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Join co-hosts Peter and Patrick as they discuss global tariffs' impact on language services with Florian Faes, Managing Director at Slator. They explore market uncertainties, increasing M&A activity, and buyer trends in translation, offering valuable insights on navigating economic headwinds in the language industry.
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Manuel Pinto, estratega de mercados, repasa los títulos de Faes Farma, Endesa, Caixabank, Barrick Gold, BBVA, Naturgy o Vidrala.
Podcast de Mercado Abierto
Manuel Pinto, estratega de mercados, repasa los títulos de Faes Farma, Endesa, Caixabank, Barrick Gold, BBVA, Naturgy o Vidrala.
Despite advances in epilepsy management, disparities and lack of inclusion of many people with epilepsy are associated with increased morbidity and mortality. Improving awareness and promoting diversity in research participation can advance treatment for underserved populations and improve trust. In this episode, Teshamae Monteith, MD, PhD, FAAN speaks Dave F. Clarke, MBBS, FAES, author of the article “Diversity and Underserved Patient Populations in Epilepsy,” in the Continuum® February 2025 Epilepsy issue. Dr. Monteith is a Continuum® Audio interviewer and an associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Clarke is the Kozmetsky Family Foundation Endowed Chair of Pediatric Epilepsy and Chief or Comprehensive Pediatric Epilepsy Center, Dell Medical School at the University of Texas at Austin in Austin, Texas. Additional Resources Read the article: Diversity and Underserved Patient Populations in Epilepsy Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @HeadacheMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Monteith: This is Dr Teshamae Monteith. Today I'm interviewing Dr Dave Clarke about his article on diversity and underserved patient populations in epilepsy, which appears in the February 2025 Continuum issue on epilepsy. So why don't you introduce yourself to our audience? Dr Clarke: Sure. My name is Dr Dave Clarke, as alluded to. I'm presently at the University of Texas in Austin, originating from much farther south. I'm from Antigua, but have been here for quite a while working within the field in epilepsy surgery, but more and more getting involved in outreach, access to care, and equity of healthcare in epilepsy. Dr Monteith: And how did you get involved in this kind of work? Dr Clarke: That's an amazing question. You know, I did it in a bit of a inside out fashion. I initially started working in the field and trying to get access to persons in the Caribbean that didn't have any neurological care or investigative studies, but very quickly realized that persons around the corner here in Texas and wherever I've worked have had the exact same problems, getting access via fiscal or otherwise epilepsy care, or geographically getting access, with so few having neurologists close at hand. Therefore, I started working both on a regional, national, and it transcended to a global scale. Dr Monteith: Wow, so you're just everywhere. Dr Clarke: Well, building bridges. I've found building bridges and helping with knowledge and garnering knowledge, you can expand your reach without actually moving, which is quite helpful. Dr Monteith: Yeah. So why don't you tell us why you think this work is so important in issues of diversity, underserved populations, and of course, access to epilepsy care? Dr Clarke: Sure, not a problem. And I think every vested person in this can give you a different spiel as to why they think it's important. So, I'll add in a few facts pertaining to access, but also tell you about why I think personally that it's not only important, but it will improve care for all and improve what you believe you could do for a patient. Because the sad thing is to have a good outcome in the United States presently, we have over three hundred epilepsy centers, but they have about eight or nine states that don't have any epilepsy centers at all. And even within states themselves, people have to travel up to eight hours, i.e., in Texas, to get adequate epilepsy care. So that's one layer. Even if you have a epilepsy center around the corner, independent of just long wait times, if you have a particular race or ethnicity, we've found out that wait may be even longer or you may be referred to a general practitioner moreso than being referred to an epilepsy center. Then you add in layers of insurance or lack thereof, which is a big concern regardless of who you are; poverty, which is a big concern; and the layers just keep adding more. Culture, etcetera, etcetera. If you could just break down some of those barriers, it has been shown quite a few years ago that once you get to an epilepsy center, you can negate some of those factors. You can actually reduce time to access and you can improve care. So, that's why I'm so passionate about this, because something could potentially be done about it. Dr Monteith: That's cool. So, it sounds like you have some strategies, some strategies for us. Dr Clarke: Indeed. And you know, this is a growth and this is a learning curve for me and will be for others. But I think on a very local, one-to-one scale, the initial strategy I would suggest is you have to be a good listener. Because we don't know how, when, where or why people are coming to us for their concerns. And in order to judge someone, if they may not have had a follow-up visit or they may not have gotten to us after five medications, the onus may not have been on that person. In other words, as we learned when we were in medical school, history is extremely important, but social history, cultural history, that's also just as important when we're trying to create bridges. The second major thing that we have to learn is we can't do this alone. So, without others collaborating with us outside of even our fields, the social worker who will engage, the community worker who will discuss the translator for language; unless you treat those persons with respect and engage with those persons to help you to mitigate problems, you'll not get very far. And then we'll talk about more, but the last thing I'll say now is they have so many organizations out there, the Institute of Medicine or the International League Against Epilepsy or members of the American Epilepsy Society, that have ways, ideas, papers, and articles that can help guide you as to how better mitigate many of these problems. Dr Monteith: Great. So, you already mentioned a lot of things. What are some things that you feel absolutely the reader should take away in reading your article? You mentioned already listening skills, the importance of interdisciplinary work, including social work, and that there are strategies that we can use to help reduce some of this access issues. But give me some of the essential points and then we'll dive in. Dr Clarke: OK. I think first and foremost we have to lay the foundation in my mind and realize what exactly is happening. If you are Native American, of African descent, Hispanic, Latinx, geographically not in a region where care can be delivered, choosing one time to epilepsy surgery may be delayed twice, three, four times that of someone of white descent. If you are within certain regions in the US where they may have eight, nine, ten, fourteen epilepsy centers, you may get to that center within two to three years. But if you're in an area where they have no centers at all, or you live in the Dakotas, it may be very difficult to get to an individual that could provide that care for you. That's very, very basic. But a few things have happened a few years ago and even more recently that can help. COVID created this groundswell of ambulatory engagement and ambulatory care. I think that can help to mitigate time to get into that person and improving access. In saying that, there are many obstacles to that, but that's what we have to work towards: that virtual engagement and virtual care. That would suggest in some instances to some persons that it will take away the one-to-one care that you may get with persons coming to you. But I guarantee that you will not lose patients because of this, because there's too big a vacuum. Only 22% of persons that should actually get to epilepsy centers actually get to epilepsy centers. So, I think we can start with that foundation, and you can go to the article and learn a lot more about what the problems are. Because if you don't know what the problems are, you can't come up with solutions. Dr Monteith: Just give us a few of the most persistent inequities and epilepsy care? Dr Clarke: Time to seeing a patient, very persistent. And that's both a disparity, a deficiency, and an inequity. And if you allow me, I'll just explain the slight but subtle difference. So, we know that time to surgery in epilepsy in persons that need epilepsy surgery can be as long as seventeen years. That's for everyone, so that's a deficiency in care. I just mentioned that some sociodemographic populations may not get the same care as someone else, and that's a disparity between one versus the other. Health equity, whether it be from NIH or any other definition, suggests that you should get equitable care between one person and the other. And that brings in not only medical, medicolegal or potential bias, that we may have one person versus the other. So, there's a breakdown as to those different layers that may occur. And in that I'm telling you what some of the potential differences are. Dr Monteith: And so, you mentioned, it comes up, race and ethnicity being a major issue as well as some of the geographic factors. How does that impact diagnosis and really trying to care for our patients? Dr Clarke: So again, I'm going to this article or going to, even. prior articles. It has been shown by many, and most recently in New Jersey, that if you're black, Hispanic, Latin- Latinx, it takes you greater than two times the time to surgery. Reduced time to surgery significantly increases morbidity. It potentially increases mortality, as has been shown by a colleague of mine presently in Calgary. And independent of that, we don't look at the other things, the other socially related things. Driving, inability to work, inability to be adequately educated, the stigma related to that in various cultures, various countries. So, that deficit not only increased the probability of having seizures, but we have to look at the umbrella as to what it does. It significantly impacts quality of life of that individual and, actually, the individuals around them. Dr Monteith: So, what are some of these drivers, and how can we address them, or at least identify them, in our clinic? Dr Clarke: That's a question that's rather difficult to answer. And not because there aren't ideas about it, but there's actually mitigating those ideas or changing those ideas we're just presently trying to do. Although outlines have been given. So, in about 2013, the federal government suggested outlines to improve access and to reduce these inequities. And I'll just give you a few of them. One of those suggestions was related to language and having more improved and readily available translators. Something simple, and that could actually foster discussions and time to better management. Another suggestion was try to train more persons from underserved populations, persons of color. Reason being, it has been shown in the social sciences and it is known in the medical sciences that, if you speak to a person of similar culture, you tend to have a better rapport, you tend to be more compliant, and that track would move forward, and it reduces bias. Now we don't have that presently, and I'm not sure if we'll have that in the near future, although we're trying. So then, within your centers, if you have trainings on cultural sensitivity, or if you have engagements and lectures about how you can engage persons from different populations, those are just some very simple pearls that can improve care. This has been updated several times with the then-Institute of Medicine in 2012, 2013, they came out with, in my mind, a pretty amazing article---but I'm very biased---in which they outline a number of strategic initiatives that could be taken to improve research, improve clinical care, improve health equity through health services research, to move the field forward, and to improve overall care. They updated this in 2020, and it's a part of the 2030 federal initiative not only for epilepsy, but to improve overarching care. All of this is written in bits and pieces and referenced in the article. To add icing on top, the World Health Organization, through advocacy of neurological groups as well as the International League Against Epilepsy and the AES, came out with the Intersectoral Action Plan on Epilepsy and Other Neurological Diseases, which advocates for parallel improvement in overall global care. And the United States have signed on to it, and that have lit a fire to our member organizations like the American Epilepsy Society, American Academy of Neurology, and others, trying to create initiatives to address this here. I started off by saying this was difficult because, you know, we have debated epilepsy care through 1909 when the International League against Epilepsy was founded, and we have continually come up with ways to try and advance care. But this have been the most difficult and critical because there's social dynamics and social history and societal concerns that have negated us moving forward in this direction. But fortunately, I think we're moving in that direction presently. That's my hope. And the main thing we have to do is try to sustain that. Dr Monteith: So, you talked about the importance of these global initiatives, which is huge, and other sectors outside of neurology. Like for example, technology, you spoke about telemedicine. I think you were referring to telemedicine with COVID. What other technologies that are more specific to the field of epilepsy, some of these monitorings that maybe can be done? Dr Clarke: I was just going to just going to jump on that. Thank you so much for asking. Dr Monteith: I have no disclosures in this field. I think it's important and exciting to think how can we increase access and even access to monitoring some of these technologies. That might be expensive, which is another issue, but…. Dr Clarke: So, the main things in epilepsy diagnosis and management: you want to hear from the patient history, you want to see what the seizures look like, and then you want to find ways in which to monitor those seizures. Hearing from the patient, they have these questionnaires that have been out there, and this is local, regional, global, many of them standardized in English and Spanish. Our colleagues in Boston actually created quite a neat one in English and Spanish that some people are using. Ecuador has one. We have created someone- something analogous. And those questionnaires can be sent out virtually and you can retrieve them. But sometimes seeing is believing. So, video uploads of seizures, especially the cell phone, I think has been management-changing for the field of epilepsy. The thing you have to do however, is do that in a HIPAA-compliant way. And several studies are ongoing. In my mind, one of the better studies here was done on the East Coast, but another similar study, to be unnamed, but again, written out in the articles. When you go into these apps, you can actually type in a history and upload a video, but the feed is not only going to you, it may be going to the primary care physician. So, it not only helps in one way in you educating the patient, but you educate that primary care physician and they become extenders and providers. I must add here my colleagues, because we can't do without them. Arguably in some instances, some of the most important persons to refer patients, that's the APPs, the PAs and the nurse practitioners out there, that help to refer patients and share patients with us. So, that's the video uploads they're seeing. But then the other really cool part that we're doing now is the ambulatory world of EEGs. Ceribell, Zeto, to name of few, in which you could potentially put the EEG leads on persons with or without the EEG technologist wirelessly and utilize the clouds to review the EEGs. It's not perfect just yet, but that person that has to travel eight hours away from me, if I could do that and negate that travel when they don't have money to pay for travel or they have some potential legal issues or insurance-related issues and I could read the EEG, discuss with them via telemedicine their care, it actually improves access significantly. I'm going to throw in one small twist that, again, it's not perfect. We're now trying to monitor via autonomic features, heart rate movement and others, for seizures and alert family members, parents, because although about 100,000 people may be affected with epilepsy, we're talking about 500,000 people who are also affected that are caregivers, affiliates, husbands, wives, etcetera. Just picture it: you have a child, let's say three, four years old and every time they have a seizure- or not every time, but 80% of times when they have a seizure, it alerts you via your watch or it alerts you in your room. It actually gives that child a sense of a bit more freedom. It empowers you to do something about it because you can understand here. It potentially negates significant morbidity. I won't stretch it to say SUDEP, but hopefully the time will come when actually it can prevent not only morbidity, but may prevent death. And I think that's the direction we are going in, to use technology to our benefit, but in a HIPAA-compliant way and in a judicious way in order to make sure that we not only don't overtreat, but at the end of the day, we have the patient as number one, meaning everything is vested towards that patient and do no harm. Dr Monteith: Great. One thing you had mentioned earlier was that there are even some simple approaches, efficiency approaches that we can use to try and optimize care for all in our clinics. Give me what I need to know, or do. Give me what I need to do. Dr Clarke: Yeah, I'll get personal as to what we're trying to do here, if you don't mind. The initial thing we did, we actually audited care and time to care delivery. And then we tried to figure out what we could do to improve that access and time to care, triaging, etcetera. A very, very simple thing that can be done, but you have to look at costs, is to have somebody that actually coordinates getting persons in and out of your center. If you are a neurologist that works in private practice, that could potentially be a nurse being associated directly one-and-one with one of the major centers, a third- or fourth-level center. That coordination is key. Educate your nurses about epilepsy care and what the urgent situations are because it will take away a lot of your headache and your midnight calls because they'll be able to know what to do during the day. Video uploads, as I suggested, regardless of the EMR that you have, figure out a way that a family could potentially send a video to you, because that has significantly helped in reducing investigative studies. Triaging appropriately for us to know what patients we can and cannot see. Extenders has helped me significantly, and that's where I'll end. So, as stated, they had many neurologists and epileptologists, and utilizing appropriately trained nurse practitioners or residents, engaging with them equally, and/or social workers and coordinators, are very helpful. So hopefully that's just some low-hanging fruit that can be done to improve that care. Dr Monteith: So why don't you give us some of your major takeaways to how we can improve epilepsy care for all people? Dr Clarke: I've alluded to some already, but I like counts of threes and fives. So, I think one major thing, which in my mind is a major takeaway, is cultural sensitivity. I don't think that can go too far in improving care of persons with epilepsy. The second thing is, if you see a patient that have tried to adequately use medications and they're still having seizures, please triage them. Please send them to a third- or fourth-level epilepsy center and demand that that third- or fourth-level epilepsy center communicate with you, because that patient will eventually come back and see you. The third thing---I said three---: listen to your patients. Because those patients will actually help and tell you what is needed. And I'm not only talking about listening to them medication-wise. I know we have time constraints, but if you can somehow address some of those social needs of the patients, that will also not only improve care, but negate the multiple calls that you may get from a patient. Dr Monteith: You mentioned a lot already. This is really wonderful. But what I really want to know is what you're most hopeful about. Dr Clarke: I have grandiose hopes, I'll tell you. I'll tell you that from the beginning. My hope is when we look at this in ten years and studies are done to look at equitable care, at least when it comes to race, ethnicity, insurance, we'll be able to minimize, if not end, inequitable care. Very similar to the intersectoral action plan in epilepsy by 2030. I'll tell you something that suggests, and I think it's global and definitely regional, the plan suggests that 90% of persons with epilepsy should know about their epilepsy, 80% of persons with epilepsy should be able to receive appropriate care, and 70% of persons with epilepsy should have adequately controlled epilepsy. 90, 80, 70. If we can get close to that, that would be a significant achievement in my mind. So, when I'm chilling out in my home country on a fishing boat, reading EEGs in ten years, if I can read that, that would have been an achievement that not necessarily I would have achieved, but at least hopefully I would have played a very small part in helping to achieve. That's what I think. Dr Monteith: Awesome. Dr Clarke: I appreciate you asking me that, because I've never said it like that before. In my own mind, it actually helped with clarity. Dr Monteith: I ask great questions. Dr Clarke: There you go. Dr Monteith: Thank you so much. I really- I really appreciate your passion for this area. And the work that you do it's really important, as you mentioned, on a regional, national, and certainly on a global level, important to our patients and even some very simple concepts that we may not always think about on a day-to-day basis. Dr Clarke: Oh, I appreciate it. And you know, I'm always open to ideas. So, if others, including listeners, have ideas, please don't hesitate in reaching out. Dr Monteith: I'm sure you're going to get some messages now. Dr Clarke: Awesome. Thank you so much. Dr Monteith: Thank you. I've been interviewing Dr Dave Clarke about his article on diversity and underserved patient populations in epilepsy, which appears in the most recent issue of Continuum on epilepsy. 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 this 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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Analiza Indra, Elecnor, Airbus, Thales, Coca-Cola, FAES, ASML, Constellation Energy y PharmaMar, entre otros
Analiza Indra, Elecnor, Airbus, Thales, Coca-Cola, FAES, ASML, Constellation Energy y PharmaMar, entre otros
Emergency treatment may be necessary after a person's first seizure or at the onset of abnormal acute repetitive (cluster) seizures; it is required for status epilepticus. Treatment for these emergencies is dictated by myriad clinical factors and informed by published guidance as well as emerging research. In this episode, Lyell K. Jones, MD, FAAN, speaks with David G. Vossler, MD, FAAN, FACNS, FAES, author of the article “First Seizures, Acute Repetitive Seizures, and Status Epilepticus,” in the Continuum® February 2025 Epilepsy issue. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Vossler a clinical professor of neurology at the University of Washington School of Medicine in Seattle, Washington. Additional Resources Read the article: First Seizures, Acute Repetitive Seizures, and Status Epilepticus Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr Dave Vossler, who has recently authored an article on emergent seizure management, taking care of patients with the first seizure, acute repetitive seizures, and status epilepticus, which is an article in our latest issue of Continuum covering all topics related to epilepsy. Dr Vossler is a neurologist at the University of Washington, where he's a clinical professor of neurology and has an active clinical and research practice in epileptology. Dr Vossler, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Vossler: Thank you very much for the introduction, Lyell. It's a pleasure to speak with you on this podcast, and I hope to go over a lot of important new information in the management of seizure emergencies. As you said, I'm a clinical professor in neurology at University of Washington, been in medicine for many decades now and have published and done research in this area. So, I'm anxious to give you not only my academic experience, but also talk about my own management of patients with status epilepticus over the last four decades. Dr Jones: Yeah, that's fantastic. And I always appreciate hearing from experienced clinicians, and I think our readers and our listeners do appreciate that voice of clinical expertise. And I'll tell you this is a topic, you know, as a neurologist who doesn't see many patients with acute seizure emergencies in my own practice, I think this is a topic that gives many clinicians, including neurologists, some anxiety. Your article, Dr Vossler, is really chock-full of helpful and clinically relevant considerations in the acute management of seizures. So, you now have the full attention of a huge audience of mostly neurologists. What's the one most important practice change that you would like to see in the care of patients with either first or acute prolonged seizures? Dr Vossler: Without a doubt, the most important clinical takeaway with regard to the status epilepticus---and for status epilepticus, many, many clinical trials, research trials have been done over the last couple decades and they all consistently show the same thing, that by and large most patients who have status epilepticus are underdosed and undertreated and treated too slowly in the initial stages of the status epilepticus. And it's important to use full bolus dosages of benzodiazepines to prevent mortality, morbidity, and later disability of these patients. To prevent the respiratory depression, many physicians are afraid to use higher doses of benzodiazepines, even guideline-recommended doses of benzodiazepines for fear of respiratory depression. But it's actually counterintuitive. It turns out that most cases of respiratory depression are due to inadequate doses and due to the status epilepticus itself. We know there's greater mortality, we know there's greater morbidity and we know that there's greater need for higher dose, subsequent, anti-seizure medications, prolonged status, if we don't use the proper doses. So, we'll kind of go over that a little bit, but that is the one clinical takeaway that I really would like our listeners to have. Dr Jones: Let's follow that thread a little bit. Dave, I know obviously we will speak in hypotheticals here. We're not going to talk about actual patients, but I think we've all been in the clinical situation where you have a patient who comes into the emergency room usually who's actively seizing, unknown history, don't know much about the patient, don't know much about the circumstances of the onset of the seizure. But we now have a patient with prolonged convulsive seizures. How do we walk through that? What are the first steps in the management of that patient? Dr Vossler: Yeah, well, I'll try to be brief for the purposes of the podcast. We do, of course, go through all of that in detail in the Continuum article, which hopefully everybody will look at very carefully. Really in the first table, the very first table of the article, I go through the recommended guideline for the American Epilepsy Society on the management of what we call established status epilepticus. The scenario you're talking about is just exactly that: established status epilepticus. It's not sort of evolving or developing status. We're okay they're having a few seizures and we're kind of getting there. No, this patient is now having evidence of convulsive seizure activity and it's continuing or it's repeated seizures without recovery. And so, the first phase is definitely a benzodiazepine and then the second phase is then a longer-acting bolus of a drug like phosphenotoine, valproic acid or levetiracetam. I could get into the details about dosing of the benzodiazepines, but maybe I'll let you guide me on whether we wanted to get into that kind of detail right at the outset. It's going to be a little bit different. For children, its weight-based dosing, but for adults, whether you use lorazepam or you use diazepam or you use midazolam, the doses are a little bit different. But they are standardized, and gets back to this point that I made earlier, we're acting too slow. We're not getting these patients quick enough, for various reasons, and the doses that are most commonly used are below what the guidelines call for. Dr Jones: That's great to know, and I think it's fine for the details to refer our listeners to the article because there are great details in there about a step-by-step approach to the established status epilepticus. The nomenclature and the definitions have evolved, haven't they, Dr Vossler, over time? Refractory status epilepticus, new-onset refractory status epilepticus, super refractory status epilepticus. Tell us about those entities, how they're distinguished and how you approach those. Dr Vossler: That's an important thing to kind of go over. They- in 2015, the International League Against Epilepsy, ILAE, which is, again, our international organization that guides our understanding of all kinds of things epileptic in nature around the world. In 2015 they put out a definition of status epilepticus, but it used to be that patients had thirty minutes of continuous seizure activity or repetitive obvious motor seizures with impairment of awareness and they don't recover impairment between these seizures. And that goes on for thirty minutes. That was the old definition of status epilepticus. Now, the operational definition is five minutes. And I think that's key to understand that, after five minutes of this kind of overt seizure activity, you need to intervene. And that's what's called T1 in the 2015 guideline, the international guideline. There are a bunch of different axes in the classification of status that talk about semiology, etiology, EEG patterns, and what age group you're talking about. We won't really get into those in the Continuum article because that's really more detailed than a clinician really should be. Needing to think about the stages, what we call the stages of status epilepticus that you mentioned and I alluded to earlier are important. And that is sort of new nomenclature, and I think probably general neurologists and most emergency room physicians aren't familiar with those. So, it just briefly goes through those. Developing status epilepticus is where you're starting- the patient's starting to have more frequent seizures, and it's heading essentially in the wrong direction, if you will. Established status epilepticus, as I mentioned, is, you know, this seizure act, convulsive or major, major outward overt seizure activity lasting five minutes or more, at which time therapy needs to begin. Again, getting back to my point, what doesn't happen often enough is we're not- we're intervening too late. Third is refractory status epilepticus, which refers to status epilepticus which continues despite adequate doses of an initial benzodiazepine given parenterally followed by a full loading dose of a single non-sedating anti-seizure medicine, which today includes phosphenotoine IV valproic acid or IV levetiracetam. In the United States, and increasingly around the world, people really are using levetiracetam. First, it has some advantages. There's now proof from a class one NIH-funded trial. We know that these three drugs are equivalent at the full doses that I go over in the article. You have your kind of dealer's choice on those. Phenobarbital, which we used to use and I used as a resident as long as forty years ago, is really a second choice drug because of its sedating and other side effects. But around the world in resource-poor countries phenobarbital can be used and, in a pinch, certainly is an appropriate drug. And then finally, you mentioned super refractory status epilepticus and that's status that's persisting for more than twenty four hours. Now, despite initial benzo and non-sedating anti-seizure medicine, but also lasting more than twenty four hours while receiving an intravenous infusional sedating, anesthetizing anti-seizure medicine like ketamine, propofol, pentobarbital or midazolam drips. Dr Jones: So, it sounds like the definitions have evolved in a way that improves the outcomes, right? To do earlier identification of status epilepticus and more aggressive management, I think that's a great takeaway. If we move all the way to the other end of the spectrum, let's move to the ambulatory setting and we have a patient who comes in and they've had one seizure, they're an adult; one seizure, the first seizure. The key question is, how do we anticipate the risk of future seizures? But walk us through how you talk to that patient, how you evaluate that patient to decide if and when to start anti-seizure medicines. Dr Vossler: Well, it depends a little bit if it's an adult or a child, but the decision making process and the data behind it is pretty robust now. And the decision making process is pretty similar for adults and children, with some differences which I can talk about. First of all, first seizures. I think it's really important to stress that there's been so much research in this area. I'd like to get a cross point that they're not as innocuous as I think many general neurologists might suspect. We know that there is a two- to threefold increased risk of death in children and adults following a first seizure. Moreover, the risk of a second seizure, both in kids and adults, is about 36% two years after that first seizure. It's about 46% five years after that first seizure. It's really pretty substantial. The risk of a second seizure is increased twofold. It doubled in the presence of any kind of a history of prior brain insults that could result in seizures. Could be infections, it could be a prior stroke, it could be prior significant brain trauma. It's also doubled in the presence of an EEG, which shows epileptiform discharges like spikes and sharp waves---and not just a sort of borderline things like sharply contoured rhythmic Theta activity. That's really not what we're talking about. We're talking about overt epileptiform discharges. It's doubled in the presence of lesion that can be seen on imaging studies, and it's doubled in the presence of seizures if that first seizure occurs during sleep. So, we have a number of things that double the risks, above the risk of a second seizure, above that 36% at two years and 46% at five years that I spoke about. And so those things need to be considered when you're counseling a patient about that. Should you be on an anti-seizure medicine after that first seizure? Specifically, to the point of anti-seizure medications, the guideline that was done, the 2015 guideline that was done by the American Academy of Neurology for adults, and the 2003 guideline was actually a practice parameter that was done by the Academy and the American Epilepsy Society for children, are really kind of out of date. They talk about the adverse effects of anti-seizure medications, but when you look back at the studies that were included in developing that practice parameter for kids and guidelines for adults, they are the old drugs: carbamazepine, phenytoin, phenobarbital and valproate. Well, I don't think I need to tell this audience, this well-educated audience, that we don't use those drugs anymore. We are using more modern anti-seizure medicines that have been developed since 1995; things like lamotrigine, levetiracetam, and lecosamide. Those three in particular have very low adverse events. So, the guideline that the Academy, American Academy Neurology and American Epilepsy Society put together for kids and for adults talks about this high adverse event profile. And so, you need to take a look at the risks that I talked about of a seizure recurrence and balance that against adverse effects. But I'm here to tell you that the newer anti-seizure medicines---and by newer I'm talking in the last thirty years since lamotrigine was approved in 1995---these drugs have much better side effect profiles. And I think all epileptologists would agree with that. They're not necessarily more effective, but they are better tolerated. That makes the discussion of the risk of a second seizure, the risk of mortality versus side effects of drugs, it really pushes the risk category higher on the first side and not on the side of drugs. We know that if you take an anti-seizure medicine, you reduce your risk of a second seizure by half. Now, that's not sustained over five years, but over the first two years, you've reduced it by half. In a person who's driving, needs to get to work, has to take the kids to school, whatever, most of my patients are like, yeah, okay, sign me up. These drugs are really pretty well tolerated. There's a substantial risk of a second seizure. So, I'll do that. In a kid, a child that's, you know, not driving yet, that might be a different discussion. And the parents might say, well, I'd rather not have my son exposed, my daughter exposed to this. They're trying to go to school. They're trying to learn. We don't want to hinder that. We'll wait for a second seizure and then if they have a second seizure, which by the way is, you know, one of the definitions of epilepsy, well then they have epilepsy, then they probably will need to go on the seizure medication. Dr Jones: Great summary, Dr Vossler, and it is worth our audience being aware that the evidence has evolved alongside the improvement in the adverse effect profile. And sounds like your threshold is a little lower to treat then maybe it would have been some time ago, right? Dr Vossler: I would say that's exactly correct in my opinion. Particularly for adults, absolutely. Dr Jones: That's fantastic, Dr Vossler. I imagine there are a lot of aspects of caring for these patients that are challenging, and I imagine many scenarios are actually pretty rewarding. What do you find the most rewarding aspect of caring for patients with acute seizure management? Dr Vossler: Yes, I mean, that is really true. I would say that the most challenging things are treating refractory status epilepticus, but worse yet, new onset refractory status epilepticus and the super refractory status epilepticus, which I talk extensively about or write extensively about in the article and provide a lot of guidance on. Really, those conditions are so challenging because they can go on for such a long time. Patients are hospitalized for a long time. A lot of really good clinical guidance doesn't exist yet. There is a tremendous amount of research in that area which I find exciting, and really there's an amazing amount of international research on that, I think most of our audience probably is unaware of. And certainly, with those conditions, there is a high risk of later disability and mortality. We go through all of that in the article. The rewards really come from helping these people. When someone was super refractory status and it were non- sorry, new onset refractory status epilepticus, has been in the hospital for thirty days, it gets really hard for everybody; the family, the patient. And for us, it wears on us. Yet when they walk out the door, and I've had these people come back to the epilepsy clinic and see me later. We're managing their anti-seizure medications. They've survived. The NORSE patients often have substantial disability. They have cognitive and memory and even some psychiatric disability. But yet we can help them. It's not just management in the hospital, but it's getting to know these people, and I take them from the hospital and see them in my clinic and manage them long-term. I get a lot of great satisfaction out of that. We're hoping to do even better, stop patients' status early and get them to recover with no sequelae. Dr Jones: What a great visual, seeing those patients who have a devastating problem and they come back to clinic and you get the full circle. And what a great place to end. Dr Vossler, thank you so much for joining us, and thank you for such a thorough and fascinating discussion on the importance of understanding and managing patients with the first seizure, acute repetitive seizures, and status epilepticus. Dr Vossler: Thank you very much, Lyell. Dr Jones: Again, we've been speaking with Dr Dave Vossler, author of an article on emergent seizure management, first seizures, acute repetitive seizures and status epilepticus in Continuum's most recent issue on epilepsy. Please check it out, and thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this 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.
Con Cristina Monge, Eduardo Madina y Elisa de la Nuez. FAES, la fundación de Aznar, envió ayer una nota para acusar al partido de Abascal de formar parte de la quinta columna del Putin Club. Dice FAES que no parece muy patriótico ni de derechas aplaudir aranceles contra productos españoles. El president valenciano, Carlos Mazón, no hizo ninguna llamada el día de la DANA hasta las 5.37 de la tarde, 10 horas después de la alerta de Aemet y dos horas más tarde de la solicitud de la UME para Utiel. Además, la jueza ha rechazado una querella de Hazte Oír contra la delegada del gobierno porque, asegura, la protección civil es competencia autonómica.El Gobierno ha anunciado una quita de deuda pactada con Esquerra pero extensible a todas las comunidades. La quita total llega a los 83.000 millones. El PP se opone, pese a que beneficia a las comunidades que gobierna, porque cree que Sánchez quiere comprar con ella La Moncloa. El presidente francés, Emmanuel Macron, reconoce que Ucrania tendrá que ceder la explotación de sus minerales a Estados Unidos porque, dice, es el modo de que ese país se comprometa con su soberanía. Son declaraciones después de verse con Donald Trump en el Despacho Oval quien ha asegurado también que pronto se verá con Volódimir Zelenski para firmar un acuerdo.
Con Cristina Monge, Eduardo Madina y Elisa de la Nuez. FAES, la fundación de Aznar, envió ayer una nota para acusar al partido de Abascal de formar parte de la quinta columna del Putin Club. Dice FAES que no parece muy patriótico ni de derechas aplaudir aranceles contra productos españoles. El president valenciano, Carlos Mazón, no hizo ninguna llamada el día de la DANA hasta las 5.37 de la tarde, 10 horas después de la alerta de Aemet y dos horas más tarde de la solicitud de la UME para Utiel. Además, la jueza ha rechazado una querella de Hazte Oír contra la delegada del gobierno porque, asegura, la protección civil es competencia autonómica.El Gobierno ha anunciado una quita de deuda pactada con Esquerra pero extensible a todas las comunidades. La quita total llega a los 83.000 millones. El PP se opone, pese a que beneficia a las comunidades que gobierna, porque cree que Sánchez quiere comprar con ella La Moncloa. El presidente francés, Emmanuel Macron, reconoce que Ucrania tendrá que ceder la explotación de sus minerales a Estados Unidos porque, dice, es el modo de que ese país se comprometa con su soberanía. Son declaraciones después de verse con Donald Trump en el Despacho Oval quien ha asegurado también que pronto se verá con Volódimir Zelenski para firmar un acuerdo.
In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Jennifer L. Hopp, MD, FAAN, FAES, FACNS, who served as the guest editor of the Continuum® February 2025 Epilepsy issue. They provide a preview of the issue, which publishes on February 3, 2025. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Hopp is a professor in the department of neurology at the University of Maryland School of Medicine in Baltimore, Maryland. Additional Resources Continuum website: ContinuumJournal.com Subscribe to Continuum: shop.lww.com/Continuum More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @JenHopp71 Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology, clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, a companion podcast to the journal. Continuum Audio features conversations with the guest editors and authors of Continuum who are the leading experts in their fields. Subscribers to the Continuum Journal have access to exclusive audio content not featured on the podcast. If you're not already a subscriber, we encourage you to become one. For more information, please visit the link in the show notes Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, Lifelong Learning in Neurology. Today I'm interviewing Dr Jennifer Hopp, who recently served as Continuum's guest editor for our latest issue on epilepsy. Dr Hopp is a professor and executive vice chair in the Department of Neurology at the University of Maryland School of Medicine, where she's also director of the Epilepsy Center. Dr Hopp, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners? Dr Hopp: Hi, Dr Jones. Thank you so much for having me on this podcast. I really had so much fun working with you and other authors of this issue and serving as editor. I feel like it was yesterday that I was author of an article in the past. And so, it's really a pleasure to take on this new role and create the content for the issue of Continuum for Epilepsy and really particularly to work with the stellar group of experts and authors that we were able to have us join this year. Dr Jones: I want to thank you for, really, it's a remarkable issue. And we usually don't get into this a lot with our guest editors, but our last issue on epilepsy came out in 2022. Fantastic issue, guest edited by Dr Natalie Jette. When you were designing the table of contents and article topics for this issue, you had some great ideas. Walk us through your thought process on what was most important to convey in this issue. Dr Hopp: Sure, I'm happy to do so. I think one of the things about Continuum that is so accessible to everybody is that it really is, to me, preeminent format of updating and educating, whether it's epileptologist, neurologist, trainees in every area of epilepsy, which is obviously an enormous task to really pull together all of these data to make updates and then to make it accessible to all of these different levels of learners as well as people like myself. I really read and always look forward to all the Continuum issues outside of my field. I use it to update my knowledge base, get ready for boards. I also read it as an educator because I want to know what my trainees are reading during their rotations and I want to be able to share materials with them. So, I really tried to go back and look at other issues and think about how we could make it fresh. So, I think one of the first challenges is just making sure that we're updating the content of each article based on the literature and the data we have. That really becomes the task of the authors. And so first of all, selecting the authors was both fun but also really important to me. But the second aspect of it to me was really the question of, how could we make this fresh this year? I think Continuum is always fresh and that it has new data, but I wanted to really think outside the box and I appreciate being able to take a few risks. One of them was really headed by Dave Clarke, who provides this incredibly thoughtful and comprehensive review of access to care and epilepsy. I think for anyone who wants a primer on the issues and language used in discussions of diversity or social determinants of health---you first of all do not have to be in the field of epilepsy to read this. So, you should check that out. But I also thought it was really critical to shed more light on these issues. So, we tried to be mindful of this in threading that through as best as we could each article, but also have a stand-alone section that he headed. And so, he addresses issues of how to think about access to care for people with epilepsy, but actually, interestingly, also thinking about the investigators, providers, and researchers, and how we think about diversity in those viewpoints as well. I think we can always do better. Dave concludes with a wonderful focus on hope in this area with next steps for our community. So, I think that that was certainly one area that I wanted to take a risk and I think it was quite successful. Dr Jones: Totally agree. I very much enjoyed that article. We have an article on implementation of guidelines and quality measures by Dr Christina Baca. I thought that was a great choice from your perspective, not only because Dr Baca is an expert on this, but it felt very practical, right? Dr Hopp: Exactly. Exactly. And that was the other area that I thought really is always covered so well by the Academy of Neurology. There's so much work in updating the guidelines, whether it's the guideline that just was updated on people with epilepsy of childbearing potential or others outside of the field of epilepsy. And I thought that we could use Continuum to help educate all of the readers on how to take those guidelines and measures and then really bring them into practice. I think there's a whole field of implementation science that I think shines a light on the gap between the guidelines and the measures and then really what we do with them in practice. And that's actually what's most important for our patients and for the providers. And so Christine does just an amazing job as an expert, not only walking us through the guidelines that are relevant for epilepsy, but then helping us and providing, essentially, a toolkit to take those measures and guidelines and use them in a very feasible, accessible way in day-to-day practice. And I would suggest that it's relevant for anyone from a student level resident to an epileptologist who's been in practice, like me, for many years. And so I hope that's relatable and useful to the reader. Dr Jones: I think it will be. And let's get right into it. So, I always enjoy talking to the guest editor. You're already an expert and now you've just read a bunch of articles and edited a bunch of articles from people who are really the premier experts in their area of the field, right? They're niche within epilepsy. So, as you've read these articles across the issue, if there were one biggest practice-changing recommendation that you would want to convey to our listeners, what would that be? Dr Hopp: I think that's a fabulous question because again, each of these articles, I think, is designed and written by the author to stand alone. But ideally, they need to all be incorporated in practice. And I think what each author was able to really successfully do is not only review the data, but really take us to the next level with practice of epilepsy. For example, I think as we embark on the next couple of decades, clearly increased technology, AI, personalized medicine are all buzzwords and taking the lead. In reality, with advances, we still have to make sure our care is personalized. And we have to remember seizures are really the symptom, but epilepsy is the disease. What I think our authors do well is make sure that our care is personalized to the patients. You could take that from the first article that Roohi Katyall writes about how to approach the patient with epilepsy, which is still, I think, the seminal way to start to think about these patients. But we need to ask issues pertaining to people with epilepsy of childbearing potential; screen for mood, other comorbidities. Mark Keezer does a great job talking about these. And then as we discussed, Christine Baca, PCU, talks about how to then incorporate those practical considerations into practice. Each author also, I think, emphasizes the need to utilize technology and testing and evaluation to make sure that our care is personalized for our patient. For example, we have a focus on certain special populations. Some patients who we see from the diagnosis of epilepsy end up not having seizures. They may have nonepileptic events. And so, Adriana Bermeo-Ovalle and her co-author talk about how to address those patients. Well, Meriem Bensalem-Owen talks about gender based issues in epilepsy as well. And, and that particular article also was updated and refreshed to really address gender and sex-based issues beyond treating the woman with epilepsy. So, I think in summary, each of them really helps us make sure that we're personalizing the care for patients by emphasizing a very thorough and individualized approach to each of our patients that we see with seizures. Dr Jones: Now that you put it that way, that really did come across as a consistent theme essentially in every article, right? All the way from the evaluation of the patient suspected of having epilepsy to the treatment options to the context of care. Personalization is really kind of a continuous thread throughout the issue. So, I think that's a great one. Dr Hopp: I think it's still aspirational in some sense, but hopefully practical in another. For example, we certainly are going to make a medication selection when we see each individual patient based on their comorbidities, perhaps genetic considerations, and how they may respond to medications or have risks of rash. But there are certainly still guidelines that we need to approach and think about when thinking about populations of people who have epilepsy as a whole. I think that what's interesting in the field of epilepsy is that we still don't have as much consensus as I think we could on the best way to treat, for example, a drug-resistant patient with epilepsy. One of, I think, the biggest areas of opportunity in terms of personalized medicine as we move forward is that there's such variability on patient care based on the epilepsy center, the tools that we have on how to treat these patients. And I think an aspiration is for us to, in the future, be able to see a patient who has seizures or a person who has seizures, maybe put an FDA-approved device, as Dan Friedman talks about in his article, to help detect the seizures. Use AI with EEG to detect abnormalities in their studies. And then use imaging processing and genetic or metabolic markers to really end up stratifying the risk and creating a treatment plan much akin to what's done in the world of cancer care. I think what's so exciting in epilepsy is that we have made so many advances in terms of our treatments, but I think there's so much to do to really stratify and personalize care for our patients that we really could take a lot of lessons from the world of cancer and in other fields of medicine to really be able to apply to our area of specialization. Dr Jones: And I guess that's one of the common tensions in neurology---and medicine, really---is the pull between standardizing and protocolizing. And usually we do better when we're standardized in our care versus that personalization, doing the right thing for that individual person. And I guess expertise lies in the middle, which is why we want people to read these articles, right? Dr Hopp: Exactly. I think you've hit the nail on the head, and I think the takeaway here is really that we need to do both. There's no question that we can't reinvent the wheel for every person who we see in the office who has epilepsy and not apply the knowledge that we've gained based on all of the research and work that's been done in the field of epilepsy. So, for example, we know that if someone is almost 25 years old, Quantum Brody published that shows that if someone does not respond to a few drugs, anti-seizure medicines, the likelihood that they're not going to respond, it is quite high. So, we need to apply data that we have to patients as a whole. But then, I think, what has changed and evolved over the past twenty-five years is our ability to potentially personalize some of that decision making. And that's where I think the field of epilepsy is right now, and hopefully where it's going to go in the next decade or so. Dr Jones: So, what do you think the next big thing in epilepsy diagnosis or management will be? Dr Hopp: I think that technology is really going to play a role. Technology, I think, will take many forms. We hear a little bit about some of the new advances in technology in several articles in this issue. One, for example, is in the ability to manage even emergent seizures or clusters of seizures in patients. The ability to provide a nasal spray that works very quickly is so different than the tools that we had to treat seizures even 10 years ago. I think that technology will likely thread through many different areas of epilepsy care, whether it's in the treatment and availability of different medications or in the ascertainment of epilepsy itself. I think that one of the very exciting areas in technology is in pharmacogenomics and genetics, which hopefully will allow us to close the gap in selecting one of the better medications or best medication for a patient earlier in their diagnosis and in their treatment plan. If we are able to get patients treated more quickly, whether it's with medication or in selection of the best surgical treatment, hopefully we will close the gap in reducing the possibility of drug resistant epilepsy, but also have impact in quality of life and getting patients and people with epilepsy and doing that, doing the things that they want to do such as driving, going to work, getting engaged in the things that make them happy. And so, I think our ability to use technology, whether it's in using a watch to make a diagnosis of seizures or pharmacogenomics to make a good medication selection, hopefully this will allow us to speed up our algorithm in making a diagnosis and getting an effective treatment plan for patients earlier. And ultimately that's our goal. Our goal for patients is ideally to have no seizures and no side effects with a good quality of life. Dr Jones: Yeah, the technology has really been breathtaking. You know, one of the commonalities between your practice and my practice is electrophysiology. I do neuromuscular electrophysiology, which is much simpler than what you do with cerebral electrophysiology. And whenever I sit down next to a colleague who is about to review forty-eight hours' worth of EEG recordings, I always think what a massive amount of data and I always feel sympathy for them. What, about AI? What about automated processing tools? Is that something that our listeners should look forward to in the future? Dr Hopp: I think so. And I hope it's a blend. I hope that---and I always actually talk about this with trainees because I love EEG so much and I love translating the principles of physics and neurophysiology when we're sitting in front of an EEG with our trainees. I am excited about AI and technology. I will admit that I hope that it doesn't replace human readers because I do think that there is an importance in threading history and semiology and thoughtfulness in a human way with the interpretation of EEG. However, you're absolutely right that the amount of data is just becoming overwhelming for epileptologists and for EEG-ers to be able to synthesize in a reasonable and feasible amount of time. So, we already are seeing the applicability of the AI to, for example, prescreen large, large amounts of EEG data and try to at least give us tools for the ability to screen EEG in a more efficient way. I think some of the more exciting areas of EEG that are coming are in the background, which is in the network analysis in high-density EEG. There are very, very smart mathematicians that currently I'm collaborating with in utilizing network analysis of EEG that will hopefully allow us to apply these algorithms to EEGs that even look normal to the naked eye, but actually may have signals that help us predict who may or may not have seizures. I agree with you wholeheartedly. I think there's so much to come and our collaboration and integration with engineers and mathematicians, I think, is going to be paramount. Dr Jones: Dr Hopp, what was your path to epilepsy? Dr Hopp: Dr Jones, that is a great question. It was not linear and it really evolved over time, but basically went something like this. I majored in behavioral biology in college, and I was fascinated by the brain and how behavior was controlled by either physiology or anatomy or abnormalities in brain function. And as I moved along in my career and education, I really had a passion for neurology and for behavioral science. But I went to medical school and absolutely loved most of the rotations I did. And in fact, I loved OBGYN so much that I changed my entire career path with the goal of becoming an OBGYN and delivering babies. And I was really torn between two specialties of going into neurology or OB. And I went to a very sage advisor, Greg Kane up at Jefferson. And I said, I really don't know what field to go into. I love aspects of both. I like doing testing. I like making immediate impact. But I also love neurology. And he gave me some of the best advice, I think, that I have ever heard. And I try to share with our trainees all the time. He said, Jenny, I think you'll be successful at either, but which do you like reading about? And I had a relative epiphany at the time, and it was no question that I loved reading about neurology. It was very clear to me that reading about neurology and learning about the brain was just fascinating and led me to do a neurology residency where I was exposed to patients with epilepsy. And it really just continued to pique my interest to read about a field that I felt I could have such an impact. I really could help patients make a diagnosis relatively quickly and have a significant impact, maybe as I would in OBGYN but in a little bit different way. And it really has been, to me, the best choice that I could have made. And on a day-to-day basis, I still love reading about neurology. So, it was some of the best advice that I was given and I try to share that with others. Dr Jones: What a great question for a mentor to ask. And I wonder if he was really thinking, if she likes to read, she probably should be a neurologist to begin with. You like to read, don't we? Dr Hopp: I think so. I think he was spot on. I think he knew the answer before he asked the question. Dr Jones: Dr Hopp, thank you for joining us today. Thank you for such a thorough and fantastic discussion on caring for patients with epilepsy and our recent issue on epilepsy for Continuum. Dr Hopp: My pleasure. Thank you for having me. Dr Jones: Again, we've been speaking with Dr Jennifer Hopp, guest editor of Continuum 's most recent issue on epilepsy. Please check it out. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.
Welcome to the NeurologyLive® Mind Moments® podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. In this episode, epilepsy expert Depobam Samanta, MD, MS, FAAP, FAES, sat down to discuss a recently published guidance paper from members of the Pediatric Epilepsy Research Consortium that provides recommendations for neuromodulation approaches to treat Lennox-Gastaut syndrome (LGS). Samanta, medical director of the Arkansas Children's Comprehensive Epilepsy Program, gave a clinical overview of the paper, highlighting the various neuromodulatory devices and their use, and the ways to improve treatment selection and personalization. Additionally, he talked about some of the potential complications with these devices as well as initiation and titration strategies for easy initiation. Furthermore, he spoke about ways to take neuromodulation to the next level, giving insight on creative trial designs, overcoming sham-controlled studies, and the necessary research to expand these approaches. Looking for more epilepsy discussion? Check out the NeurologyLive® Epilepsy clinical focus page. Episode Breakdown: 1:05 – Overview of the published guidance and reasons behind the paper 5:15 – Patient selection for neuromodulation and tailoring treatments by patient and preference 8:25 – Overcoming complications with neuromodulation devices 11:25 – Multidisciplinary team necessary for successful implementation of neuromodulation 13:15 – Neurology News Minute 15:15 – Initiation and titration strategies for vagus nerve stimulation, deep brain stimulation, and resective surgery 18:30 – Next steps in research and expanding neuromodulation for patients with LGS 21:10 – Finding creative trial designs to test neuromodulation devices, combination approaches The stories featured in this week's Neurology News Minute, which will give you quick updates on the following developments in neurology, are further detailed here: FDA Accepts BLA for Subcutaneous Autoinjector Formulation of Lecanemab Cell Therapy Bemdaneprocel Advances to Phases 3 Registrational Trial in Parkinson Disease Real-World Study Highlights Positive Treatment Benefits of Tofersen on ALS Disease Progression, Function Thanks for listening to the NeurologyLive® Mind Moments® podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com.
On this episode of Buzzing About Romance, we're stirring the cauldron and diving into the world of witches and fae—those sassy spellcasters, mysterious fae kings, and the downright enchanting stories they star in.
Today, I interviewed Florian Faes, founder of Slator.com, about his company, the language industry, the roles of freelance translators, the latest technologies and much more. Hope you enjoy!
Was bedeutet Demenz für einen Betroffenen? Der Schriftsteller Urs Faes zeichnet diesen Prozess nach, aus rein subjektiver Perspektive, in einem vielschichtigen Monolog mit ZDF-Star Dietrich Hollinderbäumer. An sich ein Paradox, denn Demenz heisst Auslöschung, das Ende von Sprache, Bewusstsein, Ich. Wer das Hörspiel am Radio hören will: Freitag, 27.09.2024, 20.00 Uhr, Radio SRF 1 Als Ben das erste Mal bemerkt, dass ihm Wörter fehlen, beginnt er Buch zu führen. Es handelt sich, so Urs Faes, um «Aufzeichnungen eines Vergesslichwerdenden vor dem Vergessen». Sie dokumentieren das Anfangsstadium der Erkrankung, in der der Betroffene das Vergessen noch wahrnimmt und demzufolge seine Situation zu kaschieren versucht und öfter mit sich selber als mit anderen spricht. Es folgt die zweite Phase, einige Jahre später. Laut ärztlicher Diagnose ist die Krankheit ins mittlere Stadium übergegangen. Ben und seine Altersliebe Thea versuchen mit den immer komplizierteren und zunehmend quälenden Umständen ihres gemeinsamen und doch getrennten Alltags zurechtzukommen. Aber auch Witz und Komik stellen sich ein, manchmal auch unfreiwillig. In der dritten Phase verirrt, verzweigt und verliert sich Ben in sich selbst, bis schliesslich «Die Löscher» ihr stilles Werk vollenden. Für seine «Genesis des Vergessens» stützte sich Urs Faes auf Tagebucheinträge von Patientinnen und Patienten. Für ihn, den Schriftsteller, der aus diesem Material bereits den Roman «Untertags» (Suhrkamp 2020) entwickelt hat, stellt sich dabei die elementare Frage: «Was ist einer noch, wenn er die Wörter verliert?» Mit: Dietrich Hollinderbäumer (Ben), Doris Wolters (Thea), Jörg Pohl (Dr. Zuber), Kaija Ledergerber (Frau Traber), Päivi Stalder (Ulrike) Posaune: Matthias Muche - Komposition & Bassgitarren: Janko Hanushevsky - Tontechnik Aufnahmen: Björn Müller - Endmix: Michael Kube - Dramaturgie: Reto Ott - Textfassung, Montage und Regie: Jean-Claude Kuner - Produktion: SRF 2024 - Dauer: 51
Was bedeutet Demenz für einen Betroffenen? Der Schriftsteller Urs Faes zeichnet diesen Prozess nach, aus rein subjektiver Perspektive, in einem vielschichtigen Monolog mit ZDF-Star Dietrich Hollinderbäumer. An sich ein Paradox, denn Demenz heisst Auslöschung, das Ende von Sprache, Bewusstsein, Ich. Wer das Hörspiel am Radio hören will: Samstag, 21.09.2024, 20.00 Uhr, Radio SRF 2 Kultur Als Ben das erste Mal bemerkt, dass ihm Wörter fehlen, beginnt er Buch zu führen. Es handelt sich, so Urs Faes, um «Aufzeichnungen eines Vergesslichwerdenden vor dem Vergessen». Sie dokumentieren das Anfangsstadium der Erkrankung, in der der Betroffene das Vergessen noch wahrnimmt und demzufolge seine Situation zu kaschieren versucht und öfter mit sich selber als mit anderen spricht. Es folgt die zweite Phase, einige Jahre später. Laut ärztlicher Diagnose ist die Krankheit ins mittlere Stadium übergegangen. Ben und seine Altersliebe Thea versuchen mit den immer komplizierteren und zunehmend quälenden Umständen ihres gemeinsamen und doch getrennten Alltags zurechtzukommen. Aber auch Witz und Komik stellen sich ein, manchmal auch unfreiwillig. In der dritten Phase verirrt, verzweigt und verliert sich Ben in sich selbst, bis schliesslich «Die Löscher» ihr stilles Werk vollenden. Für seine «Genesis des Vergessens» stützte sich Urs Faes auf Tagebucheinträge von Patientinnen und Patienten. Für ihn, den Schriftsteller, der aus diesem Material bereits den Roman «Untertags» (Suhrkamp 2020) entwickelt hat, stellt sich dabei die elementare Frage: «Was ist einer noch, wenn er die Wörter verliert?» Mit: Dietrich Hollinderbäumer (Ben), Doris Wolters (Thea), Jörg Pohl (Dr. Zuber), Kaija Ledergerber (Frau Traber), Päivi Stalder (Ulrike) Posaune: Matthias Muche - Komposition & Bassgitarren: Janko Hanushevsky - Tontechnik Aufnahmen: Björn Müller - Endmix: Michael Kube - Dramaturgie: Reto Ott - Textfassung, Montage und Regie: Jean-Claude Kuner - Produktion: SRF 2024 - Dauer: 54
De druk die jongeren door school ervaren, verdriedubbelde bijna tussen 2001 en 2021. Ik, twintig jaar, weet hoe die druk voelt. En ook hoe je ervan afkomt. Lees hier het artikel: https://decorrespondent.nl/15539/hoe-ik-van-mijn-faalangst-afkwam Probeer De Correspondent nu een gratis maand uit: decorrespondent.nl/gratismaand Productie: Nathan Kofi Voor vragen, opmerkingen of suggesties mail naar post@decorrespondent.nl
Riverside Love - Part 2 concludes the love story of Marta Anisia Mouriño Faes and René Julio Riquelme Babé, written by their daughter, Marta Mayer. Amor Riverside - Part2 2 - Concluye la historia de amor de Marta Anisia Mouriño Faes y René Julio Riquelme Babé, escrita por su hija, Marta Mayer. #TheGreenPlantainpodcast #TheCubanStoriesProjectpodcast #Cubanstories #Cuba #cubanosporelmundo #cubanstoriesonthegreenplantainpodcast #cuba #untostonanyone #LaHabana #NewJersey #Astoria #boleros #untostonanyone #LaHabana #NewJersey #Astoria --- Support this podcast: https://podcasters.spotify.com/pod/show/susana-mueller/support
I never tire of sharing Cuban love stories and how, despite often coinciding with the challenges of exile, they give us hope, a sense of continuity, and admiration. This is the love story of Marta Anisia Mouriño Faes and René Julio Riquelme Babé, written by their daughter, Marta Mayer. No me canso de compartir historias de amor cubanas y cómo, que a pesar de coincidir muchas veces con los desafíos del exilio, nos dan esperanza, un sentido de continuidad y admiración. Esta es la historia de amor de Marta Anisia Mouriño Faes y René Julio Riquelme Babé, escrita por su hija, Marta Mayer. #TheGreenPlantainpodcast #TheCubanStoriesProjectpodcast #Cubanstories #Cuba #cubanosporelmundo #cubanstoriesonthegreenplantainpodcast #cuba #untostonanyone #LaHabana #NewJersey #Astoria --- Support this podcast: https://podcasters.spotify.com/pod/show/susana-mueller/support
Los líderes de los dos principales partidos no coincidieron en ningún acto oficial. Además, la fundación FAES, que lidera el expresidente Aznar, sacó un comunicado en el que defendió la actuación del gobierno de Aznar que no descartó la posible autoría de ETA. Es noticia que la pareja de Isabel Díaz Ayuso defraudo 350.000 euros a Hacienda entre 2020 y 2021. En Portugal, el conservador Luis Montenegro, que ganó las elecciones del domingo, ha empezado su ronda de consultas y mantiene su veto a la ultraderecha. En Haití, el primer ministro ha dimitido tras la ola de violencia.
Veinte años después de ese terror que nos paralizó, el recuerdo doloroso de esa tragedia nos ha traído una impresión melancólica: la de una sociedad que todavía era inmune a la mentira o al menos, no era indiferente a la verdad. No puedo evitar conjeturar qué efectos hubieran tenido las mentiras del gobierno de Aznar si los atentados de 2004 hubieran sido en el contexto del actual libre comercio de falsas noticias y desinformación. Que hoy ni siquiera FAES pueda reverdecer con éxito sus mentiras de entonces acerca de la autoría de ETA, puede significar un atisbo de esperanza, pero parece que el problema está en el aturdimiento del tiro en ráfaga que definió Xavier Vidal-Folch. La metralleta sirve para aturdir y no para ganar la guerra, y eso es lo que hace el PP.
No tiene explicación la ausencia del PP del acto convocado por la Comisión Europa, con la presencia del jefe del Estado. Hubo convocatoria paralela, con Isabel Díaz Ayuso de anfitriona, de un acto de homenaje a las víctimas y allí sí estuvieron todos los del PP. Aunque nos parezca incomprensible, aunque pensemos que no hay explicación posible para un plante así, resulta que sí la hay, porque casi en paralelo FAES, la fundación liderada por José María Aznar, hizo público un comunicado manteniendo la mentira. Asegura que a su gobierno nunca le llegó ningún tipo de información que descartase la pista de ETA como autora de los atentados, y afirmase sin titubeos la responsabilidad yihadista.
Con Eduardo Madina, Berna González Harbour y Gonzalo Velasco. Por si le faltaban tramas e historias a la familia real británica, el episodio de la fotografía manipulada de la princesa de Gales ha alimentado todo tipo de especulaciones en el Reino Unido tras la opacidad sobre la operación de la princesa Kate. En nuestro país, José María Aznar, a través de su fundación FAES, ha defendido su gestión hace 20 años. Dice FAES que jamás llegó a manos del Gobierno ningún documento oficial que descartase la autoría etarra y afirmara sin titubeos la responsabilidad yihadista. Esta mañana cuenta eldiario.es que la pareja de Díaz Ayuso defraudó a Haciendo 350.000 euros en 2020 y 2021, hablamos con el periodista que firma la noticia. Empieza la ronda de consultas en Portugal para encargar la formación de gobierno. Todavía queda por recontar el voto exterior que debe repartir hasta 4 escaños.
PP y PSOE no coincidieron en los actos de conmemoración de las víctimas de los atentados de Atocha. De hecho, la fundación FAES, que preside Aznar, sacó un comunicado donde defendió la actuación del gobierno del expresidente que no descartó la autoría de ETA. También es noticia que la pareja de Isabel Díaz Ayuso defraudó 350.000 euros a Hacienda entre 2020 y 2021. Del caso Koldo, la investigación ha revelado qué papel tenía el comandante de la Guardia Civil vinculado con la trama. Además, este martes Pedro Sánchez comparece en el Senado por la sesión de control al Gobierno. También les contamos que Eslovaquia ha pedido que los refugiados ucranianos vuelvan a su país a luchar.
Monsters, Hockey Players and Faes oh my! Today our guest is Author C.R. Jane Enchantress After Dark a new series presented by The Audiobook Lovin' Podcast! We are the official podcast for the Dark Star Con 24 which is happening August 29th thru Sept. 1, 2024 in New Orleans, Louisiana. Dark Star Con is a book convention focused on Audiobooks and what is the next big thing happening in the audiobook world. Listen to the full episode to learn this and much more! Viviana, Enchantress of Books: https://www.vivianaenchantressofbooks.com/2024/02/enchantress-after-dark-podcast-s5-ep16.html Support the podcast by becoming a patreon at https://www.patreon.com/AudiobookLovin or Buy Me A Coffee: https://www.buymeacoffee.com/enchantresspr Subscribe to newsletter here: eepurl.com/cD_VHX Subscribe & Listen on: Audible: https://adbl.co/3lbkxl2 Amazon Prime Music: https://amzn.to/32xUgaA Apple Podcasts: https://apple.co/3L3Nf25 Spotify: https://spoti.fi/38l1odY Pandora: https://www.pandora.com/podcast/audiobook-lovin-pocast/PC:1001022570 Pocket Casts: https://pca.st/5bmvo1zo Soundcloud: https://bit.ly/AudiobookLovinSoundcloud iHeart Radio Podcast: https://ihr.fm/38qaZ31 Google Podcast: https://bit.ly/AudiobookLovinGooglePodcast We hope you have enjoyed this production of The Audiobook Lovin' Podcast. Host: Viviana Izzo Podcast Intro & Outro: Emma Wilder Podcast Patreon: Benjamin Charles Audio Editor: Dark Star Con This has been an Audiobook Lovin' production Copyright 2017 by Viviana Izzo, Enchantress of Books. Production Copyright 2017 by Audiobook Lovin'. Audiobook Lovin' Series, The Audiobook Lovin Podcast is a division of Viviana, Enchantress of Books. Please visit Viviana, Enchantress of Books to learn more about the Audiobook Lovin' Series. All rights reserved. No part of this publication may be reproduced, modified, copied, distributed, repackaged, shared, displayed, revealed, extracted, emailed, transmitted, sold or otherwise transferred, conveyed or used, in a manner inconsistent with the Agreement, or rights of the copyright owner. You shall not redistribute, repackage, transmit, assign, sell, broadcast, rent, share, lend, modify, extract, reveal, adapt, edit, sub-license or otherwise transfer the Content. You are not granted any synchronization, public performance, promotional use, commercial sale, resale, reproduction or distribution rights for the Content. For permission requests, please visit Viviana, Enchantress of Books for more information.
La maquinaria policial de Venezuela es un organismo represor de la oposición y la prensa. En otros casos más cotidianos, es una institución que abusa de su poder con la ciudadanía, quitándole desde la comida hasta la vida. En este capítulo de Prisma, el podcast del CLIP, escucha dos voces que desde orillas distintas convergen para delinear la historia de abusos policiales en Venezuela. Conoce a Carmen Arroyo, madre de Cristian Arroyo, un joven asesinado por las Fuerzas de Acciones Especiales, FAES, de forma extrajudicial y pasado por criminal. En su duelo y lucha por la verdad, Carmen fundó, junto a otras víctimas, el colectivo Madres Poderosas. Junto a su voz, escucha el testimonio de un antiguo miembro de la policía venezolana, quien se convirtió en investigador académico sobre la cultura policial en el país, especialmente sobre la Operación Liberación del Pueblo en 2015.
En el episodio 235 de este condensado de información semanal, tres grandes reportajes destacaron esta semana por Tal Cual, El Pitazo y Runrun.es, los tres medios digitales venezolanos que conforman la Alianza Rebelde Investiga (ARI). Desde Tal Cual esta semana nos comparten el trabajo: “¿Habrá aumento salarial en octubre? Esto esperan los empresarios y sindicatos". Con las elecciones presidenciales a celebrarse el próximo año, se espera que 2024 esté dedicado al aumento salarial constante, pues el chavismo promedia 3,8 ajustes al ingreso de los trabajadores en épocas de elecciones presidenciales. Economistas y empresarios coinciden en que un mayor poder adquisitivo es imprescindible para superar el ciclo recesivo en el que ingresó Venezuela este año, pero los incrementos salariales, incluso en dólares, se quedan cortos frente a la inflación.“La DAET, aunque se vista de seda, FAES se queda" es el #RRPlus que destacan en Runrun.es esta semana. La Misión Internacional Independiente de determinación de los hechos sobre Venezuela de la ONU destacó que 10 de los 15 funcionarios de alto mando en la DAET pertenecían a la FAES, perpetuando la cadena de mando de ejecuciones extrajudiciales, detenciones arbitrarias y torturas en los cuerpos de seguridad del país. La Cancillería venezolana calificó esas investigaciones como «falsas» y «sin fundamento» por cuarta vez consecutiva. En El Pitazo destacan el trabajo "¿Inflación en dólares, rezago en los precios o especulación? El reto de hacer mercado en Venezuela". Los precios en dólares se incrementaron en los últimos años, lo que afectó el bolsillo de los venezolanos. Actualmente, se ha visto un ligero descenso en algunos rubros, pero sigue limitado el consumo porque los salarios pierden cada día su capacidad de compra. Ir al mercado pasa por establecer prioridades y reducir las cantidades de productos a adquirirTe invitamos a sumarte a nuestra comunidad desde tu plataforma de podcast preferida y compartirlo, para que se mantengan informados. Además, puedes visitar las páginas web para tener acceso a las noticias y mayor detalle de los reportajes que destacaron esta semana en el Tres en Uno, tu suplemento informativo semanal.Narración y producción ejecutiva: Luis D. MiquilenaGuión: Francisco ZambranoEdición y montaje: Abrahan Moncada
Aunque desde 2020 parecen haberse reducido los abusos en Venezuela contra opositores al gobierno de Nicolás Maduro, continúan con mecanismos más selectivos, según denunció el nuevo informe publicado por la Misión Independiente para Venezuela que se debatirá luego en el Consejo de los Derechos Humanos de las Naciones Unidas (ONU) Eduardo Trujillo, director del Centro De Derechos Humanos de la UCAB (CDH UCAB), indicó que el día de ayer, la Misión Internacional Independiente para la Determinación de los hechos sobre Venezuela, presentó una cuarta actualización ante el Consejo de los Derechos Humanos en sus 64 periodos. Explicó que en esta oportunidad, por mandato del propio Consejo de los Derechos Humanos de las Naciones Unidas, otorgado a la misión en octubre 2022, la misión ha seguido en un proceso de documentación de la comisión de posibles crímenes de lesa humanidad e infracciones al derecho internacional que tiene un impacto en los Derechos Humanos de la población venezolana. «En esta oportunidad, la misión analizó información de casos ocurridos en 2020, 2021, 2022 y parte de 2023 donde hubo dos tópicos de análisis fundamental» añadió. Trujillo aseguró que estos tópicos hablan del aparato estatal y sus mecanismos de represión junto con las restricciones al espacio cívico, por otro lado, la mutación de las fuerzas de acciones especiales de la policía (FAES) a la Dirección de Acciones Estratégicas y Tácticas (DAET). También te puede interesar: Misión ONU para Venezuela: los ataques a la sociedad civil se reducen, pero continúan Destacó que estos tópicos en el informe vinieron con fuertes críticas al estado venezolano en las líneas temáticas de detenciones arbitrarias, desapariciones arbitrarias, privaciones arbitrarias y graves casos de tortura. El director de CDH UCAB recordó que la Misión Internacional Independiente es un mecanismo de supervisión especializado que ha generado Naciones Unidas sobre DDHH en Venezuela. «Este mecanismo que procura la documentación especializada de violaciones de Derechos Humanos en términos genéricos, que podrán ser usados como indicios en procedimientos de arreglo internacional como el asunto Venezuela I» acotó. Sin embargo, resaltó que al mismo tiempo esto genera un debate en el consejo a efecto de dar recomendaciones que deben ser cumplidas por el estado venezolano al ser parte de la Naciones Unidas. Señaló que este informe pone en la palestra la gravedad de la situación de Derechos Humanos y habla de la refinación de las técnicas del gobierno en la persecución de opositores o personas consideradas opositoras. El abogado recalcó que el Estado tiene capacidad de recuperar su línea dura de represión, lo cual puede implicar situaciones tan graves como detenciones arbitrarias, desapariciones arbitrarias, privaciones arbitrarias, uso de la violencia sexual en la represión y graves casos de tortura. «La comunidad Internacional pretende que esto genere un estado inhibitorio en torno a la emisión de conductas positivas o negativas que constituyan violaciones de Derechos Humanos» dijo.
Hoy en Las Noticias de ABC, os contamos la reacción del Gobierno a las palabras de José María Aznar ante FAES. La ministra Portavoz ha calificado de actitud «golpista» al expresidente. Además, en Marruecos por fin ha aparecido Mohamed VI en la zona más afectada, lo ha hecho visitando un hospital de Marrakech. Por último, se siguen sucediendo los efectos no deseados de la ley del 'sí es sí', esta vez el beneficiado ha sido Ángel Boza, uno de los miembros de 'La Manada'
Sara Moro de Faes es una exgimnasta española, especializada en la disciplina de gimnasia artística, olímpica en Sídney 2000 y Atenas 2004. En ambos Juegos logró el diploma olímpico, es fisioterapeuta, osteópata, PNI y Profesora en el Máster de Programación Neuromotriz. Los valores en el deporte de élite. Las diferencias entre hombres y mujeres. Aprendizajes de toda una vida dedicada al cuerpo humano. Visión de una persona saludable En este episodio contamos con una de las personas más extraordinarias que ha pasado por nuestros micrófonos que gracias a vuestras peticiones he podido volver a traer para compartir su visión de distintas perspectivas de la actualidad y la filosofía de una vida con sentido. Gracias a todos.
City centre half Wout Faes talks to us about his goals for the season under Enzo Maresca.
S'mae... Dych chi'n gwrando ar Pigion - podlediad wythnosol Radio Cymru i'r rhai sy'n dysgu ac sydd wedi dysgu Cymraeg. Trystan ab Ifan dw i ac i ddechrau'r wythnos yma … Pigion Dysgwyr – Dechrau‘r Steddfod Buodd Radio Cymru‘n darlledu o Faes yr Eisteddfod ym Moduan drwy'r wythnos diwetha gan ddechrau am ganol dydd ar y dydd Sadwrn cyntaf. Dyma sut dechreuodd y darlledu…… Darlledu To broadcast Cynnau tan To light a fire Cynnal To maintain Blodeuo To flower Eisteddfodwr o fri A renowned Eisteddfod person Hawlio To claim Deuawd Duet Craith A scar Llwyfan Stage Noddi To sponsor Pigion Dysgwyr – Martin Croydon …ac wrth gwrs bydd blas ar sawl darllediad o'r Eisteddfod yn y podlediad wythnos yma, gan ddechrau gyda Martyn Croydon enillodd wobr Dysgwr y Flwyddyn yn yr Eisteddfod Genedlaethol ddeg mlynedd yn ôl. Daw Martin o Kidderminster yn wreiddiol, ond erbyn hyn mae o'n byw ym Mhen Llŷn. Gwobr Prize Enwebu To nominate Rowndiau terfynol Final rounds Gwrthod To refuse Cyfweliad Interview Beirniaid Judges Cynifer So many Cyfathrebu To communicate Ysbrydoli To inspire Cynulleidfa Audience Terfynol Final Pigion Dysgwyr – Dysgwr y Flwyddyn Ac roedd Martyn yn un o'r criw fuodd yn brysur iawn yn cynnal gweithgareddau Maes D yn Steddfod Boduan. Ond pwy enillodd gwobr Dysgwr y Flwyddyn eleni tybed? Roedd pedwar ymgeisydd ardderchog wedi cyrraedd y rownd terfynol, a dydd Mercher yn yr Eisteddfod cyhoeddwyd mai Alison Cairns yw Dysgwr y Flwyddyn eleni. Daw Alison yn wreiddiol o'r Alban ond mae hi a'i theulu erbyn hyn yn byw yn Llannerchymedd ar Ynys Môn. Dyma hi'n sgwrsio ar Post Prynhawn yn dilyn y seremoni wobrwyo. Y gymuned The community Pigion Dysgwyr – Esyllt Nest Roberts de Lewis A llongyfarchiadau i Alison ar ennill y wobr – dwi'n siŵr bydd hi'n mwynhau ei blwyddyn. Daw Esyllt Nest Roberts de Lewis yn wreiddiol o Bencaenewydd ger Pwllheli ond mae hi erbyn hyn yn byw yn ardal Gymraeg Patagonia, sef Y Wladfa, ac wedi bod yno ers nifer o flynyddoedd. Ar Dros Frecwast yr wythnos diwetha cafodd Kate Crocket gyfle i'w holi hi gan ofyn iddi'n gynta iddi pam aeth hi allan i'r Wladfa yn y lle cynta? Yn y cyfamser In the meantime Annerch To address (a meeting) Y cyfryngau The media Dylanwadu To influence Rhyngrwyd Internet Yn anymwybodol Unaware Pigion Dysgwyr – Cai Erith Ac Esyllt oedd yn arwain Cymru a'r Byd, sef y Cymry sy'n byw ym mhob rhan o'r byd erbyn hyn, yn yr Eisteddfod Genedlaethol eleni Os chwiliwch chi ar BBC Sounds gwelwch raglen arbennig wnaeth Aled Hughes ei recordio dan y teitl Mordaith. Rhaglen yw hi lle mae Aled yn hwylio o amgylch Penrhyn Llŷn yn sgwrsio gyda rhai o drigolion yr ardal. Morwr yw Cai Erith a dyma fe'n sôn ychydig am ei fywyd Penrhyn Peninsula Trigolion Residents Porthladdoedd Ports Yn llythrennol Literally Wedi dy hudo di Has lured you Pigion Dysgwyr - Ffobia Hanes bywyd diddorol Cai Erith yn fanna ar raglen Mordaith. Buodd Catrin Mai yn siarad ag Emma Walford a Trystan Ellis Morris ar eu rhaglen yn ddiweddar. Mae gan Catrin ffobia anarferol iawn… sbyngau, neu sponges! Dyma Emma yn holi Catrin gynta……. Cyffwrdd To touch Colur Makeup Fatha Yr un fath â Trin To treat Nadroedd Snakes Corynnod Pryfed cop Arnofio To float Amsugno To absorb
Lo analizamos con Adrián Sánchez, analista senior de Renta Variable de Singular Bank e Ignacio Cantos, de atl Capital.
On the latest episode of The Cannabis Conversation, we're joined by Nikolaas Faes, a senior research analyst at Bryan, Garnier & Co - an independent full-service investment bank for European healthcare and technology-led companies and their investors.We discuss the size and potential growth of the European Cannabis market, the different sub-sectors such as CBD and medical cannabis, and the challenges of investing in an industry heavily reliant on regulatory change.The Cannabis Conversation is sponsored by Lumino - a boutique HR and Recruitment Agency specialising in building high performance teams for the European Cannabis Industry. They work in three main verticals: Commercial, Medical and Plant Facing.Get in touch at www.luminorecruit.com/About Nikolaas FaesAs a senior research analyst at Bryan Garnier, Nik Faes examines not only the global cannabis sector but also the fields of alcoholic beverages and AgriTech. Based in London, he has worked over the past 35 years for a number of international financial institutions and has been a professor in financial analysis, fund management and financing.ResourcesConnect with Nik on LinkedIn: https://www.linkedin.com/in/nikolaas-faes-42b34b28Bryan Garnier Website: https://www.bryangarnier.com/
Only 6 more GWs left but plenty of doubles sprinkled in there up until the end of the season. Hopefully it's not too late and you all realized that GW33 starts..TODAY. The episode, we lend our humble advice on how to manage these back to back fixtures and triple down on our Palace/Roy Hodgson take. Also be sure to listen in for a never-before-seen FPL forward lineup. Good luck to everyone who hasn't been paying attention and are probably playing with City, United, & Brighton players on their bench this week!
En ce moment, en Young Adult, la mode est la romantasy (la romance dans un univers de Fantasy, avec souvent des Faes), mais avant il y avait eu l'ère de la Dystopie, mais aussi les années Romance Paranormale et tous les romans qui ont hérité d'Harry Potter... La question étant : en tant qu'auteur de roman, doit-on suivre les tendances et écrire les genres à la mode pour être publié ?Cliquez ici pour vous découvrir le programme "Auteurs du Web" pour créer son site internet d'auteur en moins de 30 joursDécouvrez le template Notion pour organiser l'écriture de votre roman et accéder aux vidéos de l'Anatomie du Scénario (avec retranscription !)Retrouvez-moi sur InstagramRecevez chaque mardi matin de nouveaux conseils écriture et marketing grâce à ma Newsletter Hébergé par Acast. Visitez acast.com/privacy pour plus d'informations.
Pete & Rob embark on yet another VAR rant: -how was Sabitzer not sent off?! -how was Rashford onside when Barnes wasn't the week before?! On the plus side, the first half an hour against Manchester United was very positive and City have a really easy game this weekend against Arsenal... we're predicting 6 or 7 goals and top spot on Match of the Day!
Dominic Wells looks at how the Faes and Souttar partnership is helping the Foxes score.
Stephan Sanders-Faes is an historian of Central and Eastern Europe at the University of Bergen, Norway. He received his Ph.D. from the University of Graz in 2011 and obtained the Habilitation in Early Modern and Modern History from the University of Zurich in 2018. Before joining the Bergen faculty in 2020, he taught for ten years at the history departments at the Universities of Zurich and Fribourg, as well as held the István Deák Visiting Professorship in East Central European Studies at Columbia University in 2018. Stephan's research focuses on post-medieval Central and Eastern Europe (c. 1350-1850), with a particular interest in urban-rural relations, administrative, bureaucratic, and constitutional changes ("ABC history"), and state transformation — that is, the emergence, and change over time, of the European national state. He's the author of two books: Urban Elites of Zadar (2013); and Europas Habsburgisches Jahrhundert (2018). His next book will be Lordship and State Transformation: Bohemia and the Habsburg Monarchy from the Thirty Years War to the War of the Spanish Succession, expected in 2022. He blogs on current events at https://fackel.substack.com. Fakel means “torch” in German. Currently, Stephan is investigating the diffusion of state authority into the rural periphery of Habsburg Lower Austria from the late eighteenth century to the advent of constitutional rule in 1860s, exploring the role of non-state actors as state-builders, the patterns of transition, and the social factors influencing them. His other contributions to the field includes consulting for the EU Commission's Research Executive Agency (Marie Curie-Skłodowska fellowships), the Polish National Science Centre (Narodowe Centrum Nauki), and the Swiss National Science Foundation, as well as serving on the international editorial board of Atti (published by the Center for Historical Research in Rovinj/Rovigo, Croatia), and as peer-reviewer for Annales: Histoire, Sciences Sociales, Archivio Veneto, and the Zeitschrift für Kunstgeschichte, among others. The KunstlerCast theme music is the beautiful Two Rivers Waltz written and performed by Larry Unger.
Three Scrooges chat about our return to Premier League action and the disappointment it brought to the festive season. Even the Carabao Cup win resulted in a tricky draw! Can the FA Cup bring some belated Christmas cheer? Here's hoping!! Despite the ups and downs of being a Fox.... It's great to be back!
Join Patrick Smith for the post-game podcast after Liverpool beat Leicester City 2-1 thanks to two own goals from Wout Faes, after initially falling behind. To react to the Reds' Anfield return is the ECHO's Paul Gorst, Jurgen Klopp, and Liverpool fans with the view from the Kop.
The Big Strong Leicester Boys (A podcast about Leicester City #LCFC)
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Kelly Cates is joined by Gary Neville and Jamie Carragher as they discuss Liverpool's 2-1 win over Leicester, thanks to Belgian defender Wout Faes' two own goals that handed the Foxes a defeat at Anfield.
Nathalie Jetté, MD, MSc, FRCPC, CSCN(EEG), FAAN, FAES, FANA, shares what she learned as the guest editor of the April 2022 Continuum issue on Epilepsy.
Learn the 3 key points about the future of our Michigan history and preservation from our resident expert at The State Historic Preservation Office, and how it could help in the hunt for knowledge jobs!Join our guest Martha MacFarlane-Faes, Deputy State Historic Preservation Officer, Michigan State Historic Preservation Office (SHPO) as she discusses with our host Ed Clemente the complicated but rewarding value of preservation and how it could be a valuable tool to attract and retain talent to the state. She currently oversees SHPO's community and economic development programs, including archaeology, local historic districts, planning, survey, historic preservation tax credits, and Certified Local Governments. Also learn about Governor's Award for Historic Preservation; Michigan Historic Preservation Network, Annual Statewide Preservation Conference and National Preservation Month. Having lived in Silicon Valley, New England and Chicago, Martha is happy to have made Michigan her home. You can also read the transcript from our conversation.
Welcome to this special episode of the NeurologyLive® Mind Moments™ podcast. Tune in to hear leaders in neurology sound off on topics that impact your clinical practice. In 2022 and onward, whenever the FDA makes a major decision for the field of neurology, we'll be releasing short special episodes to offer a snapshot of the news, including the main takeaways for the clinical community, as well as highlights of the efficacy and safety profile of the agent in question. In this episode, we're covering the recent approvals of ganaxolone (Ztalmy; Marinus Pharmaceuticals) in cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder, also known as CDD, as well as fenfluramine (Fintepla; Zogenix/UCB) in Lennox-Gastaut syndrome (LGS). Offering commentary is a pair of experts. The first is Scott Demarest, MD, MSCS, neurologist and clinical director of precision medicine, Children's Hospital Colorado, and assistant professor of pediatrics-neurology, University of Colorado, and an investigator of the Marigold trial (NCT03572933). The second is Kelly G. Knupp, MD, MSCS, FAES, pediatric neurologist, Children's Hospital Colorado, and associate professor of pediatrics-neurology, University of Colorado, and an investigator of Study 1601 (NCT03355209). For more of NeurologyLive®'s coverage of ganaxolone's approval, head here: Ganaxolone Wins Landmark Approval for CDKL5 Deficiency Disorder. For more of NeurologyLive®'s coverage of fenfluramine's approval, head here: Fenfluramine FDA-Approved for Treatment of Lennox-Gastaut Syndrome. For more coverage of epilepsy and seizure disorders, head to NeurologyLive®'s Epilepsy clinical focus page. Episode Breakdown: 0:30 – Ganaxolone (Ztalmy; Marinus) approved for CDD 2:30 – Scott Demarest, MD, with his reaction to the approval 3:00 – Data from the Marigold study of ganaxolone 4:45 – Safety profile of ganaxolone in development 5:10 – Demarest on the landscape of care for CDD 6:20 – Clinical takeaways ahead of DEA scheduling for ganaxolone 8:40 – Fenfluramine (Fintepla; Zogenix/UCB) approved for LGS 10:55 – Kelly Knupp, MD, with her reaction to the new indication 11:30 – Efficacy data on fenfluramine in LGS 13:50 – Safety profile in LGS and Dravet syndrome 16:05 – Knupp on the potential to improve quality of life and optimal use Thanks for listening to the NeurologyLive® Mind Moments™ podcast. To support the show, be sure to rate, review, and subscribe wherever you listen to podcasts. For more neurology news and expert-driven content, visit neurologylive.com. REFERENCES 1. Marinus Pharmaceuticals Announces FDA Approval of ZTALMY® (ganaxolone) for CDKL5 Deficiency Disorder. News release. March 18, 2022. Accessed March 21, 2022. https://www.businesswire.com/news/home/20220318005282/en/Marinus-Pharmaceuticals-Announces-FDA-Approval-of-ZTALMY%C2%AE-ganaxolone-for-CDKL5-Deficiency-Disorder 2. FINTEPLA® (fenfluramine) Oral Solution Now FDA Approved for Treatment of Seizures Associated with Lennox-Gastaut Syndrome (LGS). News release. UCB. March 28, 2022. Accessed March 28, 2022. https://finance.yahoo.com/news/fintepla-fenfluramine-oral-solution-now-050000058.html