Podcasts about Evaluation

Episode 194: Acute low back pain.  Future Dr. Ibrahim presents a clinical case to explain the essential points in the evaluation of back pain.  Future Dr. Redden adds information about differentiating between a back strain and more serious diseases such as cancer, and Dr. Arreaza shares information about returning to work after back strain.Written by Michael Ibrahim, MSIV. Editing and comments by Jordan Redden, MSIV, and Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.Dr. Arreaza:Welcome back, everyone. Today's topic is one that every primary care provider, emergency doctor, and even specialist sees routinely: low back pain. It's so common that studies estimate up to 80% of adults will experience it at some point in their lives. But despite how frequent it is, the challenge is to identify which cases are benign and which demand urgent attention.Jordan:Exactly. Low back pain is usually self-limiting and mechanical in nature, but we always need to keep an eye out for the rare but serious causes: things like infection, malignancy, or neurological compromise. That's why a good history and physical exam are our best tools right out of the gate.Michael:And to ground this in a real example, let me introduce a patient we saw recently. John is a 45-year-old warehouse worker who came in with two weeks of lower back pain that started after lifting a 50-lb box. He describes it as a dull, aching pain that radiates from his lower back down the posterior left thigh into the calf. He says it gets worse with bending or coughing, but he feels better when lying flat. He also mentioned some numbness in his left foot, but he denies any bowel or bladder issues. His vitals are completely normal. On exam, he had lumbar paraspinal tenderness, a positive straight leg-raise at 40 degrees on the left and decreased sensation in the L5 dermatome, though reflexes were still intact.Dr. Arreaza:That's a great case. Let's take a minute and talk about the straight leg raise test. This is a bedside tool we use to assess for lumbar nerve root irritation often caused by a herniated disc. ***Here's how it works: the patient lies supine, and you slowly raise their straight leg. If pain radiates below the knee between 30° and 70°, that suggests radiculopathy, especially involving the L5 or S1 nerve roots. Pain at higher angles is more likely due to hamstring tightness or mechanical strain.Michael:Right. So, stepping back: what do we mean by "low back pain"? Broadly, it's any pain localized to the lumbar spine, but it's often classified by type or cause:Mechanical (like muscle strain or degenerative disc disease), Radicular (nerve root involvement), Referred pain (like from pelvic or abdominal organs), Inflammatory (AS), and Systemic or serious causes like infection or malignancy. Jordan:In John's case, we're thinking radicular pain, most likely from a herniated disc compressing the L5 nerve root. That's supported by the dermatomal numbness, the leg pain, and that positive straight leg test.Dr. Arreaza:Good reasoning. Now, anytime we see back pain, our brains should run a checklist for red flags. These help us pick up more serious causes that require urgent attention. Let's run through the red flags.Michael:Sure. For fracture, we think about major trauma or even minor trauma in the elderly, especially those with osteoporosis or on chronic steroids. Also, anyone over 70 years old.Jordan:Then we have infections, which could include things like discitis, vertebral osteomyelitis, or epidural abscess. Red flags include fever, IV drug use, recent surgery, or immunosuppression.Michael:Malignancy is another critical one, especially if there's a history of breast, prostate, lung, kidney, or thyroid cancer. Clues include unexplained weight loss, night pain, or constant pain not relieved by rest.Jordan:And don't forget about inflammatory back pain, like ankylosing spondylitis, which is often seen in younger patients with morning stiffness that lasts more than 30 minutes and improves with activity.Dr. Arreaza:And of course, we always rule out cauda equina syndrome: a surgical emergency. That's urinary retention or incontinence, saddle anesthesia, bilateral leg weakness, or fecal incontinence. Missing this diagnosis can be catastrophic.Michael:Thankfully, in John's case, we don't see any red flags. His presentation is classic for uncomplicated lumbar radiculopathy. But we must stay vigilant, because sometimes patients don't offer up key symptoms unless we ask directly.Jordan:And that's where associated symptoms help guide us. For example:Radicular symptoms like numbness or weakness follow dermatomal patterns. Constitutional symptoms like fever or weight loss raise red flags. Bladder/bowel changes or saddle anesthesia raise alarms for cauda equina. Pain that wakes patients up at night might point to malignancy. Dr. Arreaza:So when do we order labs or imaging?Michael:Not right away. For most patients with acute low back pain, imaging is not needed unless they have red flags. If infection is suspected, we'd get CBC, ESR, and CRP. For cancer, maybe PSA or serum protein electrophoresis. And if inflammatory back disease is suspected, HLA-B27 can be helpful.Jordan:Yes, imaging should be delayed for at least six weeks unless red flags or significant neurologic deficits are present. When we do image, MRI is our go-to especially for suspected radiculopathy or cauda equina. X-rays can help if we're thinking about fractures, but they won't show soft tissue or nerve root issues.Michael:In the example from our case, since the patient doesn't have red flags, we'd go with conservative management: start NSAIDs and recommend activity modification. As this is the acute setting, physical therapy would not be recommended.Jordan:For the acute phase, research shows no serious difference between those with PT and those without in the long term. However, physical therapy is really the cornerstone of management for chronic back pain. It's not just movement: it's education, body mechanics, and teaching patients how to move safely. And PT can actually reduce opioid use, imaging, and injections down the line for patient struggling with long term back pain.Dr. Arreaza:Yes, and PT is not one-size-fits-all. PT might include McKenzie exercises, manual therapy, postural retraining, or even neuromuscular re-education. The goal is always to build core stability, promote healthy movement patterns, and reduce fear of motion.Jordan:Let's take a minute to talk about the McKenzie Method, a physical therapy approach used to treat lumbar disc herniation by identifying a specific movement, (often spinal extension) that reduces or centralizes pain. A common exercise is the prone press-up, (cobra pose for yoga fans) where the patient lies face down and pushes the upper body upward while keeping the hips on the floor to relieve pressure on the disc. These exercises should be done carefully, ideally under professional guidance, and discontinued if symptoms worsen.Michael:For our case patient, our working diagnosis is mechanical low back pain with L5 radiculopathy. No imaging needed now, no red flags. We'll treat conservatively and educate him about proper lifting, staying active, and recovery expectations.Jordan:We also emphasized to him that bed rest isn't helpful. In fact, bed rest can make things worse. Keeping active while avoiding heavy lifting for now is key.Dr. Arreaza:Return-to-work recommendations should be individualized. For example, an office worker, positioning while working, or work hours may be able to return to work promptly. However, those with physically demanding jobs may need light duty or be off work.Ice: no evidence of benefit. Heat: may reduce pain and disability in pain of less than 3 months, although the benefit was small and short.And we should always teach safe lifting techniques: bend at the knees, keep the load close, avoid twisting. It's basic knowledge, but it is very effective in preventing recurrence.Jordan:Now, if a patient fails to improve after 6 weeks of conservative therapy, or if they develop new neurologic deficits, that's when we think about referral to spine specialists or surgical consultation.Michael:And as previously mentioned: in cases where back pain becomes chronic (lasting more than 12 weeks) a multidisciplinary approach works best. That can include:Physical therapy, Cognitive behavioral therapy (CBT) And sometimes pain management interventions. Jordan:We can't forget the psychological toll either. Chronic back pain is associated with depression, anxiety, and opioid dependence. Increased risk factors include obesity, smoking, sedentary lifestyle, and previous back injuries.Dr. Arreaza:Well said. So, let's summarize. Michael?Michael:Sure! Low back pain is common, and most cases are benign. But we have to know the red flags that point to serious pathology. A focused history and physical exam are more powerful than many people realize. And the first step in treatment is almost always conservative, with a strong emphasis on maintaining physical activity.Jordan:And don't underestimate the value of patient education. Helping patients understand their pain, set realistic expectations, and stay active is often just as important as the medications or therapies we offer.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Chou, R., Qaseem, A., Snow, V., Casey, D., Cross, J. T., Shekelle, P., & Owens, D. K. (2007). Diagnosis and treatment of low back pain: A joint clinical practice guideline from the American College of Physicians and the American Pain Society. Annals of Internal Medicine, 147(7), 478–491. https://doi.org/10.7326/0003-4819-147-7-200710020-00006Deyo, R. A., Mirza, S. K., Turner, J. A., & Martin, B. I. (2009). Overtreating chronic back pain: Time to back off? Journal of the American Board of Family Medicine, 22(1), 62–68. https://doi.org/10.3122/jabfm.2009.01.080102National Institute for Health and Care Excellence. (2020). Low back pain and sciatica in over 16s: Assessment and management (NICE Guideline No. NG59). https://www.nice.org.uk/guidance/ng59Qaseem, A., Wilt, T. J., McLean, R. M., & Forciea, M. A. (2017). Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 166(7), 514–530. https://doi.org/10.7326/M16-2367UpToDate. (n.d.). Evaluation and treatment of low back pain in adults. Wolters Kluwer. https://www.uptodate.com (Access requires subscription)Theme song, Works All The Time by Dominik Schwarzer, YouTube ID: CUBDNERZU8HXUHBS, purchased from https://www.premiumbeat.com/. 

In this episode, Tracey Davidoff, MD and Joe Toscano, MD discuss the June 2025 Evidence-Based Urgent Care article, Evaluation and Management of Wrist Injuries in the Urgent Care SettingCommon Wrist Injuries and Their ManagementDetailed Examination and Diagnostic TipsTreating FracturesHematoma Block ProcedureSplinting TechniquesPain Management StrategiesRisk Management and PitfallsClosing Thoughts and Future Topics

In this episode, Sallie Hyman, VMD, DACVIM-LA, CVA, CVTP, MBA, joined us to discuss the lameness evaluation technology Equinosis Q. She explained different applications for this technology and how she's incorporated it into her practice. She also briefly discussed some of the other objective lameness technologies currently on the market, including Sleip.This episode of Disease Du Jour is brought to you by Bimeda.Disease Du Jour Podcast Hosts, Guests, and Links Episode 160:Host: Carly Sisson (Digital Content Manager) of EquiManagement | Email Carly (CSisson@equinenetwork.com)Guest: Sallie Hyman, VMD, DACVIM-LA, CVA, CVTP, MBAPodcast Website: Disease Du JourThis episode of Disease Du Jour podcast is brought to you by Bimeda Equine.Connect with Host: Carly Sisson (Digital Content Manager) of EquiManagement | Email Carly (CSisson@equinenetwork.com)

PWTorch editor Wade Keller is joined by PWTorch's Brian Zilem to discuss the June 18 edition of AEW Dynamite, "Grand Slam Mexico," in Arena Mexico. They discussed the MJF vs. Mistico match, Mercedes Mone winning the CMLL Women's Title from Zeuxis, the presentation of the show, the Hangman Page opening promo and angle with Jon Moxley at the end, and more.Become a supporter of this podcast: https://www.spreaker.com/podcast/wade-keller-pro-wrestling-post-shows--3275545/support.

For this week's Horror Bytes, Safe Room's indie horror showcase, Neil and Jay sift through their demons with Evaluation! Safe Room is a Bloody Disgusting weekly horror video game podcast with new episodes every Monday and Thursday. For additional streaming services: ⁠⁠⁠⁠⁠⁠⁠Linktree⁠⁠⁠⁠⁠⁠⁠.  Feel free to follow the show and hosts on Twitter & Blusky: ⁠⁠⁠⁠⁠⁠⁠Twitter⁠⁠⁠⁠⁠⁠⁠ | ⁠⁠⁠⁠⁠⁠⁠BluSky⁠⁠⁠⁠⁠⁠⁠ | ⁠⁠⁠⁠⁠⁠⁠Neil⁠⁠⁠⁠⁠⁠⁠ | ⁠⁠⁠⁠⁠⁠⁠Jay⁠⁠⁠⁠⁠⁠⁠ | ⁠⁠⁠⁠⁠⁠⁠Horror Bytes⁠⁠ ⁠⁠⁠⁠⁠| Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode of Nutrition Pearls: the Podcast, co-hosts Megan Murphy and Jen Smith speak with Megan Horsley on her involvement with an intensive tube feed weaning program.  Megan is a pediatric dietitian at Cincinnati Children's Hospital Medical Center. She has 18 years of experience in pediatrics with a focus in cardiology and currently practices as a Lead dietitian as well as a cardiac float, serving all areas of cardiology (the Critical Cardiac Intensive Care Unit, the Acute Care Cardiology Unit and Outpatient Cardiology). Her most recent work has involved establishing a tube wean program in 2020 for heart patients which focuses on optimizing oral skills and getting them safely off their feeding tube.She is a Certified Nutrition Support Clinician and in addition maintains her Certification as a Specialist in Pediatric Nutrition. She is involved in many projects, research, and quality improvement work, including the National Pediatric Cardiology Quality Improvement Collaborative (NPC-QIC), the Advanced Cardiac Therapies Improving Outcomes Network (ACTION) and the Pediatric Cardiac Intensive Care Society (PCICS). She has also served as a board member of the Congenital Heart Alliance of Cincinnati since 2017 and is a member of the Prolacta Clinical Advisory Board (PCAB) since 2019. Megan has eighteen years of professional practice in pediatric nutrition and twenty-one years of personal experience as a heart mom herself. She plans on continuing to concentrate her efforts on improving the nutritional care, experience and outcomes for all children affected by congenital heart disease.Nutrition Pearls is supported by an educational grant from Mead Johnson Nutrition.Resources:Tool Kit: NPC-QIC Tube Weaning — NPC-QICKaskie, S., Horsley, M., & Marcuccio, E. (2024). Experiences in Tube Weaning Children with Congenital Heart Disease and Oral Feeding Aversion. Pediatric Cardiology. https://doi.org/10.1007/s00246-024-03515-8Wong, J., Loomba, R., Allen, K. Y., Chan, T., Coolidge, N., Del Grippo, E., Horsley, M., Slater, N., Spader-Cloud, M., Steltzer, M., & Marcuccio, E. (2024). Structured Tube Weaning Using the Hunger Provocation Method in Infants with Single Ventricle Heart Defects: A Multicenter Study. Pediatric Cardiology. https://doi.org/10.1007/s00246-024-03558-xHorsley, M., Hill, G. D., Kaskie, S., Schnautz, M., Brown, J., & Marcuccio, E. (2022). Evaluation of an Outpatient and Telehealth Initiative to Reduce Tube Dependency in Infants with Complex Congenital Heart Disease. Pediatric Cardiology, 43(7), 1429–1437. https://doi.org/10.1007/s00246-022-02864-6Weaning from a feeding tube in children with congenital heart disease: A review of the literature: www.sciencedirect.com/science/article/abs/pii/S1058981321000801?via%3DihubCardiology Feeding Tube Wean ClinicProduced by: Corey IrwinNASPGHAN - Council for Pediatric Nutrition Professionalscpnp@naspghan.org

Show SummaryOn today's episode, we welcome back a previous guest, Marine Corps veteran Waco Hoover, an entrepreneur and investor with over 20 years of experience in venture capital, M&A, entertainment, media and live events. We talk about MCON, an annual event that celebrates military culture and includes MCON Health conducted in partnership with PsychArmor.  Provide FeedbackAs a dedicated member of the audience, we would like to hear from you about the show. Please take a few minutes to share your thoughts about the show in this short feedback survey. By doing so, you will be entered to receive a signed copy of one of our host's three books on military and veteran mental health. About Today's GuestWaco Hoover is an entrepreneur and investor with over 20 years of experience in venture capital, M&A, entertainment, media and live events.He served in the U.S. Marine Corps from 1997-2001 as an infantry Marine, combat water survival instructor and infantry scout. He served several deployments across Southeast Asia.After separation from the military, Hoover graduated from New York University, cum laude and completed Harvard Business School executive education programs. He then became an entrepreneur and investor who now has over 18 years of experience in venture capital, M&A, entertainment, media and live events.He is currently Chair of the Be The One initiative for the American Legion. He is also a co-owner of Veteran Entertainment Television, advisor to Founders Factory, a London based venture capital firm, Managing Partner at Xperiential Group, and serves on the board of Irreverent Warriors, a non-profit preventing veteran suicide. He has advised global brands including MGM Resorts, Informa, Vivendi, and Las Vegas Sands Corp. He was a co-founder and investor in businesses sold to Informa, Emerald, Endeavor Business Media and Onstream Media.Hoover speaks at industry events including VenuesNow, PTTOW!, CEMA, The American Legion, Military Influencer Conference, SXSW, Pollstar, TSE 100, Society for Independent Show Organizers, National Sports Forum and XLIVE.He lives in Southern California with his wife, son and two yellow labs, Tucker and Winnie. In his spare time, he enjoys surfing, diving, and mountaineering as often as possible. He is a member of The American Legion and recently hosted the Be the One Symposium at the 104th American Legion National Convention in Charlotte.Links Mentioned During the EpisodeMCON Web SiteMCON HealthPsychArmor Resource of the WeekThis week's resource of the week is the previous podcast episode featuring Waco, episode 156 where we talk about the American Legion's Be The One Campaign an initiative whose goal it is to eliminate the stigma related to mental health treatment, and in turn, lower the number of veterans who die by suicide every day.   You can find the resource here:  https://psycharmor.org/podcast/waco-hoover Episode Partner: Are you an organization that engages with or supports the military affiliated community? Would you like to partner with an engaged and dynamic audience of like-minded professionals? Reach out to Inquire about Partnership Opportunities Contact Us and Join Us on Social Media Email PsychArmorPsychArmor on TwitterPsychArmor on FacebookPsychArmor on YouTubePsychArmor on LinkedInPsychArmor on InstagramTheme MusicOur theme music Don't Kill the Messenger was written and performed by Navy Veteran Jerry Maniscalco, in cooperation with Operation Encore, a non profit committed to supporting singer/songwriter and musicians across the military and Veteran communities.Producer and Host Duane France is a retired Army Noncommissioned Officer, combat veteran, and clinical mental health counselor for service members, veterans, and their families.  You can find more about the work that he is doing at www.veteranmentalhealth.com  

This is an audio version of a Review article from the June 2025 issue of JGME, "The Use of Artificial Intelligence in Residency Application Evaluation—A Scoping Review" by Maxwell D. Sumner, BS, T. Clark Howell, MD, MSHS, Alexandria L. Soto, BS, Samantha Kaplan, PhD, Elisabeth T. Tracy, MD, Aimee K. Zaas, MD, John Migaly, MD, Allan D. Kirk, MD, PhD, and Kevin Shah, MD.

In the second episode of the Dairy Focus Lab's new "PaperCast" series, Dr. Jim Drackley and Dr. Phil Cardoso of the University of Illinois continue their discussion of a symposium review on nutrition strategies for improved health, production, and fertility during the transition period.Links to papers mentioned in this episodeSymposium review: Nutrition strategies for improved health, production, and fertility during the transition period. FREE version until July 02, 2020 (Note: if the link doesn't work, try turning off ad blocking):https://authors.elsevier.com/a/1b3IT50bFT94%7EPart 1 of the discussionhttps://www.youtube.com/watch?v=JXV4Coi22VsGoff et al. 2005, Comparison of 0.46% calcium diets with and without added anions with a 0.7% calcium anionic diet as a means to reduce periparturient hypocalcemiahttps://www.sciencedirect.com/science/article/pii/S002203021830256XFehlberg, (Abstract T136 page 227) Evaluation of two pH strips on urine from multiparous Holstein cows fed a partially acidified diet prepartumhttps://www.adsa.org/Portals/0/SiteContent/Docs/Meetings/2019ADSA/2019ADSA_Abstract_Book.pdf?v20190715Kelly Ryan, Increased dietary calcium inclusion in fully acidified prepartum diets improved postpartum uterine health and fertility when fed to Holstein cowshttps://www.sciencedirect.com/science/article/abs/pii/S0093691X19304674Glossom et al. 2020, Negative dietary cation-anion difference and amount of calcium in prepartum diets: Effects on milk production, blood calcium, and healthhttps://www.journalofdairyscience.org/article/S0022-0302(20)30387-8/fulltext?dgcid=raven_jbs_aip_email

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Jason Olson and Jabra Ghneim join Greg once again as attacks from both Israel and Iran continue. Who is obviously in the right? Where does it go from here? What does the rest of the Middle East really think about this? Trump goes bold. Doubles down. Jason Olson holds his Ph.D. in Near Eastern and Judaic Studies from Brandeis University (2016). His first book, “America's Road to Jerusalem,” was released by Lexington Books in 2018. He researched the role of Christian Zionism in the development of a pro-Israel U.S. foreign policy. His second book, “The Burning Book,” won the 2022 Association for Mormon Letters award in creative nonfiction. In his doctoral studies, Jason held fellowships with The Schusterman Center for Israel Studies, Crown Center for Middle East Studies, Hertog Global Strategy Initiative at Columbia University, Israel Institute, American-Israeli Cooperative Enterprise, and the American Jewish Archives. In 2013, he served as teaching fellow for the Summer Institute for Israel Studies (Brandeis), where he educated an international group of scholars in Israel and the Palestinian territories. Jabra Ghneim is an educator, translator, and researcher with deep expertise in language services, refugee integration, and Middle Eastern affairs. A native Arabic and English speaker, he has led major translation and localization efforts for faith-based organizations and U.S. government clients, including curriculum design, interpretation, and training for Arabic, Farsi, Pashto, and other critical languages. For over three decades, he has served as the lead Arabic interpreter and translator for The Church of Jesus Christ of Latter-day Saints, translating sacred texts, including the Book of Mormon and Doctrine and Covenants, into Arabic. He holds a PhD in Educational Inquiry, Measurement, and Evaluation and an MSc in Economics from Brigham Young University, as well as a BA in Economics and Finance from Yarmouk University in Jordan. Jabra is passionate about cultural bridge-building, Jewish-Arab relations, and the power of language to connect people across divides. Website- www.cwicmedia.com

A new City Bar report (https://bit.ly/3FURuAi) from the Presidential Task Force on Artificial Intelligence and Digital Technology highlights the harmful effects of artificial intelligence (AI) on people with disabilities, and the harm likely to occur for them in the future. The Task Force's  Subcommittee on the Impact of Artificial Intelligence on People with Disabilities and Underserved Communities continues the conversation in this podcast episode featuring attorneys, researchers, and technology leaders. They talk about the current challenges and opportunities AI presents for people with disabilities, emphasizing the importance of inclusive design and representation. Want to be part of the discussion? Register for the City Bar's Artificial Intelligence Institute on June 16 (available on-demand thereafter): https://services.nycbar.org/AIInstitute/ Visit nycbar.org/events to find all of the most up-to-date information about our upcoming CLE programs and events as well as on-demand CLE content. 03:06 Overview of AI's Impact on Disabilities 04:44 Building a Disability Inclusive AI Ecosystem 09:08 Generative AI and Representational Harms 15:54 AI in Digital Accessibility: Test Party's Mission 19:39 Challenges and Legal Perspectives on AI and Disabilities 35:26 Inclusive Design and Evaluation in AI 44:54 Final Thoughts and Future Directions

This PedsCases episode based on the CPS position statement will give you an approach to the evaluation and management of enuresis in the general pediatric setting. By the end of this podcast, listeners will be able to 1) define enuresis in the general pediatric setting, 2) identify the key points in history taking for a child with enuresis, 3) determine appropriate investigations for a child presenting with enuresis, 4) recognize which situations need intervention and select appropriate treatment for enuresis, and 5) establish the proper follow-up for the child and their family. Today's episode was created by Anne-Sophie Munger, a fourth-year medical student at the University of Montreal, in collaboration with Dr. James Harris, a community-based pediatrician from the University of British Columbia. There are no conflicts of interest to disclose by the authors.

This week on “Paul, Weiss Waking Up With AI,” Katherine Forrest introduces two recent studies that examine the concepts of evaluation faking and Group Think as they pertain to highly capable AI models, and what these studies might mean for future AI development. ## Learn More About Paul, Weiss's Artificial Intelligence practice: https://www.paulweiss.com/industries/artificial-intelligence

In the April 2025 episode of Critical Decisions in Emergency Medicine, Drs. Danya Khoujah and Wendy Chang discuss acute psychosis and lithium toxicity. As always, you'll also hear about the hot topics covered in the regular features, including pelvic inflammatory disease in a non–sexually active teen in Clinical Pediatrics, joint capsule foreign bodies in Critical Cases in Orthopedics and Trauma, male urethral catheterization in The Critical Procedure, high-dose nitroglycerin for SCAPE in The LLSA Literature Review, and a patient with recurrent chest pain in The Critical Image.In the April 2025 episode of Critical Decisions in Emergency Medicine, Drs. Danya Khoujah and Wendy Chang discuss acute psychosis and lithium toxicity. As always, you'll also hear about the hot topics covered in the regular features, including pelvic inflammatory disease in a non–sexually active teen in Clinical Pediatrics, joint capsule foreign bodies in Critical Cases in Orthopedics and Trauma, male urethral catheterization in The Critical Procedure, high-dose nitroglycerin for SCAPE in The LLSA Literature Review, and a patient with recurrent chest pain in The Critical Image.

The research from ALONE, a national organisation that enables older people to age at home, highlights how their services are transforming the experience of aging in Ireland. Formore on this Dr Aileen O'Reilly, Head of Research, Evaluation & Policy for ALONE.

Watching treatment implementation is one of the key determinants behind whether great treatments lead to great results. But, deep down in our hearts, we all struggle to hit that magic 33% of sessions with greater than 80% agreement we all learned about in graduate school. But, what if interobserver agreement didn't have to be that. What if we were thinking about IOA all wrong? This week we brush up on some of the basics of IOA procedures like “How do I calculate IOA again?” before moving on to more interesting research in the field like training folks to take good IOA and questioning the standard wisdom of how much IOA is good enough. We'll be watching you! This episode is available for 1.0 LEARNING CEU. Articles discussed this episode: Hausman, N.L., Javed, N., Bednar, M.K., Guell, M., Schaller, E., Nevill, R.E., & Kahng, S. (2022). Interobserver agreement: A preliminary investigation into how much is enough? Journal of Applied Behavior Analysis, 55, 357-368. doi: 10.1002/jaba.811 Garrity, M.L., Luiselli, J.K., & McCollum, S.A. (2008). Effects of a supervisory intervention on assessment of interobserver agreement by educational service providers. Behavioral Interventions, 23, 105-112. doi: 10.1002/bin.258 Hartz, R.M., Gould, K., Harper, J.M., & Luiselli, J.K. (2020). Assessing interobserver agreement (IOA) with procedural integrity: Evaluation of training methods among classroom instructors. Child and Family Behavior Therapy, 43, 1-12. doi: 10.1080/00168890.2020.1848404 If you're interested in ordering CEs for listening to this episode, click here to go to the store page. You'll need to enter your name, BCBA #, and the two episode secret code words to complete the purchase. Email us at abainsidetrack@gmail.com for further assistance.

Mark Grote and the crew asked Anthony Herron, the "Score Football Guy," for his evaluation of various players on the Bears roster.

In the final hour, Mark Grote and the crew asked Anthony Herron, the "Score Football Guy," for his evaluation of various players on the Bears roster. After that, Bulls Radio play-by-play announcer Chuck Swirksy joined the show to preview an event he'll emcee Saturday at Rate Field that will celebrate Pope Leo.

Hui Chen is a luminary in the world of Ethics and Compliance, and she is our guest on today's episode of Great Women in Compliance. Today, Hui is one of the co-founders of CDE Advisors, which stands for “Culture. Data. Ethics.” Most of us know Hui from her work at the Department of Justice (DOJ) and her contributions to the Evaluation of Corporate Compliance for the Fraud Section. However, my career path included being a prosecutor, in-house compliance work, and even being inspired to pursue a Master's degree in Divinity after the 9/11 attacks. Hui discusses the origins of the ECCP and her perspective on its current use. She also discusses the opportunity in the “FCPA pause” and how organizations can broaden their ethical considerations beyond foreign bribery to focus on relationships with all stakeholders. She discussed how the focus on regulatory guidance, particularly on bribery outside the United States, is just one of many areas to consider as a compliance professional.  She also offers practical advice based on her experiences working with global compliance functions and the lessons she has learned.

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

Show SummaryOn today's episode, we welcome back a previous guest Marine Corps Veteran and Veteran Advocate Dean Dauphinais. Dean is an enrolled member of the Turtle Mountain Band of Chippewa Indians, and was born and raised on the Spirit Lake Dakota Reservation in North Dakota. Dean and I talk about his work and his role on an advisory committee for PsychArmor to ensure cultural responsivity in content for Native and Tribal Veterans.  Provide FeedbackAs a dedicated member of the audience, we would like to hear from you about the show. Please take a few minutes to share your thoughts about the show in this short feedback survey. By doing so, you will be entered to receive a signed copy of one of our host's three books on military and veteran mental health. About Today's GuestDean Dauphinais served in the United States Marine Corps from 1995 to 1999 with 1st Battalion, 1st Marines, 1st Marine Division. He is the President and CEO of Native Eco Solutions, a consulting firm that has a goal of connecting tribal communities with opportunities to improve the quality of life of their people by inspiring collaboration in Indian Country and matching Indigenous values with strong business fundamentals in order to improve tribal communities·      Enrolled Member of the Turtle Mountain Band of Chippewa Indians·      Bachelor of Education degree - University of North Dakota·      AA Liberal Arts, Cankdeska Cikana Community College·      United States Marine Corps Veteran, Honorable Discharge·      National Congress of American Indians (NCAI), member·      California American Indian Business Chamber of Commerce, member·      Minnesota American Indian Chamber of Commerce, member·      Government Contract Consulting, Project Management, Community Organizing, Veterans Advocacy, Nonprofit Leadership& Management·      Strong network for collaborations in Indian Country, Veterans' Affairs and underserved communities Links Mentioned During the EpisodeDakota 38 FilmPsychArmor Resource of the WeekThis week's resource of the week is the previous two podcast episodes featuring Dean's colleagues on the PsychArmor American Indian and Alaska Native Advisory group, episode 214 with Dr. Chepa Rank and episode 220 with Retired Army Command Sergeant Major Julia Kelly.  You can find the resource here:  https://psycharmor.org/podcast/dr-melita-chepa-rank https://psycharmor.org/podcast/julia-kelly Episode Partner: This week's episode is brought to you by Humana, a leading health and well-being company that has joined forces with PsychArmor to develop campaigns and courses that support veterans and their families in achieving their best health. To learn more about how Humana honors and serves veterans visit healthequity.humana.com/veterans Contact Us and Join Us on Social Media Email PsychArmorPsychArmor on TwitterPsychArmor on FacebookPsychArmor on YouTubePsychArmor on LinkedInPsychArmor on InstagramTheme MusicOur theme music Don't Kill the Messenger was written and performed by Navy Veteran Jerry Maniscalco, in cooperation with Operation Encore, a non profit committed to supporting singer/songwriter and musicians across the military and Veteran communities.Producer and Host Duane France is a retired Army Noncommissioned Officer, combat veteran, and clinical mental health counselor for service members, veterans, and their families.  You can find more about the work that he is doing at www.veteranmentalhealth.com  

Evaluation of a child with edema can be stress-inducing given the differential diagnoses invoked including nephrotic syndrome, liver disease, and heart failure. Determining the cause involves dusting off some principles of physics. Protein, namely albumin, hangs onto water to maintain intravascular osmotic pressure. Not having enough protein causes leakage into surrounding tissues to create characteristic puffiness, begging the question: are we losing protein or not making enough? If protein and osmosis are not the primary drivers, we must also consider capillary hydrostatic pressure as we see with the engorged vessels of heart disease or the retention of fluids with chronic kidney disease. This case investigates a toddler with an initial complaint of periorbital edema and abdominal distention to frame an approach to edema in pediatrics.

On today's episode of the Reinventing Education, Brendan sits down with Craig Randall, educator, author, and creator of the Trust-Based Observations (TBO) model. Craig shares how TBO replaces judgment and anxiety with trust, reflection, and meaningful growth—helping teachers feel safe to take risks, innovate, and truly improve. We dive into how short, frequent, conversation-based observations offer a more supportive and sustainable alternative to traditional evaluation models. If you're an educator or school leader looking for a more human, more effective approach to professional growth, this one's for you. You can find Craig here. https://trustbased.com/  

With a body of information from the Evaluation stage, we enter the Education stage. We will revisit some fundamental biblical truths as a priority to gain unity and clarity among the leadership. The episode highlights the most basic elements and draws some contrasts with fuzzy truths known, promoted, or accepted in our present day. We'll discuss a few key principles for funding missions, including some initial thoughts on church missions funding.

On this Salcedo Storm Podcast: 

This opinion piece by John Ley discusses a Metro analysis that shows the Interstate Bridge Replacement Program falls short of key Regional Transportation Plan goals including safety, climate action, and mobility, with travel times and congestion predicted to worsen by 2045. https://www.clarkcountytoday.com/opinion/opinion-ibr-fails-metro-green-priorities-and-safe-system-evaluation/ #JohnLey #InterstateBridgeReplacement #IBR #RegionalTransportationPlan #Transportation #ClimateAction #Safety #Vancouver #Metro

Now that we've got some vacation time coming up in our near futures, we can sit back, relax…and make our listener's choose our episodes for us! That's right. We've got not one but TWO polls for listeners this month that will determine our summer Listener Choice topic as well as the next year's worth of Book Clubs. Excited to vote? Well, only patrons (at ANY level) will have access to the LC and Book Club polls so, if you haven't signed up yet, better get on it before everyone else chooses your books for you. Oh, and we have a full month of episodes all about IOA, working with an interpreter, and a whole grab bag of ethics! So, by vacation, we meant podcasting wearing sunglasses and shorts. Listener Choice Poll Book Club Poll Join the Patreon! Articles for June 2025 IOA Hausman, N.L., Javed, N., Bednar, M.K., Guell, M., Schaller, E., Nevill, R.E., & Kahng, S. (2022). Interobserver agreement: A preliminary investigation into how much is enough? Journal of Applied Behavior Analysis, 55, 357-368. doi: 10.1002/jaba.811 Garrity, M.L., Luiselli, J.K., & McCollum, S.A. (2008). Effects of a supervisory intervention on assessment of interobserver agreement by educational service providers. Behavioral Interventions, 23, 105-112. doi: 10.1002/bin.258 Hartz, R.M., Gould, K., Harper, J.M., & Luiselli, J.K. (2020). Assessing interobserver agreement (IOA) with procedural integrity: Evaluation of training methods among classroom instructors. Child and Family Behavior Therapy, 43, 1-12. doi: 10.1080/00168890.2020.1848404   Ethicstime! (Summer 2025 Grab Bag) Henderson, T.B., Ludden, B.J., & Romero, R.A. (2023). The ethical obligations, barriers, and solutions for interprofessional collaboration in the treatment of autistic individuals. Behavior Analysis in Practice, 16, 963-976. doi: 10.1007/s40617-023-00787-z Shreck, K., Ivy, J. W., & Zane, T. (2023). Teaching behavior analysts to address unethical behavior: Developing evidence based ethics instructional methods. Behavior Analysis in Practice. doi: 10.1007/s40617-023-00845-6 Logue, J. J., Hustyi, K. M., Toby, L M., & Outlaw, E. E. (2023). Promoting ethical and evidence-based practice through a panel review process: A case study in implementation research. Behavior Analysis in Practice. doi: 10.1007/s40617-023-00807-y   Tutorial: Working With an Interpreter Dowdy, A., Obidimalor, K.C., Tinanci, M., & Travers, J.C. (2021). Delivering culturally sound and high-quality behavior analytic services when working with an interpreter. Behavior Analysis: Research and Practice, 21, 51-64. doi: 10.1037/bar0000206 Vasquez, D.J., Lechago, S.A., & McCarville, M.J. (2024). Training behavior analysis graduate students to work with an interpreter. Behavior Analysis in Practice, 17, 1160-1174. doi: 10.1007/s40617-024-00938-w Hadziabdic, E., Albin, B., Heikkila, K., & Hjelm, K. (2014). Family members' experiences of the use of interpreters in healthcare. Primary Health Care Research and Development, 15, 156-169. doi: 10.1017/S1463423612000680

Kristen discusses the emotional challenges and dynamics of evaluation season in cheerleading. She emphasizes the importance of managing expectations and supporting athletes (and ourselves!) through anxiety. The conversation also explores how parents can redefine success for their children beyond just outcomes, focusing on personal growth and character development. Visit tccjewelry.com and enter code CHEERMOMPOD for 15% off your order Apolla Socks are changing the cheer game, two feet at a time! Visit apollaperformance.com and use CHEERMOM2024 for 10% off!

In this episode, hosts Brad and Michael are joined by Cameron Atlas, a keynote speaker, performance coach, and musician, to discuss how business owners can stay focused, avoid burnout, and lead with intention. Cameron specializes in helping leaders and teams enhance performance, improve decision-making, and effectively navigate change. Tune in to learn how a career built on performance and precision can contribute to burnout and discover how regularly evaluating key decisions can help you build a more resilient business.Watch full episodes of our podcast on our YouTube channel: https://www.youtube.com/@byrdadattoStay connected for the latest business and health care legal updates:WebsiteFacebookInstagramLinkedIn

https://bit.ly/4mDRbKKAula de Laringoscopia: O passo a passo para fazer do jeito certo.

Show SummaryOn today's episode, we're featuring a conversation with Navy Veteran Trinidad Aguirre, CEO and Co-Founder of VetsForever, a VA Accredited Law Group that supports veterans in obtaining disability ratings and discharge upgrades. We talk about the importance of finding support in accessing the benefits applications for the Department of Veterans Affairs. Provide FeedbackAs a dedicated member of the audience, we would like to hear from you about the show. Please take a few minutes to share your thoughts about the show in this short feedback survey. By doing so, you will be entered to receive a signed copy of one of our host's three books on military and veteran mental health. About Today's GuestTrinidad Aguirre, a 100% disabled U.S. Navy Gulf War veteran, has excelled in both military and civilian careers. He is known for his hands-on leadership style and emotional intelligence, which he uses to build high-performing, collaborative teams. Integrity and innovation are the cornerstones of his leadership philosophy, which prioritizes mentorship, continuous improvement, and community impact. Throughout his career, he has demonstrated a steadfast commitment to providing top-tier legal services to the veteran community.He has held several executive board positions, including with the Hispanic Chamber of Commerce, as National President of Verizon's ERG Hispanic Support Organization, and as President of the American Marketing Association DFW. In addition, he has been at the forefront of change in the marketing industry, pushing for a greater emphasis on integrating awareness and advanced data analysis to effectively engage the desired target audience.A transformational leader driven by a passion for veteran advocacy, Trinidad has built a distinguished career dedicated to enhancing veterans' lives through financial security, mental health awareness, and strategic business excellence. He co-founded VetsForever (VF LLC), a 100% disabled veteran-owned organization. He leverages his two decades of dynamic experience in sales, marketing, and operational leadership to empower veterans to navigate the complexities of the VA claims process.Trinidad has implemented a proven, viable process for how VA-accredited organizations should approach the VA disability system. His primary mission focuses on delivering results within months rather than years, helping to meet veterans' urgent need for validation and economic support. The expedited process creates a safe space for veterans to improve and maintain their mental wellness. Financial security, in turn, provides the stability needed to sustain mental health, reinforcing his mission to integrate economic support with holistic veteran care.Trinidad is deeply committed to serving the community through his extensive involvement with nonprofit organizations such as OneTribe, Carry The Load, and the Stephen A Cohen Family Clinic. These organizations all concentrate on veterans' mental health, and Trinidad tirelessly supports through various initiatives that advocate for veterans and provide them with essential resources.Links Mentioned During the EpisodeVetsForever Web SitePsychArmor Resource of the WeekThis week's resource of the week is PsychArmor course, 15 Things Veteran Service Officers Want You to Know. This course aims to provide education about the role of Veterans Service Officers (VSOs) to make it easier for Veterans and their loved ones to navigate the benefits and claims process. We hope this course will encourage Veterans to work with a VSO to file claims for benefits, prevent continued misinformation about Veteran benefits and VSOs, and help Veterans recognize the importance of accessing the benefits they earned. You can find the resource here:  https://learn.psycharmor.org/courses/15-things-veterans-service-officers-want-you-to-know Episode Partner: This week's episode is brought to you by Humana, a leading health and well-being company that has joined forces with PsychArmor to develop campaigns and courses that support veterans and their families in achieving their best health. To learn more about how Humana honors and serves veterans visit healthequity.humana.com/veterans Contact Us and Join Us on Social Media Email PsychArmorPsychArmor on TwitterPsychArmor on FacebookPsychArmor on YouTubePsychArmor on LinkedInPsychArmor on InstagramTheme MusicOur theme music Don't Kill the Messenger was written and performed by Navy Veteran Jerry Maniscalco, in cooperation with Operation Encore, a non profit committed to supporting singer/songwriter and musicians across the military and Veteran communities.Producer and Host Duane France is a retired Army Noncommissioned Officer, combat veteran, and clinical mental health counselor for service members, veterans, and their families.  You can find more about the work that he is doing at www.veteranmentalhealth.com  

Listen to Dr. Graham's interview with Drs. Hernan Roca and Nik Kazmers regarding their paper "Evaluation of Test-Retest Reliability for the Patient-Reported Outcomes Measurement Information System Upper Extremity and Pain Interference Computer Adaptive Tests in a Hand Surgery Population" that is the lead article in the June 2025 issue of the Journal of Hand Surgery.

Matt and Todd saddle up once more for another ride with Emilio Estevez as Billy "The Kid" and his posse:Lou Diamond Phillips as Chavez y Chavez and Kiefer Sutherland as Josiah "Doc" Scurlock, in Young Guns II, the 1990 sequel to the 1988 classic.Directed by Geoff Murphy.Does this follow-up stand the test of time? Let's find out.Matt has spent over three decades dismissing it, while Todd mostly overlooked it. Now, they set aside old frustrations for a fresh viewing.Plagued by production challenges and lukewarm reviews upon release, Young Guns II was written off by many. But was that judgment too harsh? Could there be a genuinely great Western hidden beneath the criticism?Matt reviews and ranks more movies including newer ones at ⁠Letterboxd⁠You can find out what he's following on Bluesky @MovieMattSirois.bsky.socialCheck out favorites of what we follow, at: ⁠⁠⁠Once Upon a Geek⁠⁠⁠⁠ and  ⁠⁠⁠⁠The Fade Out Podcast⁠⁠ As Marcus he reviews all sorts of films but unlike here, they often they range from bad, worse, or terrible at the ⁠⁠⁠⁠MovieAsylum of the Weird, Bad and Wonderful⁠.

GLP-1 medications and Evaluation & Management (E&M) services present two very different prior authorization challenges—one is high-volume and fast-moving, the other is nuanced and frequently blocked by PBM red tape. In this episode, Infinx's Jonathan Aguiar and Jennifer Glockzin break down how their team uses AI, automation, and hands-on intervention to streamline both, improving speed and accuracy while reducing provider burden. 

Devi Sridhar's new book  “How Not to Die  (Too Soon) - The Lies We've Been Sold, and the Policies That Could Save Us” is focussing on the way wellness culture ignores the societal context in which health is really created. As a trained personal trainer and professor of global public health, Devi's straddling both of those worlds, and joins us to talk about how she would tackle our lowering life expectancy. Also, John Downey, from the Centre of Health Technology at Peninsula Medical School, and Martha Lee from NHS Devon Integrated Care Board, have written about Portsmouth's "Living Lab" - which has been set up to test how health tech can actually work in the real world, but also (importantly, critically) how it can be properly evaluated and integrated into the NHS and social care. Reading list How Not to Die (Too Soon) Harnessing predictive prevention to shift elderly care from hospital to community in England

Founder of more than 50 Counseling Clinics, Brian Nystrom took the time in 2023 to share the importance of the Tru316 message, on this Classic flashback episode of The Eden Podcast. The Tru316 Foundation (www.Tru316.com) is the home of The Eden Podcast with Bruce C. E. Fleming where we “true” the verse of Genesis 3:16. The Tru316 Message is that “God didn't curse Eve (or Adam) or limit woman in any way.” Once Genesis 3:16 is made clear the other passages on women and men become clear too. You are encouraged to access the episodes of Seasons 1-11 of The Eden Podcast for teaching on the seven key passages on women and men. Are you a reader? We invite you to get from Amazon the four books by Bruce C. E. Fleming in The Eden Book Series (Tru316.com/trubooks). Would you like to support the work of the Tru316 Foundation? You can become a Tru Partner here: www.Tru316.com/partner

Luke 7:18-35

New set is upon us and we have an impossible task of figuring out which cards are grerat and which are traps without the advantage of having them ever in our hands. Data won't solve that problem but it can definitely help, by looking at the general trends in card power across mana values, colors, etc. Also we can look into the amazing #P0P1 initiative from MTG_DS, where hundreds of people put their bets on the best cards in a set before its release (which mtg_ds kindly shared with me). This let me look at the wisdom of the crowd - what cards were widely liked but turned out to be duds, which cards nobody saw coming. Why some cards fly under the radar, while some lure us into the trap?Here is the example fo P0P1 results from TMD for reference - make sure to give MTG_DS a follow - in the end it stands for Magic Data Science, you should be interested!https://x.com/mtg_ds/status/1920641850546815335Ping me for coaching. Join the ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Discord⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠, sign up for ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Patreon⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠, and use this ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Linktree⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ for everything else! Watch this episode and see the slides: ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Episode #154 vid⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠This podcast is sponsored by ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠mtgazone.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ - get your reading fix from the best and brightest Magic writers in the business.You can get the BulkBox if you are in the UK. Remember to use SIERKO10 code for a 10% discount!If you are outside of UK, you can find your local distributor on the ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠BulkBox website⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠.

Connect with Tara :@burn.the.stigma0:00 Intro 0:07 Massachusetts 1:48 Strict catholic 3:00 Human breatherliser 4:10 End of life cancer care 5:00 Overdose death 7:08 It wasn't a sloppy drug 7:20It got unmanageable 8:00 Academic probation9:05 Suboxone10:50 Rehab 12:00 From pills to heroin 13:20 My 20s in rehab 14:15 Your not surrendering enough 15:15 Get out of your will 15:47 Sober living 16:40 I would end up picking up 17:30 Service commitments 18:15 5 brothers overdosed 19:00 ADHD20:00 Your powerful 22:00 You never truly finish 12 step 23:10 Cannabis doctors 24:20 Bank robbery 25:20 Federal half way house 26:40 Engaged 27:00 He didn't care 28:50 we would dabble a little bit 29:35 How do you make peace 30:45 Lifestyle of drugs 31:10 Euphoria 32:10 Cutting back , switching drugs 33:38 Ladder goals 35:00 If I take one hit 36:00 It helps me with nausea 37:10 processing feelings 38:10 prevention39:10 isolation 40:45 Shame 41:25 Motivation42:05 Boundaries 43:35 Evaluation 44:10 I wasn't good at anything 45:40 Harmful side of 12 step 47:10 Narkan 47:50 Evidence based treatment

The completion of our consideration of evaluating your church's potential as a good sending church includes thoughts that will ultimately help your church rise to that challenge. Start with prayer. End with prayer. Pray throughout the process. Ask lots of probing questions. Understand that you must win the participation and ownership of your church leaders. Seek to find the right resources and partners to become the good sending church the Lord desires to use in His plan for fulfilling the Great Commission.

In this episode, we discuss the diagnosis and treatment of resistant hypertension, including a newer endothelin receptor antagonist (ERA) called aprocitentan (Tryvio®). Key Concepts The diagnosis of true resistant hypertension is based on requiring more than 3 antihypertensives (ACE inhibitor or ARB + calcium channel blocker + diuretic) to achieve goal BP, ruling out inaccurate BP readings, and ensuring patient adherence to their antihypertensive therapy. Non-pharmacologic therapy (especially dietary sodium restriction), medication adherence, and lifestyle changes are critical to the treatment of resistant hypertension. The preferred 4th line option for most patients with resistant hypertension is spironolactone. After adding spironolactone, additional therapies are based on expert opinion and patient-specific factors. These additional therapies may include beta blockers, alpha-2 agonists, alpha-1 blockers, hydralazine, minoxidil, and aprocitentan. References Carey RM, Calhoun DA, Bakris GL, et al. Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association. Hypertension. 2018;72(5):e53-e90. doi:10.1161/HYP.0000000000000084 Mancia G, Kreutz R, Brunström M, et al. 2023 ESH Guidelines for the management of arterial hypertension The Task Force for the management of arterial hypertension of the European Society of Hypertension: Endorsed by the International Society of Hypertension (ISH) and the European Renal Association (ERA). J Hypertens. 2023;41(12):1874-2071. doi:10.1097/HJH.0000000000003480

In the beginning of the year you made some goals and now it's the perfect time for you to look at the action you've taken, what's going well, and what needs to change. Mid-Year audits are the one thing that I do every year to help me stay on track with reaching my business, life and wellness goals. It's an evaluation of everything that has happened so far and will help show you how well you're doing or point out things that need to change in order for you to have a successful second half of the year. I am sharing some important questions to ask yourself and evaluate every area of your life. To create the life or business you want, you must be willing to spend time planning, strategizing, but also evaluating so that things don't go unnoticed and you don't waste your time doing the wrong things over and over again. Hope you find this helpful.    xoxo,    Jeannet    Work with Jeannet:   Apply for one on one private coaching: https://forms.gle/bwoTL8HCUDPmM1LY8 Get my FREE workbook to help you identify the skills you can monetize with an online business: https://www.jeannetsacks.com/monetizeskills Coaching Business Workshop: This Workshop is designed to take you from newbie to launching your own Online Coaching Business or restructure your current Coaching Program so it starts making you money. You will develop your Coaching Program and create streams of income from the comfort of your home, while having an impact on others. https://www.jeannetsacks.com/coachingbusiness Subscribe to my newsletter for awesome tips to live your best life:  https://www.jeannetsacks.com/newsletter Instagram: @JeannetSacks   Website: https://www.JeannetSacks.com  

CR is testing the 2025 Buick Enclave Sport Touring, the new luxury 3-row SUV from GM positioned just below Cadillac. Built on the same platform as the Chevrolet Traverse and GMC Acadia, the new Enclave aims to combine upscale comfort with family-friendly practicality. But does it deliver real value in a crowded segment? And how does it stack up against competitors like the Toyota Highlander, Grand Highlander, and the Honda Pilot? We also answer viewer questions about niche tire sizes on some Toyota and Lexus vehicles (like the Prius and Crown Signia), and is it worth keeping a 2009 Toyota Highlander with over 250k miles, or is it time to find a replacement?   Join CR at https://CR.org/joinviaYT to access our comprehensive ratings for items you use every day. CR is a mission-driven, independent, nonprofit organization. More info on the 2025 Buick Enclave here: https://www.consumerreports.org/cars/buick/enclave/2025/overview/?EXTKEY=YSOCIAL_YT     SHOW NOTES ----------------------------------- 00:00 - Introduction 00:17 - Overview: 2025 Buick Enclave 02:05 - What is The Enclave? 05:27 - The Controls 09:35 - Ride Comfort 10:36 - The Powertrain 12:54 - Driving 13:39 - Cargo Area 14:24 - Super Cruise System 18:18 - Would You Buy It? 20:49 - Question #1: Why do manufacturers make cars with odd tire sizes that are hard to find? 24:58 - Question #2: When is the right time to replace an older vehicle?     ----------------------------------   First Drive: 2025 Buick Enclave 3-Row SUV Tries to Justify Its Almost-Luxury Price https://www.consumerreports.org/cars/suvs/2025-buick-enclave-review-a2392197540/?EXTKEY=YSOCIAL_YT   SUVs and Minivans With the Best Third-Row Seats https://www.consumerreports.org/cars/suvs-and-minivans-with-the-best-third-row-seats-a6809768331/?EXTKEY=YSOCIAL_YT   Most Reliable 3-Year-Old Used Midsized SUVs https://www.consumerreports.org/cars/cars-most-reliable-3-year-old-midsized-suvs-a1933721124/?EXTKEY=YSOCIAL_YT   Safest New Cars of 2025, According to the IIHS https://www.consumerreports.org/cars/car-safety/safest-new-cars-of-2025-according-to-iihs-a3325666134/?EXTKEY=YSOCIAL_YT  

CR is testing the 2025 Buick Enclave Sport Touring, the new luxury 3-row SUV from GM positioned just below Cadillac. Built on the same platform as the Chevrolet Traverse and GMC Acadia, the new Enclave aims to combine upscale comfort with family-friendly practicality. But does it deliver real value in a crowded segment? And how does it stack up against competitors like the Toyota Highlander, Grand Highlander, and the Honda Pilot? We also answer viewer questions about niche tire sizes on some Toyota and Lexus vehicles (like the Prius and Crown Signia), and is it worth keeping a 2009 Toyota Highlander with over 250k miles, or is it time to find a replacement?   Join CR at https://CR.org/joinviaYT to access our comprehensive ratings for items you use every day. CR is a mission-driven, independent, nonprofit organization. More info on the 2025 Buick Enclave here: https://www.consumerreports.org/cars/buick/enclave/2025/overview/?EXTKEY=YSOCIAL_YT     SHOW NOTES ----------------------------------- 00:00 - Introduction 00:17 - Overview: 2025 Buick Enclave 02:05 - What is The Enclave? 05:27 - The Controls 09:35 - Ride Comfort 10:36 - The Powertrain 12:54 - Driving 13:39 - Cargo Area 14:24 - Super Cruise System 18:18 - Would You Buy It? 20:49 - Question #1: Why do manufacturers make cars with odd tire sizes that are hard to find? 24:58 - Question #2: When is the right time to replace an older vehicle?     ----------------------------------   First Drive: 2025 Buick Enclave 3-Row SUV Tries to Justify Its Almost-Luxury Price https://www.consumerreports.org/cars/suvs/2025-buick-enclave-review-a2392197540/?EXTKEY=YSOCIAL_YT   SUVs and Minivans With the Best Third-Row Seats https://www.consumerreports.org/cars/suvs-and-minivans-with-the-best-third-row-seats-a6809768331/?EXTKEY=YSOCIAL_YT   Most Reliable 3-Year-Old Used Midsized SUVs https://www.consumerreports.org/cars/cars-most-reliable-3-year-old-midsized-suvs-a1933721124/?EXTKEY=YSOCIAL_YT   Safest New Cars of 2025, According to the IIHS https://www.consumerreports.org/cars/car-safety/safest-new-cars-of-2025-according-to-iihs-a3325666134/?EXTKEY=YSOCIAL_YT      

Listen as Michael S. Blaiss, MD provides case-based perspectives on chronic cough recognition, burden, management, and pathophysiology and describes the evolving treatment landscape for refractory chronic cough.PresenterMichael S. Blaiss, MDClinical Professor of PediatricsDivision of Allergy-ImmunologyMedical College of Georgia at Augusta UniversityAugusta, GeorgiaLink to full program: https://bit.ly/4kweynG

Show SummaryOn today's episode, we're featuring a conversation with Retired Command Sergeant Major Julia Kelly of the Crow Nation from Pryor, Montana. We talk about Julia's Native heritage and her membership of an advisory group to PsychArmor for content related to Native and Tribal veterans. Provide FeedbackAs a dedicated member of the audience, we would like to hear from you about the show. Please take a few minutes to share your thoughts about the show in this short feedback survey. By doing so, you will be entered to receive a signed copy of one of our host's three books on military and veteran mental health. About Today's GuestJulia Kelly “Baassáannee Xiassaa” (One Who is in Front)” is of the Ties The Bundle / Piegan Clans of the Apsáalooke (Crow) Nation, from Pryor, Montana.  Julia brings experience of military service and working with non-profit organizations across the Nation.  Julia entered the US Army July 31, 1981, as an Ammunition Specialist, PVT/E1. She retired October 31, 2010, as a Command Sergeant Major with over 28 years of service. She has two combat tours to Iraq and had many assignments in leadership positions, culminating with her last military career assignment as the Command Sergeant Major for the 299th Brigade Support Battalion, 2ndBrigade Combat Team, 1st Infantry Division, Fort Riley, Kansas.  Julia spends much of her time helping Native Veterans/Veterans across the United States in connecting them with resources that serve Veterans.  She currently resides in Huntsville, Alabama. She has five children, 11 grandchildren, and three great grandchildren.  PsychArmor Resource of the WeekThis week's resource of the week is the recently released podcast episode with another member of PsychArmor's Native and Tribal Advisory group, Dr. Chepa Rank in episode 214. In that episode, we talk about Chepa's experience as a military family member and member of the Húŋkpati Dakota Tribe as well as her work as a a dedicated social worker whose mission centers around holistic wellness and well-being within Tribal and Indigenous communities. You can find the resource here:  https://psycharmor.org/podcast/dr-melita-chepa-rank Episode Partner: This week's episode is brought to you by Humana, a leading health and well-being company that has joined forces with PsychArmor to develop campaigns and courses that support veterans and their families in achieving their best health. To learn more about how Humana honors and serves veterans visit healthequity.humana.com/veterans Contact Us and Join Us on Social Media Email PsychArmorPsychArmor on TwitterPsychArmor on FacebookPsychArmor on YouTubePsychArmor on LinkedInPsychArmor on InstagramTheme MusicOur theme music Don't Kill the Messenger was written and performed by Navy Veteran Jerry Maniscalco, in cooperation with Operation Encore, a non profit committed to supporting singer/songwriter and musicians across the military and Veteran communities.Producer and Host Duane France is a retired Army Noncommissioned Officer, combat veteran, and clinical mental health counselor for service members, veterans, and their families.  You can find more about the work that he is doing at www.veteranmentalhealth.com  

A 28 year old assigned male at birth presents with the chief complaint of a "new problem in my private parts” He states he feels well otherwise. Which of the following would be most consistent with the clinical presentation of primary syphilis?A. A three day history of purulent penile discharge with dysuria.B. A one week history of a painless genital ulcer on the penile shaft.C. A 5 day history of painful vesicular lesions over the penile glands, with some lesions now crusting over.D. A one week history of N void dysuria without penile discharge.---YouTube: https://www.youtube.com/watch?v=Jp-dk0BZ37o&list=PLf0PFEPBXfq592b5zCthlxSNIEM-H-EtD&index=116Visit fhea.com to learn more!

There are plenty of opinions, both for and against the Pittsburgh Steelers, that go along with the majority. Sometimes it's good to pose a counter argument for ones that could be taking it too much to the extreme. Join Dave Schofield as he offers some unpopular opinions about the Pittsburgh Steelers that go against the general narrative. This week Dave looks at the evaluation of players and how much is done where the fans don't see. Learn more about your ad choices. Visit megaphone.fm/adchoices

How to have the conversations that are most difficult — and most important.Before you can have hard conversations with others, you need to have an honest conversation with yourself. That's the counterintuitive advice from Sheila Heen, who says our own internal narratives often derail our attempts at negotiation and conflict resolution."The first negotiation is actually a negotiation I have with myself about my own story," explains Heen, a Harvard Law School lecturer and co-author of Difficult Conversations: How to Discuss What Matters Most. When entering challenging interactions, she recommends a powerful shift where we consider that our perspective is only one side of the story. "If I can shift my purpose from convincing you of something to just understanding how you see it and why we might see it differently, that actually is more likely to generate a good conversation with less defensiveness for both of us."In this episode of Think Fast, Talk Smart, Heen joins Matt Abrahams to explore effective communication in high-stakes situations. From giving and receiving feedback with her “ACE” framework (Appreciation, Coaching, and Evaluation) to recognizing the "degrees of difficulty" in disagreements, she offers practical strategies for having productive conversations even when emotions run high.Episode Reference Links:Sheila Heen Sheila's Books: Difficult Conversations / Thanks for the Feedback  Ep.144 Communicating Through Conflict: How to Get Along with AnyoneEp.136 The Art of Disagreeing Without Conflict: Navigating the Nuance  Connect:Premium Signup >>>> Think Fast Talk Smart PremiumEmail Questions & Feedback >>> hello@fastersmarter.ioEpisode Transcripts >>> Think Fast Talk Smart WebsiteNewsletter Signup + English Language Learning >>> FasterSmarter.ioThink Fast Talk Smart >>> LinkedIn, Instagram, YouTubeMatt Abrahams >>> LinkedInChapters:(00:00) - Introduction (01:36) - Managing Anxiety in Tough Conversations (04:15) - Why Emotions Matter (07:23) - Shifting the Story We Tell Ourselves (08:41) - Starting with the Real Issue (10:20) - Getting Unstuck in Conflict (13:18) - ACE: The Three Types of Feedback (16:20) - Making Feedback Actionable (18:40) - Finding Common Ground (20:17) - The Final Three Questions (27:32) - Conclusion    *****This episode is brought to you by Babbel. Think Fast Talk Smart listeners can get started on your language learning journey today- visit Babbel.com/Thinkfast and get up to 55% off your Babbel subscription.Support Think Fast Talk Smart by joining TFTS Premium.