articles and textbook chapters, has been a keynote speaker at large conferences, and hosts a variety of courses both in person and online. He is the owner of TheSciencePT.com and the creator of the Elite Rehab Conferences, which currently include conferences on basketball, football, soccer, and hockey. Fun fact: Erik is also a pilot! Enjoy!https://thesciencept.com/https://eliterehabconferences.com/Erik's TwitterErik's Instagram----Noah's InstagramNoah's WebsiteFor questions and business inquiries: noahmandelphysio@gmail.com

Red light therapy has started to gain traction in popular culture. From sports medicine recovery to beauty treatments, more and more people are starting to catch on to the benefits of using red light. But why does red light therapy work? And what are its science-backed benefit? On today's show, we're going to dive into the science of red light therapy. You're going to learn how light therapy can help reduce pain, enhance skin quality, improve the symptoms of certain disorders, and so much more! You're also going to learn about other types of light therapy, like ultraviolet and green light therapy. We're going to discuss the health benefits of getting adequate sunlight, why human biology is so responsive to input from light sources, and how to integrate more light into your routine. Enjoy!   In this episode you'll discover:  How red light therapy can help reduce pain. (0:21) The link between red light exposure and wrinkle reduction. (1:22) Which bacteria has been shown to be reduced by far UV light. (2:09) How red light therapy can help with muscle growth. (2:45) The science behind why the human body is so responsive to light. (5:09) How your circadian timing system works. (5:47) The #1 influencer of your circadian clocks. (6:26) How mitochondria respond to red light therapy. (7:38) A fascinating study on hypothyroidism and red light therapy. (11:19) The link between light therapy and fat loss. (17:28) What the ultimate source of light therapy is. (23:09)  Items mentioned in this episode include:  ⁠Thelumebox.com/model⁠  -  Experience the next-level benefits of red light therapy at home? Enjoy an exclusive $260 off the premium LUMEBOX red light therapy system, designed to boost recovery, skin health, and overall vitality. Be sure you are subscribed to this podcast to automatically receive your episodes:   ⁠Apple Podcasts⁠ ⁠Spotify⁠ ⁠Soundcloud⁠ ⁠Pandora⁠ ⁠YouTube⁠   This episode of The Model Health Show is brought to you by Lumebox. Clinically-designed to deliver both red (660 nm) and near-infrared (850 nm) wavelengths in one sleek handheld device.Independently lab-tested for performance: more coverage, higher irradiance, greater effect. Perfect for skin health, pain support, recovery and overall vitality — in your routine, on your terms. Use this link to claim your discount: ⁠thelumebox.com/model⁠ to claim or $260 off your device.   Learn more about your ad choices. Visit megaphone.fm/adchoices

Host: Ryan Quigley New research presented at the 2025 American College of Rheumatology Convergence highlights a critical link between adverse childhood experiences and mental health outcomes in adolescents with childhood-onset systemic lupus erythematosus (cSLE). In this AudioAbstract, Ryan Quigley explores the findings, the implications for trauma-informed care, and the need to assess psychosocial history in managing cSLE.

Galen Clavio and Scott Caulfield recap Indiana's 38–13 win over Michigan State — a dominant, businesslike homecoming victory. They break down Fernando Mendoza's near-perfect day, IU's offensive balance, the defense's steady control, and how the Hoosiers continue proving they belong among the nation's best.Presented by Homefield Apparel.

In this episode of Real Life Pharmacology, we take a deep dive into daptomycin, a lipopeptide antibiotic primarily used for serious Gram-positive infections, including MRSA and VRE. Daptomycin works by binding to bacterial cell membranes in a calcium-dependent manner, causing rapid depolarization and cell death. One key limitation is that daptomycin should never be used for pneumonia because pulmonary surfactant inactivates the drug. Clinically, it's often reserved for bacteremia, endocarditis, or complicated skin and soft tissue infections. From a pharmacokinetic standpoint, daptomycin is given intravenously and primarily eliminated unchanged by the kidneys, so dose adjustments are necessary in renal impairment. Monitoring creatine kinase (CK) levels is crucial, as one of the major adverse effects is myopathy and, rarely, rhabdomyolysis. Patients on statins have a higher risk of muscle toxicity, and clinicians should consider holding or monitoring statin therapy closely. Eosinophilic pneumonia is another rare but serious adverse reaction that can develop after prolonged therapy. Daptomycin has minimal drug interactions, making it an appealing option when other agents pose risks. Overall, it's a powerful antibiotic when used appropriately, but requires careful monitoring for muscle and respiratory-related side effects.

For The Other Side NDE Videos Visit ▶️ youtube.com/@TheOtherSideNDEYT Purchase our book on Amazon

Steven Noack is a quantum healer and zero point healing practitioner. At a very young age Steve was struck by a motor vehicle and this event bio electrically connected him to the quantum field. During Steve's near death experience he experienced sitting with a being comprised solely of light. The being of light revealed to Steve the quantum field and its connection to humanities healing contained in their divine blueprint.Steve's gift enables him to stimulate emotional and physical healing from any distance through quantum entanglement and photonics. Every living being emits Biophotons or weak radiation generated as a bio electrical field and this is what links all living beings to collective consciousness. By using his unique gifts he is able to create a zero point field or ground state for the bio electrical nervous system and open pathways for healing.Steve began using his gifts to give back to humanity by first studying Usui Reiki over ten years ago and has only grown from there. He now teaches heals and coaches clients from around the world. Steve works with hundreds of clients of all ages and backgrounds, guiding them on their journey of freedom from pain and trauma. Steve has a wide range of experience healing both spiritual and physical ailments from cancerous tumors to common injuries.Become a supporter of this podcast: https://www.spreaker.com/podcast/next-level-soul-podcast-with-alex-ferrari--4858435/support.

Cefepime is a fourth-generation cephalosporin antibiotic with broad-spectrum activity against both gram-positive and gram-negative organisms, including Pseudomonas aeruginosa. It works by inhibiting bacterial cell wall synthesis through binding to penicillin-binding proteins, leading to cell lysis and death. Clinically, cefepime is commonly used in hospital settings for serious infections such as pneumonia, febrile neutropenia, urinary tract infections, skin infections, and intra-abdominal infections. It's typically administered intravenously, with doses often ranging from 1 to 2 grams every 8 to 12 hours depending on the indication and renal function. From a pharmacokinetic standpoint, cefepime is primarily renally eliminated, so dose adjustments are required in patients with impaired kidney function. Failure to reduce the dose appropriately can lead to neurotoxicity — one of the key adverse effects associated with cefepime — manifesting as encephalopathy, confusion, myoclonus, or seizures, particularly in elderly or renally impaired patients. Common side effects include gastrointestinal upset and rash. Cefepime has relatively limited drug interactions, though concurrent nephrotoxic agents can increase the risk of renal injury.

Discover how clinically integrated networks (CINs) empower physicians, specialists, and pharmacy partners to deliver coordinated, patient-centered care. In this episode, Debi Hueter of WakeMed Key Community Care joins Rebecca Grandy from CHESS Health Solutions to discuss collaboration, trust, and innovation in value-based care. Learn how team-based care models reduce administrative burden, improve outcomes, and support providers at the top of their license.

Nearly all hiring managers are using AI to help narrow the field of job candidates... Should job seekers be using the same tools to narrow the field of positions to apply for? (at 13:31) --- Throwback Thursday: Healthcare is at the center of the government shutdown - Clinically, America's system is the finest in the world – so why are so many patients complaining? A closer look at the disconnect between doctors, hospitals and the people they serve (at 21:33) --- Around Town: The All Developmental Differences and Abilities Parent Teacher Community Organization of Hancock County - aka ADDAPTCO - is hosting their 9th annual Fall Fest this weekend (at 44:27)

The newly signed One Big Beautiful Bill Act is reshaping the healthcare landscape, with ripple effects for providers, payers, and patients. From Medicaid coverage shifts and rural hospital funding challenges to stricter ACA rules, expanded value-based care, and mandatory risk models, the implications are broad and far-reaching. In this episode of Value-Based Care Insights, host Daniel J. Marino speaks with Ben Sparks, President of Bryan Health Connect, a clinically integrated network, to examine four critical areas leaders must prepare for: projected Medicaid losses, financial pressures on hospitals, new insurance access rules, and the wider fiscal and political fallout across states. Drawing on Bryan Health Connect's experience, Ben shares practical takeaways to help leaders adapt to the new law.

The newly signed One Big Beautiful Bill Act is reshaping the healthcare landscape, with ripple effects for providers, payers, and patients. From Medicaid coverage shifts and rural hospital funding challenges to stricter ACA rules, expanded value-based care, and mandatory risk models, the implications are broad and far-reaching. On this episode Dan speaks with Ben Sparks, President of Bryan Health Connect, a clinically integrated network, to examine four critical areas leaders must prepare for: projected Medicaid losses, financial pressures on hospitals, new insurance access rules, and the wider fiscal and political fallout across states. Drawing on Bryan Health Connect's experience, Ben shares practical takeaways to help leaders adapt to the new law. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

Midodrine is an oral alpha-1 agonist most commonly used for the treatment of symptomatic orthostatic hypotension. Its mechanism of action is through peripheral vasoconstriction, which helps increase blood pressure. Because of its short duration of action, it is typically dosed three times daily, with the last dose recommended in the late afternoon to reduce the risk of hypertension at night. Clinically, midodrine is often considered when non-pharmacologic strategies for orthostatic hypotension (such as increased salt/fluid intake, compression stockings, or physical counter-maneuvers) are not enough. Pharmacists should also be aware of prescribing cascades—such as urinary retention leading to tamsulosin initiation—that can arise when midodrine is used. Midodrine is generally not metabolized through cytochrome P450 pathways, so significant drug–drug interactions are less common. However, caution should be exercised with other agents that can raise blood pressure (like decongestants) or slow the heart rate (such as beta-blockers). Monitoring parameters include blood pressure, pulse, symptoms of urinary retention, and the patient's overall response to therapy.

Clinically Dead, Walking with Jesus for 44 Hours - NDE Miracle!: Robert Marshall. When Robert Marshall went into cardiac arrest, he was clinically dead—no heartbeat, no breath—for 44 hours. During that time, he says he was fully conscious in heaven, with Jesus. What he witnessed was beyond anything imaginable: harmonic trees, divine light, and a mission he didn't want but ultimately accepted.

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Revefenacin (brand name Yupelri) is a long-acting muscarinic antagonist (LAMA) used for the maintenance treatment of chronic obstructive pulmonary disease (COPD). It works by blocking muscarinic receptors, particularly the M3 subtype, in airway smooth muscle. This antagonism reduces cholinergic bronchoconstriction and leads to sustained bronchodilation. Unlike short-acting anticholinergics such as ipratropium, revefenacin provides 24-hour bronchodilation with once-daily dosing. One of the distinguishing features of revefenacin is that it is the first nebulized LAMA approved for COPD maintenance therapy. Many patients with advanced COPD, physical limitations, or difficulty using handheld inhalers benefit from a nebulized formulation, as it allows medication delivery without requiring hand-breath coordination or a forceful inhalation. This makes it a useful option for patients with poor inhaler technique or those transitioning from hospital care. Pharmacokinetically, revefenacin is delivered via nebulization, with peak effects typically observed within a couple of hours. Importantly, systemic absorption is relatively low, but elderly patients or those with hepatic impairment may be more susceptible to anticholinergic side effects. Clinically, revefenacin improves lung function, reduces COPD symptoms, and can decrease exacerbation frequency. Common adverse effects include cough, dry mouth, constipation, and urinary retention. Caution is advised in patients with narrow-angle glaucoma or prostatic hyperplasia due to its antimuscarinic properties. Revefenacin is not intended for acute bronchospasm or rescue therapy—it is strictly for long-term, once-daily maintenance.

Two Onc Docs, hosted by Samantha A. Armstrong, MD, and Karine Tawagi, MD, is a podcast dedicated to providing current and future oncologists and hematologists with the knowledge they need to ace their boards and deliver quality patient care. Dr Armstrong is a hematologist/oncologist and assistant professor of clinical medicine at Indiana University Health in Indianapolis. Dr Tawagi is a hematologist/oncologist and assistant professor of clinical medicine at the University of Illinois in Chicago. In this episode, OncLive On Air® partnered with Two Onc Docs to feature a conversation about soft tissue sarcoma management. Drs Armstrong and Tawagi discussed that soft tissue sarcomas represent a rare and heterogeneous group of malignancies that arise from mesenchymal cells rather than epithelial cells and encompass several distinct histologic subtypes. They explained that although uncommon, these sarcomas are frequently emphasized in board examinations, partly because their management has historically been stable, though recent FDA approvals and ongoing research have expanded therapeutic options. They noted that risk factors may include prior radiation exposure, environmental agents, and viral infections. Additionally, they shared that chronic lymphedema is associated with angiosarcoma, whereas rare hereditary syndromes may predispose individuals to specific sarcoma subtypes.  Clinically, they explained that sarcomas may arise anywhere in the body, though many occur in the thigh, buttocks, or groin, typically presenting as painless, enlarging masses often mistaken for benign lesions. They emphasized that diagnosis requires core needle biopsy to preserve tissue architecture and that staging relies on MRI of the primary site and CT of the chest, given the strong predilection for pulmonary metastases. They also summarized the five subtypes of soft tissue sarcoma—synovial, clear cell, angiosarcoma, rhabdomyosarcoma, and epithelioid. They reported that the cornerstone of localized disease management is surgical resection, preferably limb-sparing when feasible, combined with radiation for larger or high-risk tumors. They also highlighted novel strategies like immunotherapy. For metastatic disease, they stated that surgical resection of pulmonary metastases can achieve durable remissions in select patients. 

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You won't believe who we have on the podcast today. She's a Phillies fan and a Gritty stan

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.

  Interviewees: Tom Pisano, MD PhD and Laura Ashley Stein, MD, MS, Ed. Interviewer: Lisa Meeks, PhD, MA Description: In Episode 111, Dr. Lisa Meeks talks with Dr. Tom Pisano (former Penn neurology resident; now neuro-hospital medicine and neuro-immunology fellow) and Dr. Laura Stein (Adult Neurology Program Director at Penn) about building an accessible neurology residency for a physician who uses a wheelchair—and how trust, planning, and culture made it work. Together, they trace Tom's match-day disclosure strategy and “find-your-people” approach, an accessibility walk-through with tape measures and ADA checks, and the practical creativity of equivalent rotations when sites differ in accessibility. They also unpack a real barrier—a security policy that blocked ED entry during stroke alerts—and how reframing access as patient safety moved the system. Listeners will hear candid advice for residents (hold onto your “why,” communicate early, invite teaching adaptations) and for program directors (start with goals, not habits; assume success; apply the same creativity you offer patients to your trainees). This episode accompanies a written case study and a Mini Grand Rounds conversation in Learn at ACGME. Part of the ACGME/DWDI Disability Resource Hub, supported by the Josiah Macy Jr. Foundation Catalyst Award, it's a practical guide for PDs, residents, and anyone committed to equitable clinical training.   Transcript: https://docs.google.com/document/d/1xB_Cp8EiekJ9ExUZLP61EvE-0y4HUv22LuRp0D6uNB0/edit?usp=sharing Key words: Medical education, physical disability, disability research, residency, accommodations, wheelchair, SCI, medical technology, residency, neurology, program director, GME, GME Policy Bio: Laura Stein I have been involved in the Neurology Residency Program since 2018, and Director of the program since 2024. I teach residents on multiple inpatient services as well as in outpatient continuity clinic and stroke clinics. I also lead didactic sessions and workshops for resident onboarding and in our resident lecture series. I am particularly interested in expanding resident exposure to structured experiences in medical education and quality improvement and currently mentor multiple residents per year in medical education and quality improvement projects. In 2020, I was honored to receive the University of Pennsylvania Neurology Residents teaching award. I received my masters in medical education from the University of Pennsylvania in 2018. I have been a member of the American Academy of Neurology (AAN) Residency-In-Training Examination Committee since 2019. I have also been a member of the American Heart Association (AHA) Stroke Professional Education Committee since 2016 and currently serve as the Vice Chair of this committee. Clinically, I function predominantly as a neurohospitalist and attend on the stroke inpatient and consult services, the neurology ward service, and the PPMC consult service. I am dedicated to ensuring delivery of high-quality neurologic care across our system and currently am the physician co-lead for our neurovascular disease team, which spans our six-hospital network, as well as our HUP inpatient neurology unit-based quality improvement team. Tom Pisano I enjoy weekend bike rides with my wife, followed by trying out a new restaurant. When traveling, if possible, I always try to get in some monoskiing or scuba diving. I would also consider myself a (very) mildly competitive board gamer. I will be pursuing a combined neurohospitalist/neuroimmunology fellowship to develop expertise in myelopathies. My research includes brain-computer interfaces, especially of the spinal cord. Producer:  Lisa Meeks Follow Us: X: @DocsWith Instagram: @DocsWithDisabilities Linked In: https://www.linkedin.com/company/docs-with-disabilities-initiative Resources:  Disability Resource Hub: https://dl.acgme.org/pages/disability-resource-hub Case Studies in Disability Resource Hub: https://dl.acgme.org/pages/disability-resource-hub#case_studies UME to GME Toolkit:  https://dl.acgme.org/pages/disability-resource-hub-transitions-toolkit-introduction Policy Toolkit: https://dl.acgme.org/pages/disability-resource-hub-policy-toolkit Disability in Graduate Medical Education Program:  https://www.docswithdisabilities.org/digme   Link to Case Study: Coming Soon!              

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In 1999, Swedish medical student, Anna Bågenholm, was skiing in Norway with friends when she fell through a frozen stream and became trapped under a thick layer of ice. Unable to free herself, and forced to wait for rescue, her body temperature quickly fell to 13.7°C (56.7°F) and she fell unconscious. 80 minutes later, Bågenholm was brought to the surface by rescuers, clinically dead. But that is not the end of Anna's story... Sources: -Aftonbladet- Her temp was down to 13.8 degrees -Swedish-Norwegian co-operation in the treatment of three hypothermia victims: A case report, Scandinavian Journal of Trauma Resuscitation and Emergency Medicine - Tjugofyra7, Clinically dead but Anna survived – My story can help others -Another Day: Cheating Death To advertise on this podcast please email: ad-sales@libsyn.com    Or go to: https://advertising.libsyn.com/Marooned 

Elon Musk is going nuclear—not on the Left, but on Republicans. He's threatening to primary GOP lawmakers and float a third party, fracturing MAGA. I'll show you why this could be the exact setup that hands the next midterm election back to the Left—and how we stop it. Today's Sponsor Multi Collagen Advanced Longevity.† Clinically studied superfoods support cellular energy,† radiant skin† and flexible joints† to help you feel younger and more vibrant. LanceWallnau.com/Renew