Podcasts about cme

Elisabeth Swan has spent more than 3 decades helping people figure out what's wrong with processes—and what to do about it. A Lean Six Sigma Master Black Belt, she has coached and taught thousands of problem solvers, from local nonprofits to Fortune 100 companies, helping them build better systems and stronger problem-solving cultures.These days, she's equally interested in what we're not trained to look for: what's working, who contributed, and what people are doing that's worth repeating. Her latest work, The Praise Paradox™, explores how our natural tendency to spot problems can cause us to overlook the contributions that drive both continuous improvement and human performance.Elisabeth is the award-winning author of Picture Yourself a Leader and co-author of The Problem-Solver's Toolkit, and co-host of the Just-in-Time Cafe podcast. She teaches Lean at UC San Diego Health and has taught improvement and leadership courses at UC San Diego, UC Davis, and the University of Denver.Before all that, Elisabeth performed with ImprovBoston—an experience that still shapes how she thinks about curiosity, experimentation, listening, and the importance of building on what other people have to offer.Link to claim CME credit: https://www.surveymonkey.com/r/3DXCFW3CME credit is available for up to 3 years after the stated release dateContact CEOD@bmhcc.org if you have any questions about claiming credit.

As we've noted on Raise the Line from Elsevier before, the system Americans rely on to keep vaccine recommendations grounded in science has changed in ways that many in the medical community find alarming. Our guest today, Dr. Jason Goldman, has watched this shift unfold from a closer vantage point than most in his role as liaison from the American College of Physicians (ACP) to the CDC's Advisory Committee on Immunization Practices.“The vaccine guidelines must be based on science and evidence and that doesn't change because of someone's political beliefs. We have to keep politics out of healthcare,” says Dr. Goldman, who has been a prominent voice responding to the risks resulting from these changes as well as other public health issues.This candid conversation with host Lindsey Smith also explores:Why Dr. Goldman calls himself a "dinosaur";The Medicare quirk that pits doctors against each other;His advice to students when choosing a specialty.Mentioned in this episode:American College of Physicians If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

Featuring perspectives from Dr Shannon N Westin and Dr Stephen "Fred" Divers, moderated by Dr Divers, including the following topics: Introduction (0:00) Ovarian Cancer (2:22) Endometrial Cancer (37:48) CME information and select publications

Highlights from the PER® CME activity "OncoBytes Adaptive Learning Pathways™: Decoding Precision Diagnostics and Targeted Therapies in Glioma" — this podcast is not certified for credit. To participate in the full accredited activity and earn CME credit, use the link below.In this podcast, experts Vinay K. Puduvalli, MD; Ruham Nasany, MD; and Angela Waanders, MD, MPH, MS; discuss advances in molecular diagnostics and strategies to treat adults with low- and high-grade gliomas.Earn CME credit by completing the full accredited activity (available through September 1, 2027): https://www.gotoper.com/courses/oncobytes-adaptive-learning-pathways-decoding-precision-diagnostics-and-targeted-therapies-in-gliomaThis podcast, including the narration, was developed by PER® (Physicians' Education Resource®, LLC) editorial staff from the full online CME activity developed with these faculty. The narration was voiced by a PER staff member or by an AI tool. The podcast contains no product advertising. The full activity is supported by an educational grant from Jazz Pharmaceuticals, Inc.This content is for educational purposes only and is not a substitute for the independent clinical judgment of a health care professional. Faculty may discuss investigational or off-label uses; consult prescribing information for any products discussed.

Listen to Jesus G. Berdeja, MD, and Ajai Chari, MD, as they discuss sequencing of antibody–drug conjugates (ADCs), bispecific antibodies, CAR T-cell therapy, and other novel treatment modalities for patients with relapsed/refractory multiple myeloma.Presenters:Jesus G. Berdeja, MDDirector of Myeloma ResearchGreco-Hainsworth Centers for Research PartnerTennessee OncologyNashville, TennesseeAjai Chari, MDProfessor of Clinical MedicineDirector of Multiple Myeloma ProgramUCSF Helen Diller Family Comprehensive Cancer CenterUniversity of California, San Francisco (UCSF) Medical CenterSan Francisco, CaliforniaContent based on an online CME program supported by an educational grant from GSK.Link to full program:https://bit.ly/3TZSmufGet access to all of our new podcasts by subscribing to the Decera Clinical Education Oncology Podcast on Apple Podcasts, YouTube Music, or Spotify. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

This is Quick Hits, where I pull the best takeaways from past podcast episodes and bring them to you in a shorter format. If today's clip resonates with you, be sure to check out the full episode linked below. Download in iTunes or on your favorite podcast platforms. Listen to the full episode here. Listen to the full episode on iTunes here. Dr. Devaki Lindsey Berkson is a thought leader in functional medicine, with an emphasis on hormones, nutrition, digestion, and intimacy. Berkson was a distinguished hormone scholar at a world-renowned estrogen think tank at Tulane University because she wrote one of the first breakthrough books on endocrine disruption). Berkson is credited with the in-depth knowledge of Estrogen Vindication and has an eBook on Hormones for Breast Cancer Survivors at DrLindseyBerkson.com. In this episode, we dive into the often misunderstood world of estrogen hormone replacement therapy with Dr. Berkson. We debunk myths, particularly those about estrogen's links to cancer and serotonin, and discuss the protective roles of hormones like progesterone and testosterone. We cover the evolution of hormone therapy, address individualized dosing, and explore how hormones interact with nutrition and lifestyle for optimal health. In the full episode we discuss: Estrogen myths that have been perpetuated by figures like Dr. Joseph Mercola. Why accurate, science-based information on natural hormone therapy is crucial for women's health. Addressing misconceptions about estrogen's link to cancer and serotonin. Why estrogen is not solely responsible for inducing cancer growth, contrary to popular belief. How progesterone and testosterone are often overlooked yet play protective roles in hormone balance. Why individualized hormone dosing is essential for optimal hormone therapy outcomes. How innovative uses of estrogen therapy can benefit breast cancer patients and overall health. Why understanding hormone receptors and metabolism is so important in HRT. How nutrition and lifestyle interplay with hormones to impact health. Why a one-size-fits-all approach to hormone dosing can potentially be harmful. The upcoming CME course on hormones that Dr. Berkson is involved with. Why collaboration with oncologists is important when administering estrogen to breast cancer patients. How estrogen supports metabolism and may reduce type 2 diabetes risk. Why high-dose oral progesterone can lead to issues like depression and breast tissue inflammation. How current research suggests estrogen may protect against breast cancer, challenging past beliefs.     Sponsors Head to cozyearth.com and use my code HORMONES for 20% off sitewide! And if you get a Post-Purchase Survey, make sure to let them know you heard about Cozy Earth right here!     Are you in perimenopause or postmenopause and struggling with symptoms—but not getting the support you deserve? At Midlife Solutions, we specialize in hormone optimization for women in midlife. Our all-female clinical team offers telehealth care across all 50 U.S. states, with the ability to prescribe bioidentical estrogen, progesterone, testosterone, and thyroid medication.   Book your FREE Hormone Discovery Call Find out what's really driving your symptoms and what your next best steps are.   Visit the website: https://karenmartel.com   Shop the Midlife Solutions Store Over-the-counter bioidentical hormone creams and oils — no prescription needed. Including: • Progesterone • Estrogen Face Cream • Vaginal Moisturizer and more!   Take the Hormone Quiz Discover hidden hormone imbalances that could be driving your symptoms. Get personalized results (and yes, they may surprise you).   Women's Peptide Weight Loss Program Clinically guided, hormone-aware weight loss for midlife women.   Midlife RESET HRT Program A complete, supportive approach to hormone replacement therapy in midlife.   Your host: Karen Martel Certified Hormone Specialist, Transformational Nutrition Coach, & Weight Loss Expert   Karen's Facebook Karen's Instagram

Featuring a slide presentation and related discussion from Professor Nicoletta Colombo, including the following topics: Rationale for targeting the glucocorticoid receptor; relacorilant mechanism of action (0:00) Key efficacy and safety findings from a Phase II study of relacorilant/nab paclitaxel for platinum-ineligible ovarian cancer (3:09) Key findings from the Phase III ROSELLA study (7:06) Case: A woman in her early 50s with FIGO Stage IVB platinum-ineligible high-grade serous carcinoma of the fallopian tube enrolls in the Phase III ROSELLA study (15:02) Case: A woman in her late 40s with FIGO Stage IIIB platinum-ineligible high-grade serous ovarian carcinoma enrolls in the Phase II BELLA trial (23:42) CME information and select publications

Featuring an interview with Professor Nicoletta Colombo, including the following topics: Mechanistic effects and rationale underlying the use of relacorilant/nab paclitaxel (0:00) Rationale underlying the study design of the Phase II BELLA trial and avenues for future exploration (8:31) Definition of platinum ineligibility; importance of platinum-containing chemotherapy for patients with ovarian cancer (14:02) Findings from a Phase II trial and the subsequent confirmatory Phase III ROSELLA study (20:25) Phase III ROSELLA study: Subgroup analyses, patient-reported outcomes, insights into overall survival data and common adverse events (29:43) Considerations for therapeutic selection and sequencing of novel therapies; ongoing and future investigations (38:46) CME information and select publications

Send us Fan MailSuccess in medicine isn't built alone. While physicians spend years mastering clinical skills, one of the most valuable assets they develop throughout their careers is a trusted network of advisors, colleagues, and industry partners who help them solve problems, introduce new ideas, and ultimately improve patient care.In this episode of Medical Money Matters, Jill Arena sits down with Maurice Rodriguez, a seasoned medical device representative who has spent years working alongside surgeons in the operating room. More than simply providing products, Maurice has built a reputation as a trusted resource, connector, and strategic partner for physicians by consistently showing up, following through, and helping solve challenges beyond the operating room.Jill and Maurice discuss what it takes to earn physicians' trust, the qualities that distinguish true partners from traditional salespeople, and why strong professional relationships can have a lasting impact on both patient outcomes and practice success. They also explore innovations in post-operative pain management, the changing healthcare landscape, and the importance of surrounding yourself with people who are invested in your long-term success.Whether you're a physician, practice administrator, or healthcare leader, this conversation offers valuable insights into building the kind of professional network that helps both your practice—and your patients—thrive.Please Follow or Subscribe to get new episodes delivered to you as soon as they drop! Visit Jill's company, Health e Practices' website: https://healtheps.com/ Subscribe to our newsletter, Health e Connections: https://share.hsforms.com/1FMup6xLPSpeA8hB77caYQwd32sx?hsCtaAttrib=171926995377 Want more formal learning? Check out Jill's newly released course: Physician's Edge: Mastering Business & Finance in Your Medical Practice. 32.5 hours of online, on-demand CME-accredited training tailored just for busy physicians. Promo pricing available now: https://education.healtheps.com/offers/Ry3zfLYp/checkout?coupon_code=PHYSEDGE3000Purchase your copy of Jill's book here: Physician Heal Thy Financial Self Join our Medical Money Matters Facebook Group here: https://www.facebook.com/groups/3834886643404507/ Original Musical Score by: Craig Addy at https://www.underthepiano.ca/ Visit Craig's website to book your Once in a Lifetime music experience Podcast coaching and development by: Jennifer Furlong, CEO, Communication Twenty-Four Seven https://www.communicationtwentyfourseven.com/    

In this episode, Tracey Davidoff, MD, Joe Toscano, MD, Benjamin Silverberg, MD, MSc, FAAFP, FCUCM, and Ammie Rodden, PA-C, discuss the September 2026 Evidence-Based Urgent Care article, Urgent Care Evaluation of Pain and Swelling in the Scrotum.0:17 — Podcast introduction1:59 — Topic introduction: acute scrotal pain; authors Dr. Ben Silverberg & Ammie Rodden PA-C2:35 — Why they wrote this article4:24 — Key takeaways5:30 — Physical exam signs & clinical judgment7:19 — TWIST score explained in detail9:33 — Ultrasound decisions & Doppler flow pitfalls13:30 — Risk-stratifying who needs imaging now vs. later14:37 — STIs & epididymitis: the age-35 cutoff is dead18:22 — Sensitive exams, chaperones & patient comfort22:09 — Beyond torsion: Fournier's gangrene & trauma24:17 — Key learning moments27:26 — Wrap-up & what's coming nextSubscribers, take the CME test here.Not a subscriber? Join here!

Eleasa Sokolski, MD, Addiction Medicine Specialist, Oregon Health & Science UniversityCME Credit Available for all Providence ProvidersIn order to claim CME credit, please click on the following link:⁠ ⁠https://forms.cloud.microsoft/r/fh3z4tRbJd or copy & paste into your browser).Accreditation Statement: Providence Oregon Region designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1  creditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Providence Oregon Region is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.Planning Committee Disclosure -The planning committee and faculty report no relevant financial relationships with ineligible companies. All relevant financial relationships have been reviewed and mitigated, in accordance with ACCME requirements.Original Date: September 29, 2026End Date: September 29, 2027

Eleasa Sokolski, MD, Addiction Medicine Specialist, Oregon Health & Science UniversityCME Credit Available for all Providence ProvidersIn order to claim CME credit, please click on the following link:⁠ ⁠https://forms.cloud.microsoft/r/fh3z4tRbJd or copy & paste into your browser).Accreditation Statement: Providence Oregon Region designates this enduring material activity for a maximum of 1.0 AMA PRA Category 1  creditTM. Physicians should claim only the credit commensurate with the extent of their participation in the activity.Providence Oregon Region is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.Planning Committee Disclosure -The planning committee and faculty report no relevant financial relationships with ineligible companies. All relevant financial relationships have been reviewed and mitigated, in accordance with ACCME requirements.Original Date: September 29, 2026End Date: September 29, 2027

Join us as we review recent practice-changing articles on Varenicline by mail for smoking cessation, anticoagulation for intermediate risk AF, CAC scores plus PREVENT for ASCVD risk stratification, blood testing for CRC, a new oral PCSK9 inhibitor, and more. Fill your brain hole with a delicious stack of hotcakes! Featuring Paul Williams (@PaulNWilliamz), Rahul Ganatra (@rbganatra), and Matt Watto (@doctorwatto).Claim CME for this episode at curbsiders.vcuhealth.org!Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CMECredits Written and Hosted by: Rahul Ganatra MD, MPH; Paul Williams, MD, FACP, Matthew Watto MD, FACP Cover Art: Rahul Ganatra, MD, MPH Reviewer: Sai S  Achi, MD, MBA, FACP Technical Production: Pod Paste Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Show Segments Intro, disclaimer Varenicline by mail for smoking cessation Anticoagulation for intermediate-risk AF CAC scores added to PREVENT for ASCVD Blood testing for colorectal cancer Oral PCSK9 inhibitor, negative results for pelacarsan and ziltivekimab  Outro Sponsor: MasterClassGet at least 15% off any annual membership at masterclass.com/CURB. Sponsor: The Permanente Medical GroupInterested physicians can visit  to get more information and RSVP at northerncalifornia.permanente.orgSponsor: UpToDateVisit www.uptodate.com/cme for CME details. Curbsiders listeners can get 10% off UpToDate packages with code CURB4Sponsor: Panacea LegalVisit Panacea.Legal/curb to schedule your free consultation.

We take the keys away from older drivers—why not older doctors? Nearly 3 in 4 Americans battling this health problem—fatigue! What super-agers over 100 have in common—a hyper-vigilant immune system guarding against cancers and infections. How does “anabolic resistance” contribute to frailty—and what to do about it? Recurrent bouts of “burning sensations” on the face—diagnosis please?

Featuring perspectives from Dr Samuel J Klempner and Dr Stephen "Fred" Divers, moderated by Dr Divers, including the following topics: Introduction (0:00) First-Line Treatment of Metastatic Gastroesophageal Cancer (1:48) Management of HER2-Positive Gastroesophageal Cancer (25:11) Neoadjuvant Therapy for Gastroesophageal Cancer (45:13) Note to listeners: Subsequent to the recording of this symposium, the FDA approved zanidatamab in combination with chemotherapy with and without tislelizumab for HER2-positive gastric, gastroesophageal junction, or esophageal adenocarcinoma based on results from the Phase III HERIZON-GEA-01 trial. CME information and select publications

Featuring perspectives from Dr Farrukh T Awan and Dr Stephen "Fred" Divers, moderated by Dr Divers, including the following topics: Introduction (0:00) First-Line Therapy (2:48) Relapsed/Refractory Disease (39:30) CME information and select publications

Highlights from the PER® CME activity "Advancing Targeted Therapy in HR+/HER2– Metastatic Breast Cancer: Integrating Next-Generation Endocrine and PAM-Pathway Strategies Into Practice" — this podcast is not certified for credit. To participate in the full accredited activity and earn CME credit, use the link below.In this podcast, experts Joyce O'Shaughnessy, MD, Sarat Chandarlapaty, MD, PhD, Mitchell Elliott, MD, FRCPC, and Seth A. Wander, MD, PhD, discuss how they are integrating recent data from pivotal clinical trials evaluating next-generation oral selective estrogen receptor degraders (SERDs) as well as inhibitors of the PI3K/AKT/mTOR signaling pathway into the management of patients with hormone receptor-positive, HER2-negative (HR+/HER2-) metastatic breast cancer (mBC), using a variety challenging clinical scenarios to draw out insights and clinical pearls.Earn CME credit by completing the full accredited activity (available through July 31, 2027): https://www.gotoper.com/courses/advancing-targeted-therapy-in-hrher2-metastatic-breast-cancer-integrating-next-generation-endocrine-and-pam-pathway-strategies-into-practiceThis podcast, including the narration, was developed by PER® (Physicians' Education Resource®, LLC) editorial staff from the full online CME activity developed with these faculty. The narration was voiced by a PER staff member or by an AI tool. The podcast contains no product advertising. The full activity is supported by educational grants from Lilly; Rigel Pharmaceuticals; and Stemline Therapeutics, Inc.This content is for educational purposes only and is not a substitute for the independent clinical judgment of a health care professional. Faculty may discuss investigational or off-label uses; consult prescribing information for any products discussed.

Featuring perspectives from Dr Brad S Kahl, Dr Jeff Sharman and Dr Tanya Siddiqi, including the following topics: Introduction (0:00) Trials in Progress (1:12) Chronic Lymphocytic Leukemia (7:09) Diffuse Large B-Cell Lymphoma (32:35) Mantle Cell Lymphoma (58:25) Follicular Lymphoma (1:14:49) CME information and select publications

Geopolitical tensions, corn export competition, and shifting cattle markets are giving agriculture plenty to watch as the week wraps up. SF Daily host Lorrie Boyer breaks down the latest developments affecting grain and livestock markets.

BEEF We will start with a little good news. The Santa Teresa, New Mexico border crossing for live cattle reopened today and so far, no issues. The next border crossing will also be in Columbus, New Mexico; no firm date yet but I'd expect if this opening continues to go well, we should see the next one in about 30 days.  We are about to finish September with middle meats, especially ribeyes, leading the way higher. Tenderloins are following up as well. Chucks are showing some strength as chuck rolls are moving higher. Rounds continue to decline and thin meats, led by briskets, continue lower as well. We'll be in October before you know it. Last week's beef harvest was 529K head, up from 505 the week prior.  Inventories are still very tight. Make sure to stay ahead of your needs and take those price declines as they arrive. Shaping up to be a very interesting market heading toward the holiday season. POULTRY Chicken production continues strong, about 2 percent above last year.  Additional good news: the hatch rate is inching up close to 80 percent, last week 79.7 percent. Chicken pricing is holding steady for another week. I really don't see anything to push pricing higher, so I do think we'll see these moderate prices well into October. Avian Flu continues to be an issue; last week we had 4 new cases affecting 140K turkeys. GRAINS Grain markets are giving back just a bit from the last couple weeks' run up. Corn closed today at $5.30, down from last week‘s $5.42 but still well above that $5 benchmark. Soy and wheat are down similarly. Spring wheat harvest is about done; winter wheat planting continues. Corn and soy harvest have begun, still a bit early but I do think with new crop arriving it will help keep pricing tempered. PORK Pork bellies closed today at $86.51 just up from last week's close $85.48.  Anytime bellies are below $100 is time to buy. We may see a bit of a rally over the next couple weeks but I'm expecting a softer market for pork well into Q4. Butts, ribs, and loins are all a bit lower for next week as production is picking up with cooler weather. DAIRY A little of everything on the dairy markets this week, through Thursday's CME close, the barrel is up 1, first barrel increase since August. The block is down 6 continuing the trend, and butter had no change. Again, not much I see to push this market higher. Savalfoods.com | Find us on Social Media: Instagram, Facebook, YouTube, Twitter, LinkedIn

John A. Dues serves as the chief learning officer and chief operating officer at United Schools in Columbus, Ohio. He is an accomplished systems leader and improvement science scholar-practitioner and recently published his first book entitled Win-Win: W. Edwards Deming, the System of Profound Knowledge, and the Science of Improving Schools. Throughout his career he has served on the founding teams of seven school and nonprofit organizations. John has a BA from Miami University, an M.Ed. from the University of Cincinnati, is a Teach For America alumnus, and completed the Improvement Advisor program through the Institute for Healthcare Improvement.Link to claim CME credit: https://www.surveymonkey.com/r/3DXCFW3CME credit is available for up to 3 years after the stated release dateContact CEOD@bmhcc.org if you have any questions about claiming credit.

As many of our listeners know from news reports, emergency departments have been under enormous strain in recent years trying to manage overcrowding, the opioid addiction crisis, the consequences of an under-resourced mental health system, and rising rates of violence against staff, among many other challenges. But our guest today guest thinks there's something else that should top that list. "I think hands down the most important issue is the reimbursement model," says Dr. Ryan Stanton, president-elect of the American College of Emergency Physicians. Dr. Stanton's uniquely-informed view is built on his work leading a physician-owned group staffing two Kentucky emergency departments, serving as EMS medical director for Lexington-Fayette County, and overseeing on-track medical response crews for auto racing series such as NASCAR. In this candid conversation with Raise the Line from Elsevier host Lindsey Smith, Dr. Stanton traces how underpayment from insurers is squeezing physicians and warping the incentives of emergency care, and why he believes the profession's ability to advocate collectively, not individually, is what will move the needle. This informative episode also explores: Why he thinks physician autonomy is the antidote to burnout; His approach to communicating medical information as a TV commentator; What it's like providing care at a NASCAR race when the “car is still smoking.” Mentioned in this episode: American College of Emergency Physicians If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

Plus: Federal Reserve Governor Michael Barr says the central bank will probably need to raise interest rates further to bring inflation down to its 2% target. And McDonald's pledges a $8.5 billion investment to help its franchisees. Alex Ossola hosts. Sign up for WSJ's free What's News newsletter. An artificial-intelligence tool assisted in the making of this episode by creating summaries that were based on Wall Street Journal reporting and reviewed and adapted by an editor. Hosted by Simplecast, an AdsWizz company. See pcm.adswizz.com for information about our collection and use of personal data for advertising.

Something unusual happened at the COMEX last week. A large amount of silver left the CME vaults. In this episode of the Money Metals Midweek Memo, host Mike Maharrey breaks down the numbers. He explains exactly what happened and the ramifications, highlighting the silver market's tight supply.  This week, Mike also engaged in some myth-busting, explaining why higher interest rates aren't necessarily bearish for gold and silver.  

Featuring an interview with Dr Douglas W Sborov, including the following topics: DREAMM-2 trial outcomes and clinical development of antibody-drug conjugates for multiple myeloma (MM); mechanism of action of belantamab mafodotin (belamaf) and predictors of response to treatment (0:00) Perspectives on findings from the Phase III DREAMM-7 trial of belamaf combined with bortezomib/dexamethasone for relapsed/refractory MM (4:26) Progression-free survival estimates with current quadruplet induction and maintenance regimens for newly diagnosed MM (6:36) Phase I DREAMM-9 trial and ongoing evaluation of belamaf in the up-front setting (11:48) Potential integration of belamaf into the relapsed/refractory and newly diagnosed MM treatment settings (16:00) Prevention and management of ophthalmic events related to treatment with belamaf (21:27) Case: A man in his mid 60s with multiregimen-recurrent MM receives single-agent belamaf (27:49) Case: A woman in her early 70s with recurrent t(11;14) MM and disease progression on single-agent belamaf experiences a sustained response to talquetamab (33:27) Case: A man in his early 70s with heavily pretreated MM receives belamaf with bortezomib (39:53) CME information and select publications

Featuring a slide presentation and related discussion from Dr Douglas W Sborov, including the following topics: Overview of the treatment landscape for early relapsed multiple myeloma (MM) (0:00) Belantamab mafodotin (belamaf) mechanism of action and Phase II DREAMM-2 study of belamaf monotherapy in heavily pretreated MM (6:20) DREAMM-7 and DREAMM-8 Phase III trials of belamaf combination strategies in patients with MM in the second- and later-line settings (9:20) Monitoring for and management of belamaf-related ocular toxicities (12:29) Phase I DREAMM-9 trial of belamaf in combination with bortezomib/lenalidomide/dexamethasone (RVd) for transplant-ineligible newly diagnosed MM (16:23) Ongoing trials evaluating alternative belamaf dosing; practical considerations and recommendations for the administration of belamaf (19:07) CME information and select publications

Negotiation is an important skill that physicians are rarely taught. Anees Chagpar, MD, MA, MBA, MPH, and Naman Desai, MD, speak with cohosts Winnie Hahn, MD, and Elizabeth Hecht, MD, about how preparation, practice, and a shift in mindset can help physicians negotiate with confidence and build careers that align with their values and priorities. Listen to their discussion in episode 3 of Mentorship Unfiltered, an AJR Podcast Series. https://www.ajronline.org/doi/10.2214/AJR.26.35921 *Key Takeaways The Collaborative Mindset: Negotiation is not a zero-sum, adversarial battle. Approaching the conversation as joint problem-solvers allows both the employer and employee to find creative ways to "grow the pie" and achieve mutual benefits. Expanding the Target: Candidates often make the mistake of focusing exclusively on base salary. Successful negotiators research historical precedents (like AAMC data) and ask for flexible perks, such as housing stipends, free childcare, CME funding, and specific call schedules. The Malpractice Trap: Understanding the difference between claims-based and occurrence-based malpractice insurance is critical. If a practice uses claims-based insurance, exiting the job requires tail coverage that can cost between $10,000 and $30,000; this should be negotiated upfront. Continuous Self-Advocacy: Negotiation does not end once the initial contract is signed. Mid-career physicians should continually reassess their value and leverage employer investments. *Chapters 0:00 - Why Negotiation Matters 4:00 - Negotiation Misconceptions 5:34 - Prepping Before First Offer 8:06 - Expand Beyond Salary 14:30 - Negotiation Phrases That Work Well? 16:16 - Avoiding Ultimatums 20:01 - Finding Market Pay Information 21:59 - Priorities and Job Stability 24:42 - W2 vs 1099 26:07 - Malpractice and Tail Coverage 28:55 - Money Priorities Checklist 31:27 - RVU Volume Reality Check 36:48 - Red Flags Researching Groups 38:25 - Switching Jobs and Credentialing 39:58 - Mid-Career Negotiation Never Ends 45:00 - Women and Negotiation Bias 52:32 - Institution Responsibilities 56:52 - Key Takeaways and Wrap Up Follow AJR on Social Media LinkedIn: https://www.linkedin.com/showcase/ajr-radiology/ YouTube: https://www.youtube.com/channel/UCfFAYezkLMxJGMgIJLN0Dpg Instagram: https://www.instagram.com/ajr_radiology/ TikTok: https://www.tiktok.com/@ajr_radiology X: https://x.com/AJR_Radiology BlueSky: https://bsky.app/profile/ajrradiology.bsky.social *These sections were generated using artificial intelligence (Descript and Google Gemini) and then reviewed for accuracy.

Sleep plays a critical role in brain development, learning, memory, and behavior throughout childhood and adolescence. In this episode, Dr. Kristin Seaborg discusses how sleep architecture changes across development, the impact of sleep disorders on attention, headaches, epilepsy, and neurodevelopmental conditions, and why neurologists should routinely assess sleep in pediatric patients. Learn practical approaches to recognizing sleep problems, including obstructive sleep apnea and insomnia, and how improving sleep can enhance neurologic and cognitive outcomes. In this episode, Casey S. Albin, MD, FAAN, speaks with Kristin Seaborg, MD, author of the article "Sleep in the Developing Brain" in the Continuum® August 2026 Sleep Neurology 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. Seaborg is an Assistant Professor in the Department of Neurology at the University of Wisconsin–Madison in Madison, Wisconsin. Additional Resources Read the article: Sleep in the Developing Brain 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 Guest: @KristinSeaborg  Full episode transcript available here Dr Albin: In neurology and life, we are all looking for the secret to being attentive, focused, and engaged, and we certainly want that for our children. And what if the answer to all of that was just in sleep?  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, this is Dr. Casey Albin. Today I'm interviewing Dr. Kristin Seaborg about her article on sleep in the developing brain. This article appears in the August 2026 Continuum issue on the neurology of sleep. Welcome to the podcast, Dr. Seaborg. Thank you so much for being here. I learned a lot from your article. Can you just briefly introduce yourself to the audience?  Dr Seaborg: Sure. Thank you for having me. I'm thrilled to be here. My name is Kristin Seaborg. I'm a pediatric neurologist and sleep neurologist at the University of Wisconsin Medicine. I also run the pediatric sleep neurology clinic at UW Madison.  Dr Albin: That is the perfect person to be writing this article. And every time I read an article about pediatric neurology, I am just so struck that like little tiny humans are not small adults, that they actually have a totally different neurobiology. They are in different stages of development. And this was really a topic that I was not familiar with, and probably for most of our listeners, they're not familiar with as well. And so, I thought we'd maybe just start with some of the basics. What is going on in terms of like pediatric sleep architecture, and how is that different than the adult architecture that we might be m- more familiar with?  Dr Seaborg: Sure. So, a lot of us think that sleep is the thing we do that when, when we're not doing other stuff. But actually, it's completely the opposite. During sleep, our brain is learning and consolidating memory and cleansing what's happened during the day, and that's especially important during infancy and early childhood development, and as a child gets older. If we take infants for an example, fifty percent of their sleep is in a precursor of REM sleep, which we call active sleep, which is much, much more than adults, as opposed to adults have about thirty percent of their sleep in REM sleep. And also, infants need sleep like fifteen to seventeen hours a day. Not all of that is consolidated in one continuous period. They usually sleep over the course of the day, fifteen to seventeen hours, and that sleep time decreases over the course of childhood and adolescence as well.  Dr Albin: Yeah, it's amazing that there's so much more going on. As someone who's had newborns, it feels like, oh my gosh, they're really just sleeping all day. They're not doing anything. But they're doing quite a lot, and that really is so much work for their developing brain. And then one of the things that also really struck me about the article is that as children move from infancy through adolescence, not only is the sleep architecture changing, but the time they go to sleep, the amount of sleep they need, some of the pathology that they may develop, it changes throughout these early years of their life. And so maybe when we are thinking about what patients might come to the clinic with, I assume a lot of parents are kind of concerned like, "Is my child getting enough sleep? Are they sleeping the normal amount? Are they sleeping in the timeframe that would be normal?" Walk us through just in broad strokes, like what is a normal amount of sleep as you go through that pediatric developmental phase?  Dr Seaborg: So that's not a one-sentence answer. And there's a table in the Continuum article.  Dr Albin: Love that.  Dr Seaborg: So, infants sleep like fifteen to seventeen hours, and it's chunked out over the course of the day. Usually they have one consolidated sleep period at night, but then two to three naps during the day. And as you move through early childhood, toddlers and adolescents usually need about fourteen hours of sleep around the time they're one year of age. As they get a little bit older, then they need like eleven to thirteen hours, depending on the child themselves. And then as we move toward like school age, like eight to ten hours of sleep is usually adequate, but especially younger school children need about ten hours of sleep at night. And then the interesting thing that happens in adolescence and early teenage years is that kids need just as much sleep, but they actually naturally fall asleep later because their melatonin is released later. So, it feels like they need to sleep all the time, but actually they just go to sleep later, and when school comes, it's not time or doesn't feel ready for them to wake up. So, adolescents and teens also need about eight to ten hours of sleep a night.  Dr Albin: Right. And I just was struck, you know, we think about it in this article and these issues, we've thought a lot about, I think it'll come up in other podcasts, the importance of daylight savings time and how that actually really is not good for our brains. And I feel so much for these teenagers who are really at a disadvantage because we make them get up early to participate in the world when it's not really aligned with how their natural sleep cycle is, and it feels unfair.  Dr Seaborg: It does. And there's so much to that. So, adolescents have school, and then a lot of time they have like after-school activities, whether that's sports or theater or music or whatever, but that usually happens after school. And then the reality of today's society is they come home, and at least my teenager disconnects or kind of decompresses by looking at her phone forever. And a lot of teenagers and adolescents bring their phone to bed. That exposure to light right up until the time when they want to go to sleep really can disrupt their circadian rhythm too. So they have the natural delayed circadian rhythm, and then they have these lifestyle exposures between activities after school and screens and everything else that really make sleep onset difficult. And so, waking up for school at 6:00 or 7:00 in the morning is really difficult for them.  Dr Albin: Gosh, I feel for that. And I suspect that many patients are coming into the sleep clinic with that exact sort of like my early teen, my preteen, my teenager. They're just exhausted all the time, but they won't fall asleep. They're developing insomnia. It sounds like there's a lot of behavioral changes that need to go along with that. Is that what you're seeing?  Dr Seaborg: Yeah. So, I'm also seeing an kind of a corollary, a lot of kids that come in with headaches because they're not sleeping enough, and they feel awful, or they're coming in with difficulty focusing in school or cognitive fog because they're not sleeping enough, and that they don't always know that that's the chief complaint. But often, as you start asking sleep-related questions, you figure out exactly what's going on. So, their amount they're sleeping and kind of their natural sleep cycle is affecting everything about their life.  Dr Albin: Yeah. It just-- it really struck me that, you know, one of the things that you talk about in the article is that there is, in patients who have neurodevelopmental differences and disorders, they may specifically have some sleep impairment, and they have a neurobiological reason for those sleep changes. But also, like you're saying, sometimes these inattentions or what's diagnosed as ADHD is actually just because they are not sleeping well, and they can't focus. And I imagine that's really hard to tease out. Like, is there something when you're trying to tease that out in the clinic that helps you figure out, is it the dog wagging the tail or the tail wagging the dog?  Dr Seaborg: Sure.  Dr Albin: Which is coming first? Is it, is it really a neurobiology problem where they have nerve developmental disorders and therefore sleep problems, or they have sleep problems causing the symptoms of a nerve developmental disorder?  Dr Seaborg: So, there's so many ways to answer that question. The very first part is you start at the beginning, not only asking the person's chief complaint, like, "Are you having trouble with attention?" But then also, uh, like I'll say, "Okay, what time do you go to sleep?" But not only that, "What are you doing before bedtime?" And then once they're asleep, are they snoring? Are they waking multiple times at night, you know, without trying to? And when they wake up in the morning, do they feel refreshed, or do they really still feel like they could fall asleep for a very, very long time? And then with regards to the neurodevelopmental disorders, it's fascinating. A lot of kids with neurodevelopmental disorders, whether that's ADHD or autism spectrum disorder or a genetic disorder that causes a developmental difference, often some of the pathophysiology of the actual neurodevelopmental difference also impacts the circadian rhythm and melatonin release and the brain's ability to initiate and maintain sleep. So, it's really important as a provider to be cognizant if you're seeing your patient with autism or ADHD to also ask about their sleep-related symptoms. And then eventually you'll ferret it out, but it takes a lot of sleuth work and investigation.  Dr Albin: So, what I'm hearing is actually when people come in with a chief complaint that probably is not like, "Hey, I'm having trouble sleeping," but maybe, "I can't focus" or, "I have headaches," or I have other problems that are being referred to a neurologist or pediatric neurologist, it really does behoove us to pause and take a good sleep history on all children coming in.  Dr Seaborg: Yes, and I'm gonna piggyback on that. Also, very, very important for our patients with epilepsy. There's a super high coincidence with epilepsy and sleep disorders, and there's actually been direct comparisons with children that-- typically developing children and children with epilepsy that's poorly controlled, and the amount of sleep-related complaints and sleep-related symptoms they have is astronomically higher. So, it's important as a neurologist to always have sleep kind of on our front burner, something we're paying attention to.  Dr Albin: No, it's so true. You know, I learned a lot about pediatric sleep and epilepsy through the article, and I think that obviously we wanna refer the listeners to checking out a little bit more. But there were a couple of things that were new terms to me that maybe others are not familiar with, and it does relate to like they are epilepsy, but they are more nocturnal, and they have more nocturnal epilepsies that we might need to really think and consciously consider. So, the new terms for me were SeLECTS, which I assume is actually just said as SeLECTS, but stands for... You tell me, what does it stand for?  Dr Seaborg: Self-limited epilepsy with central temporal spikes.  Dr Albin: Perfect. So okay. So, let's just start with that. Like, what is going on there? What do I need to know about it?  Dr Seaborg: So, SeLECTS was previously known as benign rolandic epilepsy 10 to 20 years ago, and then that, the term evolved to childhood epilepsy with central temporal spikes. But then it evolved again to SeLECTS, which is self-limited epilepsy with central temporal spikes. I think the primary motivation of changing the terminology, at least initially, was to acknowledge that even though this type of epilepsy occurs during childhood and it's self-limited, it is not benign always because seizures can cause some daytime dysfunction, and also there has been some association with ADHD-like symptoms or learning disability symptoms later in life. The other term you just mentioned, developmental epileptic encephalopathy with spike wave activation in sleep. That's a mouthful. That's the new terminology for what we used to call ESES or electrical status epilepticus of slow wave sleep. So, DEE-SWAS, developmental epileptic encephalopathy with spike wave activation in sleep is a broader term to encompass a bunch of epilepsy syndromes that have spike wave activation that during sleep, it is associated with developmental delay and per-perhaps developmental regression.  Dr Albin: And is that typically seen early childhood infancy? Like, I think of that as being something that you're gonna encounter really early in the life cycle. Am I correct?  Dr Seaborg: Not always. Sometimes, like school-aged children, one of the classic presentations is what it can be known as Landau-Kleffner syndrome, where you have spike wave activation during sleep in a, a school-aged child at like between the ages of six and 10, and then they have language regression, and you look at their EEG overnight and you see that they have epileptiform activity for up to 85 to 95% of the night.  Dr Albin: Wow. So, I wanna drill down on this. Since both of these things may come up, and probably are not something that the family is coming to you and saying, "Hey, I've seen these bizarre things happen in sleep," but are coming with daytime symptoms, how is it that you decide who is going to need a pediatric sleep study?  Dr Seaborg: Great question. So, if a child ever or a parent ever comes and complains or with concerns of developmental regression, and I guess I'm biased cause I'm a sleep doctor, but I would always do an EEG recording overnight if there were any concerns. And then if patients come and they just talk about rhythmic movements at night or waking up at night with some facial twitching, or the next day they're really acting tired, then I would order a sleep study. And of course, I would always ask the typical questions: Are they snoring? Are they waking up with a headache or not well refreshed? And ask a little bit more about a sleep history. But developmental regression and rhythmic movements at night definitely should be studied.  Dr Albin: And those questions about, you know, snoring at night, waking up with a headache, you're trying to get to pediatric obstructive sleep apnea. Is that right?  Dr Seaborg: Correct. Yes. Thank you for clarifying.  Dr Albin: Yeah. No, I just wanna make sure, like, because obviously that is a very common problem in the adult patient population. How frequently are you encountering that now in pediatric land?  Dr Seaborg: So actually, it's more common than you would think.  So kids have, especially kids that I'm seeing in the pediatric neurology clinic, sometimes have some different facial anatomy or enlarged tonsils or enlarged adenoids, or they have a primary genetic disorder that gives them a little bit different facial anatomy, and they're at much higher risk for obstructive sleep apnea. Kids with different muscle tone, whether they have cerebral palsy or a different kind of hypotonia disorder, are at very high risk of obstructive sleep apnea. And then kids with epilepsy, for reasons that we don't fully understand, are at higher risk for obstructive sleep apnea. So, it's actually quite common in children. We see it a lot.  Dr Albin: Wow, that's fascinating. And then I wanna just in our little limited time together, there were two other sort of neurodevelopmental disorders that came up in the article and I think are at least worth previewing for the listeners. So, autism spectrum disorder, obviously a very large and a range of how patients can present, but sleep really does seem to be a manifestation. Walk us through the association there.  Dr Seaborg: Sure. So, we don't know 100%, but I can give you a few statistics. For instance, 20 to 75% of kids with autism spectrum disorder have some sort of sleep onset or sleep maintenance insomnia or some primary sleep disorder, which is astronomically high. We all know the etiology of autism is multifactorial, and there's not just one gene or one difference that leads to autism, but there are a fair amount of genetic differences that sometimes can lead to a diagnosis of autism spectrum disorder. We've found there's kind of coincidence of some differences in some of the circadian genes. Specifically, time and clock are two of the circadian rhythm genes that have been shown to have higher incidence of differences in kids with autism spectrum disorder. And then kids with autism spectrum disorder also sometimes have some underlying anxiety or hyperactivity in it that also compounds their difficulty falling asleep and sometimes their difficulty staying asleep at night. And so, there's multiple things that are playing in that can make sleep difficult, which in turn can affect their daytime performance and their daytime regulation. So, lots going on there.  Dr Albin: Absolutely. I mean, in reading this, I was struck by, oh gosh, there's a lot of both pharmacological and sort of behavioral therapy that has to go into like readjusting and, and setting normative patterns and expectations. It sounds like melatonin can, in some cases, be helpful here.  Dr Seaborg: Yes, melatonin. So, I know there's a lot of patients will come to me, they're like, "I don't wanna use melatonin 'cause my Facebook group told me it was terrible." There's a lot of literature and a lot of recently published literature to show the safety and efficacy in low-dose melatonin, especially in children with neurodevelopmental disorders and specifically in kids with autism spectrum disorder. Melatonin is safe and okay to use. It's important to educate your patients though. So, a little bit works, and then a patient's kind of natural reaction is, "Oh, if a little bit is good, I'm just gonna give them more." But the more melatonin you give a person, actually the less their brain produces, and it's almost like a negative feedback. So, the studies support using two to five milligrams of melatonin one to two hours prior to bedtime to kind of stimulate melatonin release and then help with sleep onset. Melatonin does not help with sleep maintenance, but for the kids that are on the kind of neurodevelopmental disability or disorder spectrum, it really can help with sleep onset. Dr Albin: Yeah. I was really fascinated to hear that there is some more evidence for the extended-release formula. And is that something that you can just go onto Amazon and get the extended release or is that prescription?  Dr Seaborg: It's not prescription. You can 100% go onto Amazon and get the extended release. Immediate release melatonin will help with sleep onset, but then a lot of kids w- with brains that work differently wake up two to three hours later. The extended release can stick with you for a little bit longer.  Dr Albin: Well, there you go. I always love the things that you're just like, "All you gotta do is get on Amazon and it'll come to your house the next day." We all love a quick fix like that.  Dr Seaborg: Right.  Dr Albin: The other topic that came up is obviously patients with ADHD and, like, how their sleep really can both impact how they are performing and some of their symptoms of inattention, and may also sort of compound, you know, or, or be a, um, manifestation of the fact that there is a neuro biologic difference.  Dr Seaborg: Right. So, ADHD is an interesting kind of disorder, disability, or condition, um, because there's so many things that play into that. Sleep-related stuff, we've been residents before, and, you know, the longer that we're awake, actually the harder it is to focus and concentrate. Interesting, there have been some stereo EEG patients that they've shown that sleep is not the whole brain happening at once, but actually there are parts of the cortex that can ha- fall asleep in, like, micro-sleep or local sleep after prolonged periods of wakefulness even while you're awake. So, it can look like you're inattentive, but literally part of your cortex is falling asleep. So, these patients that have been awake for forever or had prolonged periods of wakefulness can look like they have inattention, but actually they're just sleeping poorly. I see this a lot in kids that have previously undiagnosed obstructive sleep apnea or previously undiagnosed periodic limb movement disorder. The parents come with a chief complaint of inattention or difficulty focusing, and then the sleep studies show that their sleep is very disrupted, and we treat OSA, and all those symptoms are better. Conversely, kids with ADHD, so the neurobiology of ADHD, the neurotransmitters that are implicated in ADHD that kind of regulate wakefulness are also different, so, like, norepinephrine and epinephrine and stuff like that. So, it makes falling asleep harder in kids with ADHD just because their genetic makeup and how kind of their brain and their biology is working. Insomnia is a common disorder in kids with attention deficit disorder.  Dr Albin: Wow. It's just amazing how integral sleep is to just the whole function. I'm not surprised because we certainly feel that having been residents. We, I think we all, as doctors, acutely know how bad it feels when you do not sleep well. We are coming to the end of our time. A lot of these questions that I had posed for you we've actually kind of answered, but I did want to give everyone who's listening in, and maybe they're in the car or cooking dinner, you might not have heard the snippet. This is just rapid-fire questions that you may encounter in neurology clinic or pediatric neurology clinic. Quick answers. My child snores. Is that normal?  Dr Seaborg: No. It's not normal, especially snoring and pausing. So, I, like, the guttural pauses. Never normal. That child should have a sleep study.  Dr Albin: Perfect. The Facebook group said that melatonin is not safe. What do you think?  Dr Seaborg: Low doses of s- melatonin are 100% safe and efficacy or efficacious, excuse me, in children. Um, but low doses. Two to five milligrams at the very most. If it's not working, use less. Don't add on more.  Dr Albin: Love that. My teen is up till midnight. Why?  Dr Seaborg: Unfortunately, your teen is normal, and their biologic clock is moved back as they approach adolescence, and their melatonin release is later. One thing you can do is make sure that the screens are out of the room two hours before bedtime, and that they have some downtime before bedtime.  Dr Albin: And then finally, a sleep study, that seems very intense. Can my child have that?  Dr Seaborg: Your child can 100% have a sleep study, especially the certified sleep centers are really good about dealing with kids that don't like all the sensors or the leads, and they can come in and readjust. I would highly recommend it. It's worth your time, especially cause it's a low-hanging fruit that we often can help.  Dr Albin: Love that. All right. Again, I've been interviewing Dr. Kristin Seaborg about her article on sleep and the developing brain. This article appears in the August 2026 Continuum issue on Neurology of Sleep. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

With more cheese competing for buyers around the world, could the global market be headed for a price war? U.S. cheese plants are running full, whey protein demand is supporting production and exports have been strong. But at home, cheese demand remains soft. That puts more pressure on exports to keep product moving. In episode 106 of The Milk Check, host Ted Jacoby III sits down with the T.C. Jacoby & Co. cheese team to discuss what happens when growing U.S. production meets intensifying competition overseas. In this episode, we cover: Why international buyers are asking for more cheese varieties, and where that could create opportunities for U.S. suppliers How freight costs and the strength of the U.S. dollar could make American cheese less competitive overseas What happens when stronger milk production in New Zealand and continued competition from Europe could puts pressure on global cheese prices Listen to The Milk Check episode 106, “We Have a Cheese Problem,” for the T.C. Jacoby & Co. team's take on what could be ahead for the global cheese market. Got questions? We'd love to hear them. Submit below, and we might answer it on the show. Ask The Milk Check Transcript: [Intro commercial text not included] Ted Jacoby III: Coming up on The Milk Check. Are you saying if we produce 2% more cheese and it all has to go into the export market, it’s gonna be a price war? Brianne Breed: Yes. Ted Jacoby III: Welcome to the Milk Check from T.C. Jacoby & Co., your complete guide to dairy markets, from the milking parlor to the supermarket shelf. I’m Ted Jacoby. Let’s dive in. Ted Jacoby III: Hello, everybody, and welcome to The Milk Check. Today is September 21st. Today we’re gonna talk cheese. I’ve got my cheese team here today. We’ve got Brianne Breed, Jeff Daanen, Miguel Aragón, Jennifer Kuo, and Michael Brown joining us. We even have Diego Carvallo to help us talk a little bit about international. But we’ve talked a lot about cheese, we’ve talked a lot about how much cheese we’re producing and how whey protein seems to be driving cheese production right now. But I thought we’d get some really great insights from our cheese team in terms of what they’re seeing out there. Bree, I’ll start with you. If you had to explain the U.S. cheese market right now without even looking at CME prices, how would you describe it? Brianne Breed: There’s a lot of cheese out there right now, especially a lot of cheddar. The large plants that have expanded over the last few years are running very full, and a lot of that is because of what you mentioned: with whey being in high demand. We’re finding a lot of cheese out in the market. Exports have been very strong. I think that there’s been a really big push over the last few years to get more and more cheese exported from the United States, and we’ve been very successful. Mozzarella seems to be growing every year. But at the same time, domestic demand has definitely slowed down. Restaurants lost maybe 1% to 2% foot traffic this year. Retail demand is also down to flat. We’re in this weird spot right now where we have a lot of cheese being made and we’re exporting a lot, but domestically, we’re not consuming as much as we have in the past. Ted Jacoby III: What’s going on in the domestic market? Are we seeing any growth anywhere? Brianne Breed: We are seeing growth in a few of the pizza chains that have been making some good pushes using mozzarella and some good deals just because, you go to out to a restaurant right now and it’s very expensive to feed a family of four, where you can just order a couple of pizzas and have your fixed cost. You know what you’re paying. And so pizza’s been doing better than it was the last couple of years, which I guess you could say is great because it was struggling for a couple of years there. But as far as anything positive domestically, it’s been a struggle, I think, on the cheese side. The positives are really more on the powder side and on the UF side. The protein demand for Americans right now is just crazy. I’ve never seen it like this, and we’re seeing cheese being made just so we can get the whey stream, and we’re seeing some cheese manufacturers lose some of their farmers because those farmers are actually taking their milk to other plants that maybe are making UF milk to go into protein beverages. Ted Jacoby III: Mike, I’m gonna ask you this question. One thing that seems really odd to me is that we’ve been talking about protein a lot. The whole nation seems to wanna be talking about protein, but it doesn’t seem to me that domestic cheese demand is participating in the big increase in demand for protein, yet for years we’ve always talked about cheese as a protein, comparing it to meat, in terms of where it fits on the pyramid. Mike Brown As far as cheese and protein, people just don’t affiliate it as a protein source like they do, for example, all the nutrition beverages that we’re seeing now and some other products. It tends to be fairly high calorie, although we know it’s very nutrition-dense. And so, when consumers are looking for that avenue to increase proteins, particularly quality dairy proteins in their diet, it’s pretty evident they’re moving toward the beverages and the bars, even though cheese is a good source. It’s been a bit of a surprise, particularly with butter being so strong, that cheese retail sales haven’t had a little more lift than they’ve had. They’ve been pretty flat. I think a lot of it is just how we’ve promoted those protein beverages and the focus, and frankly the shelf space they’re now getting in a lot of your stores, particularly your big box stores and your big club stores. Ted Jacoby III: Okay, thanks Mike. Jeff, what are you seeing out there? Where are the places where you see demand being decent domestically for cheese? Jeff Daanen: Pizza sales seem to be extremely strong, and mozzarella is tight. There seems to be plenty of colored cheddar out there. Retail is down, food service is down. I don’t see where we’re gonna see any relief real soon. White processing solids are still in high demand for processing plants. We heard that there’s a big expansion going on down your way and there’s a big expansion for making processed cheese in Minnesota as well, too. So, I think that will stay strong. The one thing that there is a lot of is colored processing solids that really are hard to get placed. Ted Jacoby III: What about the export market? Jen, what are you seeing out there? Jennifer Kuo: Export demand is really good this year. I think the biggest barrier are a lot of the things we cannot control. Obviously, freight has been really bad both domestically and internationally this year. It’s hurting everybody’s budgets. The demand is there. What we’re learning is that there’s more opportunity for new and innovative ways to get cheese into the international market. They don’t necessarily have all the conversion capabilities that we do in the U.S., so we’re moving more finished retail-ready goods internationally than we do domestically. But those are all, avenues we’re pursuing, and the demand is there. We are surprised, I think, month over month that freight keeps going up and the customers keep placing orders, so don’t know where that kind of ceiling will start making an impact. But as of right now, we are able to move even a good amount of colored cheddar overseas, more than we have in the past. That’s the metric we use domestically to measure how much colored cheddar volume are we moving. That’s what the market is based on. Overseas, it’s more a combination of many other different kinds of cheese. Not necessarily as colored cheddar-based, but it’s still, a good measuring point for many of our customers. They still understand that’s what we make day in and day out. But yeah, we have seen good growth in Asia, the Middle East, and South Americas, and Australia. Oceania is still very strong. We’ll see what happens if freight doesn’t start leveling off. Ted Jacoby III: Miguel, how about you? What are you seeing as we look south? Miguel Aragón: I have to echo what Jen just said. We are seeing still a lot of interest in Mexico and the rest of Latin America. But there are three things I’m really looking at right now. I’m looking at what the CME is doing because that is helping, undoubtedly. But freight is hindering us. However, the exchange rate is favorable right now. If any of those three things change, if the CME starts going up or the exchange rate starts going up and the dollar starts getting stronger we may see some movement in regards to demand. But right now, so far, whatever freight was gonna hurt us is being helped by the CME. The second thing is that the types of cheeses that are going into these markets like Mexico, Colombia, Peru, Chile Panama, are diversifying. We are no longer just shipping a cheddar. Now, we have a lot of demand for Colby Jack, Pepper Jack, Gouda, Monterey Jack, feta, others that we never used to have before. The market is diversifying. And of course, we do have a lot of demand for mozzarella still. Ted Jacoby III: When we talk about international cheese demand, is it more restaurant-driven, food service-driven, or is it more retail-driven? Miguel Aragón: At least a lot of our clients are food service and retail. Ted Jacoby III: So both? Miguel Aragón: They’re both. They’re both. We have requests for for pound blocks that are going to converters that are either, cutting or shredding the product. But, also, we’re finding a lot of requests for five-pounders or retail packages ready to go. So, we’re seeing it in both places. Ted Jacoby III: We’ve seen some really excellent growth just in international cheese demand in general. One of the slides when we had Will Loux from the U.S. Dairy Export Council on that really stuck out to me was the fact that, the overall global cheese trade has gone up enough that all the major exporters have been exporting more cheese the last three years. It’s not just the U.S. taking market share away from someone else, it’s everybody that’s been benefiting. Bree, I’m gonna throw this one out to you. Is that gonna continue? Are we hitting a wall in terms of global cheese demand, or is it we’re just gonna keep going? Brianne Breed: I think we’re gonna keep going. I think it could be slower, right? We really accelerated very quickly the last year or two. And I think that, with everything going on around the world right now I think it’s going to slow things down, but I think that the volume and the opportunities are going to keep growing year-over-year. Ted Jacoby III: Who’s our biggest competitor right now in the world market? Who should we be afraid of? Europe, New Zealand? Brianne Breed: I think that we need to keep our eyes on New Zealand. They’re entering spring right now, and their milk production is up. I believe it’s up 2% in last month. And we haven’t even hit spring really. So, I think these next couple of months they’re gonna have plenty of milk to go towards cheese production and other dairy products. We definitely need to keep our eyes on New Zealand and on where they’re marketing. Like Jen mentioned, we have gained a lot of ground in Asia and Australia. But when you throw in the elevated freight rates into those regions from the United States, like it’s gonna be a competition. And then, I do think Europe’s gonna enter the party here, also. We’re approaching a time when we’re all going to be maybe racing to the bottom to try and capture as much business as we can. So, 2027 could be a very interesting year for other reasons. The first half of this year in 2026, we exported a lot of cheese out of the United States, and I think we’re gonna need to continue to do that. I just think our pricing’s going to be quite different than it was earlier this year. Ted Jacoby III: Sounds like you’re bearish. Are you saying if we produce 2% more cheese and it all has to go into the export market, it’s gonna be a price war? Brianne Breed: Yes. Ted Jacoby III: Who do you think’s gonna lose between us, New Zealand, and Europe? Brianne Breed: I think Europe’s gonna lose. I think that we, in the United States, we’re gonna make it happen, no matter what. We have a lot of capacity to make just about anything that the international market needs. We can change things in order to adapt to the growing demand internationally, whereas a lot of the European manufacturers can’t adapt as quickly. Ted Jacoby III: Really? That’s good to hear. It’s exciting to hear to me that the U.S. producer is starting to figure out how to be flexible and how to meet the needs of the international market. Give me some examples. Miguel, Jen, Bree, give me some examples of how the U.S. has been adapting to the international market. Jennifer Kuo: It’s almost that they adapted to us. I’ll say innovation in new foods and new trends seems to be moving faster overseas than in the U.S. We have had a very robust domestic market for a very long time, but cheese is still very new in some of the international markets. Bree was introducing the slices to Australia. Just that American cheese slice on a burger is still pretty new for them. We’ve grown a lot of cream cheese, both in South America and Asia, just because of new innovations that the end user there has figured out with what we have in the U.S. that, in the U.S. we use cream cheese in bagels, in bakery, and sushi, but we haven’t concentrated as much on finding the next new innovation as much as they do overseas. And Pepper Jack and Colby Jack and some of these are still very new over there, but we’ve had them here for decades. So, I think it’s just the overall growth to the entire range of cheeses we offer. It’s not just, oh, cheddar or American cheese or mozzarella anymore. Those all grow, but in addition to other things as well. And USDEC, a lot of the programs they run overseas are to help the end customer innovate and find new ideas and new foods that they introduce to the market. I’m a little bit older now, but I can say when I was younger, I was the only person in my entire family that ate cheese. And I think many of my cousins and extended family in Asia still don’t have regular access. They can’t go to the grocery store and just buy cheese, whether it’s from Europe or the U.S. or Australia. So, cheese is still very available to us here, which is not necessarily true to all the customers internationally, and that’s something that is growing much faster than it is here. Ted Jacoby III: So, Jen your cousins in Asia. When they consume cheese, where do they consume it? Jennifer Kuo: Pizza was the first food that was introduced. Pizza Hut I feel like Pizza Hut’s not necessarily one of the brands you hear a lot about in the U.S. There are many other pizza brands that have expanded and grown beyond that. But Pizza Hut is very big in Taiwan and China. They put a lot of effort into expanding in the late ’90s, early 2000s, and that was still their first introduction to cheese. It was something all of my cousins in Taiwan had not had up until then, and it wasn’t really available on any other foods. ‘Cause, Asian food doesn’t quite yet incorporate a lot of dairy like that. And then McDonald’s obviously has grown there. And now I can say just in June when we were in South Korea, the big talk was the first Chick-fil-A was opening in Seoul, and everybody was really excited to try that. So yeah, there’s just a lot of growth about U.S. brands and U.S. foods overseas that we take for granted here almost. We can get it almost anywhere. We have, I think I have five Chick-fil-A’s within a reasonable driving distance of my house, and they were all very excited in a huge city metropolis that, “Oh, there’s gonna be one. We can all go.” And so yeah, the growth overseas has been exciting. Ted Jacoby III: What kind of flavors do they put on pizza in places like Taiwan and Korea? Jennifer Kuo: Mainly what they call mozzarella, but I can say the last time I was there, so that was over a decade ago, it wasn’t what we consider mozzarella. It was kinda just a white American cheese blend. Something that would freeze and melt and do everything they needed to do. But yeah, now we’re seeing, the demand for mozzarella, like a true U.S. mozzarella, is really high, almost to the point where we can’t keep up production-wise with the demand overseas. All the capacity we’re adding in the U.S. is exciting. I think 2027 will be a really good year. Their palate for what they used to consider cheese was very generic, and then now they know there’s many other options they can add on top of what they used to just call cheese. Ted Jacoby III: It’s just not pepperoni pizza and cheese pizza and sausage pizza. They- Jennifer Kuo: Not anymore. It was for a long time, but not anymore. Ted Jacoby III: So what’s an innovative cheese concoction that you’ve heard when you’ve traveled in Taiwan and Korea? Jennifer Kuo: Something that includes seafood, which I still don’t really see here. That’s the innovation that they’re trying that we don’t necessarily see as prevalent here in the U.S. I’m not sure a seafood pizza would sell here, they also have access to probably fresher seafood than 50% of the U.S. Miguel Aragón: In regards to the question of who would be more susceptible to our growth, and Bree said the Europeans, and I have to agree 100%. Because at first we were just replacing, let’s say, Gouda or an Emmental coming from Europe into the Mexico market or the Latin Americans markets. But now not only have we taken a lot of that market, but we are going in with the varieties that we produce, like a Monterey Jack, that in Mexico it replaces a Manchego, for example, or we’re going with a Pepper Jack. Things that are made for the U.S. market are actually really gaining ground in Mexico, Central America, South America. There is not much of a chance that unless they start producing things like that, that they will take that market. So, we are not only taking some of the market, but we’re innovating with some of the domestic product that we have that is being accepted in those markets. Ted Jacoby III: Everybody, we will be right back after these messages. [Central Commercial] Diego Carvallo: I’m Diego Carballo with T.C. Jacoby & Co. T.C. Jacoby & Co. specializes in international dairy markets. For new customers that haven’t done business with Jacoby, I would tell them that we can provide them with many of the powders, dairy products that they consume, not only with the physical product, but we can also help them mitigate their risk. We know dairy. We know the main players. We know the main providers for the whole value chain. We are one of the strongest players in the U.S. market because we have contact all the way from the farmer moving the liquid milk all the way to the end users that buy the end products. I am Diego Carballo with T.C. Jacoby & Co., and we bring dairy to the world.  [End Central Commercial] Ted Jacoby III: Bree, Jeff, is the CME price in the let’s call it the, the 130s and 140s right now in September, is it accurate? Is it an accurate reflection of where the market is today? Brianne Breed: I think so. Jeff Daanen: I agree. I think it’s very accurate of where we’re at. Ted Jacoby III: just because there’s more than enough cheddar out there and we’re having trouble clearing cheddar. Brianne Breed: Yes. We had a lull, I think, back in August where freight rates had come down a little bit. A lot of the export deals had already been put together, cheese has already been made. It was still just wrapping up leaving the country. A lot of that business that was executed for first half production. And we just hit this lull and colored cheddar started backing up back in August, and it just has continued into September. Things have slowed down. I think that everyone’s excited for the holidays to come so that we can clear out some inventory and reload, after the holidays. I’m just a little concerned, with some of the data we’ve been seeing about, restaurant foot traffic being down and retail being down, that we’re not gonna completely clear that inventory that has started to build back in August, and is continuing to build right now. We’re all thinking good thoughts at the moment, but we’re gonna need this low price. So, it goes back to, are we at the right price? I think so. I think the 1.30s, it’s a very low historical price for cheese, and if we stay down here, I think that’s gonna help get some more promos out there so that the consumer starts seeing lower prices on the shelves and start buying more. Ted Jacoby III: I can’t disagree with what you’re saying. What about the mozzarella market? If the mozzarella market was a CME market, would it be a higher price, let’s say, than cheddar right now? Is that market a lot tighter? Jeff Daanen: Mozzarella is extremely tight. Brianne Breed: Especially in the Midwest. Jeff Daanen: Yep. Ted Jacoby III: So, it almost sounds like we’ve added too much cheddar capacity and not enough mozzarella capacity in the last three to four years. Brianne Breed: Jeff works with a lot of mozzarella manufacturers in the Midwest and I will say all year mozzarella has been balanced and then tight and then balanced, and now we’re tight again. It’s the Midwest and there’s more competition, I think, for the milk. And given everything that’s going on with GLP-1 use and protein being the focus, a lot of that milk that used to be a surplus for some of those mozzarella manufacturers is no longer there. And so, we’re not seeing as much mozzarella being produced. But you look out west at some of those mozzarella manufacturers, and they do continue to have some additional product, it’s just the freight to get it to the Midwest is so high that it just doesn’t make the math equation work. So, mozzarella just continues to be tight. It’s kinda like CME cheddar block. White cheddar may be tight, but colored cheddar’s really long. Mozzarella Midwest, very tight. Mozzarella out west, balanced. Ted Jacoby III: All right, I’m gonna go around the room as we wrap up. What do you think is the biggest risk to the cheese market, either upside or downside, over the next six to 12 months that you think people are underestimating? Jeff Daanen: Freight is obviously a major concern. I don’t see a lot of traction of ads via your big box stores. You don’t see a lot of advertising. You see a lot of variety in these stores, I don’t see where cheddar gonna sell at a buck 89. Nobody’s doing the ads. Mike Brown I think Jeff just hit on it. Having worked in retail, we don’t aggressively promote cheese like we used to. That really ended during COVID when cheddar got so high and markets got so high. We just aren’t as aggressive in our promotions. Even though the store brands are doing well, even there, the promotions aren’t as strong as they used to be on the retail side. And then the second one is if we don’t keep our world demand for our cheese strong, and that’s not a secret. That’s the thing that I worry about. Jennifer Kuo: International and domestic, this is the same. Freight has continued to go up this year. Regardless of demand, at some point, freight prices it out of what the end consumer can afford. No matter what promotions we run, when you’re paying three times in freight what we were paying in January of this year, 2026, and there’s no relief in sight at some point, that affects everybody’s budget. Ted Jacoby III: Makes sense. Miguel, how about you? Miguel Aragón: Freight is the thing to keep an eye on, and the dollar strength too. If the dollar starts strengthening, and our exports will become more expensive. If our producers for some reason let the innovation go, or they don’t continue, for some reason, pushing as they are right now, we will suffer. Ted Jacoby III: Thank you, Miguel. Diego, I’ve been ignoring you ’cause we’ve been talking about cheese. Diego Carvallo: That’s fine. Ted Jacoby III: … What are your thoughts? Diego Carvallo: Good lesson for me though. The main thing that people are probably not expecting, I think it’s gonna happen, is Latin America, and particularly Mexico demand is gonna be pretty strong. And that’s gonna disappear a lot of product in the coming years. Ted Jacoby III: Bree, we’ll finish with you. Brianne Breed: I think that we just need to keep our eyes on the international markets. Obviously freight, we’ve talked about that being very high, and it will probably continue to be high domestically and internationally. Everybody’s going to be dealing with that, though. So, I think we need to keep our eyes on just where the cheese is trading in Europe and in Oceania because those are the markets we’re gonna continue to compete with. So, if we need to focus on getting more cheese out of the U.S., we need to maintain a competitive price. Ted Jacoby III: Do you think we will continue to have a competitive price? Brianne Breed: I think so. I don’t think we have a choice anymore. Ted Jacoby III: Before we close, guys, share with everybody what shows we’re gonna be at. Miguel, are you gonna be at any international shows in the next month or two? Miguel Aragón: Yes, I will be in FOOD TECH® Mexico on the 29th of September and the 1st of October. Please come visit us. We’ll be talking cheese. We’ll be talking butter. We’ll be talking ingredients. We’ll be talking everything. Ted Jacoby III: Looking forward to it. I’ll actually be there, too, and so will Diego. How about you, Jen? What shows are you gonna be at? Jennifer Kuo: It’s a busy week in the dairy industry. I will be in Santiago, Chile for Espacio. So, also representing cheese, butter, and dairy ingredients, and everything Jacoby can help anybody with. Ted Jacoby III: Awesome. All right. Bree, what shows are you gonna be at in the next few weeks? Brianne Breed: In October, I’ll be attending SIAL Paris Food Show along with Joe, who will be representing our butter and ingredients group. And then Joe will be attending FI Europe in Germany. Ted Jacoby III: And I think I’m gonna tag along with Big Joe for that as well. Brianne Breed: So yeah, lots of travel coming up. Ted Jacoby III: And it sounds like we’ve got a lot of cheese to sell. Brianne Breed: Always. Ted Jacoby III: Excellent. Thanks, guys. Thanks for listening, everybody. Look forward to seeing everybody soon. ​[Ending commercial not included]

Join us for a FREE live Q&A with Dr. Boz on October 14 at 9:00 AM PT / 12:00 PM ET and ask her your questions directly. No membership required. Register here.What happens when an internist teaches ketogenic nutrition to 200 students at the same time and tracks every one of their glucose and ketone readings on shared dashboards?Dr. Annette Bosworth, MD, known to her audience as Dr. Boz, is an internal medicine physician and the author of ANYWAY YOU CAN and ketoCONTINUUM. After leaving corporate medicine she rebuilt her practice around ketone metabolic therapy, first with her own patients and now through a live 21-day class where small groups of ten work with coaches who have done the diet themselves.In this episode she walks Dom D'Agostino through what that model has taught her: why every student does a 72-hour sardine fast and the changes she has observed in morning glucose and ketone readings the day after, how she started a medically supervised group already in ketosis on 0.6 mg of tirzepatide once weekly (approximately one-quarter of the labeled 2.5 mg starting dose) and her report that roughly nine in ten stayed at that dose, and why she asks every participant to keep their own physician involvedThe conversation also covers the six-week ketogenic trial she ran with her mother during a leukemia recurrence, why she treats carbohydrate cravings the way she treated addiction in her clinic, and the free weekly support groups that classes from her first cohort still attend.Questions Answered in This Episode:What has Dr. Boz observed during her 72-hour sardine challenges?What did Dr. Boz observe when using low-dose tirzepatide in patients already in ketosis?What does "relief, not joy" reveal about carbohydrate addiction?Why can blood pressure medications require reassessment when starting a ketogenic diet?Why does she emphasize physician involvement when participants take prescription medications?Why does she combine group coaching with glucose and ketone tracking?Listeners and viewers will come away with a practical picture of ketone metabolic therapy as it is actually delivered: the protocol, the monitoring, the medication monitoring and reassessment, and the community structure that keeps people in it.Special thanks to the sponsors of this episode:✅ Genova Connect: Get 15% off any Genova Connect test kit with code METABOLICLINK here. ✅ Cowboy Colostrum: Get up to 25% off your entire order with code METABOLIC here. ✅ iRestore: Get the iRestore Elite helmet and Illumina face mask bundle at an exclusive discount with code LINK here.More LinksLive Q&A with Dr. Boz, October 14, 9:00 AM PT / 12:00 PM ET (free, no membership): register hereDr. Boz's website: bozmd.comDr. Boz on YouTube: @DoctorBozDr. Boz's books: ANYWAY YOU CAN and ketoCONTINUUMThe Metabolic Initiative (expert lectures, CME, ad-free episodes, live Q&As; first 7 days free): membership.metabolicinitiative.comIn every episode of The Metabolic Link, we'll uncover the very latest research on metabolic health and therapy. If you like this episode, please share it, subscribe, follow, and leave us a comment or review on whichever platform you use to tune in!You can find us on all your major podcast players here and full episodes are also up on our Metabolic Health Summit YouTube channel!Find us on social: InstagramFacebookYouTubeLinkedInPlease keep in mind: The Metabolic Link does not provide medical or health advice, but rather general information that does not serve as a substitute for a licensed healthcare professional. Never delay in seeking medical advice from an appropriately licensed medical provider for any health condition that you may have.

Featuring perspectives from Dr David W Cescon, including the following topics: Clinical treatment of BRCA-mutated metastatic triple-negative breast cancer (0:00) CNS activity of TROP2-directed antibody-drug conjugates (5:36) Autoimmune considerations with immunotherapy (10:09) Treatment of oligoprogressive advanced breast cancer (17:31) CME information and select publications

Send us Fan MailToday is a special one, because we're celebrating 200 episodes together.When we started this podcast back in September of 2022, the very first episode was about what they don't teach you in medical school. That idea has really been the thread running through everything we've done since. Physicians receive extraordinary clinical training, but then we ask you to lead people, understand financial statements, negotiate contracts, manage multimillion-dollar organizations, oversee revenue cycles, hire and fire, develop strategy, evaluate technology, manage risk, and somehow anticipate what's coming next in healthcare. And very little—if any--of that was part of your medical education.So we set out to help fill that gap.Two hundred episodes later, I'm incredibly grateful that so many of you have come along for the ride. Some of you have been listening almost from the beginning. Some of you found us through a particular episode because you were trying to solve a problem in your practice. Others have joined more recently and started working your way through the back catalog. However you got here, thank you. Truly. You've given us your time, your attention, your questions, and, in many cases, your trust. That means a great deal to me and to all of us at Health e Practices.For a list of content specific episodes listed in this podcast, see our website at www.healtheps.comPlease Follow or Subscribe to get new episodes delivered to you as soon as they drop! Visit Jill's company, Health e Practices' website: https://healtheps.com/ Subscribe to our newsletter, Health e Connections: https://share.hsforms.com/1FMup6xLPSpeA8hB77caYQwd32sx?hsCtaAttrib=171926995377 Want more formal learning? Check out Jill's newly released course: Physician's Edge: Mastering Business & Finance in Your Medical Practice. 32.5 hours of online, on-demand CME-accredited training tailored just for busy physicians. Promo pricing available now: https://education.healtheps.com/offers/Ry3zfLYp/checkout?coupon_code=PHYSEDGE3000 Purchase your copy of Jill's book here: Physician Heal Thy Financial Self Join our Medical Money Matters Facebook Group here: https://www.facebook.com/groups/3834886643404507/ Original Musical Score by: Craig Addy at https://www.underthepiano.ca/ Visit Craig's website to book your Once in a Lifetime music experience Podcast coaching and development by: Jennifer Furlong, CEO, Communication Twenty-Four Seven https://www.communicationtwentyfourseven.com/    

Send us Fan MailWhat if the reminder to renew your license isn't an insult, just a line item in a business you didn't know you were running?Most of us never took a business class, and we can still tell you exactly how it feels when the CME reminder arrives and no one offers time to do it. This week I want you to try on a different frame: your career is a business, and you are the one thing that makes it run.We walk through the three core pieces of any business (a value proposition, a target market, and a revenue model) and what each one looks like whether you're employed or you own the practice. Then we get to the part I think changes the most: what it means to treat yourself as the talent, and who is actually on your team. It gets much easier to drop the resentment about the tasks nobody does for us once we decide when and how they happen.Here's a taste of what's inside:Why your employer, not your patient, may be your real target market, and how that changes the way you walk into your next evaluation.Why "we are not a charity" isn't a cold thing to say, even to the kindest doctor in the building.Who counts as your team, from the nanny to the meal service, and what to do when your circle is thin.How to stop being furious about license renewals, the DEA and CME hours, and simply decide when they get done.Press play, and let's take some of the drama out of it.If this resonates and you want support actually living it, let's talk. Schedule a free discovery call here: https://calendly.com/healthierforgood/coaching-discovery-call. You can also find me at www.healthierforgood.com or email me at megan@healthierforgood.com. And if you haven't seen the refreshed website yet, I'd love to hear what you think.Episode 106: Be Your Own Boss from March 5, 2024: https://www.buzzsprout.com/1957629/episodes/14630537This episode grew out of my time with EntreMD Business School, the business coaching community for physicians led by Dr. Nneka Unachukwu, MD. Learn more at https://entremd.com/.Connect with Megan:Instagram: @MeganMeloMDWebsite: healthierforgood.comEmail: megan@healthierforgood.com Support the showTo learn more about my coaching practice and group offerings, head over to www.healthierforgood.com. I help Physicians and Allied Health Professional women to let go of toxic perfectionist and people-pleasing habits that leave them frustrated and exhausted. If you are ready to learn skills that help you set boundaries and prioritize yourself, without becoming a cynical a-hole, come work with me.Want to contact me directly?Email: megan@healthierforgood.comFollow me on Instagram!@MeganMeloMD

Grain futures rallied, but weak farmer selling, harvest pressure, and thin news flow are raising questions about how long the move can last. SF Daily host Lorrie Boyer breaks down the latest grain markets, trade developments, livestock, and weather risks.

Done paid clinicians by the refill, not the visit. We trace how a telehealth company built its business model around stimulant prescriptions. Along the way you'll learn why amphetamines are the #1 stimulant in America, but rarely used outside the US.Plus: a research update on tapering and switching sleep medication.CME: Take the CME Post-Test for this EpisodePublished On: 09/21/2026Duration: 26 minutes, 00 secondsChris Aiken, MD and Kellie Newsome, PMHNP have disclosed no relevant financial or other interests in any commercial companies pertaining to this educational activity.This activity includes brief excerpts from interviews conducted by the faculty member with informants. The interviewees provided historical information and/or commentary as source material only. They did not participate in planning, developing, reviewing, editing, or approving the educational content of this CME activity and have no role in controlling its content. The faculty member independently selected, contextualized, and incorporated the interview excerpts into the presentation. 

In this episode of Bowel Sounds, hosts Dr. Peter Lu and Dr. Jenn Lee talk to Dr. A. Jay Freeman, pediatric gastroenterologist at Nationwide Children's Hospital and Professor at The Ohio State University College of Medicine.  He is a leading clinician and researcher in pediatric pancreatic disorders and the GI and liver complications of cystic fibrosis. He provides a massive update on the treatment of cystic fibrosis, including the changing clinical landscape with the advent and use of CFTR modulator therapies.Dr. Freeman does not have any conflicts of interest to disclose.Learning objectivesDescribe key GI and liver manifestations of cystic fibrosisExplain how CFTR modulatos have changed GI and Liver disease in children with cystic fibrosis.Apply current screening and management strategies for GI complications in children with cystic fibrosisSend us Fan MailSupport the showThis episode may be eligible for CME credit!  Once you have listened to the episode, click this link to claim your credit.  Credit is available to NASPGHAN members (if you are not a member, you should probably sign up).  And thank you to the NASPGHAN Professional Education Committee for their review!As always, the discussion, views, and recommendations in this podcast are the sole responsibility of the hosts and guests and are subject to change over time with advances in the field.Check out our merch website!Follow us on Bluesky, Twitter, Facebook and Instagram for all the latest news and upcoming episodes.Click here to support the show.

Featuring perspectives from Dr David W Cescon, including the following topics: First-line treatment of metastatic triple-negative breast cancer (mTNBC) in patients not eligible for immunotherapy (0:00) First-line treatment of mTNBC in patients eligible for immunotherapy (12:05) Adverse events (19:39) CME information and select publications

Highlights from the PER® CME activity "SimulatED: Integrating Precision Pathways in HER2+ Gastroesophageal Adenocarcinoma — Testing, Treatment, and Supportive Care" — this podcast is not certified for credit. To participate in the full accredited activity and earn CME credit, use the link below.In this podcast, experts Geoffrey Y. Ku, MD, and Sunnie Kim, MD, discuss essential biomarker testing for advanced gastroesophageal adenocarcinoma, first-line treatment selection for HER2-positive metastatic disease in light of data from HERIZON-GEA-01 (NCT05152147), management of treatment-related diarrhea and other adverse events, and HER2 retesting at disease progression.Earn CME credit by completing the full accredited activity (available through August 31, 2027): https://www.gotoper.com/courses/simulated-integrating-precision-pathways-in-her2-gastroesophageal-adenocarcinoma-testing-treatment-and-supportive-careThis podcast, including the narration, was developed by PER® (Physicians' Education Resource®, LLC) editorial staff from the full online CME activity developed with these faculty. The narration was voiced by a PER staff member or by an AI tool. The podcast contains no product advertising. The full activity is supported by an educational grant from Jazz Pharmaceuticals, Inc.This content is for educational purposes only and is not a substitute for the independent clinical judgment of a health care professional. Faculty may discuss investigational or off-label uses; consult prescribing information for any products discussed.

Can becoming a mother be compatible with being an ophthalmic surgeon? In part one of this two-part series, Host Dr. Ben Young invites Dr. Jaya Kumar to discuss the challenging fertility and maternal health outcomes for female surgeons, her tips for how she practiced while pregnant and then returned successfully to work, and how physicians can support one another in the operating room. Referenced during the episode: MotherToBaby Dr. MILK (Mothers Interested in Lactation Knowledge) Pregnancy Discrimination and Pregnancy-Related Disability Discrimination (US Equal Employment Opportunity Commission) ACGME Common Program Requirements Tools for Responding to Patient-Initiated Verbal Sexual Harassment (Eyerounds.org) For all episodes or to claim CME credit for selected episodes, visit www.aao.org/podcasts.

BEEF The tight inventories coupled with good demand is slowing this market decline. Continuing to be exempt from market declines, middle meats being led higher by ribeyes continue to move higher. Strips and tenderloins following along.  Chucks, rounds, and grinds did get the memo and are moving lower. Thin meats - briskets, flanks, sirloin flap - also finding their pricing inching down. This should continue at least to the end of the month. A little good news, a second port of entry, this one in New Mexico, is scheduled to begin allowing live cattle from Mexico starting next week. I do see heifer retention is increasing with needs to happen so the beef herd can be rebuilt. It is a three-year cycle for a calf to be harvested for beef so while it doesn't help short term, there is relief ahead, maybe 2028. I'm keeping the same advice, stay ahead of your needs but be aware of pricing opportunities as they emerge. POULTRY Chicken production was back up over last year by 2 percent, and pricing is steady for next week on boneless skinless random breasts, tenders, and party wings. We may see some movement higher, but I don't expect anything to push the market up for any length of time. On the Avian flu front, another three new cases affecting 118K turkeys. I think this will continue as the weather cools and the southern migration has begun for wild birds. GRAINS Corn closed today at $5.42, up a few pennies from last week. Harvest continues on new crop, but it is very early. Soy leveled off after the last couple weeks pushing higher but I don't see much to push anything lower. Wheat holds for a second week with all eyes on the Black Sea and unrest there. I don't see anything to push these markets back down. PORK Bellies had farther down to go. Today's close was the third day below $100 with bellies closing at $85.48. That is a big flashing “buy” sign. I was expecting this belly market to settle about $120, so I severely overestimated the demand for fall bellies. Pork production will increase as the weather cools so I'm thinking we could see these low belly prices for a bit. Butts and ribs also move a bit lower; loins are steady but already a great protein value. DAIRY Dairy is down for the week. Through Thursday's CME close Barrel is down 5, block and butter both down 4. With plenty of raw material I'm thinking we could see a lower dairy market well into Q4. Savalfoods.com | Find us on Social Media: Instagram, Facebook, YouTube, Twitter, LinkedIn

Barry O'Reilly is an entrepreneur, executive advisor, and bestselling author who works with senior leaders to redesign how their organizations perform, make decisions, and innovate at scale.He is the co-founder of Nobody Studios, a global Top 10 AI venture studio building and launching 100 companies in five years—applying venture-speed experimentation to de-risk new business creation before significant capital is deployed.Barry is the author of Lean Enterprise: How High Performance Organizations Innovate at Scale—part of Eric Ries's Lean Series and recognized by Harvard Business Review as a must-read for CEOs—and Unlearn: Let Go of Past Success to Achieve Extraordinary Results, a repeatable system that enables leaders to surface legacy behaviors, replace outdated assumptions, and build the capabilities required to perform under uncertainty. His latest book, Artificial Organizations, challenges leaders to redesign work, judgment, and productivity in an era defined by human and machine intelligence.His work is grounded in enterprise transformation and venture-scale execution. He serves as faculty at Singularity University, contributes to The Economist, and advises boards and executive teams of global, high-growth and established organizations.Link to claim CME credit: https://www.surveymonkey.com/r/3DXCFW3CME credit is available for up to 3 years after the stated release dateContact CEOD@bmhcc.org if you have any questions about claiming credit.

Limiting the side effects of cancer treatments has been an animating force in the field of oncology for many years, and there's been progress to report on that front, but what if you could target cancer tumors without using radiation or chemotherapy and instead generate heat from inside the tumor to kill cells? That's the quest of our guest today, Dr. Hadiyah-Nicole Green, whose promising research using lasers and nanoparticles to eliminate tumors received Breakthrough Device Designation from the FDA earlier this year. “The laser beam that we're using is low power like a laser pointer, and without activation by the laser, the nanoparticles are harmless. Both are targeted just at the site of the tumor so because we don't use systemic delivery, we avoid all of the systemic side effects,” she explains.Dr. Green is also the founder and president of the Ora Lee Smith Cancer Research Foundation, named for an aunt who raised her and who died of cancer without pursuing curative treatment because of her fear of the side effects. Shortly after, her aunt's husband also died of cancer, opting for treatments that took a heavy toll on his body. “At 22 years old, I saw the horrors of cancer and the horrors of cancer treatment and just felt in my heart that there has to be something better than this,” she tells host Michael Carrese.On this fascinating episode of Raise the Line from Elsevier, we'll explore the science behind Dr. Green's approach, the challenges of raising the millions of dollars needed for human clinical trials, and rethinking the current funding landscape for cancer treatments.Mentioned in this episode:Ora Lee Smith Cancer Research Foundation If you like this podcast, please share it on your social channels. You can also subscribe to the series and check out all of our episodes at www.osmosis.org/podcast

Some episodes are worth bringing back. This is one of them. Salem Abraham is a bit of a legend in the trend following and managed futures world. With 30+ years in the business, he's got the experience, the war stories, and, thankfully, the willingness to tell them. We originally sat down with Salem a few years ago, and the conversation was too good to leave in the archives.  In this re-release, we cover tiny Canadian, Texas; why you need noodles and red sauce if you're competing to make the best spaghetti; the Turtle Traders; a tourist boat capsizing in front of the nude beach; just how low oil can go; hanging out with Boone Pickens; honeybees; sending the first computer-generated orders electronically to the CME; trend following, naturally; why an apple salad is not a fruit salad; bonds at zero; and pecan and apple orchards. You know, the usual. Salem is the founder of Abraham Trading Company, a research-driven investment management firm that has managed alternative asset portfolios since 1988 for families, individuals, foundations, endowments, and institutions. Today, the firm runs the Fortress Fund for endowments and institutional investors.So whether you caught this one the first time around or somehow missed it, we're digging it back out of the archives. - SEND IT!Chapters:00:00-01:20= Intro02:20-13:14=Canadian, Texas: Orchards, Eight Kids, and Community Capital13:15-34:45=From 1987 Crash Kid to Panhandle Prop Trader: Lessons, Oil Busts, and Early HFT34:46–38:45 = When Everyone's on One Side of the Boat: Crowded Trades, Crashes, and Naked Risk38:46–58:38 = Building a Hurricane‑Proof Portfolio: Bonds Are Broken, Alternatives Step In58:39–1:09:59 = From Crashes to Coronavirus: Rethinking 60/40 and Birth of the Fortress Fund1:10:00–1:19:49 = Salem's Lightning Round: Favorite Things, Real Assets, and Star WarsFrom the Episode:T. Boone Book: The First Billion Is The HardestCheck out our Trend Following Guide!Follow along with Salem and Abraham Trading Co. ⁠on LinkedIn, and be sure to check out abrahamtrading.com to learn more about what they are up to.Don't forget to subscribe to⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠The Derivative⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠, follow us on Twitter at⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠@rcmAlts⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ and⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠sign-up for our blog digest⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠.Disclaimer: This podcast is provided for informational purposes only and should not be relied upon as legal, business, or tax advice. All opinions expressed by podcast participants are solely their own opinions and do not necessarily reflect the opinions of RCM Alternatives, their affiliates, or companies featured. Due to industry regulations, participants on this podcast are instructed not to make specific trade recommendations, nor reference past or potential profits. And listeners are reminded that managed futures, commodity trading, and other alternative investments are complex and carry a risk of substantial losses. As such, they are not suitable for all investors. For more information, visit⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠www.rcmalternatives.com/disclaimer⁠⁠⁠⁠⁠

Featuring perspectives from Dr Gottfried E Konecny and Dr Brian M Slomovitz, including the following topics: Introduction (0:00) Preventing Ovarian Cancer (1:04) Endometrial Cancer (5:27) Ovarian Cancer (25:36) Cervical Cancer (54:04) CME information and select publications

Featuring perspectives from Dr Alexandra Drakaki, including the following topics: Case: A man in his early 80s with bladder cancer and metastatic progression in the viscera and lymph nodes receives enfortumab vedotin (EV) with pembrolizumab — Part 1 (0:00) Case: A man in his early 80s with metastatic bladder cancer achieves a complete response with EV/pembrolizumab therapy but develops gastrointestinal toxicity — Part 2 (5:37) Case: A man in his early 50s with metastatic bladder cancer receives second-line EV monotherapy intermittently (15:09) Case: A woman in her mid 60s with bladder cancer and a history of rheumatoid arthritis develops oligometastatic progression in the lung and receives EV monotherapy (21:03) Case: A man in his mid 80s with HER2-positive (IHC 3+) metastatic bladder cancer receives trastuzumab deruxtecan and develops ground glass opacities in his lungs concerning for pneumonitis (30:43) CME information and select publications

Featuring perspectives from Dr Alexandra Drakaki, including the following topics: Case: A man in his late 70s with diabetes and metastatic bladder cancer achieves radiographic response with enfortumab vedotin (EV) and pembrolizumab but develops uncontrolled hyperglycemia (0:00) Case: A man in his early 70s with muscle-invasive bladder cancer receives adjuvant nivolumab and experiences metastatic progression after 9 cycles of therapy (6:23) Case: A woman in her early 70s with Lynch syndrome and metastatic upper tract bladder cancer receives EV/pembrolizumab and develops myasthenia gravis (13:59) Case: A woman in her late 40s with FGFR3 mutant metastatic bladder cancer receives erdafitinib and experiences rising serum phosphate levels (20:04) CME information and select publications

Live coverage of the Fed's decision with markets pricing a 94.5% chance of a 25bp hike, one day after the Senate killed CLARITY 49-50 and the 10-year closed above 5% for the first time since 2007. We track the statement, Warsh's press conference, and crypto's reaction in real time.~This episode is sponsored by Tangem~Tangem ➜ https://bit.ly/TangemPBNUse Code: "PBN" for Additional Discounts!#Crypto #Ethereum #Bitcoin~Rate Hikes Begin?

Circadian rhythms influence far more than sleep, affecting neurologic disease expression, treatment response, and overall health. In this episode, Dr. Sabra Abbott discusses common circadian rhythm disorders, the health consequences of circadian misalignment, and practical strategies for managing jet lag, shift work, and disrupted sleep-wake schedules. Learn how circadian biology can shape neurologic outcomes and why considering the timing of behaviors, light exposure, and treatments may improve patient care. In this episode, Katie Grouse, MD, FAAN, speaks with Sabra M. Abbott, MD, PhD, author of the article "Circadian Neurology" in the Continuum® August 2026 Sleep Neurology issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California, San Francisco in San Francisco, California. Dr. Abbott is an Associate Professor of Neurology at Northwestern University Feinberg School of Medicine in Chicago, Illinois. Additional Resources Read the article: Circadian Neurology Subscribe to Continuum®: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full episode transcript available here Dr Grouse: Circadian rhythm disruption affects many of our patients in far-reaching aspects of their general health and has likely personally affected most neurologists at some point in their career. Today, I have the opportunity to interview Dr. Sabra Abbott, who is the author of the latest issue of Continuum on Neurology of Sleep.  Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Grouse: This is Dr. Katie Grouse. Today, I'm interviewing Dr. Sabra Abbott about her article on circadian neurology. This article appears in the August 2026 Continuum issue on Neurology of Sleep. Welcome to the podcast, and please introduce yourself to our audience.  Dr Abbott: Thanks for having me. I'm Dr. Sabra Abbott. I'm an associate professor of neurology at Northwestern, and I'm also director of our circadian medicine clinic.  Dr Grouse: It's really great to have you today. I definitely enjoyed reading your article, and not only did I learn a lot, but I feel like it's really applicable to a lot of topics that come up in clinic when I see patients. Now, I was wondering if you had to choose one key point that readers of your article would take away after reading it, what would it be?  Dr Abbott: I think the most important thing to keep in mind is that time is an important variable in every single thing that we do. And so, it can impact when your patient's disease is at its best and at its worst, and then it also can impact when it's actually most appropriate to provide medications for your patients. There can be times where they may be more impactful and times where they may actually cause more harm for your patients. So, the short answer is think about time always with your patients.  Dr Grouse: On that topic, I was really amazed to learn about the significant health risks associated with circadian misalignment, including even malignancy risks. Can you review some of these risks and why this might be the case?  Dr Abbott: So, I think the risk that we have the most data for is the risk for cancer associated with circadian misalignment, and this comes from a lot of studies that we're looking at patients who are shift workers. The data has actually come back on two separate reviews indicating that shift work could be a probable carcinogen, and we think that that probably comes down to a lot of different factors. So, when you're a shift worker, you are often working in the middle of the night. You may be getting light exposure at a time when you're normally producing melatonin, and that may be one factor that is actually putting you at increased risk for cancer.  Dr Grouse: And certainly, after reading this and hearing all of these things, I'm not surprised that many sleep specialists really dislike daylight savings time, which also is enough of a factor to potentially increase some of these health risks. Do you agree that daylight savings time is something that's contributing to poor health in our population?  Dr Abbott: So, I think it is definitely something that almost all of us want to get rid of, and I think where everybody is in agreement is that we should get rid of these shifts in the spring and the fall. I think the only benefit to those shifts that I see is it does create a time where we start having conversations about your circadian clock, so people become aware of circadian timing twice a year when we have these shifts. Outside of that, that shift back and forth seems to be very problematic. So, we do see both in the fall and the spring an increased risk for car crashes, an increased risk for heart attacks, stroke. People perform worse at work, and so I think in general, we probably should get rid of it. There's a little bit of a debate as to whether we should go to permanent standard time or permanent daylight saving time. I think most sleep and circadian scientists prefer permanent standard time. A lot of people who really like their evening activities prefer permanent daylight saving time, but I think that's also biased by the fact that daylight saving time, everybody has longer days, and I think they want longer days year-round, and you don't get that no matter which way you shift the clock in the winter.  Dr Grouse: That's really interesting. I do see that debate pop up every, I guess twice every year, and I guess there is a silver lining that at least we are all talking about it and thinking about it. I wanted to take a step back about the topic of circadian rhythm disorders in general. Could you just really quickly, like twenty-thousand-foot view, summarize what these main circadian rhythm disorders are?  Dr Abbott: So, at the moment, we primarily think of circadian rhythm disorders in the context of how they impact your sleep-wake timing. And so, at the largest level, we think of them as either intrinsic disorders, so disorders where your internal timing doesn't match up with the environment. The four key disorders there are advanced and delayed sleep wake phase disorders, so you're either earlier or later. You have non-twenty-four, where you actually generally get later and later each day, so it's like you're living on Mars. And then we have irregular, where you have multiple bouts of sleep that happen both night and day. And then the other two are the extrinsic disorders, so these are shift work disorders. So, you may have a normal functioning clock, but the external environment is forcing you to do things you wouldn't normally, or jet lag, where you again have a normal functioning clock, but then you end up having to shift multiple time zones faster than you can adapt to. Now, I think the interesting thing, and we can talk about this more if you want, is that we are moving into thinking of circadian rhythm disorders as being much more than just abnormalities of sleep-wake timing, and I think that's kind of where the future of the field goes.  Dr Grouse: Tell me more about that.  Dr Abbott: So, I think as the article gets into beyond just these kind of classically recognized disorders, we realize that circadian disruption can play a role in almost any other medical disorder that you can experience. And so, we can see circadian disruption as either a symptom or a potential cause of many other disorders. And then also in the optimal care of pretty much any patient, thinking about all of these other factors that they're experiencing on a day-to-day basis, whether it's their light exposure, whether it's the timing of their meals, whether it's the timing of their medications, all of those can play a role in their overall health and improving your ability to care for them.  Dr Grouse: Now, I did find it really fascinating. This was not something that I had really been aware of prior to reading your article about the fact that it really can make a difference about when you time particular medications for particular types of neurologic conditions just related to the circadian rhythm. And really interesting was the epilepsy connection. Can you tell me about how that affects how we should be dosing anti-seizure medication?  Dr Abbott: So, I think the epilepsy connection is an interesting one that definitely needs far more studies. So, at this point, a lot of this data is really coming from observational studies, looking at when patients have received medications and then how good their outcomes are. And in epilepsy, I think a lot of us tend to time anti-seizure medications so that patients get more of them in the evening and lower doses during the daytime. And I think a lot of this has been driven a little bit more by the fact that many of these medications are sedating, so we tend to put the more sedating medications at bedtime. But it turns out that outcomes in patients are actually better if they get higher doses at night and lower doses in the morning. Now, this is sort of theorizing at this point, but it could either be targets of these medications or your ability to uptake these medications across the blood-brain barrier may change with the time of day component. So, at this point, these are still really observational studies, but I think an area where we really need to do a lot more work.  Dr Grouse: Well, I look forward to hearing more about other ways that we'll learn how best to manage our medications for circadian rhythm function. Now, I wanted to ask, which circadian rhythm disorder do you think is the hardest to treat, and why would that be the case?  Dr Abbott: So, I'm gonna give you two answers to that. In terms of the primary circadian disorders that I see come through my clinic door, I would say cited non-24. These are patients who have normal vision, but they act as though they are living in a world without these external light time cues. And so, they, every single day, get a little bit later and a little bit later, and it's really, really hard to get them from a 25-hour schedule back onto a 24-hour schedule. The second part of my answer to that is shift work disorder, and those, I would say, are much more common patients to encounter. I think every single one of us, as we've gone through our medical training, has probably had some degree of shift work disorder, difficulty sleeping when we need to, staying awake during our shifts. But it's still really hard to figure out what we should be doing because, one, it's a multi-component system, so anything that I do to change your shift schedule has trickle-down effects to every one of your coworkers, and so we can't just tell one person, "Change what you're doing." It's also really hard to figure out what we should be doing. Should you only be working nights forever and ever and become purely nocturnal, and should we adapt everything to that, or we-- should we find some sort of compromise so that you can work the night shift but still have time to socialize and spend time with your family during the daytime? And how do we do all of that while still optimizing your health? And so, I think from a patient population, that is really a large problem we don't have a good answer to yet.  Dr Grouse: Sounds like it's something that you really have to customize to every single patient who walks in and their, their particular scenarios.  Dr Abbott: Absolutely.  Dr Grouse: Jet lag disorders is another circadian rhythm disorder that I think we all have had some personal experience with. Any tips or tricks on how to manage jet lag going east or west, or any resources that you recommend that can help us manage this, or we can advise to our patients?  Dr Abbott: Yeah. When we're talking about individualized, personalized treatment, I would say jet lag absolutely is way up there at the top of the list because it's not only a matter of where do you currently go to sleep and wake up in your current time zone, it is how many time zones are you going across to get to where you're going? Do you wanna keep the same schedule when you're at the new time zone? And all of these other factors in terms of how long you're gonna be there. When are you gonna come back? Does it make sense to fully adapt yourself to that new schedule? With that in mind, the general tips are if you are heading east, generally your goal is to shift everything earlier, and if you're heading west, generally the goal is to shift everything later. There are a lot of online calculators you can use where you can put in your current time zone, your destination time zone, and it will give you very specific information about when you should be getting light, when you should be avoiding light When melatonin may be helpful as another time cue that can help shift you. But again, it really depends on which direction and how many time zones and what time you're gonna arrive. I would say the practical tip that I have is whatever you do when you get to the new time zone, um, most of the time international travel involves overnight flights, so you may arrive in the morning. Resist the temptation to take a nap as soon as you arrive because that's just gonna make things harder and harder to adapt to. So, get out, be active, eat on the new time zone, try to push through that day, and then the homeostatic drive for sleep is gonna help you through that first night.  Dr Grouse: Great tip, and definitely a tip I have failed to follow in past trips and regretted greatly afterwards. There were some other really great points that you made that as an ambulatory neurologist I hadn't thought of that was really, really helpful, including when we take care of patients in the hospital, of course, we-- we're always careful about, you know, potential sort of things we can do to minimize delirium. But in fact, there's probably a lot of things we can do to minimize disruption to circadian rhythms, which we already know that if we're not careful about, can be deleterious to health. What are some things that you recommend generally for patients who are admitted regarding monitoring and treatment that we can try to do to mitigate that effect?  Dr Abbott: So, I would say the number one most important thing that you can do, and I did this every single day when I was on the wards, is when you walk into the patient's room for rounds in the morning, turn on the lights, open the curtains. We did an interesting study a few years ago because there was all of this discussion of nighttime disruption to hospital patients and a lot of concern that they were getting too much light and too much interruption to their sleep at night. But what we found out was actually the bigger problem may be that none of our patients are getting light during the daytime, and so they've just lost that amplitude of light rhythm. And so as much as you can maximize daytime and opening those curtains, turning on the lights, giving them a bunch of light during the day. And then obviously, on the opposite end, you wanna make sure that they're getting dark at nighttime. Being really thoughtful about what your patients actually need to have done while they're in the hospital. And so, do they really need to have vitals every four hours in the middle of the night? Is that gonna change their outcome, or are they just sitting there waiting for insurance to approve their rehab bed, and they're probably gonna be fine overnight without that disruption? I think those are the easy things that you can do. The slightly harder piece is there's a lot of debate about whether we really need to be doing four AM labs on all of our patients, for example. Obviously, that's disrupting everybody's sleep. It's making a phlebotomist be a shift worker. It's problematic in many respects, but at the same time, you need to collect the labs so the labs can actually be processed and you can have the results, and they can be available for rounds, and so you can discuss them so that then you can discharge the patient on time. And so, it's a whole set of moving parts that are sometimes a little hard to optimize specifically for the patient.  Dr Grouse: Certainly, worth a discussion to have, though, and all really great tips. Another question kind of on that same vein. A lot of patients ask for something to help sleep at night. Melatonin is something we often give as sort of an easy, relatively gentle treatment that can help with sleep. Do you agree that that's a good idea? Is that something that you would generally recommend?  Dr Abbott: So, I would say that melatonin on the overall risk versus benefit spectrum probably has very low side effects for your hospitalized patient. At the same time, we actually fought this battle here. On many of the hospital formularies, you have very high doses of melatonin, so it's five, ten milligrams. Now, the problem with that is it takes you long enough to metabolize that ten milligrams of melatonin that it is still gonna be in your system the next day. So, then you go to round on the patient the next day and they're groggy and they're out of it, and it may not be that they've neurologically deteriorated, it may still be that they have melatonin still in their system. So, if you are going to use that as sort of a first-line low-harm option, I would stick to one to three milligrams.  Dr Grouse: Great. One to three milligrams is something I've often heard. Is that generally optimal dose and timing for melatonin, uh, you suggest for patients, or how do you approach thinking about the dose and timing?  Dr Abbott: So, this is where it gets a little more complicated because we actually don't recommend using melatonin as a general hypnotic. It's not that great for treating insomnia in general. So, where we do more often use melatonin in circadian patients is as a phase-shifting stimuli. So, this is something that if you give melatonin at a specific time, it can either move your clock earlier or move your clock later. And that tends to be something that is a little more challenging to sort out. It's a conversation to figure out where your patient currently is from a rhythm standpoint, where you're trying to move them to. So not something I would use typically for insomnia, but more if you're trying to adjust somebody's timing.  Dr Grouse: Excellent point and great recommendations. Now, switching gears a little bit, you had mentioned and you alluded earlier that circadian rhythm disruption can be something that we find in certain neurologic diseases and conditions we all treat and may even be an early sign of some of them. What are some general conditions in neurology that we see circadian rhythm disruption? Dr Abbott: So, I think one of the areas where it's often an early sign of a disorder is in neurodegenerative disorders. So, we often do see that that typical daily rhythm and amplitude, and what I mean by that is that sort of difference between how active you are during the daytime and how inactive you are at night. That tends to become dampened and more fragmented even before you start to see some of the other signs and symptoms of neurodegenerative disorders, so things like Alzheimer's. So, it often can be kind of an early hallmark that something else might be coming. Now, other ways that we can see circadian rhythm disruption in other neurologic disorders, I think probably the more under-recognized is in any disorder where a patient may have decreased mobility, sort of overall inactivity during the day. Maybe they have chronic pain, maybe they have really bad migraines, so they're spending lots of time in a dark room disrupting their sleep schedule. All of these things can lead to patients having more of an irregular pattern, so having chunks of sleep and wake that are just sort of distributed randomly throughout the night and the day, and they lose that overall rhythmicity to their behaviors, which then translates into a loss of rhythm and light exposure, a loss of rhythm in food intake. All of these things can kind of build on each other.  Dr Grouse: Well, that's a really good point. You know, often we think of, you know, sleep disruption causing a lot of these problems, like migraine being a very common one. But don't think about as much of the fact that the migraine itself could be contributing to the sleep dysfunction. So, a very, very interesting point there. Now, I was curious, having read the article, what isn't in the article that you wanted to put in?  Dr Abbott: So, I think the focus of this article really was primarily on the neurologic aspect of things, but I do think it's important that if people are interested in this and excited about this area, that they recognize that it's not just neurologic disorders that are impacted by this. There's a lot of really exciting research going on in the area of oncology, for example. There's some really cool research showing that the timing of your first dose of chemotherapy actually dramatically impacts your outcomes. And so, I think there are a lot of really interesting areas where thinking about your circadian system can really optimize treatment, not just within the area of neurology.  Dr Grouse: That's amazing. Well, I'll be really interested to see where that heads. And then of course, on that same topic, any new treatments or diagnostic modalities on the horizon that our listeners should be on the lookout for?  Dr Abbott: So, I think as a field, we are always looking for better ways of looking at circadian markers within the clinic. And so, multiple groups, including our own, have been looking at blood tests. So, is there a way that with one or two samples we can actually get a profile of what your current biological time is? And so, I think those blood tests are still being validated in patients with disorders. We've mostly looked at them in healthy controls. I think other areas we're looking at new diagnostic tools to actually get a sense of how people are responding to their environment. So, we're doing a study looking at using pupillometry, which is a way of measuring how your pupil responds to light, and using that to figure out whether you may or may not be somebody who responds well to light or poorly to light, and can we tailor your treatments for that? So, I think we're looking at many different ways that we can improve diagnostics in the outpatient setting.  Dr Grouse: Well, that's really fascinating. I can't wait to hear more about what may be coming around the corner. Thanks so much for sharing, and I'm sure you've inspired some of our trainees considering a career in sleep medicine. Thank you so much for sharing, and I really again encourage all of our listeners to check out her wonderful article.  Dr Abbott: Thanks for having me. It was great to have a chance to talk about this, and I second your hope that more trainees will be interested in sleep and circadian medicine. It's really an exciting field to get into.  Dr Grouse: Again, today I've been interviewing Dr. Sabra Abbott about her article on circadian neurology. This article appears in the August twenty twenty-six Continuum issue on Neurology of Sleep. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audiocme. Thank you for listening to Continuum Audio. 

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