Podcasts about functional assessment

David and Beau 'The Stress Fracture' Physio dive into the world of bone stress injuries, especially in runners, breaking down causes, symptoms, and recovery strategies. This episode is packed with insights on  why these injuries happen, how to spot them, and the best ways to heal, from effective rehab to proper nutrition. You can find Beau on Instagram here. _____ (00:15) -Introduction to Bone Stress Injuries (3:15) - Understanding Bone Stress Injuries (6:15) - Why Runners Are Susceptible (11:59) - Identifying Stress Fractures (18:20) - Clinical Assessment of Stress Injuries (25:11) - Management and Recovery Strategies (38.45) - Gradual Return to Activity (50:46) - Reintroduction to Running (4312) - The Importance of Functional Assessment in Rehab (53:51) - Managing Running Frequency and Volume (1:04:56) - Defining Shin Splints and Treatment Approaches ___ Don't forget to check out our programs:

In this episode, David and “tendon God” Jake Tuura do a deep dive into all things to do with tendons; break down rehab strategies, and explore whether isometrics really work. This is one of those episodes you should not skip because there are insights at every turn. You can find Jake Tuura on Instagram here. _____ (00:15) - Introduction (0:59) - The Journey into Tendon Research (6:15) - The Role of Isometrics in Tendon Health (12:29) - Calf Strength and Rehabilitation Strategies (18:30) - Metabolic Health and Tendon Pain (31:56) - Understanding Tendon Pain and Inflammation (37.08) - Rehabilitation Strategies for Tendon Injuries (29:46) - The Journey Begins: Finding the Right Support (4312) - The Importance of Functional Assessment in Rehab (57:14) - Navigating Pain Management and Recovery (1:10:56) - The Importance of Permission in Rehab (1:16:40) - The Role of Assertiveness in Rehab (1:21:03) - Choosing the Right Protocol for Recovery ___ Don't forget to check out our programs:

Many of our learners struggle with being unable to communicate their basic wants and needs. In some cases, this can cause challenging behavior. Functional communication training, or FCT, is an effective way to build those important communication skills in our learners. Here, we discuss how to incorporate FCT within skills-based treatment.We touch on why behavior doesn't just serve a single function and how to introduce healthy communication as a replacement skill. We discuss Dr. Gregory Hanley's approach to FCT and the importance of starting with a practical functional assessment. We also share some practical examples, the value of shaping, and why we should prioritize building healthy relationships with our learners.What's Inside:How to incorporate FCT into skills-based treatmentHow to introduce communication as a replacement skillThe importance of starting with a functional assessmentMentioned In This Episode:HowToABA.com/joinHow to ABA on YouTubeFind us on FacebookFollow us on Instagram Cooperation Over Compliance Series

We are back with "The Phelan-McDermid Podcast: Sharing Research, Progress, and Hope"! We continue our mini-series featuring the 2023 PMSF Grant Winners! In this episode, Lauren is talking to Dr. Bridgette Moffitt from Clemson University. Dr. Moffitt received the 2023 PMSF Innovation Award for her project titled, “Functional Assessment of Candidate Treatments for Phelan-McDermid Syndrome”. Tune in to hear about her research, which is setting the stage for precision, individualized medicine by testing candidate drugs on cell lines from actual individuals with Phelan-McDermid syndrome! And don't forget to follow us to never miss an episode!

Commentary by Dr.  Jian'an Wang

Join the PSL1 opt-in list now for an exclusive discount on our next semester. Learn more at https://www.pre-script.com/psl1 Shallow and Jiunta explore knee pain management, blending personal stories with expert insights on injury triage, rehab strategies, and the balance between structural and functional assessments. Tune in for practical advice on integrating daily activities with performance training and the value of subjective assessments in tracking recovery. FREE Coach's Field Guide: https://www.pre-script.com/coachs-field-guide We've got a new sponsor! Marek Health is a health optimization company that offers advanced blood testing, health coaching, and expert medical oversight. Our services can help you enhance your lifestyle, nutrition, and supplementation to medical treatment and care. https://marekhealth.com/rxd Code RXD Don't miss the release of our newest educational community - The Pre-Script ® Collective! Join the community today at www.pre-script.com. For other strength training, health, and injury prevention resources, check out our website, YouTube channel, and Instagram. For more episodes, subscribe and tune in to our podcast. Also, make sure to sign up to our mailing list at www.pre-script.com to get the first updates on new programming releases. You can also follow Dr. Jordan Shallow and Dr. Jordan Jiunta on Instagram! Dr. Jordan Shallow: https://www.instagram.com/the_muscle_doc/ Dr. Jordan Jiunta: https://www.instagram.com/redwiteandjordan/ Understanding Knee Pain (00:06:04) Triage and Troubleshooting Injuries (00:08:59) Structural vs Functional Assessment (00:12:04) Rehabilitation Strategies for Knee Injuries (00:14:53) Understanding Passive and Active Range of Motion (00:19:33) Assessing Injuries: A Personal Experience (00:22:50) Rehabilitation Strategies Post-Injury (00:27:10)   The Importance of Daily Activities in Recovery (00:33:22) Subjective vs. Objective Assessment in Rehab (00:39:14) Functional Rehabilitation Techniques for Knee Pain (00:45:23) Integrating Rehab into Performance Training (00:49:03)

Dr. Anthony Cammilleri - better known as Tony to friends and colleagues - joins me in Session 276. In this episode, we talked about his early experiences in Behavior Analyst, his experiences working in Greg Hanley's lab as a grad student, of course his work collaborating with Greg and other colleagues in the founding and development of the FTF consultancy, the recent news of his migration over to Action Behavior Centers, and what opportunities lie ahead in this partnership. We then talk more generally about what's new in the world of the IISCA or Practical Functional Assessment, along with Skills-Based Treatment, and how those processes have evolved over the years, common mistakes people make when implementing these procedures, and more. We also talked about my semi-misgivings about terms like Compassionate-ABA, Trauma-Informed-ABA, Trauma-Assumed-ABA, and the like, as well as Tony's upcoming talk at the 2024 Stone Soup Conference. Here are links to some of the resources we mentioned: Free State Brewing (Lawrence, KS). All thing FTF. FTF's credentialing options. Action Behavior Center's big announcement! Action Behavior Center's homepage. The 2024 Stone Soup Conference (use PODCAST24 to save at checkout!). Hanley (2012). Functional Assessment of Problem Behavior: Dispelling Myths, Overcoming Implementation Obstacles, and Developing New Lore. Anderson and St. Peter (2013). Functional Analysis With Typically Developing Children: Best Practice or Too Early to Tell?: In Response to Hanley (2012). Hanley et al. (2014). Producing meaningful improvements in problem behavior of children with autism via synthesized analyses and treatments. Rajaraman and Hanley (2020). Mand compliance as a contingency controlling problem behavior: A systematic review. Fisher et al. (1996). On the reinforcing effects of the content of verbal attention. Dr. Tim Vollmer's appearance on the podcast in Session 257. Session 176: Towards Trauma-Informed Applications of Behavior Analysis. This podcast is brought to you by: ACE Approved CEUs from .... Behavioral Observations. That's right, get your CEUs while driving (maybe even this episode!), walking your dog, doing the dishes, or whatever else you might have going on, all while learning from your favorite podcast guests! The 2024 Stone Soup Conference! Behavior Analysis' premier online event is taking place on October 25th. Come hear from pod faves including Drs. John Austin, Lina Slim, Jim Moore, and many others! 8.5 Learning CEUs are available, and when you use the promo code PODCAST24, that comes out to less than 8 bucks per credit. Learn more here! The Behavioral Toolbox. thebehavioraltoolbox.com is a new education and training site that my colleagues Anika Costa and Dr. Paulie Gavoni and I have been working on for over two years. We have two courses available: our first course, Ready, Set, Consult! and our newly released course, When Not to FBA: 5 Quick Strategies for Improving Behavior in Classrooms.

Summary In this podcast episode, we talk with Jente Wachemans, a physiotherapist and researcher specializing in ankle sprains and chronic instability. We discuss the nature of lateral ankle sprains, differentiating them from other types of ankle injuries, and touch on chronic ankle instability, a condition that remains somewhat ambiguous and under-researched. Jente emphasizes that while ankle sprains are common, particularly in sports, the transition to chronic instability isn't always straightforward and requires more prospective data for a clearer understanding. We also explore the prevalence of ankle sprains across various sports and demographic groups, noting higher incidences in females and younger populations. Jente shares his approach to managing ankle sprains, from the acute phase to return to sport, advocating for exercise-based rehabilitation and the importance of patient education. He highlights the Peace and Love principles for immediate post-injury care and emphasizes the role of neurocognitive tasks in rehabilitation. We also discuss the use of orthopedic tests, ultrasound, and the significance of understanding which ligaments are involved in the injury for effective treatment. Jente stresses the importance of not underestimating ankle sprains, ensuring proper rehabilitation to prevent recurrence, and the potential role of surgery in persistent cases.    Guest Jente Wagemans is a physiotherapist and researcher at the University of Antwerp who is currently doing is PhD in collaboration with Ulster Universtity and Bern University of applied sciences. As part of his PhD he has published several papers about ankle sprains and chronic instability.   Timestamps 00:00 Intro 00:49 What is a lateral ankle sprain? 02:04 How is it different from other sprains? 03:12 At what point do we talk about chronic instability? 08:00 Prevalence 09:36 The typical patient 11:22 Risk factors 14:00 Ankle mobility & strength metrics 15:07 Chronic Instability risk factors 18:45 Red Flag Awareness 23:46 PEACE & LOVE 26:45 Orthopedic Testing 31:20 When is MRI valuable? 32:54 Functional Assessment 36:37 Management Approach  45:18 Taping & Braces 47:13 Recurrence & Prevention 49:00 When surgery is indicated 52:10 Return to Sport timeline 56:20 Jente's closing thoughts 57:53 Contact Info 59:40 Outro   Bonus Material Download the referenced transcript including PubMed Links and a high-resolution infographic on this episode as part of your Physiotutors membership on the Physiotutors App. Download the Free App now   Follow our Podcast on: Spotify | Apple Podcasts  

This week, we're excited to welcome Dr. Bethany Raiff, a leader in combining technology with behavioral interventions to promote healthy behaviors. Dr. Raiff will share her insights on using innovative tools to support families raising autistic children, including video game-based learning and mobile interventions for encouraging positive habits. Whether you're a parent, therapist, or passionate about autism support, this episode will offer new understanding and opportunities. Resources  (31) Bethany Raiff | LinkedIn HABIT Lab Recent Publications: Kirby, K.C., Dwyer, M.J., Burrows, C., Fife, D.A., Bresani, E., Tabit, M., Raiff, B.R. (in press). Beliefs related to Healthcare Incentives: Comparison of Substance Abuse Treatment Providers, Medical Treatment Providers, and a Public Sample. Journal of Substance Abuse Treatment Raiff, B.R., Burrows, C.+, Dwyer, M.+ (2020). Behavior Analytic Approaches to the Management of Diabetes Mellitus: Current Status and Future Directions. Behavior Analysis in Practice., Online First, DOI: https://doi.org/10.1007/s40617-020-00488-x; (link to article: https://rdcu.be/catZG) Nastasi, J.A.+, Shepphard, R.D.+, Raiff, B.R. (2020). Token-Economy-Based Contingency Management Increases Daily Steps in Adults with Developmental Disabilities. Behavioral Interventions, 35, 315-324. DOI: 10.1002/bin.1711 Burrows, C.+, Dallery, J., Kim, S.J., & Raiff, B.R. (2020). Validity of a Functional Assessment for Smoking Treatment Recommendations Questionnaire. Psychological Record, 70, 215-226. DOI: https://doi-org.ezproxy.rowan.edu/10.1007/s40732-020-00375-5 ................................................................ Autism weekly is now found on all of the major listening apps including apple podcasts, google podcasts, stitcher, Spotify, amazon music, and more. Subscribe to be notified when we post a new podcast. Autism weekly is produced by ABS Kids. ABS Kids is proud to provide diagnostic assessments and ABA therapy to children with developmental delays like Autism Spectrum Disorder. You can learn more about ABS Kids and the Autism Weekly podcast by visiting abskids.com.  

Dr. Shannon Westin and her guest, Dr. Patrick Stone, discuss the article, Methylphenidate Versus Placebo for Treating Fatigue in People with Advanced Cancer, a Randomized, Double-Blind, Multicenter Placebo-Controlled Trial, recently published in JCO. TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Shannon Westin: Hello, everyone, and welcome to another episode of JCO After Hours, the podcast where we go in depth on manuscripts and research published in the Journal of Clinical Oncology. I am your host, Shannon Westin, Social Media Editor for JCO and a Gynecologic Oncologist by trade. I am thrilled today to present Methylphenidate Versus Placebo for Treating Fatigue in People with Advanced Cancer, a Randomized, Double-Blind, Multicenter Placebo-Controlled Trial. This manuscript is a dual publication in the Journal of Clinical Oncology and presentation at the European Association of Palliative Care Congress here on May 17, 2024.   And to review this incredible research with us will be Professor Patrick Stone, the Head of Department of Marie Curie Palliative Care Research Department, Division of Psychiatry at University College London. Welcome, Dr. Stone. Dr. Patrick Stone: Thank you very much. Thank you. Shannon Westin: Let's get right to it, we'll level set. Can you speak a bit about the definition of cancer-related fatigue and how common it is in people with advanced cancer? Dr. Patrick Stone: Sure. I think fatigue is a difficult thing to nail down really and define it clearly, and there are lots of definitions out there. In many ways, the simplest definition is the EAPC, the European Association of Palliative Care's definition of just a subjective sensation of weakness, feeling tired, and exhaustion. The reality is that that symptom is very common in the general population. And so if you really want to get a handle on it, I think a good way to do it is to think about taking an operational definition and say, “Look, if fatigue is normally distributed approximately in the general population, then we should consider severe fatigue or pathological fatigue could be defined as fatigue that is worse than 95% of the general population. And if you think that definition, then prevalence of fatigue in patients with newly diagnosed breast or prostate cancer, for instance, is around 15%, so three times as common as the most severe fatigue in the general population. If you come to patients with newly diagnosed non-small cell lung cancer, it's up to about 50%. And if you come to my area, which is palliative care and you go to a hospice and you ask people to complete a fatigue questionnaire, 78-80% of people complain of fatigue that is more severe than 95% of the general population. So that I think gives us a good handle on sort of the severity of this problem in cancer patients and how it progresses as disease progresses. Shannon Westin: I love this because I think we always struggle with exactly how to nail down the definition and exactly how to treat it. So I think that it's a really nice transition to existing treatment options for this issue and exactly how they might work. Dr. Patrick Stone: The first thing to say is in medicine if you can find a cause then you give a treatment directed at the cause and obviously that applies to fatigue as well. So the first thing is to do a thorough assessment of your patient, and if you can find an easily remediable cause such as anemia, hypocalcemia, or hypomagnesemia, or maybe other things like depression, which might manifest as fatigue, then you should try and give a treatment directed at that cause. But, for many patients, there won't be a single clearly identifiable cause you can target. And then people use more broad spectrum approaches if you like. The most well-studied I think is exercise. And exercise, there have been lots of randomized controlled trials in different types of exercise and it's a well attested treatment, which I think has good evidence of effectiveness, certainly in patients who are on treatment and in disease-free survivors. There is less evidence in advanced cancer because the trials are fewer. I would still say that there's moderate quality evidence that exercise is effective in advanced cancer.  The other group of treatments, broadly speaking, would be psychological therapies, cognitive behavioral therapy and psychoeducational approaches, mindfulness based stress reduction, that sort of thing. And again, in earlier stage disease and in patients on treatment and in survivors, there's more quality evidence that that sort of approach can help, if not alleviate fatigue, allow people to cope better with fatigue. But the evidence in advanced cancer is weaker than for exercise. So I think the evidence for the effectiveness of those psychological therapies is not so strong.  And then you come on to pharmacological therapies and there have been lots of trials of different agents. I won't list them all because most of them are negative and don't show any benefit. A few things which perhaps still show promise from previous trials, there have been, for instance, a few trials looking at ginseng as a herbal therapy. One very good quality trial showed benefit. Although another trial in advanced cancer didn't replicate that finding, so that ginseng is out there. Steroids, widely used in advanced cancer for general relief of many symptoms like fatigue, lack of energy, low moods, appetite. But although widely used, surprisingly little hard evidence or effectiveness, specifically for fatigue, but one relatively recent, well conducted randomized control trial, provides us with some firm evidence, also, that dexamethasone can help in the short term in advanced cancer patients. It obviously wouldn't be a recommended treatment longer term because of its side effects.   And then we really come on to the crux of this study which is probably the most widely studied single agent beyond that, is methylphenidate, which is a psychostimulant agent, raises central dopamine catecholamine levels in the brain. And there's probably a thousand or so randomized control trials sort of being conducted looking at that prior to prize of this study that we're talking about. Shannon Westin: I would love to hear a summary of the data that were pre-existing in this study. So how well does methylphenidate seem to work, or what were the conflicting results that were seen prior? Dr. Patrick Stone: I think the rationale for this study was that it was the perfect background to justify another randomized controlled trial, which there have been– Well, I can't remember exactly how many there were in existence before my trial started, but when I last looked, there were 10 studies, 10 randomized controlled trials in cancer patients. Most of those trials have been neutral. They've shown no benefit over placebo, so most of the individual trials are negative. But meta-analyses always tend to show a positive result. So when you count the trials together, it gets you over the finishing line and you can see a positive benefit. But individually, the trials were quite heterogeneous, they're quite different. There were only four trials prior to the publication of this one that were done specifically in advanced cancer patients. One of them was published only a couple of years ago while my study was going on. And of those four trials, three of those have also been neutral, not showing a benefit over placebo. One study involving 28 patients and using a PRN as required dosing schedule showed some benefit. But the other studies with a total of about 330 odd patients have been neutral.   Shannon Westin: I think that brings us to a great transition, just to talk a little bit about the design and objectives of your current study. Dr. Patrick Stone: Well, what we wanted to do was take the best bits, if you like, of the previous studies, and try to give ourselves the best chance of finding a clinically meaningful improvement in fatigue in patients with advanced cancer. And I was focusing on advanced cancer, principally because I'm a specialist in palliative medicine. That's the group of patients I'm most working with, whereas a lot of the studies have involved mixed groups of cancer patients or patient's disease-free or on treatment. But we looked at patients who were under the care of palliative care services, with incurable cancer, with a prognosis estimated to be less than a year or around a year.  We wanted to try to get the dose of the medication up to a good level because some of the other studies which have shown benefit have got up to quite high levels of methylphenidate, approximating to about 40 to 60 milligrams of methylphenidate a day or equivalent. And we wanted to give the drug in an individually titrated dose because that would reflect the way it is used in clinical practice. You would adjust the dose like you might with morphine for pain relief. You would expect to adjust the dose of this medication up to get a therapeutic benefit. So we had this titration period where we adjusted the dose of the drug every week. We reviewed whether patients were feeling better, worse, or the same. We asked about side effects. And on the basis of the response to those questions, we either went up with the drug or kept the dose the same, or, if necessary, would come down. The primary endpoint was designed to be fatigue after six weeks of dose titration, plus or minus a window of two weeks, accepting the fact that we might miss a few patients at the six-week mark, for whatever reason. So we had a little window around that. That's what we were looking to do.  Shannon Westin: And why did you choose the six-week time point? Dr. Patrick Stone: Well, there was no obvious time point to choose. One of the biggest positive studies previously was by Lower and colleagues back in 2009, and they had found their maximum benefit at around four weeks, or it took rather four weeks to reach the maximum benefit. So we wanted to give the patients in our trial every chance of demonstrating the benefit, and they'd also escalated the doses in their study up to above 40 milligrams or equivalent. And so we wanted to go up as high as we could, and we didn't feel that if we were adjusting the dose every week, that we could get up to a sufficiently high dose in any shorter time span. So six weeks sort of fitted, allowing us to titrate the dose up to a maximum of 60 milligrams a day, which is where we wanted to get up to. Shannon Westin: And what about a little bit more detail on the population you included, and maybe give us a sense of how well you think that represents your general population affected by fatigue in the setting of advanced cancer? Dr. Patrick Stone: We recruited patients from hospices, so that's inpatient palliative care units in the UK, but also from hospital palliative care services, from oncology outpatient services as well, oncology patients who are under the care of palliative care services, and we also recruited from some community palliative care services. So we had quite a good spread of settings, and all of our patients had advanced incurable cancer under the care of palliative care services. But I would say, I think by the nature of doing this randomized controlled trial, inevitably we ended up with quite a selected population, just because of the inclusion and the exclusion criteria that we had to apply. And the regulators were quite clear about who we shouldn't be putting on the drugs. And I think by the time you've excluded all the potential adverse consequences of using methylphenidate, we probably have ended up with a group of patients who were relatively fit compared to the general run-of-the-mill palliative care population, I would say. So I think that that is a limitation with regards to the generalizability of our result. Shannon Westin: How did you measure fatigue in this study? What was the mechanism for that objective? Dr. Patrick Stone: It's a subjective rating scale. We use a very well-established and well-validated measurement instrument. It's the Functional Assessment of Chronic Illness Therapy FACIT-F which is the fatigue subscale of their anemia subscale, which is a 13-item questionnaire, very well validated and widely used in lots of previous studies. Higher scores represent better quality of life and, therefore, lower levels of fatigue. So that's the scale that we used. Shannon Westin: Got it. So let's get to it. How well did methylphenidate work to impact fatigue compared to placebo? And were there any groups that seemed to have a bigger impact? Dr. Patrick Stone: Well, the bottom line, of course, is that at six weeks, plus or minus two weeks, there was no statistically significant benefit for methylphenidate over placebo. There was a two-point improvement in fatigue scores, but it wasn't statistically significant. And two points on the FACIT-F did not reach our predetermined five-point difference that we regarded as representing a minimally clinically important difference. We looked at lots of secondary fatigue endpoints. We measured fatigue every week over the whole course of the study. And actually, at weeks 2, 3, 4, 5, and 6, there was indeed a statistically, nominally statistically significant difference in fatigue scores. But I really would not want anybody to read anything over much into that finding because it was not a pre-stated hypothesis of our study. It wasn't a pre-stated endpoint, it was a secondary outcome. And moreover, even if this was regarded as a statistically significant finding, and as I say, it was only nominally statistically significant finding, the magnitude of the change was still not sufficiently large that I think it would want to influence your clinical decision making. With other groups just to say, we did look specifically at whether patients with the most severe fatigue would experience benefit over and above other patients, because in a previous study, that looked at modafinil, an agent that promotes vigilance, although the overall finding was neutral in a subgroup of patients with the most severe fatigue, modafinil seemed to work. So we thought we better check in this study whether patients with the most severe fatigue had a differential benefit. But we found no such effect. We found no difference in patients who were on or off treatment or indeed among the patients who scored highest with the depression subscale on the hospital anxiety and depression scale. None of these subgroups showed any benefit over placebo. Shannon Westin: How did patients tolerate methylphenidate? Was it tolerable? Dr. Patrick Stone: That was the thing I think that I was most relieved about. I am a cautious and anxious investigator, and the last thing I wanted to do was to put palliative care patients at risk by giving them a drug which might cause some harm. So I was very relieved when we analyzed the results to confirm that methylphenidate was very well tolerated. There was no real pattern of evidence for any increase in adverse effects over placebo. In fact, when we looked at just people who self-reported severe adverse effects, we found a higher rate in the placebo group than in the methylphenidate group in fact. And in terms of serious adverse events, there were 25 serious adverse events in both groups, so there was, again, no pattern that suggested methylphenidate was causing harm. So, yes, it was well tolerated, but did not result in a clinically important improvement in fatigue. Shannon Westin: Were you surprised by the results?  Dr. Patrick Stone: I honestly went into this with an open mind. I didn't come in with a real fixed agenda that I want to prove that this thing works. In fact, although methylphenidate was being used by some of my colleagues around the country and I know it's used by some colleagues internationally, personally I was not using it because I didn't feel the evidence was strong enough to justify using it. So I was waiting for the results of my own trial before making my decision. And I don't plan now to be using it on the basis of the results of the study. Shannon Westin: Sounds pretty definitive. It's always frustrating, and I know our patients, when we tell them to exercise when they're exhausted, they're like, “Are you kidding me?” Right? So it would be wonderful if there is like the perfect pill that we can give them. It's certainly disappointing. What do you think we should be exploring next for the resolution of fatigue in this patient population?  Dr. Patrick Stone: Well, I think one thing. Going back to your very first question to me about defining fatigue, I think one problem is we don't really have a mechanistic understanding of what we're talking about here necessarily with cancer related fatigue. And it's a bit of an umbrella term, I suspect, for a lot of different things, and may have a common endpoint in terms of the symptom. But maybe if we could better define, if you like, for want of a better word, the phenotype of fatigue, it may be that we could actually target a treatment in certain subgroups of patients that may be of more benefit. So maybe some greater basic science pinpointing what is causing fatigue, so that we can design the treatments, rather than just try repurposing existing drugs on the off chance that they work. And the other thing is okay, maybe we can't pinpoint a particular cause, we think it's multi factorial. If we think it's multifactorial, then perhaps we ought to be using a multimodal treatment approach and maybe it's actually exercise, psychological therapies, and diet, plus or minus a drug, and that's the approach if we can't pinpoint a specific cause. Shannon Westin: I love the idea of incorporating the  translational work to really try to understand the etiology better and then use something more targeted. It's that version of precision medicine but for palliative care as well. I really like that.   Well, this has been awesome. Thank you so much, Dr. Stone. I think that your insight is so much appreciated, and thank you for putting together this definitive work to help us treat our patients better every day. I really appreciate the time you took.  Dr. Patrick Stone: Thank you very much. Shannon Westin: You're so welcome.  And thank you to our listeners. This has been methylphenidate versus placebo for treating fatigue in people with advanced cancer, randomized, double-blind, multicenter, placebo-controlled clinical trial. And again, this is a dual publication in the JCO as well as a presentation at the European Association of Palliative Care Congress on 5/17/24. And we are so thrilled that you could join JCO After Hours and we hope you will check out our other offerings wherever you get your podcasts. Have an awesome day.  The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions.   Guests on this podcast express their own opinions, experience, and conclusions. Guest statements on the podcast do not express the opinions of ASCO. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

I'm thrilled to be joined by none other than Dr. Tim Vollmer. In this podcast, we talk about a wide variety of research and practice topics, as well as some funny stories from his long and prolific career. Specifically, talk about how his dog ate his copy of Strategies and Tactics, how he and his colleagues analyzed 2 and 3-point shot patterns in basketball games, his line of research that examined The Good Behavior Game, Behavior Analysis and the game of Poker, and his take on why he and his students have such an affinity for one another.  That's not all. We probably spent the most amount of time discussing the topic of ignoring in the context of Behavioral Intervention Plans, and its potential problems.  I really hope you stick around until the end of the podcast, because we close the show in a slightly different format. Instead of asking Tim my normal closing question (advice for the newly minted), I ask him to share his thoughts on the future direction of Behavior Analysis, including both risks and opportunities. Here are the links to the resources we mentioned: Beyond Freedom and Dignity (note: Amazon Associates Link). Vollmer and Bourret (2013). An application of the Matching Law to evaluate two and three-point shots by college basketball players.  Football Behavior (BA-driven sports analytics from Brett Yarris). Chris Bosh on the Tim Ferriss show (wherein Chris discusses the evolution 3-point shooting strategy in the NBA). Strategies and Tactics for Behavioral Research and Practice, 4th edition (note: Amazon Associates Link). (Lloveras et al., 2023). Recommendations Regarding Use of the Term “Ignore” in Applied Behavior Analysis. Good Behavior Game episode with Dr. Jeanne Donaldson. Lambert et al., (2006). Effects of response cards on disruptive behavior and academic responding during math lessons by fourth-grade urban students. (this is the paper I mentioned from Bill Heward's research group, and I mistakenly noted that it was published in 1996, when in fact it was published in 2006).  Follow Tim's lab on Instagram! This podcast is brought to you by: HRIC Recruiting. Barb Voss has been placing BCBAs in permanent positions throughout the US for just about a decade, and has been in the business more generally for 30 years. When you work with HRIC, you work directly with Barb, thereby accessing highly personalized service. So if you're about to graduate, you're looking for a change of pace, or you just want to know if the grass really is greener on the other side, head over to HRIColorado.com to schedule a confidential chat right away. ACE Approved CEUs from .... Behavioral Observations. That's right, get your CEUs while driving, walking your dog, doing the dishes, or whatever else you might have going on, all while learning from your favorite podcast guests! The Behavioral Toolbox. thebehavioraltoolbox.com is a new education and training site that my colleagues Anika Costa and Dr. Paulie Gavoni and I have been working on for over two years. If you're a Behavior Analyst working in public schools, please check out our first course, Ready, Set, Consult! Our second course, When Not to FBA: 5 Strategies to Implement before Conducting a Functional Assessment, will also be out soon, and more trainings are on the way!  

In this JCO Article Insights episode, Subodh Selukar summarized findings from the original article published in the January 2024 JCO issue: “The Importance of Low and Moderate Grade Adverse Events on Patients' Treatment Experience and Treatment Discontinuation” and accompanying editorial “Patient Experience, Adverse Event Reporting, and Clinical Trial Design”. The summary provides information regarding low and moderate grade adverse events and the patient experience in clinical trials. TRANSCRIPT Welcome to the JCO Article Insights episode for the January 2024 issue of Journal of Clinical Oncology. This is Subodh Selukar, your host, and today I will be providing a summary on 2 articles focused on low and moderate grade adverse events. The first article, titled “The Importance of Low and Moderate Grade Adverse Events on Patients' Treatment Experience and Treatment Discontinuation” by Dr. O'Connell and colleagues, investigated low and moderate grade adverse events and the patient experience in clinical trials. Their article is accompanied by an editorial entitled “Patient Experience, Adverse Event Reporting, and Clinical Trial Design” by Dr. Neuman.  In clinical trials, a standardized system for reporting adverse events is the Common Terminology Criteria for Adverse Events (or “CTCAE”) established by the NCI, the United States National Cancer Institute. The CTCAE categorizes adverse events at 5 severity grades across 26 system organ classes. However, some clinical trials may only report adverse events at grade 3 or higher, with one possible rationale being that low and moderate grades are unlikely to affect patient safety or key trial endpoints. In Dr. O'Connell's article, the team investigated how the numbers of grade 1 and 2 adverse events related to patient self-reported side-effect burden and treatment discontinuation. To do this, they analyzed data from the Phase 3 trial E1912 conducted by ECOG-ACRIN comparing two treatments for chronic lymphocytic leukemia. They chose this trial as an example because the study data included all adverse event grades throughout the duration of treatment for each patient. The authors studied side-effect burden based on GP5, which is the fifth item in the FACT-G subscale in the Functional Assessment of Cancer Therapy. GP5 rates the patient's agreement with the statement “I am bothered by side effects of treatment” in the past 7 days, and it has previously been connected with adverse event grade and treatment discontinuation. For treatment discontinuation, the authors focused on those discontinuations that were recorded as being due to “adverse events, side effects or complications.” They found that, for each adverse event grade, there were, on average, more adverse events in cycles that ended with a patient discontinuing treatment compared to other cycles. Next, they used Bayesian models to assess how the numbers of grade 1 and grade 2 adverse events in a treatment cycle were associated with the odds of higher side-effect bother and odds of treatment discontinuation, after adjusting for cycle number, treatment and occurrence of grade 3 or higher adverse events within the cycle. Baseline GP5 was also included in the models, and these models also accounted for the inclusion of multiple cycles for each patient. When adjusting for baseline GP5, treatment, cycle and presence of grade 3 or 4 adverse events, both the number of grade 1 and the number of grade 2 adverse events were each strongly associated with increasing side-effect bother. The adjusted odds of treatment discontinuation were also higher with more grade 2 adverse events. However, with the same adjustment variables, the odds of treatment discontinuation were actually lower with larger numbers of grade 1 adverse events. In their primary analysis, they focused on adverse events that were attributed to treatment, so they excluded non-treatment-related adverse events from the counts. Sensitivity analyses including these adverse events have similar conclusions but with a weaker magnitude of effect. They attributed this to issues like existing adverse events not causing new bother. Next, the authors analyzed whether symptomatic versus asymptomatic adverse events affected these results by re-fitting the models and separating the predictors into numbers of asymptomatic and symptomatic grade 1 or 2 adverse events. In these results, they found no evidence for associations between numbers of asymptomatic adverse events at any grade and side-effect bother. On the other hand, they found strong evidence for associations with symptomatic adverse events of grade 2 and 3 or higher both for side-effect bother as an outcome and with treatment discontinuation. Asymptomatic grade 2 adverse events were associated with treatment discontinuation but not side-effect bother, and symptomatic grade 1 adverse events were associated with side-effect bother but not treatment discontinuation.  ·       The authors conclude that adverse events of all grades, especially symptomatic adverse events, should be recorded regularly in cancer clinical trials. Formal patient reported outcomes are not typically collected as frequently as adverse events are recorded, so identifying patients with a high number of lower grade adverse events could be used to facilitate early supportive care to improve patient quality of life and reduce the likelihood for treatment discontinuation. ·       They also highlight their result identifying lower odds of treatment discontinuation with larger numbers of grade 1 adverse events. They provide one explanation that patients may perceive grade 1 adverse events being associated with treatment efficacy, but this perception changes with higher grades.  In their call to collect more lower grade adverse events, the authors acknowledge that recording more adverse events may be time-consuming and burdensome for sites and recommend cost-benefit analyses to develop future guidelines. ·       This balance between the benefits and costs of increased adverse event data collection is the focus of Dr. Neuman's editorial. Dr. Neuman acknowledges that Dr. O'Connell's article provides a convincing argument for how low grade adverse event information is valuable, but notes the clinical trial context that current efforts at the NCI are to more efficiently conduct cancer research, which could be supported by streamlining data collection. ·       Requiring the collection of low grade adverse events could have important impacts to trial logistics. Due to the high volume of low grade adverse events, reporting all low grade events could delay reporting higher grade and more serious adverse events; and it would require an increase in the effort of clinical trial research staff, which would be difficult if not accompanied by an increase in reimbursement to sites. ·       Dr. Neuman suggests 3 approaches to balance the costs and benefits of collecting low and moderate grade adverse events. First, investigators could consider limiting low-grade adverse event reporting to the experimental arm. The standard of care regimens may not always have low-grade adverse event data available, but this may still be justified when there is extensive clinical experience with the standard of care. However, this approach is only practical when the experimental arm is not blinded. ·       A second approach for moderating the effort in collecting low-grade adverse events is to limit collection to symptomatic adverse events, connecting with Dr. O'Connell's example E1912 dataset. This approach could be addressed by prespecifying types of symptomatic adverse events that would be most impactful during the trial design phase. ·       Dr. Neuman's third suggestion is to plan for a follow-up study after the phase 3 trial to collect low-grade adverse event data and their impact on patients' experiences and treatment discontinuation. This would be beneficial by only requiring low-grade adverse events in an experimental regimen that has successfully passed phase 3. However, a new study would require funding and site enthusiasm, which could prove challenging. ·       Overall, Dr. Neuman emphasizes that investigators should develop trial-specific considerations and engage with the relevant stakeholders during study design. Because of the complexity of adverse events in these patient populations, the best uses of grade 1-2 adverse events will likely continue to develop in the future. In their article, Dr. O'Connell's team studied grade 1 and 2 adverse events as separate predictors, but I would be curious to know how the accumulation and trajectory of these adverse events affect the patient experience. For example, even if the severity does not rise to grade 3, an increasing trend in a patient's adverse event severities could signal the treating physician to modify study dose or to discontinue the treatment. I'm not sure if that type of information was available in their trial E1912, but perhaps that could be a factor to consider for the future. And, of course, it will be important to assess how these grade 1-2 adverse events relate to the patient experience in different studies, especially across different cancer patient populations, acknowledging that this is inherently challenging to study because the data to inform this research is not universally available. As Dr. Neuman indicates, trial-specific goals and expertise will remain critical when considering the data collection for a given trial.  That concludes this episode of JCO Article Insights regarding a summary of the article “The Importance of Low and Moderate Grade Adverse Events on Patients' Treatment Experience and Treatment Discontinuation” by Dr. O'Connell and colleagues and the editorial entitled “Patient Experience, Adverse Event Reporting, and Clinical Trial Design” by Dr. Neuman. This is Subodh Selukar. Thank you for your attention and stay tuned for the next episode of JCO Article Insights.

What to listen for:“Be kind and open and giving, even when they don't know anything, that's okay, still give and still branch out. And that's where those connections happen. And it's magic. And I'm so thankful for all these connections.”Ever wondered how your training methods truly impact your loyal canine? Join our hosts Robin Greubel, Stacy Barnett, and Crystal Wing as they unravel the hidden implications behind various training techniques and their potential dangers. They share their personal experiences, insights, and challenges faced in the canine detection domain and stress the value of consistency in training while cautioning against adopting new training techniques without considering their compatibility with existing methods.From discussing the essence of a clear training progression plan, to emphasizing the need to be mindful of training plateaus, they cover it all. The Dames of Detection underline the importance of a dedicated instructor to guide you through this process and the benefits of venturing out to seminars and experimenting with your dog - all the while being fully conscious of the lessons you impart.Key Topics:“You can't really mess up your dog” It's a Big Statement. Is it True? (01:05)Challenges in Dog Training and Boundaries as a Clinician (07:13)Dog Training Techniques and the Importance of Choosing the Right Instructor (13:32)Dog Training and Frustration Management (18:46)What You Expose Your Puppy to and the Effects (26:41)Doing What Works for Your Dog in Seminars (33:08)Teamwork in Dog Training (38:31)Communication Skills and Being a Positive Influence (47:07)Collaboration and Community in Dog Training (52:45)Resources:Denise FenziDetection Dog EssentialsK9 Detection Collaborative Episode 79: Distraction Camp 2023 DownloadCrystal's FUNtional Obedience Seminar in Kansas (audit spots)The Coffee Bean: A Simple Lesson to Create Positive Change (book)We want to hear from you:Check out the K9 Detection Collaborative FB page and comment on the episode post!K9Sensus Foundation can be found on Facebook and Instagram. We have a Trainer's Group on Facebook!Scentsabilities Nosework is also on Facebook. Here is a Facebook group you should join!Crystal Wing K9 Coach can be found here at CB K9 and here at Evolution Working Dog Club. Also, check out her Functional Obedience Class here.You can follow us for notifications of upcoming episodes, find us at k9detectioncollaborative.com

This episode of the Physiotutors podcast features Julia Treleaven, a researcher and physiotherapist, who discusses cervicogenic dizziness and its diagnosis. We delve into the condition's pathophysiology and prevalence in patients with chronic neck pain. We also discuss red flags to watch for during patient history taking and differentiating cervicogenic dizziness from other forms of dizziness. The episode covers functional tests used to assess balance and motor control and treatment options, including sensory-motor exercises, manual therapy, and posture correction. The discussion emphasizes the importance of focusing on the neck's role in such cases rather than just diagnosing the condition.   Content 00:00 Introduction 01:20 Definition 06:36 Characteristics of Cervicogenic Dizziness 12:08 Physical and Orthopedic Tests for Cervicogenic Dizziness 15:03 Functional Assessment for Cervicogenic Dizziness 18:25 Treatment for Cervicogenic Dizziness 26:10 Progressing Sensory Motor Control Exercises for Cervicogenic Dizziness 29:46 Role of the neck in dizziness 32:08 Research endeavors in neck-related dizziness 34:58 Determining the role of the neck in dizziness and the controversy of cervicogenic dizziness   Bonus Material To view and download the bonus content such as transcripts of this episode become a Physiotutors Member. All episodes and bonus content can be found here   Follow our Podcast on: Spotify | Apple Podcasts  

Dr. MaryAnne Dimak is the Program Director for the Strength and Human Performance programs at Parker University. She also teaches Functional Assessment and Clinical Nutrition within the College of Chiropractic and has been heavily involved in integrating more active care and functional movement principles with students, clinicians and coaches. Before joining Parker in 2018, she and her husband owned and operated Maximum Performance Chiropractic, an active-care-focused practice in Orange County, CA.

Using functional assessment tools in practice is critical to getting objective data. On today's episode, I chat with J-Tech Medical CEO Chris Neil about the importance of functional assessment tools and why you should implement them in your practice.Episode Notes:Learn more about J-Tech Medical by clicking here- https://www.jtechmedical.com/ebcDesigned by a Podiatrist over 30 years ago after seeing similarities in many of the custom devices he was creating, PowerStep offers an affordable, same day solution that combines support and cushioning. Want to try a pair for yourself, click here for a free sample pair. with the code EBCPatient Pilot by The Smart Chiropractor is the fastest, easiest way to grow your practice on autopilot…without spending any money on advertising. Discover more and access our 3X ROI Guarantee here! ChiroMatchMakers specializes in DC and CA hiring. We have over 100 positions available right now with salaries starting at $85K. Discover the available positions today by clicking here. If you're ready to see why ChiroSpring is voted the best solution for chiropractors by chiropractors, go to chirospring.com/offer to schedule a demo! ChiroSpring has a special offer for the Evidence-Based Chiropractor listeners and will send you a $100 Amazon gift card upon completing your demo. So don't wait, book your demo today!Our members use research to GROW their practice. Are you interested in increasing your referrals? Discover the best chiropractic marketing you aren't currently using right here!

Functional assessments are the gold standard of behavior analysis. They're the best technology we have to show the effectiveness and the function of our antecedent and consequence manipulation. Conducting functional assessments in a school setting comes with its own set of unique challenges, and behavior analyst Matt Cicoria is joining us at our next live CEU event to cover just that. The event takes place on Thursday, April 20th at 12:00pm EST. Matt also hosts the Behavioral Observations Podcast, which is linked below. If you're anything like us, you have a hectic schedule. The next thing you know, three years have passed and it's time to get recertified. We wanted to make the CEU process easier by offering all the CEUs you need for recertification as well as presenting our live CEUs once a month. Our website has a new page specifically for events where you can easily sign up and add our events to your calendar. Check out the new page by clicking the link below. What's Inside:Information on our upcoming CEU event with Matt Cicoria.Mentioned In This Episode:HowToABA.com/joinHow to ABA on YouTubeFind us on FacebookFollow us on InstagramHowToABA.com/eventsBehavioral Observations PodcastEP 67: How to Use ABA in Classrooms

At the recent American Society of Clinical Oncology (ASCO) Genitourinary (GU) Cancers Symposium, Dr. Lisa Gudenkauf, an Applied Research Scientist at Moffitt Cancer Center, presented her team's research regarding the Functional Assessment of Cancer Therapy—Radionuclide Therapy (FACT-RNT), a novel patient-reported outcomes (PRO) measure for patients with prostate cancer. In this follow-up interview, Dr. Gudenkauf shares more about how the measure was developed, its importance for capturing the patient experience, and its future implementation into both clinical practice and trials.

​​Dr. Corey Whelan, SLP-BCBA joins me in this episode to discuss a really important assessment for autistic individuals that can add to compassionate care across the lifespan.Practical Function Assessment (PFA) is a process aimed at understanding individuals and the barriers they face in therapy. The goal of PFA is to provide a treatment plan via a skills-based therapy process that will prevent unsafe behavior and help clients reach their optimal learning environment. The first step in PFA is an open-ended interview to learn about the individual and their barriers. The information gathered in the interview is then synthesized into an Interview-Informed Synthesized Contingency Analysis (IISCA) to move forward with the assessment.PFA allows for the safe evaluation of dangerous behavior without the need to witness it. Instead, the focus is on reinforcing non-dangerous, early responses in the chain of behavior, with the ultimate goal of providing a skills-based therapy process to treat problematic behavior. Three critical skills are emphasized in treatment with the PFA: functional communication training, tolerating disappointment when a response is not reinforced, and cooperating with adult-directed instruction during a delay.Behavior Analysts looking for training in PFA can do so through online courses or by seeking mentorship from the center of the company they work with. PFA is ideal for individuals who are making minimal gains in therapy but behavior barriers remain a concern, or for new clients engaging in problem behavior prior to starting therapy.It's important to note that the purpose of PFA is not to understand why a behavior is occurring, but to treat it and prevent it, leading to more effective therapy. By breaking through barriers, individuals can access their optimal learning environment, allowing them to make the most of their therapy sessions.#autism #speectherapyWhat's Inside:What are the PFA and the steps involved?How IISCA influences therapy response.Three critical skills for treatment after PFA.Breaking barriers and providing access to the optimal therapy environment. Mentioned In This Episode:VinfenPractical Functional AssessmentABA Speech: Learn About Current ASHA and ACE CEUs

Tongue ties, also referred to as tethered oral tissues (TOTs) can seem like a complex issue, but what it really comes down to is understanding when functional eating, speaking and sleeping are impaired.  This episode is a review of Merkel-Walsh and Overland's book Functional Assessment and Remediation of TOTs. With the information in this book, SLPs gain a clear understanding of their role in diagnosing and treating clients with TOTs.  Therapists with a background in a muscle-based approach to speech therapy are best equipped to serve clients with TOTs. Here's is a list of training resources the authors suggest: Ages and StagesBeckman and AssociatesChrysalis FeedingInternational Association of Orofacial MyologyNorthern Speech ServicesTalk ToolsThe Academy of Orofacial Myofunctional TherapyThe PROMPT Institute

Resources from the show:1. Functional Assessment of Standardized Items2. Dr. Weaver's article on the Coma Recovery Scale3. Help Dr. Weaver's research by participating in the surveys below if applicable. Are you a rehabilitation practitioner that has evaluated and/or treated individuals with disorders of consciousness following a brain injury? If so, please complete Survey #4.Are you a family member  who has cared for a loved one who was/is unconscious following a brain injury?Please consider completing one of our surveys. You can request to take this survey via Zoom with one of our research assistants.4. OT Graphically Library MembershipFor more information about this episode contact Katie at katie@otgraphically.com or Dr. Jen Weaver at Jen.Weaver@colostate.edu

Emily Sandoz, Evelyn Gould, and Troy Dufrene join us to talk about their paper, Ongoing, Explicit and Direct Functional Assessment is a Necessary Component of ACT as Behavior Analysis: A Response to Tarbox et al.    Show Notes   Remember to join us on Facebook to suggest articles to review and questions for authors. https://www.facebook.com/BApractice Acknowledgments Host and Executive Producer: Cody Morris, Ph.D., BCBA-D, LBA https://salve.edu/users/dr-cody-morris Assistant Producers Elizabeth Narvaez Jesse Perrin Organizational Support ABAI https://www.abainternational.org/welcome.aspx Behavior Analysis in Practice Editor, Stephanie Peterson, Ph.D., BCBA-D, LBA https://www.abainternational.org/journals/bap.aspx Music Cruising Altitude by Jim Carr and his band New Latitude http://www.newlatitudemusic.com Link to Article https://link.springer.com/article/10.1007/s40617-021-00607-2 Links from Talk https://books.google.com/books/about/Mindfulness_for_Two.html?id=zL0wr19xkdEC&source=kp_book_description https://books.google.com/books/about/Applied_Behavior_Analysis_of_Language_an.html?id=6s_ODwAAQBAJ&source=kp_book_description References Fryling, M., Rehfeldt, R. A., Tarbox, J., & Hayes, L. J. (2020) Applied Behavior Analysis of Language and Cognition: Core Concepts and Principles for Practitioners. New Harbinger Publications Sandoz, Emily. (2020). Interbehavior as a clinical focus in CBS: A response to Hayes and Fryling (2019). Journal of Contextual Behavioral Science. 18. 273-275. 10.1016/j.jcbs.2020.10.006. Ming, S., Gould, E., Fiebig, J. (In press). Understanding and Applying Relational Frame Theory: Mastering the Foundations of Complex Language in Our Work and Lives as Behavior Analysts. Oakland, CA: Context Press/New Harbinger Wilson, K. G., & Dufrene, T. (2009). Mindfulness for Two: An Acceptance and Commitment Therapy Approach to Mindfulness in Psychotherapy. New Harbinger Publications

In this episode, accomplished behavior analyst Dr. Keith Storey discusses PBIS and punishment in education. Here is the list of contact information, videos and books if you are interested in checking out some of Dr. Storey's work.Amazon Author Page: www.amazon.com/author/keithstorey Goodreads Author Page: https://www.goodreads.com/author/show/105547.Keith_StoreyAcademia page: https://tu-ca.academia.edu/KeithStoreyResearchgate page: https://www.researchgate.net/profile/Keith_StoreyGoogle Play: https://play.google.com/store/books/author?id=Keith+Storey Instagram: keith.storey.books. Facebook: keith.storey.books.Videos on Instruction, Positive Behavior Supports, Transition, and other topics  at https://www.youtube.com/channel/UCTfL7zEI4D3mPJDbpQF5olw“Systematic Instruction of Functional Skills for Students and Adults with Disabilities” which is available at https://www.ccthomas.com/details.cfm?P_ISBN13=9780398093808“Case Studies for Positive Behavior Supports in Classrooms and Schools” which is available at https://www.ccthomas.com/details.cfm?P_ISBN13=9780398093662“Case Studies for Inclusion in Education:  Strategies and Guidelines for Educating Students with Disabilities in the General Education Environment” which is available at https://www.ccthomas.com/details.cfm?P_ISBN13=9780398093402The second edition of the book “Positive Behavior Supports for Adults with Disabilities in Employment, Community, and Residential Settings: Practical Strategies that Work” which is available at https://www.ccthomas.com/details.cfm?P_ISBN13=9780398092849“Case Studies in Transition and Employment for Students and Adults with Disabilities” which is now available at  https://www.ccthomas.com/details.cfm?P_ISBN13=9780398092412“Case Studies in Applied Behavior Analysis for Students and Adults with Disabilities” which is available at https://www.ccthomas.com/details.cfm?P_ISBN13=9780398091316Ranked as one of the best 30 books on Applied Behavior Analysis at https://www.appliedbehavioranalysisprograms.com/best-books-abaThe 3rd edition of the book “The Road Ahead: Transition to Adult Life for Persons with Disabilities” which is available at https://www.iospress.com/catalog/books/the-road-aheadThe 3rd edition of the book “Functional Assessment and Program Development for Problem Behavior: A Practical Handbook" is available at https://www.cengage.com/c/functional-assessment-and-program-development-3e-o-neill/9781285734828PFThe second edition of the book “Positive Behavior Supports in Classrooms and Schools: Effective and Practical Strategies for Teachers and other Service Providers” available at https://www.ccthomas.com/details.cfm?P_ISBN13=9780398091651&

Why do people lie? It's an age-old question that's been asked for perhaps as long as our species has had verbal capabilities.  In this episode, Dr. Corey Stocco from The University of The Pacific joins me to discuss the existing scholarship in this area, as more specifically, the work that he and his colleagues have done in this area. Specifically, we walk through a recent paper that was published in Behavioral Interventions, Further Evaluation of Contingencies on Lying About Homework Completion.  Regarding this paper, we got way into the weeds in terms of how he recruited participants, the data that they had to leave out for space considerations, what they learned from this work, and where they want to go next in looking into the lying/truth-telling dynamic.  We even talked about how Kevin Luczynski's kid earned reinforcement for peeing on his floor.  As always, Corey closes out the show with some great advice for the newly minted! Lastly, on a housekeeping note, if I sounded more nasally than usual, your ears are working correctly. I was battling a cold during the interview, and I hope it wasn't too distracting for the purposes of this interview.  Bon Iver  Matt Norman's appearance in Session 65 of the BOP Prisoners of Silence film Rollins College speech (see the likely incomplete Editor's note at the bottom of the article) UW Eau Claire Behavior Analysis Undergraduate Program  Pat Friman's Under the Dome article A Behavior Analytic View of Human Development by Hank Schlinger (note: Amazon associates link) Stocco et al. (2021). Further evaluation of contingencies on lying about homework completion.  Resources for Corey's lab (website, IG) Say-Do Correspondence review paper  Parsons (1989). Lying  Victoria Talwar's Google Scholar page  Nurtureshock: New thinking about children (Amazon associates link) Bergstrom et al. (2016). Teaching children with Autism to tell socially appropriate lies  This episode of Behavioral Observations is brought to you by: Behavior Development Solutions (aka “BDS”) is back to sponsor Behavioral Observations! I know BDS, because their modules were part of my own exam prep strategy when I took the BCBA exam back in 2002. Their modules are so thorough, you'll feel confident at the Board Exam and, you'll be well prepared for your career. For BCBA and BCaBA candidates, they report a 98.5% pass rate for first-time exam takers… plus a money-back guarantee! They also have solutions for RBT aspirants, plus CE courses, and live webinars (most of which are free for anyone to attend). To learn more, head over to bds.com/bop for a special offer for podcast listeners!  The University of Cincinnati Online. UC Online designed a Master of Education in Behavior Analysis program that is 100% online and asynchronous, meaning you log on when it works for you. Want to learn more? Go to online.uc.edu and click the “request info” button. Do you need CEUs? Do you want to learn while you're on the go? Check out the podcasts that are available for BACB Continuing Education. Learn about Functional Assessment, Ethics, Supervision, and lots more from your favorite Behavioral Observations guests!

Oh boy, as the kids these days say, this show is a straight up banger. Dr. Jim Moore joins me again in our second installment in the Apollo Case Study Series, where we go deep into all things functional assessment.  Right out of the gate, I want to note that we do spend time reviewing both functional analysis and treatment data of clients that Jim has worked with in the past. We do the best we can to narrate the these data, but you're going to want to go to the show notes of the episode to see what we're talking about in order to get the most out of the discussion.  OK, in this episode, we discuss the following: How much evidence does one need in order to move forward with a behavioral intervention. How to assess the confidence in your functional assessment interview, and get the most out of these interactions with caregivers. How to train staff to be great interviewers. Treatment decisions based on functional assessment outcomes. When to use Isolated vs. Synthesized contingencies. How the staff at Apollo are mentored and supported in these functional assessment and treatment strategies. This list could actually go on and on (including a sidebar about values-based care - a topic I'd like to return to at some point), so I encourage you to listen to the episode all the way through. For example, in the last moments of the show, we discussed how to navigate some of the quasi-tribal verbal behavior that comes with the functional analysis territory. You definitely don't want to miss that.  Here are some links to resources we discussed in this episode: The inaugural Apollo Case Study Series show where Jim discusses scientific problem-solving. Mueller, Sterling, and Moore (2005). Towards Developing a Classroom-Based Functional Analysis Condition to Assess Escape-to-Attention as a Variable Maintaining Problem Behavior. A podcast I did with longtime friend, Dr. Jim Murphy, on Motivational Interviewing.  Forehand and Long book, as well as a podcast I did on those parenting principles with Brandon Franklin. Apollo Behavior's website, as well as their Facebook and LinkedIn pages. House, MD.

In Session 187, Steve Ward joins me to discuss how to help individuals - in particular, individuals with severely limited communicated repertoires - who demonstrate challenging repertoires that are colloquially referred to as Anxiety.  Given that tortured sentence, you can probably already imagine that in this episode, we discuss how Steve conceptualizes what exactly Anxiety is, especially in populations who cannot verbally report on their private verbal behavior. More importantly, we discuss how he developed what he calls the "calm counts" procedure, and review a case study of this intervention that he recently published.  Here are the resources we discussed in this podcast: Using Differential Reinforcement in the Presence of Stressors to Teach Self-Calming (Ward, 2022). Calm Counts data sheet. Video of the technique being implemented. Whole Child Consulting (Steve's website that has tons of resources).  Whole Child Consulting FB Page. Good Learner Repertoires FB Group. Task As Reinforcer paper. Pink Floyd reference. Top Shelf Sports Bar and Grille. Steve's first appearance on BOP, Session 111. Friman, Hayes, and Wilson (1998). Why Behavior Analysts Should Study Emotion: The example of anxiety.  This session is brought to you with support from: Behavior Development Solutions (aka “BDS”) is back to sponsor Behavioral Observations! I know BDS, because their modules were part of my own exam prep strategy when I took the BCBA exam back in 2002. Their modules are so thorough, you'll feel confident at the Board Exam and, you'll be well prepared for your career. It's the premier exam-prep and curriculum supplement for BCBA and BCaBA candidates with a 98.5% pass rate for first-time BCBA exam takers… plus a money-back guarantee! They also have solutions for RBT aspirants, plus CE courses and live webinars (most of which are free for anyone to attend). To learn more, head over to "bds.com forward-slash "B O P"  for a special offer!  The University of Cincinnati Online. UC Online designed a Master of Education in Behavior Analysis program that is 100% online and asynchronous, meaning you log on when it works for you. Want to learn more? Go to online.uc.edu and click the “request info” button. Pick up some CEUs while you listen to Behavioral Observations! Click here to see the various ACE events on topics like Functional Assessment, Trauma-Informed Behavior Analysis, ACT, and much more!

In this episode, we will be learning about an occupational therapy practitioner in oncology. Vanessa Monique Yanez, MSOT, OTR/L is an occupational therapist with a specialization in oncology. She is a cancer survivor and an advocate for rehabilitative services across the continuum of cancer care, from prevention to survivorship. She holds a faculty position at the University of St. Augustine and runs a private practice in San Antonio, TX. Vanessa is a frequent presenter at state and national conferences and is currently pursuing a Ph.D. from Texas Woman's University. She strongly believes that occupational therapy coalesces compassion, research, and a client-centered approach in a unique way that can help cancer survivors not only function but fully participate in a life they deserve. Her clinical and research interests include hematological cancers, stem cell transplants, psychosocial supportive care, sexual functioning, and theory-driven practice in cancer care. Show Key Points:· Vanessa gives us a glimpse of her background and interests· Vanessa describes her Uncommon OT work, the setting, and population she serves· Vanessa describes what drew her to this type of work and her path there· Vanessa describes typical goals sessions · Vanessa dispels some myths about the profession· Vanessa provides other OTPs valuable advice· Vanessa provides her contact information RESOURCES:a) Assessment tools at FACIT.org https://www.facit.org/facit-measures-searchable-libraryb) Functional Assessment of Chronic Illness Therapy - Fatigue Scale (FACIT-F) https://www.facit.org/measures/FACIT-Fatiguec) Functional Assessment of Cancer Therapy - Cognitive Function (FACT-Cog): https://www.facit.org/measures/FACT-Cogd) Psychosocial article by Sleight & Duker (2016): https://research.aota.org/ajot/article-abstract/70/4/7004360030p1/6182/Toward-a-Broader-Role-for-Occupational-Therapy-in?redirectedFrom=fulltexte) Systematic Review of OT and Adult Cancer Rehab (Part I) by Hunter et al. (2017): https://research.aota.org/ajot/article-abstract/71/2/7102100030p1/6304/Systematic-Review-of-Occupational-Therapy-and?redirectedFrom=fulltextf) Systematic Review of OT and Adult Cancer Rehab (Part II) by Hunter et al. (2017): https://research.aota.org/ajot/article-abstract/71/2/7102100040p1/6287/Systematic-Review-of-Occupational-Therapy-and?redirectedFrom=fulltextg) Occupational Therapy Group Intervention in Oncology: A Scoping Review by Udovicich (2020)https://research.aota.org/ajot/article-abstract/74/4/7404205010p1/8439/Occupational-Therapy-Group-Interventions-in?redirectedFrom=fulltexth) NCCN Guidelines: https://www.nccn.org As always, I welcome any feedback & ideas from all of you or if you are interested in being a guest on future episodes, please do not hesitate to contact Patricia Motus at transitionsot@gmail.com or DM via Instagram @transitionsotTHANK YOU for LISTENING, FOLLOWING, DOWNLOADING, RATING, REVIEWING & SHARING “The Uncommon OT Series” Podcast with all your OTP friends and colleagues! Full Episodes and Q & A only available at: https://www.wholistic-transitions.com/the-uncommon-ot-series Sign Up NOW for the Transitions OT Email List to Receive the FREE Updated List of Uncommon OT Practice Settingshttps://www.wholistic-transitions.com/transitionsot Happy Listening Everyone! Big OT Love!All views are mine and guests own.Be a Patron to support The Uncommon OT Series Podcast project via Patreon.

As noted in the first few minutes of this episode, Dr. Florence DiGennaro Reed has been one of the most-requested guests by audience members, and I'm thrilled to have her back on the show for a one-on-one chat.  Dr. DiGennaro Reed, better known as Flo by friends and colleagues, is the Chairperson of the Department of Applied Behavioral Science as well as the Director of The Performance Management Laboratory at the University of Kansas.  In this interview, we chat about her unique early experiences in Behavior Analysis and the fascinating research that she's conducting at KU. We also spent a good chunk of time talking about meetings. I know that may sound boring, but hear me out... we talk about the attributes of bad meetings, and conversely how to run effective meetings. We also talk about how to determine whether that meeting you had really could have bene an email (insert meme here ;-).  We then segued into discussing navigating power differentials in the workplace, having difficult conversations in the workplace, optimizing Behavioral Skills Training sequences, and learning essential professional repertoires for today's BCBAs.  We close the public feed of this interview with some fantastic advice for the newly-minted BCBA (or BCBAs of all experience levels for that matter!) For Patreon subscribers, we spend some additional content time discussing how to present effectively via Zoom or other conferencing platforms.  Resources discussed in this episode: The Performance Management Laboratory. An Introduction to Behavior Analysis (disclosure: Amazon Affiliate Link).  Meeting vs. Email decision chart.  Planning and Leading Effective Meetings (LeBlanc and Nosik, 2019).  Enhancing the training integrity of human service staff using pyramidal behavioral skills training (Erath et al, 2020).  Training human service staff to implement behavioral skills training using a video-based intervention (Erath, DiGennaro Reed, and Blackman, 2021).  Functional Assessment and Intervention for Organizational Behavior Change: Improving the Timeliness of Staff Meetings at a Human Services Organization (Fienup et al, 2013).  Crucial Conversations (disclosure: Amazon Affiliate Link). ACT Bullseye Exercise.  Reddit ABA page. Session 175 is brought to you with support from: HRIC Recruiting. Barb Voss has been placing BCBAs in permanent positions throughout the US for just about a decade, and has been in the business more generally for 30 years. When you work with HRIC, you work directly with Barb, thereby accessing highly personalized service. So if you're about to graduate, you're looking for a change of pace, or you just want to know if the grass really is greener on the other side, head over to HRIColorado.com to schedule a confidential chat right away. Behavior University. (who incidentally is sponsoring the Stone Soup Conference!) Their mission is to provide university quality professional development for the busy Behavior Analyst. Learn about their CEU offerings, including their brand new 8-hour Supervision Course, as well as their RBT offerings over at behavioruniversity.com/observations.

Commentary by Dr. Valentin Fuster

Instruction in Functional Assessment introduces learners to functional assessment (FA), which includes a variety of assessment approaches (indirect, observational, and experimental) for identifying the cause of an individual's challenging behavior for the purpose of designing effective treatments.

ASCO: You're listening to a podcast from Cancer.Net. This cancer information website is produced by the American Society of Clinical Oncology, known as ASCO, the world's leading professional organization for doctors who care for people with cancer. The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement. Cancer research discussed in this podcast is ongoing, so the data described here may change as research progresses. In the Research Round Up series, members of the Cancer.Net Editorial Board discuss the most exciting and practice-changing research in their field and explain what it means for people with cancer. In today's podcast, 4 Cancer.Net Specialty Editors discuss new research in prostate, bladder, kidney, and testicular cancers presented at the 2021 Genitourinary Cancers Symposium, and 2021 ASCO Annual Meeting. This episode has been adapted from the recording of a live Cancer.Net webinar, held June 16th, 2021, and led by Dr. Neeraj Agarwal, Dr. Tian Zhang, Dr. Petros Grivas, and Dr. Timothy Gilligan. Dr. Agarwal directs the Genitourinary Oncology Program at the Huntsman Cancer Institute at the University of Utah. Dr. Grivas is the clinical director of the Genitourinary Cancers Program at University of Washington Medicine. He is also an associate member of the clinical research division at the Fred Hutchinson Cancer Research Center. Dr. Zhang is an associate professor of medicine at Duke University School of Medicine and is a medical oncologist at Duke Cancer Institute. Dr. Gilligan is an Associate Professor and Medical Oncologist at the Cleveland Clinic Taussig Cancer Institute. Full disclosures for Dr. Agarwal, Dr. Grivas, Dr. Zhang, and Dr. Gilligan are available at Cancer.Net. Greg Guthrie: So today, let's introduce our participants. First we have Dr. Neeraj Agarwal of Huntsman Cancer Institute and University of Utah and the Cancer.Net Specialty Editor for Prostate Cancer. Next we have Dr. Petros Grivas from Fred Hutchinson Cancer Research Center and University of Washington. He is the Specialty Editor for Cancer.Net for Bladder Cancer. Next we have Dr. Tian Zhang of Duke Cancer Institute. And she's our Cancer.Net Specialty Editor for Kidney Cancer. And last, we have Dr. Timothy Gilligan. He is with the Cleveland Clinical Taussig Cancer Institute and the Specialty Editor for Testicular Cancer. So to start off, we'll have Dr. Agarwal talking about prostate cancer. Dr. Agarwal: Thank you, Greg. It's such a privilege and honor to be here discussing these studies. So I would like to start with the first study, which was led by Dr. Stephen Freedland, a urologist at the Cedars-Sinai Medical Center in Los Angeles and was co-authored by me, Dr. Dan George, and many others. And here in this study, we present the utilization of therapies, which are associated and known to be associated with very significant, in fact, I would say dramatic improvement in overall survival, as shown by multiple randomized control trials over the period of the last 5 to 6 years. Just to take a step back for the audience, until 2014, standard treatment for metastatic castration-sensitive prostate cancer or newly diagnosed metastatic castration-sensitive prostate cancer used to be androgen deprivation therapy. And combining androgen deprivation therapy with those medications which were approved in the castration-resistant metastatic prostate cancer setting. So basically, using those drugs upfront led to dramatic improvement in overall survival with 33% to 35% reduction in risk of death across those clinical trials. So we actually wanted to look at the real-world utilization, so look at the real-world users of these medications in these patients who are being diagnosed with -- newly diagnosed metastatic prostate cancer in the United States. We also wanted to see how patients who belong to minority populations or racial minority populations, how they are being treated with these medications, which are backed by level 1 evidence. So this was a retrospective analysis of a Medicare database, more than 35,000 patients were included from 2009 to 2018. And we can see here a very representative patient population, predominantly white patients, 11.8% were African American, and 5% were Hispanic. And here are the results. From 2010 to 2014, the use of standard androgen deprivation therapy with bicalutamide, was used in 97% of patients. We did not have trials reporting by that. Let's go to 2015 to 2016. Docetaxel was already approved in this setting now, and we can see some patients received docetaxel, but a small minority of patients received docetaxel. And then let's move to 2018, which is 4 or 5 years after docetaxel data had been presented by Dr. Sweeney in the ASCO plenary session. And abirateron was approved in 2017, and we are still seeing even like almost 2 years after -- we are still seeing the vast majority of patients being treated with standard androgen deprivation therapy or standard deprivation therapy with bicalutamide. So 62% plus 19%, we are talking about almost 80% of patients still not being treated with standard of care treatment, which is androgen deprivation therapy plus docetaxel, or androgen deprivation therapy plus abiraterone at this point of time, and now we have 2 more drugs available, which include enzalutamide and apalutamide in this study. Another interesting thing was if you look at the patients who belong to minority populations, so let's look at African American patients compared to Caucasian patients. The use of intensified therapy was numerically lower. So in Caucasian patients, we are seeing higher use of intensified, as we call them, intensified therapy, or therapies which are considered standard of care, compared to African American men. So overall, the use was lower across the board, but if you look at African American men, the usage was even lower. So this is definitely concerning. I call it alarming, underutilization of life-prolonging therapy in patients who are being diagnosed with newly -- or new diagnosis of metastatic prostate cancer, and we definitely can improve this. We can definitely offer better care to our patients. It is not acceptable in my view to have 30% or less patients receiving standard of care therapies. So with that, I'll go to the next study.  Greg Guthrie: Great, thanks. And this study is, “Health-related quality of life and patient-reported outcomes at final analysis of the TITAN study of apalutamide versus placebo in patients with metastatic castration-sensitive prostate cancer receiving androgen-deprivation therapy.” And you were the presenting author of this, Dr. Agarwal? Dr. Agarwal: Yes, Greg, thank you for giving the opportunity to present this study. And this is basically the continuation of the previous trial. I will not delve into in-depth analysis of these data. I just wanted to show that quality of life is not being impacted adversely by using intensified androgen deprivation therapy, so if you are using these drugs, which improves survival in a very significant fashion, and they are not being used in our patients, as we just saw in the previous study, what could be the reason? Is it the concerns about quality of life or adverse impact on quality of life? If that is the concern, this study, I think, helps refute those concerns. And in this study, which was a large study known as the TITAN trial, which led to approval of apalutamide for patients with hormone-sensitive or castration-sensitive metastatic prostate cancer and showed improved survival and radiographic progression-free and overall survival. We looked at quality of life data as reported by these patients, and these quality-of-life data were assessed by very standardized, validated scales known as FACT-P, or Functional Assessment of Cancer Therapy Prostate scale, or Brief Pain Inventory tool. And there are many other tools. So I will show you the results. And we can see here consistently there was no difference in quality of life as reported by the patients, or I would say any adverse impact on quality of life for these patients in any of these questions. As they were taking these questionnaires. So whether it was physical wellness, emotional wellness, functional well-being, social, or family, we go in and look at fatigue and there was no adverse impact on quality of life. At least from this perspective, we should not be concerned about using these drugs up front in our patients who have newly diagnosed metastatic prostate cancer.  Greg Guthrie: Great. And so what does this mean for patients?  Dr. Agarwal: From patient perspective, we can see here very clearly that using standardized tools, very validated tools, which have been used in multiple trials in the past, patients are not reporting any adverse impact on their quality of life when being treated with intensified androgen deprivation therapy. In this context, apalutamide. Greg Guthrie: Great. Alright. So let's move on to our next study, which is, “Phase 3 study of lutetium-177-PSMA-617 in patients with metastatic castration-resistant prostate cancer.” The VISION trial. Dr. Agarwal: Thank you. In my view, this is 1 of the most important studies presented in the 2021 ASCO Annual Meeting. This study was a phase 3 study where 7,000 patients were recruited, and they had metastatic castration-resistant prostate cancer and had disease progression on a prior novel hormonal therapy such as enzalutamide or abiraterone and the patients had received a taxane chemotherapy. So at least 1 taxane chemotherapy was required before the trial, and the patient had to have disease progression on a novel hormone therapy. These patients were randomized in 2 to 1 fashion to a novel drug, which is a type of radiation, intravenous radiation, as I would explain to my patients, and this is known as beta radiation. And this is a novel radiotherapy where radiation particle, which is delivering beta radiation particle to the cancer cells, is tagged to a molecule, which binds with the prostate cancer cells. So I'm simplifying it for the sake of our patients. And this particle or this compound was added to standard of care therapy and patients were randomized to standard of care therapy versus standard of care therapy plus this new compound. And standard of care therapy was a novel hormonal therapy or anything which did not include chemotherapy or radium 223, which is another type of radiation particle, but a different kind of particle known as alpha particle. So in this study, radiographic progression-free survival and overall survival were primary endpoints. We can see here that the study met both primary endpoints. There was a significant improvement in radiographic progression-free survival with an almost 5 month, 5.4 months, to be precise, improvement in radiographic progression-free survival, with a 60% reduction in risk of disease progression or death. If you look at overall survival, it was also improved in a significant fashion in patients who received the new compound known as lutetium-PSMA-617, and the median survival was improved by 4 months with an approximately 40% reduction in risk of death.  This was a well-tolerated drug overall, and if you look at hybrid side effects, treatment, and emergent side effects, there were 52.7% of patients in the experimental arm, and 38% in the control arm had those treatment-related side effects. So overall, Wwell-tolerated regimen with improved overall survival and radiographic progression. Thank you very much. Greg Guthrie: Thank you, Dr. Agarwal. This is really interesting, and it will be interesting to see if this treatment does change standard of care based on this research. Let's move on to Dr. Grivas and bladder cancer research. Let's see, so Dr. Grivas, your first study is, “Avelumab first-line maintenance for advanced urothelial carcinoma: analysis of clinical and genomic subgroups from the JAVELIN Bladder 100 trial.” And Dr. Grivas was a co-principal investigator in this trial and is senior author of the New England Journal of Medicine publication and co-author of this abstract. Go ahead, Dr. Grivas.  Dr. Grivas: Thank you so much, Greg, and thank you to Cancer.Net for the opportunity, and thanks to the audience. We welcome questions. I would like to update the audience today about the data we saw at the ASCO meeting, and I would like to place this data in context, and I would remind the audience the JAVELIN Bladder 100 trial that changed clinical practice was initially presented last year at the ASCO Virtual Meeting 2020 by Professor Powles. And this particular trial tried to answer the following question: does the immunotherapy, especially the PD-L1 inhibitor avelumab, add value in patients who completed chemotherapy in the first-line setting of metastatic urothelial cancer compared to just best supportive care in terms of longer life, in terms of overall survival, and time until the cancer grows or death, progression-free survival? This is important because until this study came about last year, the practice was, in the setting of spread metastatic urothelial cancer, when the chemotherapy stops, was we cannot give it for a long time because of potential side effects. Usually you used to wait until the cancer grows back, it progresses, or grows. So this trial compared this approach, the best supportive care, versus the immunotherapy with avelumab and the best supportive care. This particular trial, so the significant improvement of life expectancy and overall survival as well as progression-free survival, time until progression of the cancer or death, in the patients that received this immunotherapy drug avelumab as a way to maintain or sustain the benefit that is seen with chemotherapy. So we call this a maintenance therapy approach because we tried to maintain or sustain the benefit with chemotherapy. I want to highlight that this was published in the New England Journal of Medicine and the audience can retrieve that from PubMed if one wants to read the manuscript. The bottom line is this trial changed practice, and we can go now to updates. We saw this in this particular meeting, ASCO 2021, and I think the main question was, are there any particular subsets of patients, different categories of patients, who benefit more from the avelumab maintenance approach, or does this benefit all the patients? And we saw at the ASCO meeting, we saw that the benefit with this immunotherapy appears consistent across the board, across different subcategories of groups of patients. And I think that it's important to point out that we looked at patients who had what we call local disease around the bladder, that was invading this area, and the pelvic side wall that was not amenable to surgical rejection and also patients with spread of the cancer in distant sites, what we call metastasis. And we look at patients who had a primary origin in the bladder or higher up in the urinary tract, what we call kidney pelvis, or ureter, and we call this upper urinary tract, versus the lower tract, which is the bladder, and we also look at patients who had metastatic spread in the lymph nodes only or other parts of the body. And with the bottom line, we saw that the benefit with the immunotherapy was consistent across the different groups of patients. So many patients benefit from this treatment, again, with variable degrees, variable magnitude of benefit, but overall, the bottom line is, take home message is if you have clinical factors or other molecular factors, we do not have a reliable, accurate tool to select which patients should go with avelumab, so we offer it nowadays in every patient who has no contraindication to get immunotherapy and has received some disease control. Meaning a response of the cancer or stabilization of the cancer with the chemotherapy phase. So that has real clinical implications, and I encourage the audience to discuss with their oncologist about the optimal roles of immunotherapy with this maintenance setting after chemotherapy when this is controlled with chemotherapy. Just for context here, I want to highlight the options the patients have in clinical practice. And when someone is diagnosed with spread urothelial cancer, they can be offered nowadays avelumab as a maintenance strategy to maintain the benefit of chemotherapy, and the other options include immunotherapy up front, like drugs like pembrolizumab or atezolizumab, and I will come back to that question how to select your treatment in my last slide. And I want to point out these are the options, and obviously clinical trials are always a great option for patients, and they should ask their oncologist about those options. So since I talked about immunotherapy, I want to point out that the ideal chemotherapy is cisplatin-based chemotherapy. Not everybody has enough fitness of the body to tolerate cisplatin. For those patients, we think cisplatin may be too much, we use carboplatin/gemcitabine, and we use avelumab maintenance in that scenario. What about immunotherapy after that? Is there data supporting that use? And the answer is yes. There is some data suggesting that immunotherapy can be an option for some of the patients, and in this particular slide, we update the data from another clinical trial. And I will let Greg, you can read the title of that. Greg Guthrie: Sure, so this study is, “First-line pembrolizumab in cisplatin-ineligible patients with advanced urothelial cancers response and survival results up to 5 years from the KEYNOTE-052 phase 2 study.” Dr. Grivas, you're a co-author on this study. Dr. Grivas: That's right, thank you, Greg. This trial presented longer follow up to see what happened in patients who received the immune checkpoint inhibitor anti-PD called pembrolizumab because they were not fit enough to get cisplatin chemotherapy. Keep in mind this was designed before the previous study I showed you presented the results and included patients who were not fit for cisplatin, but some of them could have been fit for carboplatin. There was no comparison here, everybody received pembrolizumab as a single agent, alone, and in this particular study, we would try to see the degree of shrinkage of the cancer and the overall response rate as well as how long people lived over time. So with longer follow-up, by the way, we published this study in the Lancet Oncology years ago, and we have longer follow-up, and what you see here is a degree of shrinkage of the cancer, what we call overall response rate, was about 29% in what we call all comers, and it was higher size of tumor shrinkage in patients with high PD-L1 expression. PD-L1 is this brake of the immune system, the checkpoint of the immune system and highly expressive measured by particular assay that pembrolizumab works better in those patients. However, some patients even with low PD-L1 measured by this CPS score I put in the slide still might have benefits, so the take-home message here is there is a particular proportion of patients who can benefit from the checkpoint inhibitor pembrolizumab. PD-L1 can be used in that setting to help decide between chemotherapy and immunotherapy. However, we have not compared directly the chemotherapy followed by the available maintenance with immunotherapy up front, so this question is still lingering. However, if the patient has a response shrinkage to pembrolizumab, many of those patients may have a long-lasting response. We tried to figure out with research how can we predict who is going to benefit more from this treatment as a matter of ongoing research. Greg Guthrie: Dr. Grivas, can you really quickly define CPS for our audience? Dr. Grivas: Absolutely. Great question. CPS is a tool we use in the pathology labs to measure the PD-L1 expression. It can be measured by different assessing antibodies, and the pathologists use a score to define if the PD-L1 is high or low. In this particular study, CPS of 10 or higher defines PD-L1 high expression, CPS below 10 defines PD-L1 low expression, and this appears to have some association with a chance of the tumor shrinking with immunotherapy with pembrolizumab. Greg Guthrie: Great. Thanks, Dr. Grivas. So our last study is, “Pembrolizumab versus investigator's choice of paclitaxel, docetaxel, or vinflunine in recurrent, advanced urothelial cancer: 5-year follow-up from the phase 3 KEYNOTE-045 trial.” Dr. Grivas Very quickly, this study compared immunotherapy, pembrolizumab, the anti-PDL1, compared to chemotherapy with paclitaxel, docetaxel, or vinflunine, the latter one is in Europe, after progression of cancer growth on platinum-based chemotherapy. This was published in the New England Journal of Medicine a few years ago, and pembrolizumab prolonged survival, people lived longer compared to the chemotherapy. And this longer follow-up presented by Dr. Bellmunt and colleagues, showed the sustained results with follow-up, this population of patients had already received cisplatin-based chemotherapy and the cancer progressed, growth, despite that chemo, and in those patients, pembrolizumab appears to produce better results compared to this salvage chemotherapy shown in that slide. And this has implications because immunotherapy can be used in those patients after progression on platinum-based chemotherapy. And just to wrap up here the discussion, I just want to give the options to the patients, see if someone has a new urothelial cancer, options include cisplatin/gemcitabine, or if someone is not fit enough for cisplatin, carboplatin/gemcitabine, and both of those scenarios can be followed by avelumab, and those with shrinking or stable disease, patients who have progression on platinum-based chemotherapy can get pembrolizumab and of course other options available. We can go into another podcast, and I encourage the audience to look and discuss with their oncologist about those options, and the take home message, the clinical trials is what got us here, and I recommend clinical trials to be discussed with your oncologist. Thank you so much, and I'll be happy to take questions.  Greg Guthrie: Thanks, Dr. Grivas. So we're going to move on to Dr. Zhang, who is going to talk about kidney cancer. So our first study today is, “Pembrolizumab versus placebo as post-nephrectomy adjuvant therapy for patients with renal cell carcinoma: a randomized, double-blind, phase III KEYNOTE-564 study.” Dr. Zhang: Thanks, Greg. I'm really excited to be here today and thanks, everyone, for joining. KEYNOTE-564 was presented at the ASCO plenary by our colleague Dr. Toni K. Choueiri, and this is a highly anticipated study in the adjuvant space for kidney cancer and enrolled patients with high-risk clear cell kidney cancer who had undergone either nephrectomy or a metastastectomy, removing their few sites of metastatic disease and treating those patients with either pembrolizumab for up to a year or placebo. And the endpoint was disease-free survival, and enough events had occurred by this ASCO for us to see the primary results. So the overall -- the study was positive. For the primary endpoint, disease-free survival improvement was met with a hazard ratio of 0.68 and the estimated disease-free survival rate at 2 years was 77% for patients treated with pembrolizumab versus 68% for patients treated with placebo. The overall survival favored pembrolizumab, but it was not yet statistically significant, and follow-up will be needed. Overall, we see an improvement in disease-free survival delaying time until recurrence for patients treated with pembrolizumab, and this was the first study in this adjuvant space showing checkpoint inhibition has a role in adjuvant treatment of renal cell carcinoma.  Greg Guthrie: Thanks, Dr. Zhang. Our next study is, “Pembrolizumab plus axitinib versus sunitinib as first-line therapy for advanced clear cell renal cell carcinoma: results from 42-month follow-up of KEYNOTE-426.” Dr. Zhang: This study, KEYNOTE-426, we are all very familiar with. Pembrolizumab and axitinib has been used for the last 2 years in the first-line treatment of clear cell metastatic kidney cell cancer, and it's a longer-term follow-up, more events and more understanding of what happens to these patients once they're treated in a longer term, so primary endpoints of course of this phase 3 study were progression-free survival and overall survival. When we're looking at this medium duration of follow-up at 42 months, so about 3 and a half years, pembrolizumab and axitinib improved both median overall survival as well as median progression-free survival. We'd point out that the -- at the 3 and a half year mark, the overall survival rate for patients treated with the combination was about 57.5%. And the progression-free survival rate was about 25%, so about a third of patients had not had progression of disease at 3 and a half years. Which is quite meaningful if they can stay on their first-line treatment for that long. The objective response was 60%, and of note, the complete response rate had been updated to about 10%. So there are some patients that do have delayed complete responses. And no new safety signals were observed. So overall, certainly still provides a lot of evidence to treat with pembrolizumab and axitinib for patients in the front-line setting. Greg Guthrie: Great. And our last study here is, “Health-related quality of life analysis from the phase 3 CLEAR trial of lenvatinib plus pembrolizumab or everolimus versus sunitinib for patients with advanced renal cell carcinoma.” Dr. Zhang: This was the phase III trial in first-line treatment of metastatic clear cell kidney cancer that was reported at GU ASCO in February of 2020, and it was a 3-arm randomization to lenvatinib with everolimus in the standard study, and lenvatinib with pembrolizumab or sunitinib alone, and we saw the efficacy data in February, and here we're seeing the quality of life outcomes, and looking at how patients are doing, patient-reported outcomes on these treatments. And so with multiple quality of life measures, we're seeing improvements in patients that had better disease-related scores of symptoms when treated with lenvatinib and pembrolizumab versus sunitinib. We're seeing pain scores improve and patients having less diarrhea, appetite loss, when we're comparing against sunitinib. Of note, it's hard to specifically tie a particular symptom, if that's improved, because they've had better disease control or if it's more from the treatment side effect itself. So still hard to tease out a causality in these quality of life measures, but overall, improvement in patients' quality of life when treated with lenvatinib and pembrolizumab. And certainly provides some more data for patients receiving this combination. And so I just wanted to highlight our ongoing phase 3 combination trials and first-line metastatic kidney cancer. PIVOT-09 with bempegaldesleukin has completed accrual in the first triplet of COSMIC-313 with ipilimumab, nivolumab and cabozantinib has completed accrual, so the actively enrolling studies currently are PEDIGREE and PROBE. These are studies that are being carried out in the cancer cooperative groups, as well as a triplet belzutifan lenvatinib with pembrolizumab, a study that Merck is running and all 3 very important studies we will continue to learn from and answer some important, clinically relevant sequencing treatment discontinuation, nephrectomy side effect questions. Thanks to everybody. Greg Guthrie: We have 1 more. So, “Clinical activity of durvalumab and savolitinib in MET-driven, metastatic papillary renal cancer.” Dr. Zhang: Dr. Rodriguez from Spain presented this of papillary renal cell carcinoma treated with savolitinib and durvalumab, and specifically looked at the MET-driven subset of 14 patients out of these 42 patients. The efficacy primary end point was objective response rate. And of note, and median progression-free survival for the 42 patients who were all treated, it was 4.9 months and in MET-driven disease, so savolitinib targets MET, so MET-driven disease was 10.5 months and the median overall survival in everyone was 14 months, versus MET-driven was 27 months, and also higher response rates for patients with MET-driven disease. So I think personally, hypothesis generating, we will likely be seeing more trials with durvalumab and savolitinib in MET-driven papillary renal cell carcinoma. Greg Guthrie: Thank you, again, Dr. Zhang. And Dr. Gilligan, we're going to talk about some testicular cancer research now, and the first study is, “Testicular cancer in the cisplatin era: causes of death and mortality rates in a population-based cohort.” Dr. Gilligan: So this study was looking at what happens with testicular cancer patients who are cured of their cancer, are they at risk of dying of other causes? They looked at over 5,000 men treated between 1980 and 2009, so it's important to recognize that some of the treatments given back then are a little different than the way they're given now. And it looked at the risk of death from causes other than testis cancer compared to men without testicular cancer in the general population, and the concerning finding from this study, and it's not the first study to report this, was that the risk of non-testicular cancer death, that is, death from other causes, was increased by about 28% in men who had been treated with radiation therapy and about 23% in men treated with chemotherapy. There's a risk of non-testicular cancer death, the risk, excuse me, was doubled in those whose treatment included both. So it was higher with either radiation or chemo and it was actually 100% higher or double than both those who had chemotherapy and radiation. As you got more chemotherapy, the risk went up. There was no trend towards the increase with just 1 or 2 cycles. We started to see the increase with 3 cycles, and it became statistically significant with 4 cycles. But there wasn't much difference between 3 and 4 in terms of the absolute number that was seen. In terms of death from other cancers, so why is this happening? Other cancers are a major issue after chemotherapy or radiation. Again, the risk was increased 60% after radiation therapy and 43% after chemotherapy, and those who got both, the risk of cancer was 3 times higher than the general population. So that's in men who had chemotherapy plus radiation therapy. Fortunately, there are not a lot of men who get both of those treatments anymore. Non-cancer deaths increased 17% after chemo and 55% of treatment included both. So the risk for non-cancer deaths was not as high as the risk for death from secondary malignancies. Interestingly, the risk of suicide increased 63% in men treated with chemotherapy. That's not affecting as many men as those other numbers, even though 63% number looks high, but it is a concern. Those treated only with surgery did not have an increased risk of non-testicular cancer death. What does this mean for patients? It really means when we can use surgical treatments instead of chemotherapy or radiation as an additional incentive to try do that, and what that may mean is there should be a larger role for retroperitoneal lymph node dissection as an alternative to chemotherapy or radiation therapy. Secondly, for patients getting chemotherapy, it's important to minimize the number of cycles of chemo as long as we're not sacrificing long-term cure rates, because the biggest risk of death is dying from the cancer, but that means limiting to the 3 cycles instead of 4 cycles is probably a good idea, and I think it's an argument to use 3 cycles of BPE instead of 4 cycles of EP because it's really the etoposide and the cisplatin that is linked to the secondary cancer risk, not the bleomycin, as far as we know. And then lastly, we need to pay attention to the mental health needs of men treated with chemotherapy. That there is more emotional distress and we're seeing here a higher risk of suicide.  Greg Guthrie: So our second trial is the, “SEMS trial: result of a prospective multi-institutional phase 2 clinical trial of surgery in early metastatic seminoma.” Dr. Gilligan: So if we're going to use more retroperitoneal dissection and less chemotherapy or radiation, 1 place to do that is in stage 1 and stage 2 seminoma, and many centers around the country have started doing that, and this was a trial that looked at that approach. So these are men who normally would be treated with chemotherapy, 3 cycles of BEP, or radiation therapy to the back of the abdomen and part of the pelvis potentially. This study looked at the small number of patients, 55 men, low volume, stage 2 seminoma up to 3 centimeters of size and maximum dimension. And what they reported of those men undergoing retroperitoneal lymph node dissection, 10 relapsed, so 18% relapsed after median follow-up of 24 months, they were all alive at the end of the study. No deaths. 8 of 10 relapses were treated with chemotherapy, and 2 were treated with additional [surgery]. Out of the 55 men, 8 ended up getting chemotherapy. Normally, all of them would have gotten either chemo or radiation. Relapse-free survival was 87%, overall survival was 100%. Seven (7) patients developed complications after RPLND and 5 of them were mild. Two (2) were more severe. So it's a well-tolerated treatment, if it's done at a large volume center, it's worth noting that the centers participating in the study were large volume centers. Again, if not treated with RPLND, all of these men would have gotten chemo or radiation. The relapse rate after chemotherapy or radiation is about 5%. So the relapse risk is higher after surgery, but in the sense, if we take 100 men with early stage 2 seminoma and do an RPLND instead of chemo or radiation, we can spare 80% of them the long-term effects of chemotherapy or radiation. Alternatively, if the priority is simply to prevent a relapse, radiation therapy and chemotherapy are more effective at that, the relapse risk being 5% but at the cost of long-term side effects from chemotherapy or radiation. Bottom line there is an additional treatment option for low volume stage 2 seminoma for men who prioritize avoiding the complications of chemotherapy or radiation therapy. Both of which are associated with an increased risk of death from other causes. The price we pay for that is the relapse risk is higher with RPLND compared to the other approaches. Not all centers are going to be offering this, but major centers that do a lot of testicular cancer, this is becoming a new treatment option. With the caveat that we have less experience with this approach. This is a relatively small study. And we have a lot more experience with chemotherapy or radiation. I don't think there's a one size fits all here, but I think patients should talk about it with their doctor. If they have early-stage seminoma, they should talk about surgery as an alternative to radiation or chemo. Greg Guthrie: Here we go. “Surveillance after complete response in patients with metastatic non-seminomatous germ-cell tumor.” Dr. Gilligan: So this study is looking at the question, if you take a man who has retroperitoneal lymph nodes that are enlarged and metastatic non-seminomatous testis cancer with lymphadenopathy in the back of the abdomen and you put them through chemotherapy and at the end, all retroperitoneal nodes are now within normal limits, normal size nodes, and no bigger than 10 millimeters or 1 centimeter, do we need to do a retroperitoneal lymph node dissection on those patients? Some centers recommend it and some don't. This looked at 388 men in that situation. They were put on surveillance. These men did not undergo the post-chemo RPLND. Two years survival, overall survival was 97.8%. Two-year progression-free survival was at 90%, 34 patients relapsed, and 10 of the men died. Men who did relapse had surgery, chemotherapy, or both as subsequent treatment. There's a prior similar study that was multicenter that had longer follow-up of 5 years, and they reported of ;161 men who had a complete response to the first-line chemo, 10 relapsed (that's 6%) and none died. If we combine these 2 studies together, the bottom line is you would have to perform a post-chemotherapy retroperitoneal dissection, which is a big operation, on about 550 men to prevent potentially at most 44 relapses and 10 deaths. We don't know if we would prevent or how many of those relapses and deaths we would prevent. But there's a lot of operations with a relatively low yield. In the future, we hope to have blood tests that will tell us which men need surgery. And even right now, we're close to the point that we have blood tests that will detect residual cancer. And the chance is we worry about residual cancer in these patients and we don't have the blood test to pick it up. But the bottom line is in the meantime, the preferred management strategy is surveillance rather than surgery for most men. There's some men for whom RPLND may make sense in the center in this setting and some centers that will probably continue to recommend it for most men. I think this data really casts doubt on whether we ought to be doing this operation in these men as a routine practice as opposed to an exceptional practice for men who have particular characteristics. Thank you. Greg Guthrie: Thank you, Dr. Gilligan. And now we can move on to answering some questions. What is the average time expected to see a decline in PSA in patients treated with lutetium-177 PSMA? Dr. Agarwal: I think this a great question and I think we're waiting for the manuscript published to go through the nuances of those data. Right now, what Dr. Michael Morris from Memorial Sloane-Kettering presented were the high-level data on pre-survival and overall survival and some secondary endpoints. We are anxiously waiting the full data in the form of a manuscript. And until then, I will not be able to answer that question. I would like to add that usually the median time, if you look at how -- for how long patients were receiving lutetium, it was 5 to 6 months. If I -- if my recollection is correct. Greg Guthrie: Is radiation required prior to initiating chemo if there's tumor presence? And Dr. Gilligan, you responded. “We rarely use radiation therapy for testicular cancer at this time. Sometimes it is used for stage 1 or stage 2 seminoma as primary treatment instead of chemotherapy.” And I'll just read these aloud for our viewers here. If a patient has both prostate and bladder cancer, how do you decide which therapy should take priority, also, is the CPS typically included on the biopsy report? And Dr. Grivas, you responded, which I'll read here. “This is a bit of a complicated scenario that requires detailed discussion with a urologist and medical oncologist. Regarding CPS, the possible role is only in the first-line setting of metastatic disease to help somewhat decide between chemotherapy followed by avelumab maintenance and immunotherapy. However, it's not a perfect biomarker and not part of the pathology report, it's a special test that requires specific ordering.” I have a question for you, Dr. Zhang. Why do combination treatments seem to work better in kidney cancer? Wouldn't you have more side effects because you're taking 2 drugs at the same time? Dr. Zhang: It's an interesting question. You know, our immunotherapy backbones seem to have good treatment benefit for these immune responsive diseases. The VEGF inhibitors that blocked blood vessel formation for many of our patients with clear cell kidney cancer, they tend to have an immunomodulatory role, so if we normalize blood vessels in the tumor microenvironment, the thought is that the T cells and immune cells can actually get into that space more readily. And so many of these blood vessel blockers are hypothesized to have increased immunomodulatory times of behaviors and the combination actually can be more effective than either agent alone, and we've certainly seen that in practice and really excited to see these combination strategies thrive and be standard of care for our patients now and first-line treatment. For the side effect question, you know, I do think that sometimes we do have to tease out which of the side effects is related to the oral treatment, the blood vessel blocker versus the immune therapy. But it's often experienced oncologists who are able to manage these side effects. We can try to tailor and see which of the side effects is due to which treatment and how to reduce or hold treatments when necessary. Greg Guthrie: Great. I just got a follow-up question for you, Dr. Zhang. Are there any studies for papillary type kidney cancer with sarcoma? Dr. Zhang: I would assume you're asking about sarcomatoid renal cell carcinoma within papillary, so for papillary type of kidney cancers, there are ongoing studies. For example, with FH mutations and FMH loss. For sarcomatoid disease, this is a special type of histology that can occur with any of our actual histologies of kidney cancer. And we know from our phase 3 trials in clear cell sarcomatoid renal cells that these tend to respond to the immunotherapy combinations. And so I would urge using an immune therapy combination in patients who had sarcomatoid renal cell carcinoma. Greg Guthrie: Dr. Agarwal, here is a question for you. There were several studies in here that showed many patients did not receive combination ADT with other novel therapies, which you describe as the standard of care, including the one you discussed. Is this something that patients should proactively bring up with their doctors? Dr. Agarwal: Fantastic question. I'm so glad you asked. The answer is yes: It is our responsibility as physicians and providers, but it doesn't hurt if our patients are educated and challenge us in our decision-making. It is a shared decision-making, it is not the doctor's decision. In my view, it's the patient's decision with help from the doctors. So, yes, please go do it. Doctors usually welcome that. Greg Guthrie: Great. Dr. Grivas: I see one for Dr. Gilligan about surveillance imaging that just popped up. [Is there any data on the benefits vs. risks for imaging based surveillance (CT, MRI, none) for longer-term follow-up periods (e.g. 2+ years)?] Dr. Gilligan: Yeah, they're asking whether there's data on benefit versus risk for imaging-based surveillance and it's actually a very timely question in the sense that we're starting to get data that MRI is very accurate for this. And may likely become a substitute for CT scans at some point in the future. This is something we talk about a lot in terms of surveillance for testicular cancer patients, can we switch to MRI from CT because CT has ionization that can cause other cancers, and MRI does not. The good news is it looks like with current CT scanning, which is lower dose than older CT scanning, the risk of cancer from the CT scan seems really miniscule. Ultimately, it would be great to get it down to 0 and not do them, but we're still doing them. The switch to MRI is being held up by the fact that when you go in and get an imaging study for surveillance, your scans get looked at by a radiologist and also by the oncologist and all of us who do a lot of testicular cancer have multiple stories of catching stuff that the radiologist missed, and they also catch stuff that we miss. It goes both directions, and we're having 2 different people read the films to get a more accurate read. With MRI, most oncologists are not competent to read an MRI well and some radiologists are not great, and the centers where they have excellence have shown that MRIs are just as good as CT scans if read by fully qualified people. And the concern is: are they going to be skillfully read? So the switch to MRI will happen in the future, and I have spoken with people very recently about this that are practicing around the country and the people I talked to were not ready to make the switch because of the concern that stuff might get missed. And I think we can be reassured with the modern lower-dose CT scans, the risk seems to be quite small, and I look forward in the future to making that switch at some point.  Greg Guthrie: And I think that's going to be our last question this afternoon. Thank you to all our participants for sharing this great research with us, as well as your expertise, it's been a real pleasure on this live webinar here. ASCO: Thank you Dr. Agarwal, Dr. Grivas, Dr. Zhang, and Dr. Gilligan.  You can find more research from recent scientific meetings at www.cancer.net. And if this podcast was useful, please take a minute to subscribe, rate, and review the show wherever you listen to podcasts. This Cancer.Net podcast is part of the ASCO Podcast Network. This collection of 9 programs offers insight into the world of cancer care, covering a range of educational, inspirational, and scientific content. You can find all 9 shows, including this one, at podcast.asco.org. Cancer.Net is supported by Conquer Cancer, the ASCO Foundation, which funds breakthrough research for every type of cancer, helping patients everywhere. To help fund Cancer.Net and programs like it, donate at conquer.org/donate. This presentation is provided solely for informational purposes. The ideas and opinions expressed in this presentation do not necessarily reflect the views of the American Society of Clinical Oncology (ASCO) or its affiliates. The mention of any product, service, or therapy in this presentation should not be construed as an endorsement of any product, service, or therapy mentioned. The information herein does not constitute medical or legal advice, and is not intended for use in the diagnosis or treatment of individual conditions or as a substitute for consultation with a licensed medical professional. ASCO assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of the presentation or any errors or omissions. © ASCO 2021, all rights reserved.

Understanding what happens when autistic kids are hitting puberty is greatly under-researched. It may be a roller coaster but it is no quick ride. We scratch the surface talking about all of the challenged that come up, and decide to walk through a path of breaking down each topic to consider the brain, body and social nuances of puberty and sexuality.

This month on Episode 22 of the Discover CircRes podcast, host Cindy St. Hilaire highlights four featured articles from the March 5 and March 19 issues of Circulation Research. This episode also features an in-depth conversation with Norberto Gonzalez-Juarbe and Maryann Platt from the J. Craig Venter Institute to discuss their study, Influenza Causes MLKL-Driven Cardiac Proteome Remodeling During Convalescence.   Article highlights:   Carnicer, et al. BH4 Prevents and Reverses Diabetic LV Dysfunction   Kyryachenko, et al. Regulatory Profiles of Mitral Valve   Mangner, et al. Heart Failure Associated Diaphragm Dysfunction   Peper, et al. Identification of McT1 as Caveolin3 Interactor       Dr Cindy St. Hilaire:        Hi, and welcome to Discover CircRes: the podcast of the American Heart Association's Journal, Circulation Research. I'm your host, Dr Cindy St Hilaire, from the Vascular Medicine Institute at the University of Pittsburgh. Today I will be highlighting four articles selected from our March 5th and March 19th issues of Circ Res. After the highlights Drs Norberto Gonzalez-Juarbe and Maryann Platt from the J. Craig Venter Institute are here to discuss their study, Influenza Causes MLKL-Driven Cardiac Proteome Remodeling During Convalescence Dr Cindy St. Hilaire:        The first article I want to share is titled, BH4 Increases nNOS Activity and Preserves Left Ventricular Function in Diabetes. The first author is Ricardo Carnicer, who is also corresponding author alongside Barbara Casadei and they're from University of Oxford in the UK. Cardiomyopathy and heart failure are common complications of diabetes, but the molecular pathology underlying this cardiac dysfunction is not entirely clear. Increased oxidative stress and reduced functioning of both mitochondria and nitric oxide synthase or nNOS have been implicated in diabetic cardiomyopathy. Tetrahydrobiopterin or BH4 is a co-factor necessary for nNOS activity. Dr Cindy St. Hilaire:        And in diabetic patients and animals oxidation of BH4 inactivates nNOS and induces vascular endothelial pathology. But, what happens in the cardiac tissue itself? This group shows that although boosting BH4 levels by genetic or pharmacological means prevented or reversed heart dysfunction in diabetic mice, the status of BH4 oxidation and nNOS function in the heart tissue of diabetic patients and mice, did not actually differ significantly from that of healthy controls. Instead through molecular analysis, they revealed that in diabetic mouse cardiomyocytes boosting BH4 promoted a nNOS dependent increase in glucose uptake, which then preserved the cell’s mitochondrial function. Regardless of the pathways involved, the fact that BH4 reversed diabetic associated cardiac dysfunction in mice suggests the potential for therapies that could be used to lower the risks of such complications in humans as well. Dr Cindy St. Hilaire:        The second article I want to share is titled, Chromatin Accessibility of Human Mitral Valves and Functional Assessment of MVP Risk Loci. The first authors are Sergiy Kyryachenko, Adrien Georges, and Mengyao Yu, and the corresponding author is Nabila Bouatia-Naji from Paris Cardiovascular Research Institute in France. The mitral valve opens and closes to direct a one-way flow of blood from the left atrium to the ventricle. If the mitral valve fails, as in the case of mitral valve prolapse or MVP, blood regurgitation, cardiac arrhythmia, and ultimately heart failure can occur. Dr Cindy St. Hilaire:        With 11 valves from MVP patients and 7 control patients, this group used a highly sensitive chromatin profiling technique called ATAC-Seq to identify regions of the genome with increased accessibility, which indicates transcriptional activity. They found that while diseased and healthy valves had similar chromatin profiles, they differed from those of other heart tissues. Valve specific open chromatin regions were enriched in binding sites for NFATC, a transcription factor known to regulate valve formation. And, specifically in MVP tissues, they found two potential causative sequence variants. These MVP-linked variants exhibited enhancer activity in cultured cells. And for one variant, the team identified the gene target of this variant. In providing the first mitral valve cell chromatin profiles and demonstrating their use and functional analysis of MVP-linked variants, this work supplies a valuable research for mitral valve prolapse evological studies. Dr Cindy St. Hilaire:        The third article I want to share is titled, Molecular Mechanisms of Diaphragm Myopathy in Humans with Severe Heart Failure. The first author is Norman Mangner, and the co-senior authors are Axel Linke and Volker Adams from Dresden University of Technology in Germany. The diaphragm is the primary muscle controlling a person's breathing. This muscle can become weakened during heart failure, which exacerbates symptoms and increases the risk of death. The pathological mechanisms underlying the diaphragm's demise are largely unclear. Studies in animals have pointed to increase reactive oxygen species as a contributing factor, but human studies have been limited. This group evaluated the histological and molecular features of human diaphragm biopsies from both heart failure patients and controls. Dr Cindy St. Hilaire:        The diaphragm samples were collected from 18 heart failure patients, who were undergoing implantation of left ventricular assist devices. And 21 control samples were obtained from patients not having heart failure bypass graft surgery. Compared with the controls, the heart failure diaphragms showed significantly reduced thickness, severe muscle fiber atrophy, increased oxidative stress in the form of protein oxidation, increased proteolysis, impaired calcium handling and mitochondrial abnormalities and dysfunction. Pathological measures also correlated with clinical severity. These data are the first insights into the pathology of heart failure related diaphragm weakness, and this work points to the molecular players that could be targeted for novel treatments. Dr Cindy St. Hilaire:        The last article I want to share before our interview is titled, Caveolin3 Stabilizes McT1-Mediated Lactate/Proton Transport in Cardiomyocytes. The first author is Jonas Peper and the corresponding author is Stephan Lehnart from the Heart Research Center, Göttingen in Germany. Caveolae are invaginations of the plasma membrane, and these structures are involved in endocytosis, signal transduction and other important cellular processes. Caveolin is the key protein component of caveolae and isoforms of Caveolin have been implicated in heart conditions. Mice lacking the isoform CAV1 develop heart failure and genome-wide association studies have been linked to human CAV1 variants with cardiac conduction disease and atrial fibrillation. Rare variants of CAV3 are known to cause hypertrophic cardiomyopathy. However, little is known about the normal or pathological actions of Caveolin in heart cells where caveolae are plentiful. To learn more, this group performed mass spectrometry, immunoprecipitation, and other analysis in cardiomyocyte, and uncovered novel CAV associated proteins, some of which turned out to be isoform specific. Dr Cindy St. Hilaire:        CAV1 interacted specifically with aquaporin while CAV3 was associated specifically with the lactate transporting McT1 protein and the iron transporting TFr1 protein. When the team knocked out the function of CAV3 in stem cells derived from human cardiomyocytes, they found that McT1 had reduced surface expression and function, and that the cells exhibited abnormal de-polarizations. Together the results set the stage for future studies of cardiomyocyte CAV biology, including how CAV variants might contribute to disease pathogenesis. Dr Cindy St. Hilaire:        Today I have with me Drs Norberto Gonzalez-Juarbe and Maryann Platt from the J. Craig Venter Institute, and they're here to discuss their study, Influenza Causes MLKL-Driven Cardiac Proteome Remodeling During Convalescence . And this is in our March 5th issue of Circulation Research. So thank you both for being with me today. Dr Maryann Platt:           Great to be here. Dr Norberto Gonzalez-Juarbe:    Thank you. Dr Cindy St. Hilaire:        So I want to start with influenza mediated cardiac complications. So what are these complications? How prevalent are they in people who catch influenza and who's most affected? Dr Norberto Gonzalez-Juarbe:    So for the last hundred years, we have known that every time there's an epidemic or pandemic from influenza, there's adverse cardiac events that come after you get the disease. During the 1918 pandemic, we could see myocardial damage and about 90% of all people that succumb to the infection, and in the latest epidemics that has been about 40% to 50%, suggesting that the more pandemic the strain of influenza is, the more virulent, the more of these adverse cardiac events we are going to see. So it seems that it is attached to severity of disease. The virus can get to the heart easy, the more severe your disease phenotype is, but it seems that some pandemic strains have a better way to get there of causing more damage than the common epidemic strengths. Dr Cindy St. Hilaire:        That was actually one of my other questions, how does it get to the heart? What's happening there? Do we know much about that? I guess, specifically for flu, but I'm sure in the back of everybody's mind, people are also thinking about SARS-CoV2 too. So how does that kind of pathway work or transportation work? Dr Norberto Gonzalez-Juarbe:    Circulation is going to be the main way it gets there for, for example, if we were to look at COVID then in the heart there's the same receptors for the epithelial cells that are in there, the ACE-2 receptor, that's also in the cardiac tissue and COVID-19 can actually infect cardiomyocytes through that receptor. In terms of influenza, it's basically similar. Some of these receptors are present on the epithelium in the lungs, are also present there and flu can actually infect cardiomyocytes. In our study we also look at some other cell types like endothelial cells and fibroblasts, and we show that there's actually some lower grade infection too. But that's why it's all of these, it starts in the severity of disease, that's the more virus is going to be in your bloodstream, the easier it's going to be to get there. And since the same receptors are present in the heart, so it's going to be easy for the virus to affect the cell. Dr Maryann Platt:           It's not necessarily dependent on age or race or anything it's dependent on how sick you are, for sure. Dr Cindy St. Hilaire:        And by sick, does that directly correlate with viral load of the patients or just their response, an overactive response or something like that? Do we know? Dr Norberto Gonzalez-Juarbe:    I think it's a double edged sword, so it's going to be related to viral load, but also the type of immune responses that you're going to be having, it's going to affect the role of the virus in their heart. In our case we studied way after you cleared the proof from the lungs. So most of the studies that have been out there for a while show, when you're really, really sick, what is happening, but that of your compounding because you have all of these immune responses happening, and the virus is doing its thing. But once you clear the virus from the lungs, your, kind of, immune system settles down. And in our study, we show that even if you clear it from the lungs, the virus is still present in the heart. Dr Cindy St. Hilaire:        So one of the mechanisms that you focused on in terms of how influenza was contributing or leading to cardiac complications, is this process called necroptosis? Can you just maybe give us a primer on what that is, and what it's doing specifically in the cardiomyocytes? Dr Maryann Platt:           Sure. So necroptosis, there's a couple of different ways that cells can die, either under normal circumstances, just maintaining the number of cells in your body or in the case of infection, trying to get rid of the infection. So most commonly, cells will undergo apoptosis, which is programmed cell death, not very inflammatory. And then necroptosis is another way that is highly inflammatory and driven by, initiated by, some of the same molecular cascades, but then affected by a different set of molecules. Dr Cindy St. Hilaire:        Interesting. And so it's really that inflammatory component that is driving pathogenesis in the cardiac tissue then. Dr Maryann Platt:           Yeah. Dr Norberto Gonzalez-Juarbe:    And evolutionarily necroptosis has been shown to help the host against viral infections. Specifically, influenza has proteins that can block apoptosis, which is kind of like the good way of dying. And then the cell has to undergo these other necrotic type of cell death to get rid of viral replication. But while some of these might interact with both pathways, necroptosis effect their molecule. MLKL is the last protein in the pathway. That's the one that actually rupture the cells. So we wanted to prevent that from happening to see if we can actually stimulate something protective by having all of the other good cascade-type molecules still there. Dr Cindy St. Hilaire:        ‘Good’in quotes (laughing). Dr Maryann Platt:           Still dying cells, less bad, not as inflammatory Dr Norberto Gonzalez-Juarbe:    Inflammatory since the heart is this type of organ that any injury will be, more or less, long lasting, and that will have detrimental effects throughout life. Dr Cindy St. Hilaire:        Got it. That's interesting. So can you maybe give us a summary of your experimental design and kind of the groups you were looking at, and a summary of the results? Dr Maryann Platt:           Sure. So we had four different groups of mice, two of them were wild type mice and two were MLKL, all knockout mice, which could not undergo necroptosis. And then each of those genotypes, we had uninfected mice or mice that were infected with flu. And then we monitored long viral titer to see how much infection was there at the lungs. And then after the infections subsided in the lungs, two days after a viral load was undetectable, we sacrificed those animals, collected their hearts. Dr Cindy St. Hilaire:        That's great. So that two day resolution, is that a similar time course with humans, in terms of a pathogenesis of developing cardiac complications? How similar, I mean, mice are never perfect models, but what's good and what's not good about using a mouse as for this model? Dr Norberto Gonzalez-Juarbe:    So, mice are not human right?. So, we are always thinking about that quote, but most of the cardiac events that occurred during these type of infections and similar things have been observed in, for example, pneumococcal infection, which is by streptococcus pneumonia. Most of these adverse cardiac events occur right after you leave the hospital. Those are a specific set of adverse cardiac events that are different from the ones that happen when you are severely infected in the hospital. And these can be arrhythmias and myocardial infarction, and some of these things that can happen up to 10 years after you recover from the pulmonary infection. Dr Norberto Gonzalez-Juarbe:    So our model was designed to see that step of the host trying to retcover. And if there was still something there in the heart, right after you get out of the hospital, that you receive your therapeutics, and you're thinking, 'Oh, I don't have any more flu in my lungs, and I'm recovering', that timeframe right after you get out, you might still have some other things happening in your body, that might determine what happens to your heart. Dr Cindy St. Hilaire:        Interesting. So you may actually be feeling pretty good, but your heart or even possibly other organs are still kind of under the weather, so to speak? Dr Norberto Gonzalez-Juarbe:    Exactly. Dr Maryann Platt:           Exactly. Dr Cindy St. Hilaire:        So in your proteomic analysis, I think you stated it was some, it was just under a hundred proteins were differentially regulated, and a majority were actually in kind of metabolic mitochondrial related pathways. Could you maybe tell us the importance about that? But then also, yes, that was a big chunk of it, but were there any other pathways that were either up or down, that were surprising in your findings? Dr Norberto Gonzalez-Juarbe:    The importance of the major mitochondrial proteins that we found, first that the MLKL knockout, so inhibiting these necrotic cell death actually promoted mitochondrial health. So that first was interesting, because that will suggest that this can be quite therapeutic target in the future. That innovation enhance some proteins that protect the mitochondria and aid in mitochondrial function. And if we think about the heart as our engine, we need energy for an engine to work and mitochondria is that energy resource that we have. And the heart is really relying on these, because if you have a metabolic breakdown in the heart, you get cardiac event. So most of the proteins that were changed upon infection had to do with these specific, important metabolic function of the heart. Some other proteins have to do with cellular signaling mechanisms and calcium homeostasis, all these other things that are important to maintaining homeostasis in the heart thus suggesting that the virus is inducing massive stress in their heart without actively replicating or causing inflammation. Dr Norberto Gonzalez-Juarbe:    And that was very important in our study that we didn’t see these antiviral effects, but at the same time, we saw all of these detrimental metabolic effects. So future studies might be also targeting what viral factors might be actually inducing these metabolic effects in the heart. But we also saw some molecules important for cell death mechanisms that were not necroptosis. Dr Norberto Gonzalez-Juarbe:    Marianne, you can describe some of those. Dr Maryann Platt:           So one third way that cells can die is called pyroptosis. And we actually saw that pyroptosis was also elevated in flu infected mice, in their hearts, suggesting that it might not just be necroptosis. All this inflammation coming from necroptosis is what's driving breakdown of heart function, but also possibly pyroptosis. Dr Cindy St. Hilaire:        The mitochondrial aspect is interesting. In heart failure normally there's the switch from fatty acid oxidation to glycolysis. Does that happen in a shorter or smaller way after flu? And in some patients they just don't recover? Is there a metabolic switch to an infected cardiomyocyte, that is more transient, and then in a subset it turns to permanent? Is that what's happening? Dr Norberto Gonzalez-Juarbe:    Yeah, that is something that we might need to follow up on, since our study was more of a snapshot of that specific time point. It will be good to do follow-up studies where we look at different time points post infection. And even maybe three months after infection, then six months after infection. We have done similar studies with pneumococcal pneumonia, and we have found that cardiac function and metabolic function, it is significantly remodeled, even three months after the pneumonia event. Dr Cindy St. Hilaire:        Interesting. So once it's actually cleared from the lungs, it's still… Dr Norberto Gonzalez-Juarbe:    The heart is still undergoing this injury recovery, which cause scarring process and these leads to reduced cardiac function. Dr Cindy St. Hilaire: So influenza actually, maybe a lot of people know this now, but it was somewhat new to me, I guess, at least a year ago when COVID first started. But influenza like SARS-CoV2 is an enveloped virus. It's a single strand RNA virus. So are these findings specific to this class of viruses, specific to RNA viruses? Or is this something that you think is operative in other types of viruses in terms of causing these cardiac complications? Dr Maryann Platt:           It's certainly possible. I'm not a virologist. (laughs). Dr Cindy St. Hilaire:        Not yet. (laughs). Dr Norberto Gonzalez-Juarbe:    Eventually you'll get there. Dr Maryann Platt:           Yeah, eventually probably. But you know, there have been reports of lots of adverse cardiac events in SARS-CoV too. So it's certainly not just unique to influenza, as far as other types of double stranded RNA viruses. I'm not sure. Dr Norberto Gonzalez-Juarbe:    Yeah, of course Coxsackieviruses viruses have shown inductionof cardiac events. And there's a Review in the New England Journal of Medicine about some of these other pneumonia causing agents, but also all other pathogens that can do some of these events, but it's all clinical observations. So, we think that our study and several others studies that are starting to come out, can induce a shift part of field to look at how some of these major respiratory viruses can induce these adverse cardiac events that we see are highly prevalent, right after the event, like during infection. And importantly, how all the pathogens may synergize. Some pathogens such as RSB, flu, COVID, have synergized with bacteria or other virus one enhancing the ability of the other to cause injury and disease. Dr Norberto Gonzalez-Juarbe:    For example, flu with pneumococcal disease, COVID with assorted grand negative pathogens, and actually influenza also has been shown to cause co-infection. So we don't know how some of these pathogens may synergize in the lungs, but also in other organs, to cause these injury that are going to be long lasting. So we are having the acute problem now with COVID and we had this with the 2009 pandemic flu, but in the next 10 years, five years, we're going to see this equivalent of disease damage, the damage associated with the disease, and we are going to have to explain why people are having these cardiac events, why people are having kidney events or liver damage problem. So we need to better understand not only how RNA viruses do this, and there's actually data shows that COVID is present in the cardiac tissue and can replicate in cardiac cells, but also how they may synergize to potentiate these effects. And how can we prevent all of these from happening? By action, therapies to antivirals, or any other way. Dr Cindy St. Hilaire:        That's a perfect segue to my last question I had. And that is, how can, what you found in the study regarding necroptosis, or even just the base proteins that are involved, is it able to be leveraged either for the development of therapies or perhaps even like a screening method, a biomarker to determine which flu patients might go on to develop cardiac phenotypes? Dr Norberto Gonzalez-Juarbe:    There might be a couple of avenues our study can help create these adjunct therapeutics to anti-virals. So one might be targeting the specific necrotic cell pathways to prevent that titrating that is long-lasting and these can be targeting necroptosis or pyroptosis, and there's FDA approved drugs that we may be able to repurpose to target some of these pathways that have these secondary effects, that can target these pathways. But also the very interesting part for me was that MLKL lesion increased this protein called NNT, which is a major factor of mitochondrial function and ATP production. So if we can improve the ability of the heart function and to protect their mitochondria, then we probably can have more roughly protective response against not only flu, but maybe COVID or other viruses that might also do similar things to the heart. Dr Cindy St. Hilaire:         Or even just other heart failures. That's pretty neat. Dr Norberto Gonzalez-Juarbe:    Exactly. Dr Maryann Platt:           Yeah, exactly. Dr Cindy St. Hilaire:        That's great. Drs Gonzalez-Juarbe and Platt. Thank you so much for joining me today. Congratulations on an excellent study and I'm really looking forward to your future, probably viral related, work. Dr Norberto Gonzalez-Juarbe:    Thank you very much. Dr Maryann Platt:           Thanks. Dr Cindy St. Hilaire:        That's it for our highlights from the March 5th and 19th issues of Circulation Research. Thank you for listening. Please check out the CircRes Facebook page and follow us on Twitter and Instagram with the handle @CircRes and Circ. Thank you to our guests, Drs Norberto Gonzalez-Juarbe and Maryann Platt. The podcast is produced by Rebecca McTavish and Ashara Ratnayaka, edited by Melissa Stoner, and supported by the Editorial Team of Circulation Research. Some of the copy text for the highlighted articles is provided by Ruth Williams. I'm your host, Dr Cindy St. Hilaire and this is Discover CircRes, your on-the-go source for the most exciting discoveries in basic cardiovascular research.  

Glenn Callaghan, PhD is in the house! Gifted with a wicked ability to put "fun" in functional analysis, Glenn guides me through some of the thickest parts of the forest. Expect to see him back to talk specifically about Interpersonal Behavioral Therapy (IBT). On a side note, I'm über grateful to this beautiful man for his counsel and encouragement from the beginning of this project. for consultation: glenn.callaghan@sjsu.edu articles mentioned: Callaghan, G.M., Follette, W.C. Interpersonal Behavior Therapy (IBT), Functional Assessment, and the Value of Principle-Driven Behavioral Case Conceptualizations. Psychol Rec (2020). https://link.springer.com/article/10.1007%2Fs40732-020-00395-1 Callaghan, G. M., & Darrow, S. M. (2015). The role of functional assessment in third wave behavioral interventions: Foundations and future directions for a fourth wave. Current Opinion in Psychology, 2, 60-64. https://d1wqtxts1xzle7.cloudfront.net/43603059/The_role_of_functional_assessment_in_thi20160310-2421-1nypa17.pdf?1457655245=&response-content-disposition=inline%3B+filename%3DThe_role_of_functional_assessment_in_thi.pdf&Expires=1599497800&Signature=JYQfTmF72FdzjNgx1OHGr1dLfk5oXzuX0QACDioA2sHX~L8GS2gGViO-0EQiQYQFC5BPNo9jvE7tjJvCGK4africnJyvARyr7FilO~hqRIubiPGi8t0MdE-ZVE4tep0mk9vKcAxCr~8vndKLcP5JTfy6thw8Gfs1C65iwkO5uw1Nu9fvK3e3HGjLWGGJd5~1Kg78e1Rqp4PvMXA~uQSjkZn-z1rNVHuwr0sfrDbjSQ0NuNgRI7aWNzL3mqLulHKkdU8UEQ6ZS5y47iKEnZ7QOIwCnyPPLkBWDU1y-0V4OhTT64uxGkRfMNfRKvgySutfjDdnB2W2pIZ9zkwUCpgCqw__&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA ( https://d1wqtxts1xzle7.cloudfront.net/43603059/The_role_of_functional_assessment_in_thi20160310-2421-1nypa17.pdf?1457655245=&Expires=1599497800&Key-Pair-Id=APKAJLOHF5GGSLRBV4ZA&Signature=JYQfTmF72FdzjNgx1OHGr1dLfk5oXzuX0QACDioA2sHX~L8GS2gGViO-0EQiQYQFC5BPNo9jvE7tjJvCGK4africnJyvARyr7FilO~hqRIubiPGi8t0MdE-ZVE4tep0mk9vKcAxCr~8vndKLcP5JTfy6thw8Gfs1C65iwkO5uw1Nu9fvK3e3HGjLWGGJd5~1Kg78e1Rqp4PvMXA~uQSjkZn-z1rNVHuwr0sfrDbjSQ0NuNgRI7aWNzL3mqLulHKkdU8UEQ6ZS5y47iKEnZ7QOIwCnyPPLkBWDU1y-0V4OhTT64uxGkRfMNfRKvgySutfjDdnB2W2pIZ9zkwUCpgCqw__&response-content-disposition=inline%3B+filename%3DThe_role_of_functional_assessment_in_thi.pdf ) also, Glenn concurred w/ me afterwards that ABCs of Human Behavior is a great book to start with: https://www.newharbinger.com/abcs-human-behavior

This “king of bitters” (so-called because of its flavor) has been used for centuries in Asia to treat gut and upper respiratory infections, fever, herpes, sore throat, and other chronic and infectious disease conditions. However, modern research is demonstrating Andrographis paniculata’s benefits include aiding with joint conditions such as arthritis. ParActin®: A Potent Form of Andrographis Paniculata for Pain Support & More The medicinal herb Andrographis paniculata has been traditionally used for its powerful anti-inflammatory properties and its ability to boost immune system activity. This “king of bitters” (so-called because of its flavor) has been used for centuries in Asia to treat gut and upper respiratory infections, fever, herpes, sore throat, and other chronic and infectious disease conditions [1]. However, modern research is demonstrating Andrographis paniculata’s benefits include aiding with joint conditions such as arthritis and it may even have anti-cancer benefits. Andrographis Goes by Many Names Andrographis is cultivated in many tropical Asian countries including India, China, Malaysia, Indonesia, and Sri Lanka, as well as in the West Indies, Brazil, parts of Africa, and Central America. Known as “chuan-xin-lian” in China, “kalmegh” in India, “senshinren” in Japan, “hempedu bumi” in Malaysia, “fah talai” in Thailand, and “green chiretta” in the Scandinavian countries, Andrographis is listed in the Indian Pharmacopoeia (a publication that lists standards for all drugs that are manufactured, sold, and consumed in India) and in a couple of dozen Ayurvedic formulas [2]. In traditional Chinese medicine (TCM), Andrographis is believed to rid the body of heat (e.g., fevers) and to dispel toxins [3]. Phytochemistry of Andrographis Paniculata Andrographis leaves are mainly responsible for its biological actions. They contain many bioactive compounds, including diterpene lactones – especially Andrographolide, the main bioactive ingredient that imparts the typical bitter taste. Andrographolide is an antioxidant that has been shown to be responsible for the herb’s anti-viral and anti-bacterial properties. Andrographolide is also reported in scientific literature to reduce blood clot formation, help protect the liver, have anti-cancer properties, and manage inflammation within safe levels [4]. What Is ParActin®? ParActin® is a patented extract of A. Paniculata, standardized to a fixed concentration of Andrographolide and other related compounds including 14-deoxyandrographolides and neoandrographolides [5]. Preliminary research shows that ParActin® promotes a healthy inflammatory response by blocking a powerful chemical known as NF-kappa B, which is known to be a key regulator of the inflammatory response system. As a result, ParActin® helps support a healthy and appropriate inflammatory response by reducing the levels of pro-inflammatory compounds that trigger the familiar pain and redness associated with inflammation. The safety and efficacy of ParActin® has been assessed in more than 30 studies, including laboratory experiments on cultured cells and animal models – and even a human clinical trial. Let’s take a closer look at some of these studies and what they tell us about Andrographis and ParActin®. Inflammation Is Linked to Many Disease Conditions Long-term, chronic inflammation that occurs when the immune system goes into overdrive may lie at the root of many otherwise unrelated diseases, including: asthma inflammatory bowel disease (IBD) rheumatoid arthritis (RA) autoimmune diseases depression cancer Alzheimer’s disease Inflammation – which manifests as swelling, redness, heat, and pain – is a normal response of our immune system and our body’s way of defending us from infections and disease. However, if it’s not managed properly, inflammation can harm the body. Chronic inflammation is the result of an overactive immune system that is constantly turned on – or cannot be turned off – so that it attacks parts of the very body it is supposed to protect. So-called oxygenated chemical species – including free radicals, oxygen ions, and peroxides – are continuously made in our body’s cells in response to UV radiation and as byproducts of ongoing metabolic activity. They are highly reactive and dangerous, because they can attack cellular DNA and proteins, damaging them. When oxygenated chemical species are generated in excess, they can overwhelm cellular defense systems, leading to a condition known as oxidative stress along with high levels of inflammation – which, as we discussed earlier, is known to contribute to the development of many diseases. Andrographolide, the best-known bioactive ingredient in Andrographis, has been shown to directly inactivate free radicals. It also protects mitochondria, blocks pro-oxidant enzymes, and activates other antioxidant enzymes in the body [6]. Andrographis Boosts the Immune System Andrographolide has been shown to enhance the immune system. For example, it boosts production of white blood cells known as lymphocytes, which scavenge and destroy bacteria and other foreign matter. It also triggers the release of signaling proteins known as interferons, along with enhancing activity of the lymphatic system [7]. Interferons are made and released by our body’s cells when they get infected with viruses, causing nearby cells to strengthen their anti-viral defenses. Interferons are potent antiviral agents that stop viruses from multiplying. The lymphatic system is another circulatory system in our body that carries a fluid known as lymph, which removes the waste products of cellular metabolism. The lymphatic system also transports invading bacteria and viruses to lymph nodes where the white blood cells (lymphocytes) destroy them. Andrographis has been shown to trigger our immune system in two ways: Antigen-specific response – specific proteins known as antibodies are made to counteract invading bacteria and viruses. Nonspecific immune response – immune cells known as macrophages are produced, which scavenge and destroy invaders. Andrographis activates both responses, meaning it is very effective against a variety of infectious and cancer-causing agents [8]. Benefits for Upper Respiratory Tract Infections & Cough Andrographis has been used for many hundreds of years in traditional medicinal systems to treat upper respiratory infections. Modern research supports this. For example, a 2004 meta-analysis of the results of seven double-blind, controlled trials (with a total of 896 participants) showed that Andrographis offers significant relief from the symptoms of upper respiratory tract infections and may even prevent them from taking hold in the first place. [Note: A meta-analysis is a quantitative epidemiological study used to systematically assess the results of previous research – typically randomized, controlled clinical trials – to derive overall conclusions about that body of research.] All the participants in these seven clinical trials reported reduced fever, runny nose, cough, and sore throat on taking Andrographis relative to control patients. Side effects were described as “generally mild and infrequent” [9]. Similarly, another meta-analysis published in 2015 reviewed six randomized controlled clinical trials, which assessed the effects of Andrographis in the treatment of cough. Combined, these six studies compared 333 patients who took various Andrographis preparations relative to 348 patients in control groups. All of these studies showed that Andrographis preparations reduced cough severity [10]. Andrographis Heals the Gut As mentioned above, Andrographis has long been used in traditional medicinal systems such as Ayurveda and traditional Chinese medicine (TCM) for treating gut infections. In a 2013 study published in the American Journal of Gastroenterology, 224 patients with mild to moderate ulcerative colitis were either given 1200 or 1800 milligrams of Andrographis for 8 weeks. Ulcerative colitis is an inflammatory bowel disease that causes long-lasting inflammation and ulcers in the gut, affecting the innermost lining of the large intestine (colon) and rectum. A colonoscopy was performed before the study started and after it ended. Stool frequency and the presence of blood in the stool were also assessed every two weeks. At the end of the study, 60% of patients who received 1800 mg of Andrographis – relative to 40% of patients in the control group – showed clinical symptoms of healing. Not only that, 50% of the patients who received the 1800 mg of Andrographis also showed mucosal healing, relative to 33% in the control group [11]. Andrographis & Joint Pain from Arthritis Arthritis affects more than 70 million Americans, leading to inflammation, pain, and stiffness in the joints and connective tissues. Over time, cartilage breaks down, bones erode, and joints become misshapen [12]. Our modern understanding is that rheumatoid arthritis (RA) happens because of the uncontrolled inflammation that is typical of an autoimmune disease. In such situations, the body’s defense mechanism malfunctions and attacks its own tissues (e.g., healthy joints) for a prolonged period of time. An immune-signaling protein known as cachexin or tumor necrosis factor-alpha is one of the key drivers of inflammation. Andrographolide has been shown to lower levels of cachexin. ParActin® and Mild Knee Osteoarthritis In a randomized, double-blind, placebo-controlled study the efficacy of ParActin® (300 and 600 mg daily) was assessed on pain reduction in 103 patients with mild to moderate knee osteoarthritis [13]. Patients treated with ParActin® showed a significant reduction in pain relative to the control group. Stiffness, physical function, and fatigue all showed a significant improvement with ParActin® treatment. At the end of the study, quality of life and Functional Assessment of Chronic Illness Therapy (FACIT) scores were significantly better in the ParActin®-treated groups compared to the control group. ParActin® and Rheumatoid Arthritis Similarly, in a randomized, double-blind and placebo-controlled study published in the journal Clinical Rheumatology in 2009, 60 individuals with compromised joints were given 100 mg of ParActin® or placebo in conjunction with methotrexate, three times a day for 14 weeks [14]. Methotrexate is proven to improve RA symptoms, but long-term use can cause serious infection and liver damage. In this study, ParActin® was effective in reducing the number and total grade of swollen joints, the number and total grade of tender joints, as well as improving scores on HAQ-52 (52-week Health Assessment Questionnaire), and SF-36 (36-item short form survey) health questionnaires. ParActin® treatment was associated with a reduction of various proteins, including enzymes, associated with cartilage damage. Currently, a human clinical trial testing the safety and efficacy of ParActin® in patients with mild to moderate osteoarthritis is ongoing. In other laboratory experiments, ParActin® and Andrographolide have also been shown to support bone [15]12, cartilage [16]13, and muscle [17]14 health and recovery. Can Andrographis Help Fight Cancer? Cancer results when our body’s cells grow uncontrollably. When cells develop normally, they become more and more specialized in their function at each stage of development. For example, immature pancreatic cells that will eventually go on to make insulin will develop the cellular machinery to do so as they become mature pancreatic cells. When cancer happens, it interferes with normal cellular development and cells do not mature. In fact, cancer cells resemble immature body cells – and the more they resemble immature cells, the more likely it is that they will spread to other locations – known as metastasis, often with fatal consequences. So, it logically follows that if cancer cells can be made to forcibly undergo maturation or differentiation, they will lose the ability to grow uncontrollably. Indeed, in one laboratory study in mice, researchers showed that Andrographis could induce differentiation in leukemia cells [18]. [Note: Leukemia is a cancer of the white blood cells, which are part of the immune system.] Andrographis can induce differentiation in laboratory conditions – but does this mean it can fight cancer? Indeed, it can – at least under laboratory conditions. A systematic review of no less than 139 pre-clinical and clinical studies shows that Andrographolide has anticancer effects on almost all types of cell lines in laboratory experiments [19]. Specifically, a 2019 study showed that Andrographolide prevented human colon cancer cells in culture from multiplying by inducing a process known as “programmed cell death” or apoptosis. Further, Andrographolide also displayed a combinatorial effect with chemotherapeutic anticancer drugs in these cells under laboratory conditions [20]. Similarly, the results of a 2019 study showed that a hot water extract of Andrographis could stimulate the production of specific components of the immune system and restore others to a more normal state. Furthermore, the Andrographis extract prevented tumor growth and metastasis in these mice, once again by inducing apoptosis, but without causing severe body weight loss as many anticancer chemotherapy drugs tend to do. Blood tests detected multiple bioactive Andrographis-derived diterpene compounds, suggesting that more than one might have contributed towards the beneficial effects seen in this study [21]. Andrographis extracts – especially bioactive lactone and diterpene compounds such as Andrographolide in them – have been shown to be very potent in suppressing the growth of various types of cancer cells in laboratory studies. In particular, Andrographolide has been shown to block the growth of human breast, prostate, and hepatoma tumors. It has even successfully been used in cancer chemotherapy [22]. Can Andrographis Help Prevent Alzheimer’s Disease? As a closing note, Andrographis is even showing promise in helping to combat Alzheimer’s disease. In a 2019 study published in the journal Plants – Basel, researchers reported that three compounds isolated from Andrographis may help stop the formation of structures known as beta-amyloid plaques, which underlie neurotoxicity and dementia, including Alzheimer’s disease [23]. As noted by the researchers “Andrographis paniculata and Spilanthes paniculata are used extensively as medicinal herbs for the treatment of various ailments, and are reported to have neuroprotective properties.”   Deeper Dive Resources   Organixx’s Turmeric T3D https://shop.organixx.com/a/secure/checkout/OobbS9ROAoETfnAGmGDF?ch-tn-box=first-box&gl=5d8908c502e26b5f0c38083c   Organixx Save & Subscribe Program https://organixx.com/subscribe-and-save/?gl=5eeaa19c8ebf588562f75d8f [1] Andrographis: In-depth review [2] Andrographolide, a Natural Antioxidant: An Update [3] Andrographis: In-depth review [4] Andrographolide, a Natural Antioxidant: An Update [5] ParActin® [6] Andrographolide, a Natural Antioxidant: An Update [7] Andrographis: In-depth review [8] Immunostimulant agents from Andrographis paniculata. [9] Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy. [10] Herbal Medicine for Cough: A Systematic Review and Meta-Analysis. [11] Andrographis paniculata extract (HMPL-004) for active ulcerative colitis. [12] HP Ingredients: ParActin Joint Health. [13] A double-blind, randomized, placebo-controlled study to assess the efficacy of Andrographis paniculata standardized extract (ParActin®) on pain reduction in subjects with knee osteoarthritis. [14] Efficacy of an Andrographis paniculata composition for the relief of rheumatoid arthritis symptoms: a prospective randomized placebo-controlled trial. [15] Assessment of the Efficacy of ParActin® in Subjects With Mild to Moderate Osteoarthritis (ParActin) [16] ParActin: Healthy Bone Support [17] ParActin: Healthy Cartilage Support [18] ParActin: Muscle Health and Recovery [19] Cell differentiation-inducing diterpenes from Andrographis paniculata Nees. [20] Andrographolide, a diterpene lactone from Andrographis paniculata and its therapeutic promises in cancer. [21] Antiproliferative and Apoptotic Properties of Andrographolide Against Human Colon Cancer DLD1 Cell Line [22] Multiple modulatory activities of Andrographis paniculata on immune responses and xenograft growth in esophageal cancer preclinical models. [23] Andrographolide and analogues in cancer prevention. [24] Multi-Target β-Protease Inhibitors from Andrographis paniculata: In Silico and In Vitro Studies. Study builds scientific support for HP Ingredients’ ParActin for joint health https://www.nutraingredients-usa.com/Article/2019/05/08/Study-builds-scientific-support-for-HP-Ingredients-ParActin-for-joint-health   A double-blind, randomized, placebo-controlled study to assess the efficacy of Andrographis paniculata standardized extract (ParActin®) on pain reduction in subjects with knee osteoarthritis. https://www.ncbi.nlm.nih.gov/pubmed/30968986     Subscribe to Empowering You Organically  Never miss an episode!    APPLE PODCASTS                 SPOTIFY                 GOOGLE PODCASTS      

This “king of bitters” (so-called because of its flavor) has been used for centuries in Asia to treat gut and upper respiratory infections, fever, herpes, sore throat, and other chronic and infectious disease conditions. However, modern research is demonstrating Andrographis paniculata’s benefits include aiding with joint conditions such as arthritis. ParActin®: A Potent Form of Andrographis Paniculata for Pain Support & More The medicinal herb Andrographis paniculata has been traditionally used for its powerful anti-inflammatory properties and its ability to boost immune system activity. This “king of bitters” (so-called because of its flavor) has been used for centuries in Asia to treat gut and upper respiratory infections, fever, herpes, sore throat, and other chronic and infectious disease conditions [1]. However, modern research is demonstrating Andrographis paniculata’s benefits include aiding with joint conditions such as arthritis and it may even have anti-cancer benefits. Andrographis Goes by Many Names Andrographis is cultivated in many tropical Asian countries including India, China, Malaysia, Indonesia, and Sri Lanka, as well as in the West Indies, Brazil, parts of Africa, and Central America. Known as “chuan-xin-lian” in China, “kalmegh” in India, “senshinren” in Japan, “hempedu bumi” in Malaysia, “fah talai” in Thailand, and “green chiretta” in the Scandinavian countries, Andrographis is listed in the Indian Pharmacopoeia (a publication that lists standards for all drugs that are manufactured, sold, and consumed in India) and in a couple of dozen Ayurvedic formulas [2]. In traditional Chinese medicine (TCM), Andrographis is believed to rid the body of heat (e.g., fevers) and to dispel toxins [3]. Phytochemistry of Andrographis Paniculata Andrographis leaves are mainly responsible for its biological actions. They contain many bioactive compounds, including diterpene lactones – especially Andrographolide, the main bioactive ingredient that imparts the typical bitter taste. Andrographolide is an antioxidant that has been shown to be responsible for the herb’s anti-viral and anti-bacterial properties. Andrographolide is also reported in scientific literature to reduce blood clot formation, help protect the liver, have anti-cancer properties, and manage inflammation within safe levels [4]. What Is ParActin®? ParActin® is a patented extract of A. Paniculata, standardized to a fixed concentration of Andrographolide and other related compounds including 14-deoxyandrographolides and neoandrographolides [5]. Preliminary research shows that ParActin® promotes a healthy inflammatory response by blocking a powerful chemical known as NF-kappa B, which is known to be a key regulator of the inflammatory response system. As a result, ParActin® helps support a healthy and appropriate inflammatory response by reducing the levels of pro-inflammatory compounds that trigger the familiar pain and redness associated with inflammation. The safety and efficacy of ParActin® has been assessed in more than 30 studies, including laboratory experiments on cultured cells and animal models – and even a human clinical trial. Let’s take a closer look at some of these studies and what they tell us about Andrographis and ParActin®. Inflammation Is Linked to Many Disease Conditions Long-term, chronic inflammation that occurs when the immune system goes into overdrive may lie at the root of many otherwise unrelated diseases, including: asthma inflammatory bowel disease (IBD) rheumatoid arthritis (RA) autoimmune diseases depression cancer Alzheimer’s disease Inflammation – which manifests as swelling, redness, heat, and pain – is a normal response of our immune system and our body’s way of defending us from infections and disease. However, if it’s not managed properly, inflammation can harm the body. Chronic inflammation is the result of an overactive immune system that is constantly turned on – or cannot be turned off – so that it attacks parts of the very body it is supposed to protect. So-called oxygenated chemical species – including free radicals, oxygen ions, and peroxides – are continuously made in our body’s cells in response to UV radiation and as byproducts of ongoing metabolic activity. They are highly reactive and dangerous, because they can attack cellular DNA and proteins, damaging them. When oxygenated chemical species are generated in excess, they can overwhelm cellular defense systems, leading to a condition known as oxidative stress along with high levels of inflammation – which, as we discussed earlier, is known to contribute to the development of many diseases. Andrographolide, the best-known bioactive ingredient in Andrographis, has been shown to directly inactivate free radicals. It also protects mitochondria, blocks pro-oxidant enzymes, and activates other antioxidant enzymes in the body [6]. Andrographis Boosts the Immune System Andrographolide has been shown to enhance the immune system. For example, it boosts production of white blood cells known as lymphocytes, which scavenge and destroy bacteria and other foreign matter. It also triggers the release of signaling proteins known as interferons, along with enhancing activity of the lymphatic system [7]. Interferons are made and released by our body’s cells when they get infected with viruses, causing nearby cells to strengthen their anti-viral defenses. Interferons are potent antiviral agents that stop viruses from multiplying. The lymphatic system is another circulatory system in our body that carries a fluid known as lymph, which removes the waste products of cellular metabolism. The lymphatic system also transports invading bacteria and viruses to lymph nodes where the white blood cells (lymphocytes) destroy them. Andrographis has been shown to trigger our immune system in two ways: Antigen-specific response – specific proteins known as antibodies are made to counteract invading bacteria and viruses. Nonspecific immune response – immune cells known as macrophages are produced, which scavenge and destroy invaders. Andrographis activates both responses, meaning it is very effective against a variety of infectious and cancer-causing agents [8]. Benefits for Upper Respiratory Tract Infections & Cough Andrographis has been used for many hundreds of years in traditional medicinal systems to treat upper respiratory infections. Modern research supports this. For example, a 2004 meta-analysis of the results of seven double-blind, controlled trials (with a total of 896 participants) showed that Andrographis offers significant relief from the symptoms of upper respiratory tract infections and may even prevent them from taking hold in the first place. [Note: A meta-analysis is a quantitative epidemiological study used to systematically assess the results of previous research – typically randomized, controlled clinical trials – to derive overall conclusions about that body of research.] All the participants in these seven clinical trials reported reduced fever, runny nose, cough, and sore throat on taking Andrographis relative to control patients. Side effects were described as “generally mild and infrequent” [9]. Similarly, another meta-analysis published in 2015 reviewed six randomized controlled clinical trials, which assessed the effects of Andrographis in the treatment of cough. Combined, these six studies compared 333 patients who took various Andrographis preparations relative to 348 patients in control groups. All of these studies showed that Andrographis preparations reduced cough severity [10]. Andrographis Heals the Gut As mentioned above, Andrographis has long been used in traditional medicinal systems such as Ayurveda and traditional Chinese medicine (TCM) for treating gut infections. In a 2013 study published in the American Journal of Gastroenterology, 224 patients with mild to moderate ulcerative colitis were either given 1200 or 1800 milligrams of Andrographis for 8 weeks. Ulcerative colitis is an inflammatory bowel disease that causes long-lasting inflammation and ulcers in the gut, affecting the innermost lining of the large intestine (colon) and rectum. A colonoscopy was performed before the study started and after it ended. Stool frequency and the presence of blood in the stool were also assessed every two weeks. At the end of the study, 60% of patients who received 1800 mg of Andrographis – relative to 40% of patients in the control group – showed clinical symptoms of healing. Not only that, 50% of the patients who received the 1800 mg of Andrographis also showed mucosal healing, relative to 33% in the control group [11]. Andrographis & Joint Pain from Arthritis Arthritis affects more than 70 million Americans, leading to inflammation, pain, and stiffness in the joints and connective tissues. Over time, cartilage breaks down, bones erode, and joints become misshapen [12]. Our modern understanding is that rheumatoid arthritis (RA) happens because of the uncontrolled inflammation that is typical of an autoimmune disease. In such situations, the body’s defense mechanism malfunctions and attacks its own tissues (e.g., healthy joints) for a prolonged period of time. An immune-signaling protein known as cachexin or tumor necrosis factor-alpha is one of the key drivers of inflammation. Andrographolide has been shown to lower levels of cachexin. ParActin® and Mild Knee Osteoarthritis In a randomized, double-blind, placebo-controlled study the efficacy of ParActin® (300 and 600 mg daily) was assessed on pain reduction in 103 patients with mild to moderate knee osteoarthritis [13]. Patients treated with ParActin® showed a significant reduction in pain relative to the control group. Stiffness, physical function, and fatigue all showed a significant improvement with ParActin® treatment. At the end of the study, quality of life and Functional Assessment of Chronic Illness Therapy (FACIT) scores were significantly better in the ParActin®-treated groups compared to the control group. ParActin® and Rheumatoid Arthritis Similarly, in a randomized, double-blind and placebo-controlled study published in the journal Clinical Rheumatology in 2009, 60 individuals with compromised joints were given 100 mg of ParActin® or placebo in conjunction with methotrexate, three times a day for 14 weeks [14]. Methotrexate is proven to improve RA symptoms, but long-term use can cause serious infection and liver damage. In this study, ParActin® was effective in reducing the number and total grade of swollen joints, the number and total grade of tender joints, as well as improving scores on HAQ-52 (52-week Health Assessment Questionnaire), and SF-36 (36-item short form survey) health questionnaires. ParActin® treatment was associated with a reduction of various proteins, including enzymes, associated with cartilage damage. Currently, a human clinical trial testing the safety and efficacy of ParActin® in patients with mild to moderate osteoarthritis is ongoing. In other laboratory experiments, ParActin® and Andrographolide have also been shown to support bone [15]12, cartilage [16]13, and muscle [17]14 health and recovery. Can Andrographis Help Fight Cancer? Cancer results when our body’s cells grow uncontrollably. When cells develop normally, they become more and more specialized in their function at each stage of development. For example, immature pancreatic cells that will eventually go on to make insulin will develop the cellular machinery to do so as they become mature pancreatic cells. When cancer happens, it interferes with normal cellular development and cells do not mature. In fact, cancer cells resemble immature body cells – and the more they resemble immature cells, the more likely it is that they will spread to other locations – known as metastasis, often with fatal consequences. So, it logically follows that if cancer cells can be made to forcibly undergo maturation or differentiation, they will lose the ability to grow uncontrollably. Indeed, in one laboratory study in mice, researchers showed that Andrographis could induce differentiation in leukemia cells [18]. [Note: Leukemia is a cancer of the white blood cells, which are part of the immune system.] Andrographis can induce differentiation in laboratory conditions – but does this mean it can fight cancer? Indeed, it can – at least under laboratory conditions. A systematic review of no less than 139 pre-clinical and clinical studies shows that Andrographolide has anticancer effects on almost all types of cell lines in laboratory experiments [19]. Specifically, a 2019 study showed that Andrographolide prevented human colon cancer cells in culture from multiplying by inducing a process known as “programmed cell death” or apoptosis. Further, Andrographolide also displayed a combinatorial effect with chemotherapeutic anticancer drugs in these cells under laboratory conditions [20]. Similarly, the results of a 2019 study showed that a hot water extract of Andrographis could stimulate the production of specific components of the immune system and restore others to a more normal state. Furthermore, the Andrographis extract prevented tumor growth and metastasis in these mice, once again by inducing apoptosis, but without causing severe body weight loss as many anticancer chemotherapy drugs tend to do. Blood tests detected multiple bioactive Andrographis-derived diterpene compounds, suggesting that more than one might have contributed towards the beneficial effects seen in this study [21]. Andrographis extracts – especially bioactive lactone and diterpene compounds such as Andrographolide in them – have been shown to be very potent in suppressing the growth of various types of cancer cells in laboratory studies. In particular, Andrographolide has been shown to block the growth of human breast, prostate, and hepatoma tumors. It has even successfully been used in cancer chemotherapy [22]. Can Andrographis Help Prevent Alzheimer’s Disease? As a closing note, Andrographis is even showing promise in helping to combat Alzheimer’s disease. In a 2019 study published in the journal Plants – Basel, researchers reported that three compounds isolated from Andrographis may help stop the formation of structures known as beta-amyloid plaques, which underlie neurotoxicity and dementia, including Alzheimer’s disease [23]. As noted by the researchers “Andrographis paniculata and Spilanthes paniculata are used extensively as medicinal herbs for the treatment of various ailments, and are reported to have neuroprotective properties.”   Deeper Dive Resources   Organixx’s Turmeric T3D https://shop.organixx.com/a/secure/checkout/OobbS9ROAoETfnAGmGDF?ch-tn-box=first-box&gl=5d8908c502e26b5f0c38083c   Organixx Save & Subscribe Program https://organixx.com/subscribe-and-save/?gl=5eeaa19c8ebf588562f75d8f [1] Andrographis: In-depth review [2] Andrographolide, a Natural Antioxidant: An Update [3] Andrographis: In-depth review [4] Andrographolide, a Natural Antioxidant: An Update [5] ParActin® [6] Andrographolide, a Natural Antioxidant: An Update [7] Andrographis: In-depth review [8] Immunostimulant agents from Andrographis paniculata. [9] Andrographis paniculata in the treatment of upper respiratory tract infections: a systematic review of safety and efficacy. [10] Herbal Medicine for Cough: A Systematic Review and Meta-Analysis. [11] Andrographis paniculata extract (HMPL-004) for active ulcerative colitis. [12] HP Ingredients: ParActin Joint Health. [13] A double-blind, randomized, placebo-controlled study to assess the efficacy of Andrographis paniculata standardized extract (ParActin®) on pain reduction in subjects with knee osteoarthritis. [14] Efficacy of an Andrographis paniculata composition for the relief of rheumatoid arthritis symptoms: a prospective randomized placebo-controlled trial. [15] Assessment of the Efficacy of ParActin® in Subjects With Mild to Moderate Osteoarthritis (ParActin) [16] ParActin: Healthy Bone Support [17] ParActin: Healthy Cartilage Support [18] ParActin: Muscle Health and Recovery [19] Cell differentiation-inducing diterpenes from Andrographis paniculata Nees. [20] Andrographolide, a diterpene lactone from Andrographis paniculata and its therapeutic promises in cancer. [21] Antiproliferative and Apoptotic Properties of Andrographolide Against Human Colon Cancer DLD1 Cell Line [22] Multiple modulatory activities of Andrographis paniculata on immune responses and xenograft growth in esophageal cancer preclinical models. [23] Andrographolide and analogues in cancer prevention. [24] Multi-Target β-Protease Inhibitors from Andrographis paniculata: In Silico and In Vitro Studies. Study builds scientific support for HP Ingredients’ ParActin for joint health https://www.nutraingredients-usa.com/Article/2019/05/08/Study-builds-scientific-support-for-HP-Ingredients-ParActin-for-joint-health   A double-blind, randomized, placebo-controlled study to assess the efficacy of Andrographis paniculata standardized extract (ParActin®) on pain reduction in subjects with knee osteoarthritis. https://www.ncbi.nlm.nih.gov/pubmed/30968986     Subscribe to Empowering You Organically  Never miss an episode!    APPLE PODCASTS                 SPOTIFY                 GOOGLE PODCASTS      

Are fall prevention programs helping our patients? Should patients receive outpatient PT based on clinical diagnosis? How has the landscape changed because of insurance reimbursement? Show note, Transcript and References: https://www.coreimpodcast.com/2020/08/05/physical-therapi…education-series/ Get CME-MOC credit with ACP: https://www.acponline.org/cme-moc/cme/internal-medicine-podcasts/core-im Time Stamps: 01:47 Functional Assessment 07:47 Documentation 14:35 Outpatient PT 18:14 Durable Medical Equipment 22:55 Reimbursement Tags: Core IM, IM Core, physical therapy, durable medical equipment, IPE, multidisciplinary team, interdisciplinary

In this podcast, Editor-in-Chief Jeanette Hasse, PhD, RD, FADA, CNSC, interviews Mary Russell about her article "Functional Assessment of Nutrition Status" published in the April 2015 issue of NCP. https://doi.org/10.1177/0884533615570094

ParActin®: A Potent Form of Andrographis Paniculata for Pain Support & More The medicinal herb Andrographis paniculata has been traditionally used for its powerful anti-inflammatory properties and its ability to boost immune system activity. This “king of bitters” (so-called because of its flavor) has been used for centuries in Asia to treat gut and upper respiratory infections, fever, herpes, sore throat, and other chronic and infectious disease conditions [1]. However, modern research is demonstrating Andrographis paniculata’s benefits include aiding with joint conditions such as arthritis and it may even have anti-cancer benefits. Andrographis Goes by Many Names Andrographis is cultivated in many tropical Asian countries including India, China, Malaysia, Indonesia, and Sri Lanka, as well as in the West Indies, Brazil, parts of Africa, and Central America. Known as “chuan-xin-lian” in China, “kalmegh” in India, “senshinren” in Japan, “hempedu bumi” in Malaysia, “fah talai” in Thailand, and “green chiretta” in the Scandinavian countries, Andrographis is listed in the Indian Pharmacopoeia (a publication that lists standards for all drugs that are manufactured, sold, and consumed in India) and in a couple of dozen Ayurvedic formulas [2]. In traditional Chinese medicine (TCM), Andrographis is believed to rid the body of heat (e.g., fevers) and to dispel toxins [3]. Phytochemistry of Andrographis Paniculata Andrographis leaves are mainly responsible for its biological actions. They contain many bioactive compounds, including diterpene lactones – especially Andrographolide, the main bioactive ingredient that imparts the typical bitter taste. Andrographolide is an antioxidant that has been shown to be responsible for the herb’s anti-viral and anti-bacterial properties. Andrographolide is also reported in scientific literature to reduce blood clot formation, help protect the liver, have anti-cancer properties, and manage inflammation within safe levels [4]. What Is ParActin®? ParActin® is a patented extract of A. Paniculata, standardized to a fixed concentration of Andrographolide and other related compounds including 14-deoxyandrographolides and neoandrographolides [5]. Preliminary research shows that ParActin® promotes a healthy inflammatory response by blocking a powerful chemical known as NF-kappa B, which is known to be a key regulator of the inflammatory response system. As a result, ParActin® helps support a healthy and appropriate inflammatory response by reducing the levels of pro-inflammatory compounds that trigger the familiar pain and redness associated with inflammation. The safety and efficacy of ParActin® has been assessed in more than 30 studies, including laboratory experiments on cultured cells and animal models – and even a human clinical trial. Let’s take a closer look at some of these studies and what they tell us about Andrographis and ParActin®. Inflammation Is Linked to Many Disease Conditions Long-term, chronic inflammation that occurs when the immune system goes into overdrive may lie at the root of many otherwise unrelated diseases, including: asthma inflammatory bowel disease (IBD) rheumatoid arthritis (RA) autoimmune diseases depression cancer Alzheimer’s disease Inflammation – which manifests as swelling, redness, heat, and pain – is a normal response of our immune system and our body’s way of defending us from infections and disease. However, if it’s not managed properly, inflammation can harm the body. Chronic inflammation is the result of an overactive immune system that is constantly turned on – or cannot be turned off – so that it attacks parts of the very body it is supposed to protect. So-called oxygenated chemical species – including free radicals, oxygen ions, and peroxides – are continuously made in our body’s cells in response to UV radiation and as byproducts of ongoing metabolic activity. They are highly reactive and dangerous, because they can attack cellular DNA and proteins, damaging them. When oxygenated chemical species are generated in excess, they can overwhelm cellular defense systems, leading to a condition known as oxidative stress along with high levels of inflammation – which, as we discussed earlier, is known to contribute to the development of many diseases. Andrographolide, the best-known bioactive ingredient in Andrographis, has been shown to directly inactivate free radicals. It also protects mitochondria, blocks pro-oxidant enzymes, and activates other antioxidant enzymes in the body [6]. Andrographis Boosts the Immune System Andrographolide has been shown to enhance the immune system. For example, it boosts production of white blood cells known as lymphocytes, which scavenge and destroy bacteria and other foreign matter. It also triggers the release of signaling proteins known as interferons, along with enhancing activity of the lymphatic system [7]. Interferons are made and released by our body’s cells when they get infected with viruses, causing nearby cells to strengthen their anti-viral defenses. Interferons are potent antiviral agents that stop viruses from multiplying. The lymphatic system is another circulatory system in our body that carries a fluid known as lymph, which removes the waste products of cellular metabolism. The lymphatic system also transports invading bacteria and viruses to lymph nodes where the white blood cells (lymphocytes) destroy them. Andrographis has been shown to trigger our immune system in two ways: Antigen-specific response – specific proteins known as antibodies are made to counteract invading bacteria and viruses. Nonspecific immune response – immune cells known as macrophages are produced, which scavenge and destroy invaders. Andrographis activates both responses, meaning it is very effective against a variety of infectious and cancer-causing agents [8]. Benefits for Upper Respiratory Tract Infections & Cough Andrographis has been used for many hundreds of years in traditional medicinal systems to treat upper respiratory infections. Modern research supports this. For example, a 2004 meta-analysis of the results of seven double-blind, controlled trials (with a total of 896 participants) showed that Andrographis offers significant relief from the symptoms of upper respiratory tract infections and may even prevent them from taking hold in the first place. [Note: A meta-analysis is a quantitative epidemiological study used to systematically assess the results of previous research – typically randomized, controlled clinical trials – to derive overall conclusions about that body of research.] All the participants in these seven clinical trials reported reduced fever, runny nose, cough, and sore throat on taking Andrographis relative to control patients. Side effects were described as “generally mild and infrequent” [9]. Similarly, another meta-analysis published in 2015 reviewed six randomized controlled clinical trials, which assessed the effects of Andrographis in the treatment of cough. Combined, these six studies compared 333 patients who took various Andrographis preparations relative to 348 patients in control groups. All of these studies showed that Andrographis preparations reduced cough severity [10]. Andrographis Heals the Gut As mentioned above, Andrographis has long been used in traditional medicinal systems such as Ayurveda and traditional Chinese medicine (TCM) for treating gut infections. In a 2013 study published in the American Journal of Gastroenterology, 224 patients with mild to moderate ulcerative colitis were either given 1200 or 1800 milligrams of Andrographis for 8 weeks. Ulcerative colitis is an inflammatory bowel disease that causes long-lasting inflammation and ulcers in the gut, affecting the innermost lining of the large intestine (colon) and rectum. A colonoscopy was performed before the study started and after it ended. Stool frequency and the presence of blood in the stool were also assessed every two weeks. At the end of the study, 60% of patients who received 1800 mg of Andrographis – relative to 40% of patients in the control group – showed clinical symptoms of healing. Not only that, 50% of the patients who received the 1800 mg of Andrographis also showed mucosal healing, relative to 33% in the control group [11]. Andrographis & Joint Pain from Arthritis Arthritis affects more than 70 million Americans, leading to inflammation, pain, and stiffness in the joints and connective tissues. Over time, cartilage breaks down, bones erode, and joints become misshapen [12]. Our modern understanding is that rheumatoid arthritis (RA) happens because of the uncontrolled inflammation that is typical of an autoimmune disease. In such situations, the body’s defense mechanism malfunctions and attacks its own tissues (e.g., healthy joints) for a prolonged period of time. An immune-signaling protein known as cachexin or tumor necrosis factor-alpha is one of the key drivers of inflammation. Andrographolide has been shown to lower levels of cachexin. ParActin® and Mild Knee Osteoarthritis In a randomized, double-blind, placebo-controlled study the efficacy of ParActin® (300 and 600 mg daily) was assessed on pain reduction in 103 patients with mild to moderate knee osteoarthritis [13]. Patients treated with ParActin® showed a significant reduction in pain relative to the control group. Stiffness, physical function, and fatigue all showed a significant improvement with ParActin® treatment. At the end of the study, quality of life and Functional Assessment of Chronic Illness Therapy (FACIT) scores were significantly better in the ParActin®-treated groups compared to the control group. ParActin® and Rheumatoid Arthritis Similarly, in a randomized, double-blind and placebo-controlled study published in the journal Clinical Rheumatology in 2009, 60 individuals with compromised joints were given 100 mg of ParActin® or placebo in conjunction with methotrexate, three times a day for 14 weeks [14]. Methotrexate is proven to improve RA symptoms, but long-term use can cause serious infection and liver damage. In this study, ParActin® was effective in reducing the number and total grade of swollen joints, the number and total grade of tender joints, as well as improving scores on HAQ-52 (52-week Health Assessment Questionnaire), and SF-36 (36-item short form survey) health questionnaires. ParActin® treatment was associated with a reduction of various proteins, including enzymes, associated with cartilage damage. Currently, a human clinical trial testing the safety and efficacy of ParActin® in patients with mild to moderate osteoarthritis is ongoing. In other laboratory experiments, ParActin® and Andrographolide have also been shown to support bone [15]12, cartilage [16]13, and muscle [17]14 health and recovery. Can Andrographis Help Fight Cancer? Cancer results when our body’s cells grow uncontrollably. When cells develop normally, they become more and more specialized in their function at each stage of development. For example, immature pancreatic cells that will eventually go on to make insulin will develop the cellular machinery to do so as they become mature pancreatic cells. When cancer happens, it interferes with normal cellular development and cells do not mature. In fact, cancer cells resemble immature body cells – and the more they resemble immature cells, the more likely it is that they will spread to other locations – known as metastasis, often with fatal consequences. So, it logically follows that if cancer cells can be made to forcibly undergo maturation or differentiation, they will lose the ability to grow uncontrollably. Indeed, in one laboratory study in mice, researchers showed that Andrographis could induce differentiation in leukemia cells [18]. [Note: Leukemia is a cancer of the white blood cells, which are part of the immune system.] Andrographis can induce differentiation in laboratory conditions – but does this mean it can fight cancer? Indeed, it can – at least under laboratory conditions. A systematic review of no less than 139 pre-clinical and clinical studies shows that Andrographolide has anticancer effects on almost all types of cell lines in laboratory experiments [19]. Specifically, a 2019 study showed that Andrographolide prevented human colon cancer cells in culture from multiplying by inducing a process known as “programmed cell death” or apoptosis. Further, Andrographolide also displayed a combinatorial effect with chemotherapeutic anticancer drugs in these cells under laboratory conditions [20]. Similarly, the results of a 2019 study showed that a hot water extract of Andrographis could stimulate the production of specific components of the immune system and restore others to a more normal state. Furthermore, the Andrographis extract prevented tumor growth and metastasis in these mice, once again by inducing apoptosis, but without causing severe body weight loss as many anticancer chemotherapy drugs tend to do. Blood tests detected multiple bioactive Andrographis-derived diterpene compounds, suggesting that more than one might have contributed towards the beneficial effects seen in this study [21]. Andrographis extracts – especially bioactive lactone and diterpene compounds such as Andrographolide in them – have been shown to be very potent in suppressing the growth of various types of cancer cells in laboratory studies. In particular, Andrographolide has been shown to block the growth of human breast, prostate, and hepatoma tumors. It has even successfully been used in cancer chemotherapy [22]. Can Andrographis Help Prevent Alzheimer’s Disease? As a closing note, Andrographis is even showing promise in helping to combat Alzheimer’s disease. In a 2019 study published in the journal Plants – Basel, researchers reported that three compounds isolated from Andrographis may help stop the formation of structures known as beta-amyloid plaques, which underlie neurotoxicity and dementia, including Alzheimer’s disease [23]. As noted by the researchers “Andrographis paniculata and Spilanthes paniculata are used extensively as medicinal herbs for the treatment of various ailments, and are reported to have neuroprotective properties.”

ParActin®: A Potent Form of Andrographis Paniculata for Pain Support & More The medicinal herb Andrographis paniculata has been traditionally used for its powerful anti-inflammatory properties and its ability to boost immune system activity. This “king of bitters” (so-called because of its flavor) has been used for centuries in Asia to treat gut and upper respiratory infections, fever, herpes, sore throat, and other chronic and infectious disease conditions [1]. However, modern research is demonstrating Andrographis paniculata’s benefits include aiding with joint conditions such as arthritis and it may even have anti-cancer benefits. Andrographis Goes by Many Names Andrographis is cultivated in many tropical Asian countries including India, China, Malaysia, Indonesia, and Sri Lanka, as well as in the West Indies, Brazil, parts of Africa, and Central America. Known as “chuan-xin-lian” in China, “kalmegh” in India, “senshinren” in Japan, “hempedu bumi” in Malaysia, “fah talai” in Thailand, and “green chiretta” in the Scandinavian countries, Andrographis is listed in the Indian Pharmacopoeia (a publication that lists standards for all drugs that are manufactured, sold, and consumed in India) and in a couple of dozen Ayurvedic formulas [2]. In traditional Chinese medicine (TCM), Andrographis is believed to rid the body of heat (e.g., fevers) and to dispel toxins [3]. Phytochemistry of Andrographis Paniculata Andrographis leaves are mainly responsible for its biological actions. They contain many bioactive compounds, including diterpene lactones – especially Andrographolide, the main bioactive ingredient that imparts the typical bitter taste. Andrographolide is an antioxidant that has been shown to be responsible for the herb’s anti-viral and anti-bacterial properties. Andrographolide is also reported in scientific literature to reduce blood clot formation, help protect the liver, have anti-cancer properties, and manage inflammation within safe levels [4]. What Is ParActin®? ParActin® is a patented extract of A. Paniculata, standardized to a fixed concentration of Andrographolide and other related compounds including 14-deoxyandrographolides and neoandrographolides [5]. Preliminary research shows that ParActin® promotes a healthy inflammatory response by blocking a powerful chemical known as NF-kappa B, which is known to be a key regulator of the inflammatory response system. As a result, ParActin® helps support a healthy and appropriate inflammatory response by reducing the levels of pro-inflammatory compounds that trigger the familiar pain and redness associated with inflammation. The safety and efficacy of ParActin® has been assessed in more than 30 studies, including laboratory experiments on cultured cells and animal models – and even a human clinical trial. Let’s take a closer look at some of these studies and what they tell us about Andrographis and ParActin®. Inflammation Is Linked to Many Disease Conditions Long-term, chronic inflammation that occurs when the immune system goes into overdrive may lie at the root of many otherwise unrelated diseases, including: asthma inflammatory bowel disease (IBD) rheumatoid arthritis (RA) autoimmune diseases depression cancer Alzheimer’s disease Inflammation – which manifests as swelling, redness, heat, and pain – is a normal response of our immune system and our body’s way of defending us from infections and disease. However, if it’s not managed properly, inflammation can harm the body. Chronic inflammation is the result of an overactive immune system that is constantly turned on – or cannot be turned off – so that it attacks parts of the very body it is supposed to protect. So-called oxygenated chemical species – including free radicals, oxygen ions, and peroxides – are continuously made in our body’s cells in response to UV radiation and as byproducts of ongoing metabolic activity. They are highly reactive and dangerous, because they can attack cellular DNA and proteins, damaging them. When oxygenated chemical species are generated in excess, they can overwhelm cellular defense systems, leading to a condition known as oxidative stress along with high levels of inflammation – which, as we discussed earlier, is known to contribute to the development of many diseases. Andrographolide, the best-known bioactive ingredient in Andrographis, has been shown to directly inactivate free radicals. It also protects mitochondria, blocks pro-oxidant enzymes, and activates other antioxidant enzymes in the body [6]. Andrographis Boosts the Immune System Andrographolide has been shown to enhance the immune system. For example, it boosts production of white blood cells known as lymphocytes, which scavenge and destroy bacteria and other foreign matter. It also triggers the release of signaling proteins known as interferons, along with enhancing activity of the lymphatic system [7]. Interferons are made and released by our body’s cells when they get infected with viruses, causing nearby cells to strengthen their anti-viral defenses. Interferons are potent antiviral agents that stop viruses from multiplying. The lymphatic system is another circulatory system in our body that carries a fluid known as lymph, which removes the waste products of cellular metabolism. The lymphatic system also transports invading bacteria and viruses to lymph nodes where the white blood cells (lymphocytes) destroy them. Andrographis has been shown to trigger our immune system in two ways: Antigen-specific response – specific proteins known as antibodies are made to counteract invading bacteria and viruses. Nonspecific immune response – immune cells known as macrophages are produced, which scavenge and destroy invaders. Andrographis activates both responses, meaning it is very effective against a variety of infectious and cancer-causing agents [8]. Benefits for Upper Respiratory Tract Infections & Cough Andrographis has been used for many hundreds of years in traditional medicinal systems to treat upper respiratory infections. Modern research supports this. For example, a 2004 meta-analysis of the results of seven double-blind, controlled trials (with a total of 896 participants) showed that Andrographis offers significant relief from the symptoms of upper respiratory tract infections and may even prevent them from taking hold in the first place. [Note: A meta-analysis is a quantitative epidemiological study used to systematically assess the results of previous research – typically randomized, controlled clinical trials – to derive overall conclusions about that body of research.] All the participants in these seven clinical trials reported reduced fever, runny nose, cough, and sore throat on taking Andrographis relative to control patients. Side effects were described as “generally mild and infrequent” [9]. Similarly, another meta-analysis published in 2015 reviewed six randomized controlled clinical trials, which assessed the effects of Andrographis in the treatment of cough. Combined, these six studies compared 333 patients who took various Andrographis preparations relative to 348 patients in control groups. All of these studies showed that Andrographis preparations reduced cough severity [10]. Andrographis Heals the Gut As mentioned above, Andrographis has long been used in traditional medicinal systems such as Ayurveda and traditional Chinese medicine (TCM) for treating gut infections. In a 2013 study published in the American Journal of Gastroenterology, 224 patients with mild to moderate ulcerative colitis were either given 1200 or 1800 milligrams of Andrographis for 8 weeks. Ulcerative colitis is an inflammatory bowel disease that causes long-lasting inflammation and ulcers in the gut, affecting the innermost lining of the large intestine (colon) and rectum. A colonoscopy was performed before the study started and after it ended. Stool frequency and the presence of blood in the stool were also assessed every two weeks. At the end of the study, 60% of patients who received 1800 mg of Andrographis – relative to 40% of patients in the control group – showed clinical symptoms of healing. Not only that, 50% of the patients who received the 1800 mg of Andrographis also showed mucosal healing, relative to 33% in the control group [11]. Andrographis & Joint Pain from Arthritis Arthritis affects more than 70 million Americans, leading to inflammation, pain, and stiffness in the joints and connective tissues. Over time, cartilage breaks down, bones erode, and joints become misshapen [12]. Our modern understanding is that rheumatoid arthritis (RA) happens because of the uncontrolled inflammation that is typical of an autoimmune disease. In such situations, the body’s defense mechanism malfunctions and attacks its own tissues (e.g., healthy joints) for a prolonged period of time. An immune-signaling protein known as cachexin or tumor necrosis factor-alpha is one of the key drivers of inflammation. Andrographolide has been shown to lower levels of cachexin. ParActin® and Mild Knee Osteoarthritis In a randomized, double-blind, placebo-controlled study the efficacy of ParActin® (300 and 600 mg daily) was assessed on pain reduction in 103 patients with mild to moderate knee osteoarthritis [13]. Patients treated with ParActin® showed a significant reduction in pain relative to the control group. Stiffness, physical function, and fatigue all showed a significant improvement with ParActin® treatment. At the end of the study, quality of life and Functional Assessment of Chronic Illness Therapy (FACIT) scores were significantly better in the ParActin®-treated groups compared to the control group. ParActin® and Rheumatoid Arthritis Similarly, in a randomized, double-blind and placebo-controlled study published in the journal Clinical Rheumatology in 2009, 60 individuals with compromised joints were given 100 mg of ParActin® or placebo in conjunction with methotrexate, three times a day for 14 weeks [14]. Methotrexate is proven to improve RA symptoms, but long-term use can cause serious infection and liver damage. In this study, ParActin® was effective in reducing the number and total grade of swollen joints, the number and total grade of tender joints, as well as improving scores on HAQ-52 (52-week Health Assessment Questionnaire), and SF-36 (36-item short form survey) health questionnaires. ParActin® treatment was associated with a reduction of various proteins, including enzymes, associated with cartilage damage. Currently, a human clinical trial testing the safety and efficacy of ParActin® in patients with mild to moderate osteoarthritis is ongoing. In other laboratory experiments, ParActin® and Andrographolide have also been shown to support bone [15]12, cartilage [16]13, and muscle [17]14 health and recovery. Can Andrographis Help Fight Cancer? Cancer results when our body’s cells grow uncontrollably. When cells develop normally, they become more and more specialized in their function at each stage of development. For example, immature pancreatic cells that will eventually go on to make insulin will develop the cellular machinery to do so as they become mature pancreatic cells. When cancer happens, it interferes with normal cellular development and cells do not mature. In fact, cancer cells resemble immature body cells – and the more they resemble immature cells, the more likely it is that they will spread to other locations – known as metastasis, often with fatal consequences. So, it logically follows that if cancer cells can be made to forcibly undergo maturation or differentiation, they will lose the ability to grow uncontrollably. Indeed, in one laboratory study in mice, researchers showed that Andrographis could induce differentiation in leukemia cells [18]. [Note: Leukemia is a cancer of the white blood cells, which are part of the immune system.] Andrographis can induce differentiation in laboratory conditions – but does this mean it can fight cancer? Indeed, it can – at least under laboratory conditions. A systematic review of no less than 139 pre-clinical and clinical studies shows that Andrographolide has anticancer effects on almost all types of cell lines in laboratory experiments [19]. Specifically, a 2019 study showed that Andrographolide prevented human colon cancer cells in culture from multiplying by inducing a process known as “programmed cell death” or apoptosis. Further, Andrographolide also displayed a combinatorial effect with chemotherapeutic anticancer drugs in these cells under laboratory conditions [20]. Similarly, the results of a 2019 study showed that a hot water extract of Andrographis could stimulate the production of specific components of the immune system and restore others to a more normal state. Furthermore, the Andrographis extract prevented tumor growth and metastasis in these mice, once again by inducing apoptosis, but without causing severe body weight loss as many anticancer chemotherapy drugs tend to do. Blood tests detected multiple bioactive Andrographis-derived diterpene compounds, suggesting that more than one might have contributed towards the beneficial effects seen in this study [21]. Andrographis extracts – especially bioactive lactone and diterpene compounds such as Andrographolide in them – have been shown to be very potent in suppressing the growth of various types of cancer cells in laboratory studies. In particular, Andrographolide has been shown to block the growth of human breast, prostate, and hepatoma tumors. It has even successfully been used in cancer chemotherapy [22]. Can Andrographis Help Prevent Alzheimer’s Disease? As a closing note, Andrographis is even showing promise in helping to combat Alzheimer’s disease. In a 2019 study published in the journal Plants – Basel, researchers reported that three compounds isolated from Andrographis may help stop the formation of structures known as beta-amyloid plaques, which underlie neurotoxicity and dementia, including Alzheimer’s disease [23]. As noted by the researchers “Andrographis paniculata and Spilanthes paniculata are used extensively as medicinal herbs for the treatment of various ailments, and are reported to have neuroprotective properties.”

In today’s episode, we hear from Dr. Neeraj Agarwal, associate editor of the ASCO Daily News and director of the Genitourinary Oncology Program at the University of Utah’s Huntsman Cancer Institute, about key abstracts and remarkable new developments in the GU field featured during the #ASCO20 Virtual Scientific Program.   Transcript ASCO Daily News: Welcome to the ASCO Daily News podcast. I'm Geraldine Carroll, a reporter for the ASCO Daily News. I'm delighted to welcome Dr. Neeraj Agarwal to the podcast today. Dr. Agarwal is Associate Editor of the ASCO Daily News and directs the Genitourinary Oncology Program at the Huntsman Cancer Institute at the University of Utah where he also serves as Professor of Medicine.   Dr. Agarwal joins us to discuss abstracts and some remarkable new developments in the GU field featured during the ASCO20 Virtual Scientific Program. Dr. Agarwal reports paid consulting on the scientific advisory boards of AstraZeneca, EMD Serono, Pfizer, Janssen, Bayer, Exelixis, Genentech. And full disclosures relating to all Daily News podcasts can be found on the episode pages. Dr. Agarwal, welcome to the ASCO Daily News podcast.   Dr. Neeraj Agarwal: It's a pleasure. Thanks for having me.   ASCO Daily News: Dr. Agarwal, can you tell us about the abstracts in the GU field that you're really excited about this year?   Dr. Neeraj Agarwal: Of course. I would like to encourage the listeners to visit abstract LBA1 on the JAVELIN 100 trial, which was presented by Dr. Tom Powles on the efficacy of avelumab in patients with metastatic urothelial carcinoma as a front-line maintenance therapy. In this remarkable study, 700 patients were enrolled in a phase III randomized control trial after they had completed chemotherapy, the standard chemotherapy for a new diagnosis of metastatic urothelial carcinoma or metastatic bladder cancer.   So, just to take a step back, currently, the standard of care for patients who are diagnosed with metastatic urothelial carcinoma is chemotherapy with cisplatin or, those patients who are not eligible for cisplatin, chemotherapy with carboplatin-based regimens. The median survival is approximately 18 months with cisplatin-based chemotherapy regimens and lower with carboplatin-based regimens.   And, at this point of time, we wait for these patients to experience disease progression, which is universal, pretty much, in these patients. And, when they have disease progression, they are treated with immune checkpoint inhibitors. And five of them are currently approved in this setting.   So what was novel about this study presented by Dr. Tom Powles and senior co-authored by Dr. Petros Grivas is that they utilized ab immune checkpoint inhibitor, avelumab, which is already approved for patients who are experiencing disease progression. So, instead of waiting for disease progression, the patients were randomized to receive standard of care, which is observation, versus treatment with avelumab. So this entirely new concept is called as front-line maintenance therapy.   So 700 patients who had completed four to six cycles of chemotherapy for their metastatic urothelial carcinoma were randomized to standard of care, which is observation with scans every three months, versus treatment with avelumab right after completion of their chemotherapy. The primary endpoint was overall survival.   And it was striking to see the improvement in overall survival. The patients who received avelumab, the median overall survival was 21.4 month versus 14.3 months in patients who did not receive avelumab. The hazard ratio for overall survival benefit was 0.69, which basically translates into a 30% reduction in risk of death in patients who receive avelumab therapy.   It was remarkable to see that overall survival was significantly improved in patients who received treatment with avelumab. The median overall survival was 21.4 months versus 14.3 months with a 30% reduction in risk of death in patients who received avelumab therapy. Even progression-free survival was also improved in patients who were receiving avelumab with approximately 40% reduction in risk of progression or death.   The side effects were expected, as to what you would see with avelumab therapy. And avelumab, as you know, is immune checkpoint inhibitor already approved in patients with metastatic urothelial carcinoma. And side effects seen were expected, and there were not new signals as far as safety was concerned.   With these results, there is no doubt that avelumab will be approved for our patients who are completing chemotherapy with carboplatin and cisplatin for metastatic urothelial carcinoma. And they will have the chance to receive avelumab up front in a front-line maintenance setting. And this is very gratifying to see these kind of results for our patients.   ASCO Daily News: Dr. Agarwal, there are several posters that show promising improvements in overall survival for patients with prostate cancer. Can you tell us about these studies?   Dr. Neeraj Agarwal: So there were three poster discussion sessions on patients with non-metastatic castrate-resistant prostate cancer. So, just to step it-- take a step back, about two years ago, three trials, PROSPER, SPARTAN, and ARAMIS, all phase III large randomized trials, which were conducted in patients with non-metastatic castrate-resistant prostate cancer, these trials utilized therapies with enzalutamide, apalutamide, and darolutamide respectively. These are potent direct androgen receptor inhibitors. And all these three trials met the primary endpoint of metastasis [INAUDIBLE].   So, just to take a step back, in patients with M0 CRPC or non-metastatic Castrate-Resistant Prostate Cancer, which is those patients with prostate cancer who are experiencing the rise in the PSA levels, but are not yet seeing metastasis on treatment with androgen deprivation therapy, and, until two or three years ago, we did not have any treatment options for these patients. And the standard paradigm was to wait for onset of metastasis before you can use-- or you can treat that with this novel androgen receptor inhibitors.   These trials used these agents early on and showed progression-free survival improvement. In this ASCO 2020, the updated results on overall survival were presented. Remarkably, all these three trials showed improved overall survival with enzalutamide, apalutamide, and darolutamide in patients with non-metastatic CRPC.   In my view, these results are very important because overall survival remains the gold standard in my mind and in several of my colleagues' minds to be the gold standard or to be the standard outcomes or the ultimate outcomes we like to see in our patients. Having overall survival be met by these trials, there's no doubt that the treatment of my patients or our patients with non-metastatic CRPC will further change with the utilization of enzalutamide, apalutamide, and darolutamide being options for these patients.   There were no new side effects reported. No new safety signals were reported. And I think-- I have no doubt that this is a welcome news for our patients, as well as providers who are treating these patients. I would like to encourage the listeners to visit the ASCO website and look at abstract number 5514, 5515, and 5516 to see further description on these three trials, which are PROSPER, SPARTAN, and the ARAMIS trial results on patients with non-metastatic castrate-resistant prostate cancer.   ASCO Daily News: Excellent. So are there other new agents that will likely move the field forward or have already done so?   Dr. Neeraj Agarwal: I would like to particularly highlight the combination of cabozantinib and atezolizumab in patients with metastatic castrate-resistant prostate cancer who are experiencing disease progression on the standard, novel, hormonal therapies, such as enzalutamide or abiraterone.   I would like to highlight the combination of cabozantinib, a multi-tyrosine kinase inhibitor, and atezolizumab, an immune checkpoint inhibitor, in patients with metastatic castrate-resistant prostate cancer who are experiencing disease progression on normal hormonal therapy, such as enzalutamide or abiraterone or both. I had the privilege of presenting these data in ASCO this year, and the abstract number is 5564.   So these are the results of a phase I trial where, originally, 30 patients were supposed to be recruited, and the cohort has since then-- since then, cohort has been expanded to 130 patients. These are the results from first 44 patients. All of these patients were experiencing disease progression on abiraterone or enzalutamide or both.   In fact, 50% patients had disease progression on both. One third of these patients had received chemotherapy with docetaxel in the castration-sensitive prostate cancers, and what we saw was remarkable. The combination of cabozantinib and atezolizumab resulted in objective responses in 32% patients and additional stability of disease in additional 48% patient. This translates into stable disease or responses, which we call as clinical benefit rate or disease control rate, in 80% of these patients.   I would like to point out that these patients had either visceral metastases or extrapelvic lymph node metastases, both of which are considered bad prognostic signs when we see these patients in our clinic. And they had to have disease progression in these sites radiographically before they could be recruited on this clinical trial.   The median duration of response was 8.3 months. And patients were able to receive this treatment for a median of six month. So duration of therapy was six months. Median duration of response was eight months. And the responses or, I would say, disease control was seen in 80% patients.   Obviously, this is data from a relatively small trial. However, based on these encouraging data, very exciting data I would say, a phase III trial has already started, which is going to start recruiting patients all over the world in different countries, including in the United States. So I'm really hoping that this combination will ultimately be proven to be efficacious and will be available to our patient.   But, for now, our patients will have the opportunity to enroll in this clinical trial, which will be open across the country and, as I mentioned, across the world in different countries. I would like to encourage the listeners to visit abstract number 5564 to look at further description of these data from the COSMIC-021 trial with the combination cabozantinib and atezolizumab in patients with metastatic castrate-resistant prostate cancer.   So next abstract I would like to highlight is the health-related quality of life data from PROfound trial, abstract number 5539. As we know from the recent presentations and publications in New England Journal of Medicine, a new class of drug for patients with prostate cancer or patients with metastatic castrate-resistant prostate cancer, PARP inhibitor or Poly ADP-Ribose Polymerase inhibitor olaparib, was presented.   Based on this report and in that trial, which was a phase III randomized trial, which included patients with metastatic castrate-resistant prostate cancer who were harboring homologous recombination repair defects in their tumors or, simply speaking, whose tumors has DNA repair-related defects, these patients were randomized to olaparib, a PARP inhibitor, versus enzalutamide or abiraterone. These patients were already experiencing disease progression on enzalutamide or abiraterone prior to enrollment on this trial.   The radiographic progression-free survival was the primary endpoint. There were two cohorts in this clinical trial. Cohort number one included patients with BRCA1, BRCA2, and ATM mutation. Cohort two included patients with 12 other mutations, which are also included in this class of mutation leading to DNA repair defects in patients with metastatic castrate-resistant prostate cancer. The radiographic progression was improved. And, per a recent press release, overall survival was also improved with olaparib.   In this abstract, number 5539, of the PROfound trial, authors presented the health-related quality of life data, as reported by the patients themselves. And, in my view, health-related quality of life data are very important because they are reported by patients themselves without any interference from the medical team or any biases introduced by the medical treatment providing team.   So very rigorous health-related quality of data were obtained during the conduct of the trial. They were obtained by using Functional Assessment of Cancer Therapy-Prostate, also commonly called as FACT-P questionnaire, which comprised five scales or five subscales, which included physical well-being, functional well-being, emotional well-being, social well-being, and prostate cancer subscale.   The results show that the baseline FACT-P total scores were similar for both treatment arms. However, during the entire course of treatment, there was a consistently high FACT-P score, total FACT-P score, as well as a subscale score for olaparib versus enzalutamide or abiraterone. And there was a clinically meaningful difference between the treatment arms.   So what we really get out of these data is that olaparib did not only improve survival in these patients with very limited options, but also delayed deterioration in health-related quality of life compared to enzalutamide and abiraterone, and was associated with improved quality of life in our patients who had this unusually aggressive type of castrate-resistant prostate cancer.   For a further description of these data, please visit the abstract number 5539 on the PROfound trial. And all I can say at this time is this is indeed a very encouraging news for our patients to have an oral pill being available for them when the other option is chemotherapy in this setting, which is not only improving survival, but also improving quality of life.   ASCO Daily News: Thank you very much, Dr. Agarwal, for sharing your insights on these very promising developments in the GU field.   Dr. Neeraj Agarwal: Thank you very much, Geraldine. It's a pleasure.   ASCO Daily News: And thank you to our listeners for joining us today on the ASCO Daily News podcast. If you're enjoying the content, please rate and review us on Apple podcasts.   The purpose of this podcast is to educate and to inform. This is not a substitute for professional medical care and is not intended for use in the diagnosis or treatment of individual conditions. Guests on this podcast express their own opinions, experience, and conclusions. The mention of any product, service, organization, activity, or therapy should not be construed as an ASCO endorsement.

Description: In our final episode in this series, we hear from an early intervention program supervisor and practitioners who have also been parents receiving intervention. They share their thoughts and experiences as they answer the question, “What does functional assessment mean to you?” 

In this episode, we discuss how to integrate ongoing functional assessment into your work with families during service delivery. We describe why and how to conduct it as a collaborative process with a family and model this process by discussing a challenging situation. We  review how the components of functional assessment help you monitor progress, address outcomes in family activities and interactions, be responsive to family updates and changing priorities, and help the family reflect on their efforts with their child during and between visits.

In episode 6, we discuss how functional assessment contributes to the development of the initial Individualized Family Service Plan (IFSP). We imagine different scenarios that illustrate (or do not illustrate) functional assessment practices during this important part of the early intervention process.

In this week's episode, Professor Leanne Togher and Lucie Shanahan discuss functional assessment and group-based intervention for people with traumatic brain injury (TBI).

Today’s episode features gym owner and sports performance coach Mike Kozak and physical therapist, Stephen Laflamme.   Mike Kozak is the Owner of SOAR Fitness in Columbus, Ohio.  He has trained hundreds of youth athletes as well as a number of current and prospective college and pro athletes. Mike has previously worked as a physical education teacher and youth basketball coach.  He frequently hosts “Rewire” clinics with Adarian Barr and is a fervent student of biomechanics and cutting edge sports performance techniques. He has written several articles for Just Fly Sports. Stephen Laflamme attained his clinical Doctorate of Physical Therapy from The Ohio State University in 2016 and graduated from the University of Maine in 2012 with a Bachelor's Degree in Exercise Science; also attaining his Certified Strength and Conditioning Specialist Certification.  Stephen competed twice in the Arnold Weightlifting Championships and qualified for the 2015 National University Championship in weightlifting. Stephen has traveled the country to be a part of the nation's best educational programs and learn from the nation's best professionals. When it comes to things like bilateral and single leg squatting, everyone tends to have their own favorite variations, but how often do we think about exactly why we are performing a front, Zercher or RFE split squat?  Are we prescribing these exercises based on what other coaches are utilizing, or based on the individual characteristics and needs of our athletes? In today’s episode Mike and Stephen get into both general and specific principles in catering to athletes optimally in these basic strength movements.  We had a great recent episode with Justin Moore in episode 176 talking about “knees in” from a holistic perspective, getting into the hydraulics of the body and the pelvic floor.  In this episode we continue in that vein, and get particularly into this dynamic in squatting, landing and jumping, and the differences that exist here, as well as practical training ramifications.  Finally, Mike and Stephen talk about training the foot, as well as integrating some concepts learned from Adarian Barr.  Today’s episode is brought to you by SimpliFaster, supplier of high-end athletic development tools, such as the Freelap timing system, kBox, Sprint 1080, and more.  Key Points General squatting concepts that make the movement more athletic Squat method difference based on hip structure (eg. anterior vs. posterior tilted) Why you might Zercher squat an athlete vs. front squat, as well as how various positions in RFE split squat bias different elements of movement Approaching athletes who lack hip internal rotation in a sequential manner “Knees in” concepts, timing, and jump training Squatting in respect to “knees out” and hip internal rotation Generalities in ACL prevention training Working with athletes who over-pronate “On my end, higher box safety bar squats seem to be the one that works the best for the majority of my population” Kozak “We’ve been big on the heels elevated ramps (while squatting)… putting them up on that buys them some more room to sit down” Kozak “In order to squat effectively, you need to be able to posteriorly rotate the pelvis, and the hamstrings are a really important muscle to be able to do that; by squatting to a high box, the hamstrings always stay within the range of motion where they can contribute to hip extension” Laflamme  “A split squat with my left foot in front and a kettlebell in my right hand would bias internal rotation of my front leg.  A kettlebell in my left hand would bias external rotation” Laflamme “If someone is really spongy when they land and can’t get off the ground quick, those are the people you see with the sway back posture, and it looks like the hips are tipped backwards.  By bringing them forward and getting a little more trunk inclination it helps unweight the pelvic fl...

Join us for another Megan’s Musings episode! This time we are discussing the Great Debate: PFA and Traditional FA. Behavior Analysts have incredible behavior change technology at their fingertips for drastically improving the quality of lives of numerous individuals who engage in challenging behavior that interferes with learning and may be harmful to themselves or others. Is the technology that was developed in the 80s and heavily researched since then sufficient for producing these changes or should we be advancing and progressive as a field and embrace the research from Dr. Hanley on Practical Functional Assessment? Dr. Miller and Joe discuss the two sides of this discussion and share their viewpoints. Before any good debate on a topic can occur, listeners must understand where the debate stems from so this episode opens with a quick overview of the historical significance of Functional Analysis. Then we dive right in to the two sides of the debate: Traditional Functional Analysis vs Practical Functional Assessment. The episode concludes by discussing who ultimately “wins” the debate. Resources to Learn More Tables Analyzing Research Articles from Fisher and Greer #dobetter Webinar on Challenging Behavior - Look at the September 2018 Row Behavioral Observations Podcast with Dr. Hanley Session 1 Functional Assessment BOP with Dr. Hanley Session 7 Function Based Treatment BOP with Dr. Hanley Session 20 Q and A BOP with Dr. Hanley Session 94 Practical Functional Assessment BOP with Dr. Fisher Session 45 Best Practices Functional Analysis Dr. Hanley’s Website on PFA

Join us as we begin our investigation into Autism in education with special guest, Dr. Keith Storey.In this episode of Mentorships in Education, we welcome Dr. Keith Storey, a professor with over forty years experience working with individuals with disabilities. Mentorships in Education is brought to you by Just Education, LLC and is hosted by Judith Epstein. Judith has a Master's degree in Education with a concentration in Language Acquisition. She is certified in special education with post-graduate coursework and professional development in Cognitive Behavior Therapy (CBT), Social Thinking, and Collaborative & Proactive Solutions and Acceptance and Commitment therapy (ACT). Judith created Just Education, LLC to compile a free resource library for mentors of students who struggle on a wide variety of topics that are all related to education and student success.Keith Storey, Ph.D., BCBA-D, is currently a Clinical Director at Juvo Autism and Behavioral Health Services in Oakland, California. He is also a Professor Emeritus at Touro University in Vallejo, California. Dr. Storey has over forty years’ experience working with individuals with disabilities, including six years as a classroom teacher. His professional and research interests include transition from school to adult life, functional analysis and positive behavioral supports, supported employment, inclusion, and curriculum development. Dr. Storey is the recipient of the 1988 Alice H. Hayden Award from The Association for Persons with Severe Handicaps; the 1996 Hau-Cheng Wang Fellowship from Chapman University, which is presented for exceptional merit in scholarship; and the 2001 Robert Gaylord-Ross Memorial Scholar Award from the California Association for Persons with Severe Disabilities. He is a member of the Illinois State University College of Education Alumni Hall of Fame. He has published over 100 journal articles on a wide variety of topics. Dr. Storey has published the books Positive Behavior Supports for Adults with Disabilities in Employment, Community, and Residential Settings: Practical Strategies that Work, Case Studies in Transition and Employment for Students and Adults with Disabilities, Positive Behavior Supports in Classrooms and Schools: Effective and Practical Strategies for Teachers and Other Service Providers, Case Studies in Applied Behavior Analysis for Students and Adults with Disabilities, Systematic Instruction of Functional Skills for Students and Adults with Disabilities, The Road Ahead: Transition to Adult Life for Persons with Disabilities, Walking Isn’t Everything: An Account of the Life of Jean Denecke, and Functional Assessment and Program Development for Problem Behavior: A Practical Handbook. He currently serves on the editorial boards of Career Development and Transition for Exceptional Individuals, Journal of Vocational Rehabilitation, Education and Training in Autism and Developmental Disabilities, Journal of Positive of Behavior Interventions, and Research and Practice for Persons with Severe Disabilities. He previously served on the editorial boards of Education and Treatment of Children, Vocational Evaluation and Career Assessment Professional Journal, and Exceptionality. Dr. Storey’s amazon author page is at www.amazon.com/author/keithstorey and his Goodreads author page is at https://www.goodreads.com/author/show/105547.Keith_Storey. You can reach him at keith.storey@tu.edu.CONNECT WITH USEmail Judi: info@justeducationfirst.comOur Website: http://justeducationfirst.comJudi on Linkedin: htt

In episode 1, we begin our discussion about functional assessment (FA) in the context of early intervention. We define FA and introduce important concepts such as conducting observation, asking meaningful questions, using active listening, and learning about how children interact and learn during daily activities. We talk about what ongoing FA should look like, compare it to traditional assessment, consider examples, and think about how to integrate it into your work with families.

Greg Hanley - the most popular Behavioral Observations guest by quite a bit - returns to the show for a fourth time, and this may be my favorite conversation with him yet! In this episode, we talk about the following: Why he started his new consultancy, FTF Behavioral Consulting, How he arrived at the decision to leave his academic post at Western New England University, Why he chose to "re-brand" the IISCA approach - which he now refers to as Practical Functional Assessment, How the PFA model has evolved over time, What should students and practitioners make regarding the divergent views between the Standard Functional Analysis and the Practical Functional Assessment models, How the PFA model can be construed as Trauma-Informed treatment, The BALANCE parent training protocol, What it's like to have PFA referenced in the 3rd edition of Cooper, Heron, and Heward, How Greg prepares for a conference presentation (in which we reference Pat Friman's contributions), What it's like to be an "ABA Rock Star," Lastly, we take several questions from The Behavioral Observations Membership Group. In answering these questions, Greg provides valuable insight into the nuances of this assessment and treatment approach for problem behavior. Greg cites a number of studies, and instead of listing them out here, I'd rather direct you to the website he's built to disseminate this work. There, you'll find a list of publications on this topic. Here's a list of a few other resources and trainings: The Facebook group for BCBAs Using the IISCA, The training event he and his colleagues are hosting on October 5th, in Worcester, MA, A two-part workshop on the BALANCE protocol at this year's NJ Autism Society's annual conference (see events B22 and B33), OK, I couldn't help myself, here is a paper that Greg mentioned not found on his site: Van Haaren (2015). Session 93 is brought to you by: Behavior University. Behavior University provides university-quality continuing education for everyday practitioners. To learn more about their CE offerings, discounts for podcast listeners, etc... please visit behavioruniversity.com/observations. The First Annual Tate Behavioral Conference taking place on October 25th in Springfield, Massachusetts, featuring presentations by Megan Miller, Ryan O'Donnell, Yours Truly, and Kim Berens. It will also include a live recording of the Behavioral Observations Podcast with my interview with Kim Berens. Here are a few other important details: 6 BACB CE credits (including 1.5 Ethics CEs) Oh, and save 15% off of your registration by using the promo code, "Matt" Did I mention that there's a free lunch? GoLotus. Go Lotus is an intuitive and easy to use, practice management system. It handles every aspect of practice management from data collection, to scheduling and billing, and more. It is so simple your entire team can be up and running in less than an hour. Listeners who use the promo code MATT, the first 100 people will receive 90 days of our data trackers completely free. And by signing up, you’ll then receive an additional discount of 25% off the first 12 months. For more info, head over to golotus.com/register.

*The practical functional assessment serves as an effective procedure to analyze and treat problem behavior. * Welcome to ABA Ultimate Showdown - a podcast promoting constructive, respectful, and professional discourse to advance the field of behavior analysis. We are stoked to be able to bring you Round 1 of the Showdown. Our first topic will be the hotly debated practical functional assessment that includes the interview-informed, synthesized contingency analysis, or IISCA, vs the traditional functional analyses, or FA. We are covering this topic across a precursor episode and one round. We put over 100 women hours over five months into this particular podcast and spent many a late night and early morning trying to fairly and accurately portray both sides and perfect the final product. During this debate, we will construct arguments for both sides to present the audience with a comprehensive and balanced view of two sides of a controversial topic. For a list of references used in this podcast, please visit www.GrahamBehaviorServices.com/showdown If you have ideas or topics for future debate, have respectful suggestions on ways we can improve this podcast, or if you are interested in being a guest debater, please email showdown@grahambehavior.com If you have enjoyed what you heard and found your Aha moment, please subscribe to our podcast, visit our website at grahambehaviorservices.com/showdown, like Graham Behavior Services on Facebook and Twitter, and visit our YouTube channel to be alerted when new episodes are out! We also appreciate your thoughtful review on the platform you listen to us. Thanks for listening and we hope to have helped you experience at least one aha moment! #GrAhamMoments --- Support this podcast: https://anchor.fm/abashowdown/support

Welcome to ABA Ultimate Showdown - a podcast promoting constructive, respectful, and professional discourse to advance the field of behavior analysis. We are stoked to be able to bring you this precursor episode of the Showdown. Our first topic will be the hotly debated practical functional assessment that includes the interview-informed, synthesized contingency analysis, or IISCA, vs the traditional functional analyses, or FA. We are covering this topic across a precursor episode and one round. As we stated in our introductory episode, good debates include definitions of any relevant terms to ensure that the debate is focused on the motion and not on parsing words. This debate requires slightly more than a few definitions so we created this, aptly named, precursor episode to include more detail. Enjoy learning a little more about the traditional functional analysis (FA) and about the practical functional assessment, which includes the interview-informed, synthesized contingency analysis (IISCA)! We put over 100 women hours over five months into this particular podcast and spent many a late night and early morning trying to fairly and accurately portray both sides and perfect the final product. For a list of references used in this podcast, please visit www.GrahamBehaviorServices.com/showdown If you have ideas or topics for future debate, have respectful suggestions on ways we can improve this podcast, or if you are interested in being a guest debater, please email showdown@grahambehavior.com If you have enjoyed what you heard and found your Aha moment, please subscribe to our podcast, visit our website at grahambehaviorservices.com/showdown, like Graham Behavior Services on Facebook and Twitter, and visit our YouTube channel to be alerted when new episodes are out! We also appreciate your thoughtful review on the platform you listen to us. Thanks for listening and we hope to have helped you experience at least one aha moment! #GrAhamMoments --- Support this podcast: https://anchor.fm/abashowdown/support

Margaret Lehman Blake, Ph.D., CCC-SLP is an associate professor in the Department of Communication Sciences and Disorders at the University of Houston. Her research focuses on cognitive-communication disorders after right hemisphere brain damage (RHD) and mild traumatic brain injury. Her work includes basic research on underlying deficits and treatment studies. She is the author of The Right Hemisphere and Disorders of Cognition and Communication as well as numerous articles and chapters on RHD. Dr. Blake has presented nationally and internationally on evidence-based practice for disorders associated with RHD as well as ethics for speech-language pathologists. She served as the President of the Academy of Neurologic Communication Disorders & Sciences (ANCDS) in 2014, and has held leadership roles in the Clinical Aphasiology Conference and the Neurogenic Communication Disorders special interest group of ASHA. UH Communication Sciences & Disorders https://urldefense.proofpoint.com/v2/url?u=http-3A__www.uh.edu_class_comd_&d=DwIF-g&c=Oo8bPJf7k7r_cPTz1JF7vEiFxvFRfQtp-j14fFwh71U&r=fuKSPxqi7q0yS0MzHXudyPNDmzLGoplPbbV_GrLsg4U&m=JmHHl9vWDY74X8R7w68WkYBRbnHVI2sAOGAVaKYGsD0&s=pj5GGIvDRzNFG_5tIBuFMhmihy9f3_u3-t_RIyBVha4&e= The Awareness of Social Inferences Test https://urldefense.proofpoint.com/v2/url?u=http-3A__www.pearsonclinical.co.uk_Psychology_AdultCognitionNeuropsychologyandLanguage_AdultAttentionExecutiveFunction_TheAwarenessofSocialInferenceTest-28TASIT-29_TheAwarenessofSocialInferenceTest-28TASIT-29.aspx&d=DwIF-g&c=Oo8bPJf7k7r_cPTz1JF7vEiFxvFRfQtp-j14fFwh71U&r=fuKSPxqi7q0yS0MzHXudyPNDmzLGoplPbbV_GrLsg4U&m=JmHHl9vWDY74X8R7w68WkYBRbnHVI2sAOGAVaKYGsD0&s=VJH5dcuBet_a8h7rK6mCVF37uj37_KomOknHUcEi85I&e= Functional Assessment of Verbal Reasoning & Executive Strategies https://urldefense.proofpoint.com/v2/url?u=http-3A__www.ccdpublishing.com_favres.aspx&d=DwIF-g&c=Oo8bPJf7k7r_cPTz1JF7vEiFxvFRfQtp-j14fFwh71U&r=fuKSPxqi7q0yS0MzHXudyPNDmzLGoplPbbV_GrLsg4U&m=JmHHl9vWDY74X8R7w68WkYBRbnHVI2sAOGAVaKYGsD0&s=XBsT7QnJ6gRoln6SV6Ne7WTYWKUZfY5Jn7xLIj9lm1s&e= The Montreal Protocol for the Evaluation of Communication https://urldefense.proofpoint.com/v2/url?u=http-3A__www.assbi.com.au_montreal-2520protocol.html&d=DwIF-g&c=Oo8bPJf7k7r_cPTz1JF7vEiFxvFRfQtp-j14fFwh71U&r=fuKSPxqi7q0yS0MzHXudyPNDmzLGoplPbbV_GrLsg4U&m=JmHHl9vWDY74X8R7w68WkYBRbnHVI2sAOGAVaKYGsD0&s=gIOtul3aSkaKVaoUVGnWAeGozqCXQ3Sbh8ezI0FPdBo&e=

These self-functional assessments will show you your weak links in your body that may lead to over-use injury and pain. Learn how the body alternates for the need of stability and mobility and what to do about it. Take the self-functional assessment quiz at https://www.healthfitcorpwell.com/quiz/functional-assessment

I sometimes joke around with folks that we Behavior Analysts are perhaps the only people who think nothing of driving one hour to do two hours of work. While that’s a little bit of an exaggeration, I find that it’s not entirely off the mark either. Obviously there are only so many hours in the day, and from both a clinical and financial perspective, these practices lead to a lot of waste. What if there was a way to leverage existing technologies to reduce travel-related barriers to providing clinical services? Well, it turns out that the answer to this question already exists, and other helping professions have been using technology to both expand services and operate more efficiently. In episode 26 of The Behavioral Observations Podcast, I chat with Dr. Wendy Machalicek, BCBA-D, who is an Associate Professor of Special Education at The University of Oregon, about using technology to provide behavior analytic services to families in rural areas. This practice goes by a few different names, but is often referred to as Telemedicine or Telehealth. Wendy discusses some of her research in this area as well as walks us through how to conceptualize the use of technology in our own work. So does that mean you can fire up Skype and start consulting with clients? Not so fast… as I learned from this conversation there are tons of technical and ethical details that have the potential to be inadvertently overlooked, including things like encryption of data, consent/assent in terms of working with adults, privacy/confidentiality of anyone who can view/hear the client-analyst exchanges, etc... Wendy also the behavior-analytic, “scene,” in Oregon and provided some helpful advice for newbies to the field (though I found her thoughts helpful for older practitioners like myself too!). We covered a lot in this episode, so here are some links of the things that were mentioned: • VSee HIPAA compliant video conferencing software • Bluetooth headsets • External web cameras • Swivl remote camera gear • The American Telemedicine Association • The APA Guidelines for practice re: Telehealth Speaking of making life more convenient, if you’re on the road a lot but need Continuing Education, check out the CE page. That’s right, you can now earn BACB Type 2 CE’s by listening to selected podcasts, and answering a few questions. Right now CE credits are available for topics such as Functional Assessment and Function-Based Interventions, The Ethics of Self-Care, and Behavioral Economics. Again, visit the CE page for more details.

In this episode, I discuss and dissect the recent trending story about Esther Gokhale and her work with back pain- specifically comparing modern, first world, anatomy of the spine (she terms the “S- Shaped Spine) and the “J- Shaped Spine found in very old anatomy books in addition to modern indigenous peoples who live a traditional, non sitting lifestyle. In this discussion I explain the reasons for the anatomical differences, their implication in poor posture, hip, SI, back, neck, and shoulder pain, and I offer a strategy for improving posture and banishing back pain. Resources: Esther Gokhale’s website: http://gokhalemethod.com Exercise tips and movement cues:   1)   lift the collarbones (disengage your shoulder girdle- engage your core) 2)   build your glute medius (stand, balance, lunge- use your legs more often!) 3)   build your glute complex (min, med, max)- squat often 4)   Leg strength and mobility is important 5)   Keep a long neck (starts in the mid back- lumbo dorsal hinge) 6)   Get a Functional Assessment and tape the non or low functioning muscles   Exercises:   Overhead squat with broomstick: https://www.youtube.com/watch?v=sJxtDGOnCOk Brick smash: https://www.youtube.com/watch?v=xVVWTIGTQ7I Banded walking (sideways): https://www.youtube.com/watch?v=fO6ppyR7lvI Kettlebell squat: https://www.youtube.com/watch?v=Mfhy67CSxAI (deadlift, Romanian deadlift, hex bar deadlift)- prep hip thrusts, banded hip thrusts Walking lunges (fwd/reverse): https://www.youtube.com/watch?v=YYWhkctnP2o   1)   Book on head (to lift collarbones)- Do this first: https://www.youtube.com/watch?v=QHIpxFCPn8Y 2)   Overhead squat with broomstick: https://www.youtube.com/watch?v=sJxtDGOnCOk 3)   Walking lunges: https://www.youtube.com/watch?v=YYWhkctnP2o 4)   Reverse lunges with thrust: https://www.youtube.com/watch?v=VPd0JVvR_gk 5)   Glute Bridge/Pelvic thrusts https://www.youtube.com/watch?v=DvQXREKFfpY 6)  Lunge matrix: https://www.youtube.com/watch?v=-_79b0N8txI

Significance of Functional Assessment

In this podcast, Editor-in-Chief Jeanette Hasse, PhD, RD, FADA, CNSC, interviews Mary Russell, about her article "Functional Assessment of Nutrition Status" published in the April 2015 issue of NCP.

The Software Process and Measurement Cast features our interview with Charley Tichenor and Talmon Ben-Cnaan on the Software Non-Functional Assessment Process (SNAP).  SNAP is a standard process for measuring non-functional size.  Both Talmon and Charley are playing an instrumental role in developing and evolving the SNAP process and metric.  SNAP helps developers and leaders to shine a light on non-functional work required for software development and is useful for analyzing, planning and estimating work. Talmon’s Bio: Talmon Ben-Cnaan is the chairperson of the International Function Point User Group (IFPUG) committee for Non-Functional Software Sizing (NFSSC) and a Quality Manager at Amdocs. He led the Quality Measurements in his company, was responsible for collecting and analyzing measurements of software development projects and provided reports to senior management, based on those measurements. Talmon was also responsible for implementing Function Points in his organization. Currently he manages quality operations and test methodology in Amdocs Testing division. The Amdocs Testing division includes more than 2,200 experts, located at more than 30 sites worldwide, and specializing in testing for the Telecommunication Service Providers. Amdocs is the market leader in the Telecommunications market, with over 22,000 employees, delivering the most advanced business support systems (BSS), operational support systems (OSS), and service delivery to Communications Service Providers in more than 50 countries around the world. Charley’s Bio: Charley Tichenor has been a member of the International Function Point Users Group since 1991, and twice certified as a Certified Function Point Specialist.  He is currently a member of the IFPUG Non-functional Sizing Standards Committee, providing data collection and analysis support.  He recently retired from the US government with 32 years’ experience as an Operations Research Analyst, and is currently an Adjunct Professor with Marymount University in Washington, DC, teaching business analytics courses.  He has a BSBA degree from The Ohio State University, an MBA from Virginia Tech, and a Ph.D. in Business from Berne University.   Note:  Charley begins the interview with a work required disclaimer but then we SNAP to it … so to speak. Next In the next Software Process and Measurement Cast we will feature our essay on product owners.  The role of the product owner is one of the hardest to implement when embracing Agile. However how the role of the product owner is implemented is often a clear determinant of success with Agile.  The ideas in our essay can help you get it right. We will also have new columns from the Software Sensei, Kim Pries and Jo Ann Sweeney with her Explaining Communication series. Call to action! We are in the middle of a re-read of John Kotter’s classic Leading Change on the Software Process and Measurement Blog.  Are you participating in the re-read? Please feel free to jump in and add your thoughts and comments! After we finish the current re-read will need to decide which book will be next.  We are building a list of the books that have had the most influence on readers of the blog and listeners to the podcast.  Can you answer the question? What are the two books that have most influenced you career (business, technical or philosophical)?  Send the titles to spamcastinfo@gmail.com. First, we will compile a list and publish it on the blog.  Second, we will use the list to drive future  “Re-read” Saturdays. Re-read Saturday is an exciting new feature that began on the Software Process and Measurement blog on November 8th.  Feel free to choose you platform; send an email, leave a message on the blog, Facebook or just tweet the list (use hashtag #SPaMCAST)! Shameless Ad for my book! Mastering Software Project Management: Best Practices, Tools and Techniques co-authored by Murali Chematuri and myself and published by J. Ross Publishing. We have received unsolicited reviews like the following: “This book will prove that software projects should not be a tedious process, neither for you or your team.” Support SPaMCAST by buying the book here. Available in English and Chinese.

Dr. Hy Muss reviews potential benefits of treatment for advanced, metastatic breast cancer, as well as the value of functional assessment of patients to predict treatment tolerability.

Dr. Hy Muss reviews potential benefits of treatment for advanced, metastatic breast cancer, as well as the value of functional assessment of patients to predict treatment tolerability.

Little is known about the effects of spiritual care training for professionals in palliative medicine. We therefore investigated prospectively the effects of such training over a six-month period. All 63 participants of the three and a half-day training were asked to fill out three questionnaires: before and after the training, as well as six months later. The questionnaires included demographic data, numeric rating scales about general attitudes towards the work in palliative care, the Self-Transcendence Scale (STS), the spiritual subscale of the Functional Assessment of Chronic Illness Therapy (FACIT-Sp) and the Idler Index of Religiosity (IIR). Forty-eight participants (76) completed all three questionnaires (91 women, median age 49 years; 51 nurses, 16 hospice volunteers, 14 physicians).Significant and sustained improvements were found in self-perceived compassion for the dying (after the training: P =0.002; 6 months later: P=0.025), compassion for oneself (P < 0.001; P =0.013), attitude towards one's family (P =0.001; P =0.031), satisfaction with work (P < 0.001; P =0.039), reduction in work-related stress (P < 0.001; P =0.033), and attitude towards colleagues (P =0.039; P =0.040), as well as in the FACIT-Sp (P < 0.001; P =0.040). Our results suggest that the spiritual care training had a positive influence on the spiritual well-being and the attitudes of the participating palliative care professionals which was preserved over a six-month period.

Hintergrund: Feststellen psychosozialer Belastung im Verlauf und bis zu zwei Jahren nach einer Strahlentherapie bei Patienten mit MammaCA unter besonderer Berücksichtigung soziodemographischer Faktoren - ohne erheblichen Mehraufwand durch Klinikpersonal bzw. Verwaltung. Methode und Material: Von November 1997 bis Juni 2002, wurden 266 Patienten mit MammaCA "gescreent". Von diesen lehnten 55 (20,7%) die Teilnahme ab und 39 (14,7%) wurden ausgeschlossen (Karnofsky Index < 50, Sprach- bzw. kognitive Defizite, Tod oder organisatorische Probleme). Insgesamt wurden 172 Patienten aufgenommen und der Functional Assessment of Cancer Therapy-General Fragebogen zu Beginn der Radiotherapie (ti1), ausgehändigt. Aus dieser Gruppe wurden 73 Patienten mit vollständigen Daten von ti1 bis ti6 (zwei Jahre nach Radiotherapie (RT)) untersucht. Ergebnisse: Die Lebensqualität (QoL) veränderte sich über den Beobachtungszeitraum. In der logistischen Regressionsanalyse konnten wir mit der Verwendung von fünf Patientenvariablen, Mastektomie, Krankenversicherung, Berufsausbildung, der Frage "pflegt oder versorgt Sie jemand" und der Frage nach einer Herz-Kreislauferkrankung, Patienten mit verminderter QoL nach RT mit einer Sensitivität von 73,3 % und Patienten mit einer guten QoL mit einer Spezifität von 77,1 % erkennen. Schlussfolgerung: Durch das routinemäßige Aufnehmen von Patientendaten im Klinikalltag ist es möglich, Patienten mit dem Risiko einer verminderten Lebensqualität während bzw. nach einer Strahlentherapie herauszufiltern, und zwar vor Beginn der Therapie. Diese Patienten könnten von einer frühzeitig eingeleiteten psychosozialen Unterstützung profitieren.

Aim: We wanted to understand coping strategies specific to different phases up to two years after radiotherapy, to identify patients who are at higher risk of mood disturbances and to characterise the association between coping strategies and psychosocial adaptation. Patients and Methods: From 1997 to 2001, 2,169 patients with different diagnoses were screened (27.8% refused to participate). Data of 276 patients from the beginning of radiotherapy (ti1) and 5 follow-up investigations (ti6/2 years) could be analysed. With the FKV ( Freiburg Questionnaire Coping with Disease) cancer-specific coping aspects were assessed. The association between coping styles and psychosocial adaptation was evaluated using the Questionnaire on Stress in Cancer Patients (QSC) and the questionnaire on Functional Assessment of Cancer Treatment (FACT-G). Results: `Active problem-orientated' coping and `distractions' are the most important coping strategies. Only `active problem-orientated' and `depressive' coping showed a significant decrease. We observed higher means on the scales of the FKV in women. Marital status ( single, married, divorced/widowed) had a significant influence on active problem-orientated coping and spirituality. Age, children, education, T/M status and curative/ palliative intention of treatment had no influence on coping styles. Breast cancer patients and lymphoma patients demonstrated the highest use of coping strategies after radiotherapy with a significant decrease of `active problem-orientated coping'. Depressive coping and minimizing importance at ti1 were associated with high psychosocial distress and low quality of life (QoL) at ti6. Conclusion: The correlation of coping mechanisms at the beginning of radiotherapy with low QoL and high psychosocial stress at 2 years could help to identify patients at risk for low psychosocial adaptation. Psychooncologically trained teams of physicians would best correspond to this profile of needs and would contribute significantly to an ameliorated adaptation of patients to cancer which could lead to higher life satisfaction.