Podcasts about international task force

Join us for this conversation on the vital issue of Online Child Protection, spotlighting the leadership and efforts of key figures from the Council of International Schools (CIS). Jane Larson, Executive Director of CIS, alongside Dan Furness, Head of Safeguarding and Wellbeing at CIS, are at the forefront of this work, shaping policies and providing guidance to international schools. We also hear from Leila Holmyard, Global Safeguarding Consultant, researcher and current Safeguarding Lead at Frankfurt International School, who shares practical insights from her PhD research and experience. Together, they address the current challenges in safeguarding children online, tips for prevention and response, and how school leaders can create safer digital environments within their communities. About Jane Larsson Executive Director, CIS Jane Larsson has led the Council of International Schools (CIS) as Executive Director since her appointment in 2010. Over the past 25 years, Jane has led the international education community with a focus on the development of collaborative partnerships to enable and support educational exchange and the development of international and intercultural perspective. Prior to her appointment at CIS, Jane was Direc­tor of International Partnerships with the Visiting International Faculty Program (VIF) in Chapel Hill, North Carolina, where she led outreach to promote international educational exchange, establishing relationships with minis­tries of education, universities, internation­al schools and educational associations.  She began her career in international education as the Director of Educational Staffing and Publications for International Schools Services (ISS) providing recruitment services and resources to international schools. Jane lends her voice to key topics shaping the future of international education, those which enable school and university communities to provide socially responsible leadership as they continually develop their programs. She currently serves as Chair of the International Taskforce on Child Protection and on the Board of Directors of the International Commission Advancing Independent School Accreditation (ICAISA). LinkedIn: https://www.linkedin.com/in/janelarssoncis/  About Leila Holmyard Safeguarding Lead, Frankfurt International School Leila Holmyard has extensive professional experience in safeguarding and child protection in international schools. She is a safeguarding consultant for a number of international schools and organisations, including the United World Colleges, Council of International Schools and Faria Education Group, as well as being Safeguarding Lead at Frankfurt International School. Leila has worked with international schools across the world and conducted her PhD research on safeguarding in international schools in Europe, Asia and Africa. She is also a volunteer for the International Task Force on Child Protection, WomenEd Germany, and the ISS Diversity Collaborative.  LinkedIn: https://www.linkedin.com/in/leila-holmyard-04767995/    About Dan Furness Head of Safeguarding and Well-being, CIS Dan Furness joined CIS in September 2023. Dan's primary responsibility as Head of Safeguarding and Well-being is to support the CIS membership community as it identifies and addresses child protection and student well-being challenges. This includes designing and delivering professional learning opportunities such as the Foundation and Deep Dive workshops in Child Protection and Safeguarding. Dan is available to support schools to strengthen their culture and systems, developing resources to educate and promote effective practices, and providing thought leadership and partnership across the international education sector. Prior to joining CIS, Dan worked in international schools in South Africa, South Korea, Germany and the Netherlands leading boarding, student support and safeguarding. Dan has also worked as an independent consultant in safeguarding and has a history of supporting staff professional development over a range of safeguarding-related areas including the following: child protection and safeguarding; safer handling and restraint; restorative justice and shared concern; response to intervention (a tiered approach to school support); and inclusion, diversity, equity and anti-racism. He has also provided supervision for other DSLs and school counsellors. Dan is a qualified counsellor and social worker, with an undergraduate degree and masters in social work from the University of Bath, and a second masters in educational leadership and management from the University of Buckingham. LinkedIn: https://www.linkedin.com/in/dan-furness/?originalSubdomain=nl   Resources https://www.cois.org/about-cis/child-protection/resources https://www.icmec.org/icmec-resources/ https://www.cois.org/about-cis/child-protection/resources https://www.childnet.com/help-and-advice/sextortion/ https://www.childnet.com/safer-internet-day/ https://takeitdown.ncmec.org/  https://www.nspcc.org.uk/keeping-children-safe/online-safety/online-reporting/report-remove/  Generative AI: A whole school approach to safeguarding children John Mikton on Social Media LinkedIn: https://www.linkedin.com/in/jmikton/ Twitter: https://twitter.com/jmikton Web: beyonddigital.org Dan Taylor on social media: LinkedIn: https://www.linkedin.com/in/appsevents  Twitter: https://twitter.com/appdkt  Web: www.appsedu.com  Listen on: iTunes / Podbean / Stitcher / Spotify / YouTube Would you like to have a free 1 month trial of the new Google Workspace Plus (formerly G Suite Enterprise for Education)? 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Equine osteoarthritis (OA), or the degeneration of cartilage and bone in a horse's joint, is a painful condition and the most common reason for lameness in horses. While there is no cure for OA, horse owners and veterinarians can work together to delay onset and slow its progression. Without treatment, OA can result in poor quality of life, early retirement, and even euthanasia if the associated pain is no longer manageable.Two veterinarians answer your questions about preventive equine joint care during this Ask TheHorse podcast. This episode is sponsored by Arthramid Vet.About the Experts: Sarah le Jeune, DVM, CVA, Cert. Vet Chiro, Dipl. ACVS, ACVSMR, focuses on the diagnosis and treatment of lameness and various performance-related musculoskeletal injuries by an integrative whole horse approach. She is the chief of the Equine Integrative Sports Medicine Service at the University of California, Davis, and is also a board-certified equine surgeon and member of the UC Davis Equine Surgery faculty since 2003. She is certified in veterinary acupuncture, veterinary chiropractic and in thermographic imaging. She is the founder and chair of the International Task Force on Laterality in Sport horses.Jennifer Feiner Groon, VMD, is an equine veterinarian with a focus on sports medicine. Graduating from the University of Pennsylvania's School of Veterinary Medicine in 2006, she has since built a successful practice, The Feiner Equine, where she splits her time between Central New Jersey and Wellington, Florida. Groon's career has been marked by a diverse range of experiences. Prior to establishing her own practice, she served as a member of the Hagyard Equine Medical group in Lexington, Kentucky, and an ambulatory veterinarian at MidAtlantic Equine Medical Institute in Ringoes, New Jersey. She served as the Head of Quarantine and a USEF/FEI Veterinary Apprentice at the 2007 Beijing Welcome Games Test Event and the 2008 Beijing Olympic Games. She was actively involved with the Area II and Area VIII Eventing Teams during the 2009 FEI Adequan North American Junior and Young Rider Championships. In 2010, she was in charge of the quarantine efforts at the Alltech FEI World Equestrian Games. In her free time, she competes in hunter and jumper disciplines. She loves sharing her passion of everything about animals with her family.

Equine osteoarthritis (OA), or the degeneration of cartilage and bone in a horse's joint, is a painful condition and the most common reason for lameness in horses. While there is no cure for OA, horse owners and veterinarians can work together to delay onset and slow its progression. Without treatment, OA can result in poor quality of life, early retirement, and even euthanasia if the associated pain is no longer manageable.Two veterinarians answer your questions about preventive equine joint care during this Ask TheHorse podcast. This episode is sponsored by Arthramid Vet.About the Experts: Sarah le Jeune, DVM, CVA, Cert. Vet Chiro, Dipl. ACVS, ACVSMR, focuses on the diagnosis and treatment of lameness and various performance-related musculoskeletal injuries by an integrative whole horse approach. She is the chief of the Equine Integrative Sports Medicine Service at the University of California, Davis, and is also a board-certified equine surgeon and member of the UC Davis Equine Surgery faculty since 2003. She is certified in veterinary acupuncture, veterinary chiropractic and in thermographic imaging. She is the founder and chair of the International Task Force on Laterality in Sport horses.Jennifer Feiner Groon, VMD, is an equine veterinarian with a focus on sports medicine. Graduating from the University of Pennsylvania's School of Veterinary Medicine in 2006, she has since built a successful practice, The Feiner Equine, where she splits her time between Central New Jersey and Wellington, Florida. Groon's career has been marked by a diverse range of experiences. Prior to establishing her own practice, she served as a member of the Hagyard Equine Medical group in Lexington, Kentucky, and an ambulatory veterinarian at MidAtlantic Equine Medical Institute in Ringoes, New Jersey. She served as the Head of Quarantine and a USEF/FEI Veterinary Apprentice at the 2007 Beijing Welcome Games Test Event and the 2008 Beijing Olympic Games. She was actively involved with the Area II and Area VIII Eventing Teams during the 2009 FEI Adequan North American Junior and Young Rider Championships. In 2010, she was in charge of the quarantine efforts at the Alltech FEI World Equestrian Games. In her free time, she competes in hunter and jumper disciplines. She loves sharing her passion of everything about animals with her family.

Host Dr. Davide Soldato and Dr. Shelia Garland discuss the JCO article "Randomized Controlled Trial of Virtually Delivered Cognitive Behavioral Therapy for Insomnia to Address Perceived Cancer-Related Cognitive Impairment in Cancer Survivors." TRANSCRIPT The guest on this podcast episode has no disclosures to declare. Dr. Davide Soldato: Hello and welcome to JCO After Hours, the podcast where we sit down with authors from some of the latest articles published in the Journal of Clinical Oncology. I am your host, Dr. Davide Soldato. I am a Medical Oncologist at Ospedale San Martino in Genoa, Italy. Today we are joined by JCO author Dr. Sheila Garland. She's a Professor of Psychology and Oncology at Memorial University, and she's the director at the Sleep, Health, and Wellness Lab and Senior Scientist at the Beatrice Hunter Cancer Research Institute. Dr. Garland will be discussing the article titled, “Randomized Controlled Trial of Virtually Delivered Cognitive Behavioral Therapy for Insomnia to Address Perceived Cancer-Related Cognitive Impairment in Cancer Survivors.” Thank you for speaking with us, Dr. Garland.  Dr. Sheila Garland: Thank you so much for having me. Dr. Davide Soldato: So, Dr. Garland, you designed a study that relied on cognitive behavioral therapy to treat insomnia, and then you assessed whether improvement in insomnia would be associated with an improvement in cancer related cognitive impairment. So I wanted to ask if you could give us a little bit of context and explain the rationale between these studies. So how common are these symptoms among cancer survivors, and why do we think that improving insomnia would also improve cognitive function?  Dr. Sheila Garland: Yeah, thank you very much. That's a really, really good question. And so cognitive behavior therapy for insomnia has been used to successfully treat insomnia in cancer survivors for quite some time. I think JCO was one of the first publishers to really demonstrate the potency of this intervention to improve insomnia. But as we know, patients will often present not just with insomnia, but insomnia comorbid with pain, fatigue, and very commonly cognitive impairment. If we take a look at the experimental research in sleep, we know that sleep quality and quantity is associated with very important cognitive functions. And so we've had clear sleep deprivation studies where if you're not able to successfully get sufficient quality or quantity of sleep, you're going to have impairments in attention and concentration and memory. So it really makes sense that if we're able to improve sleep in cancer survivors, that we're also able to address maybe some of the other concerns that they would have related to sleep. So this is an important clinical question for the patient's quality of life, but I also think it has important system implications where if we're looking at like resources and efficiency of allocating those resources, if we have an intervention that can treat multiple problems, that means that we can more effectively address lots of symptoms and use fewer resources in doing so. So that was the thought in designing this trial. Dr. Davide Soldato: Thank you very much. That was very, very clear. So you spoke about the intervention that you implemented in the clinical trial. So I was wondering if you could give us a little bit of context. How long was the intervention? What were the main points addressed? Because you said that, in the end, we already have some data regarding cognitive behavioral therapy for treating insomnia. So I was wondering, did you personalize in any way, the program or the intervention to fit more to the cancer survivors population?  Dr. Sheila Garland: Yeah. So it is based on a protocol that has been well researched and has a great deal of evidence of efficacy. But we delivered this intervention over a course of seven weeks. So individuals had individual sessions with a trained therapist, and those sessions lasted about an hour and were over roughly about two months or so. Seven sessions over two months. And because they were delivered individually, there was some adaptation based on the clients' presenting problems. So while there's sort of a standard protocol, if the client is also presented with levels of fatigue or pain or anxiety or depression, the therapist was able to integrate those concepts into the therapy as well. There was nothing for cognitive impairment. So there was no additional intervention for cognitive impairment at all. We weren't doing any memory training or anything like that. So it was strictly the sleep and other symptoms looking at the impact of improving that on not only your perception of your cognitive abilities, but also on performance on a number of neuropsychological test measures. Dr. Davide Soldato: So thank you very much for the detail. And I think that it's very interesting what you said, that the personalization of the intervention would also allow to treat some other symptoms that are distressing for cancer survivors. Like, for example, you mentioned fatigue or anxiety or depression. And I think that this goes back to the first point that you made about the intervention. So being able to treat different symptoms all at one in one single intervention, I think that that is a very intelligent use of resources and also to promote and implement, potentially some interventions that are beneficial for survivors of cancer on different domains and potentially different symptoms. So, going to the results a little bit, what did you observe regarding specifically insomnia with the intervention that you delivered? Dr. Sheila Garland: Yeah, so, of course, we wanted to make sure that we were effective in targeting the primary outcome of what the trial was supposed to do, which was we were supposed to treat effectively, treat insomnia, and then determine whether treating that insomnia was related to improvements in cognition. So we were expecting that the intervention itself was going to be successful at improving insomnia, and we were. So we were able to not only demonstrate a statistically, but also a clinically meaningful improvement in insomnia severity. Usually that's measured by a change of about 8.4 on a measure called the insomnia severity index. And the change that we were able to produce was over 11 points. So it was clearly over the clinically meaningful change threshold. Dr. Davide Soldato: Going back a little bit to the design of the study, this was a randomized clinical trial. And how did you allocate the participants of the study into which arms? And can you guide us a little bit in the study design?  Dr. Sheila Garland: Yes. A lot of thought went into the study design. We ultimately decided on having a waitlist randomized controlled trial, and this was because there is no other intervention for insomnia that has comparable efficacy. And we felt it would be unethical to not give people the standard treatment that we know works to treat insomnia. So that's where having them wait for a period of time and then receive the treatment was ultimately what we decided on. Overall, we were able to recruit 132 participants, and those were randomized into either receiving treatment immediately or receiving treatment after a two month waiting period. Dr. Davide Soldato: So you mentioned that the intervention was actually very effective for treating insomnia. You reported an improvement in the insomnia severity index of almost 11 points. And as you mentioned, this is both clinically meaningful and it was also statistically significant. Did you see any improvement also on cognitive function, and how did you measure this outcome? Was it self reported, or did you also have some objective measure to see, for example, working memory or some other type of cognitive function? Dr. Sheila Garland: Yeah. Also, a lot of thought went into choosing the primary outcome for this. And there's people who have argued compellingly that self reported cognitive function should be the primary target because we know, based on past research, that objective and subjective ratings of cognitive performance do not always correlate well with each other. And taking a very patient oriented approach, we wanted to make sure that we prioritized the patient's perception of their own function. We used one of the subscales of the functional assessment of cancer treatment cognition scale. So it was the Perceived Cognitive Impairment subscale that was what we used as our primary, but we also reported the two other subscales, which was the Perceived Cognitive Abilities and the Impact of Cognition on Quality of Life. We were able to not only discover that there were clinically significant improvements on all three of those subscales, but actually translated into, again, the clinically meaningful change threshold that's been established for the perceived cognitive impairment subscale is, I think it's around, like 5.9 points. So, using that cutoff, 75% of the participants in the trial reported clinically meaningful improvements in their perceived cognitive impairments, compared to just 43% of those participants in the wait list group. And we looked not only at the immediate intervention effects, but also on whether they were durable. So we had follow up assessments of both three months and six months after completing treatment, and the effects on insomnia, as well as the cognitive dimensions, they were maintained.  Dr. Davide Soldato: Thank you very much for this last remark, because I think that one of the worries I would say that we have when implementing this type of behavioral intervention is that in the end, the change that we produce and the behavioral change that we produce might be effective in the immediate time after completing the intervention. But frequently we sort of see the loss of this benefit that we produce with the intervention at later time points. And I think that this is very important that you also looked at the benefit that was maintained over time for the three and six months after the end of the intervention. And it's true that before we add some data regarding other types of behavioral intervention, for example, for weight loss or some other symptoms and other toxicity that we frequently target with this type of intervention, I was wondering, do you think that it's something specific to cognitive behavioral therapy and the specific symptoms that you were treating, so insomnia, that in the end, produced a durable and meaningful benefit over time?  Dr. Sheila Garland: So I do think that there's something really specific about this type of intervention. With insomnia, you're really changing the person's fear of not sleeping, and you're giving them tools to be able to both prevent the reocurrence of insomnia and also if the reocurrence should happen, they know what to do then to address it themselves. I was very curious about the impact that it might have long term. I actually wasn't sure whether it would have an effect immediately, considering that people do accumulate kind of a sleep debt after having insufficient sleep for a period of time. So I didn't know whether we would see anything immediately. I thought maybe we would need the long term follow ups to see some of the effect. But I guess maybe not surprisingly, at the end of the trial, thinking about when somebody has a good night's sleep, they're feeling the effects even the next day. Dr. Davide Soldato: Thank you. That was very insightful. Regarding the duration of the intervention, because in the end, this was very short, because it was just seven sessions weekly, and usually also when we design or implement this kind of behavioral intervention, we frequently go for a longer period of time where the patient is subjected to this type of behavioral intervention. Frequently, we see around three, six months of intervention. And so I think it's really amazing the effect that you had on this specific symptom with such a short intervention. So I think that that is also something that speaks to the possibility of further implementing this type of intervention and this type of program for symptom control.   And going back a little bit to what was one of the main questions of the trial that you designed and the results of the article that you published, did you observe a mediating effect of the improvement of insomnia on the cognitive function? So, you said that insomnia improved, and so improved also your primary outcome, which was the scale of the FACT-Cog questionnaire. But did you see whether this improvement in cognitive function was really related and associated to the improvement that you observed in insomnia? Dr. Sheila Garland: Yeah. So that was a very, very important question. We needed to first demonstrate that there was a relationship between the intervention and insomnia, and then there was a relationship between insomnia and cognition. And then we did some mediation analyses subsequent to determining both of those, and we found that the change in insomnia was a full mediator of the change in cognition. So we were able to say that it's not just time or it wasn't related to something else, that improving sleep did have this direct effect on the improvement that patients reported in their cognitive impairment.  Dr. Davide Soldato: We spoke a lot about the subjective improvement in cognitive performance. But you said that you also evaluated some specific and objective scale with, for example, I imagine some neuropsychological tests. Did you also observe some improvement for those specific tests, and did you observe the same amount of benefit or the same improvement, we could say, between the subjective and the objective weight of measuring cognitive function?  Dr. Sheila Garland: I think that's where the outcomes become a little less clear. So, we did measure performance based cognition at all of the time points, and we were very careful in selecting these measures. So we followed the guidance provided by the International Task Force on Cognition and Cancer. They had some very specific recommendations about how and what measures we use. So we made sure to use measures that were able to be repeated, so that had multiple forms, that had very identifiable ways to indicate improvements. So we used the Hopkins Verbal Learning Test to measure word recall, both immediately and delayed. We used measures to look at verbal fluency and working memory. Overall, we had six different specific aspects of cognition that we were looking at, immediate word recall, delayed word recall, word retention, verbal fluency, word recognition, and working memory. Some of those presented with a different pattern of change overall. So a little bit trickier to interpret than the person's perception of their own cognition. Dr. Davide Soldato: That's very interesting because it's important to have this kind of objective assessment. But in the end, what we are really trying to target is a symptom that is distressing for cancer survivors. I'm not even sure that sometimes we need all of this detail, or at least that even if these outcomes that are more objectively measured, we do not observe the same amount of benefits. Still, if we are able to produce an improvement in the symptoms and the perception that the survivor or the individual or the patient, whoever we are trying to help in that specific moment and for those specific symptoms, reports an improvement, I think that is already very important. And I totally share the patient oriented approach that you followed in the study.  Going back a little bit to the population, because I think that this speaks a little bit also to potential avenues for further research. You included a population of cancer survivors who completed treatment at least six months before being enrolled in the trial. And relating to the population, I had two questions. So the first one is, do you think that you would have the same kind of results, so the same benefit, also among a population of patients who's in active treatment? And then the second one is a little bit more speculation, but do you think that we will arrive, or do you envision research where we kind of deliver this type of intervention in sort of a preventative way? So if we would be able to identify those patients who might later develop these types of symptoms, could we use this type of intervention sooner? So can we prevent these symptoms even before they appear? And could this be potentially associated also in a less symptoms developed over time and less need to treat these symptoms when they become more severe?  Dr. Sheila Garland: Those are two very, very good questions. The first one is regarding the population. You're right. These people were at least six months out of treatment, and we wanted to make sure that if there was any temporary disruption, that would have maybe been stabilized over that. But most of the people in this trial, and I will mention that we didn't focus on any specific cancer type or site. So this was really a heterogeneous group of cancer survivors, both male and female. The most prevalent diagnosis that we had was breast. But some of these people who were enrolled in the trial had advanced cancer, and as long as their cancer treatment, their regimen was stable, they were eligible to participate in the trial. So I think that's a very important point. If somebody is on a very intensive round of chemotherapy, it can be tricky to implement some of the more aggressive behavioral changes that can come with some of these insomnia treatments, because their level of wellness just isn't there. So during active treatment it can be challenging, but it is definitely not impossible. We would just tweak things a little bit to accommodate their physical well being at that time.  To your next question, though, this is where I think we really need to be going. Just like they've done in the area of, like, physical activity, trying to really strengthen people prior to treatment is the way to go. Because some of my other research looked at symptoms prospectively from the time of diagnosis over the first year, and it's roughly about half of people, at least, this was in my work with women with breast cancer, about half of women with breast cancer come into treatment with clinically significant sleep problems. So, a proportion of those people just continue to have sleep problems or even get worse after it. So there's definitely a role for that, sort of like rehabilitation, not only for maybe physical fitness to try and ward off fatigue, but also getting their sleep on track. I think people are really focused, especially in that early time, about like, “I want to eat right, I want to exercise,” but I say it as many times as I possibly can, that you're not going to make healthy food choices, and you're not going to be getting out there and working out if you're not getting sufficient sleep. So we really need to have sleep there as the foundation and what supports all of those other healthy lifestyle behaviors that people are trying to change. Dr. Davide Soldato: So sort of comprehensive intervention for people undergoing treatment where we kind of identify symptoms that are already there at the beginning, and we deliver some sort of intervention that can target a lot of those symptoms, maybe not all of them, but maybe improving also the way that treatment is perceived or the toxicity that they might develop over treatment. Dr. Sheila Garland: And that's what I think. I think that if you're taking people who are already coming into treatment, that are looking after their health in ways that they can, they may be able to tolerate more aggressive treatments, they might be able to complete more rounds of chemotherapy, just getting them strong, going into treatment that way.  Dr. Davide Soldato: Also still focusing on that very patient oriented perspective that I think it's very important in general for oncologists and also for patients. I think that you were very wise in choosing an intervention that could be also delivered virtually, and this was one of the bases of the intervention. And regarding also the way the intervention was delivered, I had a question regarding the fact that this was actually an intervention that was delivered by professionals. But we also have some, maybe initial evidence, that suggests that some of this cognitive behavioral therapy can also be experienced, or at least the benefits can be obtained by the patients, even when it's self directed. So programs where patients are not actually interacting with a professional, but they are just following these types of programs. So do you think that there is room for both of those? And maybe should we suggest this type of self directed programs for all patients or all survivors and then just refer only those with a more significant or important symptom severity for the intervention with professionals? And this, I think, also goes to the discussion that we had at the very beginning about allocation of resources and ability also to tailor these types of interventions to the needs of different individuals. Dr. Sheila Garland: I think that's really important to consider when looking at what's available for patients. They did a survey in the US of NCI Cancer Centers where they looked at the availability of CBT-I, and it was very low. I think around 20% or so of NCI Comprehensive Cancer Centers had the ability to refer to in-house CBT-I. If we had sort of a stepped care model like you're talking about, we may be able to more appropriately allocate people to the level of care that they need. A line of my research now is going into a specific app delivered cognitive behavior therapy for insomnia tailored to cancer survivors. And so looking at that very point, not everybody needs a provider, but I think that a self help manual or an app is also not going to work for everybody. So you're not going to completely take out the person. And depending on the complexity of the situation that the patient finds themselves in, they may really need that provider to consider all of the other factors. They might need it to encourage adherence or address maybe some of the barriers that would be getting in the way. So having different levels of care and being able to match people not only to the level of care, but also maybe by their preference. So, “I'd like to use an app.” Great, we've got an app for you. Or “I'd like to see somebody.” And I think matching it to people's preferences automatically encourages or enhances their engagement and their motivation to complete because they're getting what their preference would be. Dr. Davide Soldato: And I think that at least if we could use a little bit more of these types of apps or tools or whatever we have out there, maybe we could increase at least that 20%. For example, if only 20% of NCI Cancer Centers, which are already places where care is delivered, probably with a higher attention to these types of symptoms for survivors compared, for example, to community hospitals or to smaller private clinics. So if we could at least have sort of a base and then refer only those that maybe have a higher need for a provider directed therapy or intervention, that maybe would also improve outcomes for a larger part of the population of survivors.   And one other thing that I wanted to ask you is, do you think, in your experience, because this was not really in the trial that you designed, but do you think that we also need cultural adaptation of these types of programs? Meaning, do we need to diversify based, for example, on ethnicity or level of education or, I don't know, just the background that the patient is experiencing? Dr. Sheila Garland: Yeah, very, very good points. There are some studies currently being conducted out of the United States that have looked at cultural adaptations of CBT-I specifically. So there was a trial looking at CBT-I for African American women survivors of breast cancer, and also the Latinx population as well. From the results of those trials, it didn't necessarily improve the effects of intervention, but it improved the engagement, so people were less likely to drop out. So it wasn't always the content. It was how the content was presented. So people were able to visually see themselves more, they were able to relate more to the content in just the way it was presented, which made them go, “Oh, okay. This is why I should be here.” And I think that that's part of the argument that I used for sort of adapting the cognitive behavior therapy for insomnia treatment that's being used in the general population, specifically to people who have had cancer, because people want to know, “All right. You know what? Is this safe for me to do? Will this work for me to do? How do I also do this when I have cancer related fatigue, or how do I do this when I also have pain?” So they want to know that, “Alright. This is right for me.” That's probably, again, relating more to getting people and keeping people engaged with the treatment, maybe even convincing them to do it to begin with, talking about getting buy-in from important leaders in their community to say, “This is something that I would recommend or I would endorse.” And those sort of community level endorsements maybe are just breaking down barriers to get people willing to engage with an evidence based treatment.  Dr. Davide Soldato: And I think especially with cognitive behavioral therapy, because I think that when we propose drugs for treating symptoms or, I don't know, intervention for losing weight or to be more physically engaged, well, the latter that I mentioned might be also a little bit more complicated, depending on the cultural context. But drugs are very easy to accept for the patients in most cases. But I think that cognitive behavioral therapy also has some type of cultural resistance, maybe among some of our patients and cancer survivors.  Dr. Sheila Garland: And I would also include oncologists in there as well. So, some of the treatment providers are not even exactly sure why would talking about this help. So I think separating it out, it's not just I'm going to talk about my sleep, it's that I'm going to engage with my sleep differently and breaking down maybe some of the stigma that, just because we're referring you to cognitive behavior therapy doesn't mean your problems are all in your head, but it means that there's ways that you can think about your sleep and ways that you can behave differently, which will reduce the things that are getting in the way of your sleep functioning the way that it should normally. I think when I talk to patients, and also when I do training with providers, I talk about how we can condition our bed to be associated with things other than sleep. So if we repeatedly snack in front of the tv, even though we've just had supper maybe a half an hour before, if we go and sit down in that chair that we always snack in, we're not hungry, but we find ourselves reaching for something to eat. The same thing can happen at night, where if you repeatedly pair your bed with things other than sleep, if you're thinking in bed, if you're planning, if you're worrying, if you're ruminating, if you know you're doing anything, if you're on your screen or you're watching tv or you're doing anything that's arousal producing, people can find that they're so tired, they're nodding off on the couch. They go up to bed, and all of a sudden, bang, they're wide awake and their mind is turning and they're thinking and they're like, “Why is this happening to me? I was just tired. I was so tired.” People with insomnia can relate to that very easily. That, “Oh, okay. So there's this conditioned association between my bed and wakefulness. How do I get rid of that?” That's where what we think and what we do around our sleep, we can change to be able to make our bed someplace that is strongly associated with sleep and not all of those other activities.  Dr. Davide Soldato: Thank you for the remarks on oncologists and sometimes our resistance to accept this type of intervention. I think that this also speaks to the merit of the Journal of Clinical Oncology, which publishes high level evidence also on symptom management, and these types of interventions that are, in the end, effective for our patients.  So I think that this concludes our interview for today. Thank you again, Dr. Garland for joining us.  Dr. Sheila Garland: Thank you Dr. Soldato. Dr. Davide Soldato: Dr. Garland, we appreciate you sharing more on your JCO article titled, “Randomized Controlled Trial of Virtually Delivered Cognitive Behavioral Therapy for Insomnia to Address Perceived Cancer-Related Cognitive Impairment in Cancer Survivors.” If you enjoy our show, please leave us a rating and review and be sure to come back for another episode. You can find all ASCO shows at asco.org/podcast. 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.      

Join us for a conversation with members of The International Taskforce on Child Protection (ITFCP).  As the taskforce celebrates its 10th anniversary, we take this opportunity to hear the story behind its founding and its mission to protect children across the international schools community and beyond.    We'll explore how international schools have and continue to adopt and adapt safeguarding standards, overcoming cultural and operational challenges to ensure a safe learning environment for all students. Our guests and members of the taskforce share their own learnings, opportunities, and challenges of collaborating across multiple international schools and organizations. We will also learn about the  resources, services and professional development the taskforce provides to international school leaders and educators.   About Jane Larson   Jane Larsson has led the Council of International Schools (CIS) as Executive Director since her appointment in 2010. Over the past 25 years, Jane has led the international education community with a focus on the development of collaborative partnerships to enable and support educational exchange and the development of international and intercultural perspective.    Prior to her appointment at CIS, Jane was Direc­tor of International Partnerships with the Visiting International Faculty Program (VIF) in Chapel Hill, North Carolina, where she led outreach to promote international educational exchange, establishing relationships with minis­tries of education, universities, internation­al schools and educational associations. She began her career in international education as the Director of Educational Staffing and Publications for International Schools Services (ISS) providing recruitment services and resources to international schools.    Jane lends her voice to key topics shaping the future of international education, those which enable school and university communities to provide socially responsible leadership as they continually develop their programs. She currently serves as Chair of the International Taskforce on Child Protection and on the Board of Directors of the International Commission Advancing Independent School Accreditation (ICAISA).   https://www.linkedin.com/in/janelarssoncis/   About Jane Foster-Sarre   Director, Safeguarding Works Ltd Area of expertise provided as part of the CIS Affiliated Consultant Network: Student Wellbeing: Protection, Safety, & Security including but not limited to School safeguarding audits Response to allegations of abuse and low level concerns Safe recruitment and safe working practice Policy development and review Investigations and risk assessments   Jane is an independent safeguarding consultant providing expert advice on safeguarding and child protection. She specialises in promoting safe organisational culture, safeguarding in the workplace, and managing allegations and low level concerns against adults working with children. Jane is a qualified teacher, who has also worked in schools as the Designated Safeguarding Lead and Safeguarding Governor across ages 4–18 years. She has also worked for statutory education and children's services departments in the UK.   Following the exposure of the criminal actions of William Vahey who abused more than 50 children when employed at an international school based in the UK, Jane was part of the statutory case panel convened to review the case and lessons learned and worked closely with the school to restore confidence in the community and reinforce the safeguarding structure.   Jane is an accredited safer recruitment specialist and has contributed to IICSA - the UK Independent Inquiry into Child Sexual abuse. She is also a co-author of the International Protocol for Managing Allegations of Child Abuse by Educators and other Adults and the Guidance on Managing Low Level Concerns.   Jane is currently Co–Chair of the International Taskforce for Child Protection (ITFCP) Recruitment Reporting & Regulations Group.   Jane is an experienced auditor of safeguarding practice and has worked with international schools across the UK and Europe, Asia and Africa, both promoting best practice and responding to serious incidents where schools and boards need support.   Jane has extensive experience of designing and delivering safeguarding training including delivering the CIS Foundation Workshop on Safer Recruitment and supporting the Deep Dives. As an independent advisor Jane has provided high-level safeguarding advice and training across the sectors including schools, universities, religious and sports organisations, charities, and private clients.    Jane is also a specialist advisor to the safeguarding boards of a UK Premier League football club, a private equity company providing residential care for children, and a faith organisation and is a member of the National Safeguarding Panels for both the Football Association and Sports Resolutions which offers advice to a range of sports In addition to her independent role Jane is also a consultant for Barnardos, a UK based Children's Charity. Jane is a regular speaker at events and is a well-known figure to many private, public and third sector organisations working with children, including state, independent and international schools.   About Dr. Christine Brown   Dr. Christine Brown is an international consultant specializing in advising educators on Program Design for Teaching and Learning, Child Protection, Social Emotional Learning initiatives, World Language and ELL programing, working with challenging student placements and managing parent expectations. From 2013 to 2023, Brown served as one of six Regional Education Officers (REOs) in the Office of Overseas Schools, United States Department of State. She covered the Western European Region and for several years also the South America region. Brown also served the DOS as one of 5 initial co-founders of the International Task Force on Child Protection.    As REO, she served on the Boards of ECIS, AAIE and AMISA. Prior to joining the Department of State in July 2013, she served as Deputy Director at the Carol Morgan School in the Dominican Republic. Brown served as an administrator in the Glastonbury, Connecticut Public Schools for 28 years, first as the Director of K-12 Foreign Languages and ELL, and for 8 years as the Assistant Superintendent for Curriculum and Instruction.   Brown has served as a president of state, regional and national language teacher organizations including the American Council on the Teaching of Foreign Languages over her career. She chaired the American Language Standards Writing Task Force sponsored by the U.S. Department of Education as well as served as the consultant to the national Arabic and Korean language standards projects and as a consultant to the Startalk Language Project for the Office of the Director of National Intelligence.    She served as a board member of the National Defense Education Language Program. Brown chairs the AERO World Languages Standards writing project for DOS. She has testified before the United States Congress on behalf of language education, and initiated and co-chaired the Year of Languages Campaign in the United States. In February 2019, she was awarded the Keith Miller Innovation Award from the Association for the Advancement of International Educators for her work in Child Protection around the world.    In March 2019 Brown received the Outstanding Graduate Student Award at Gwynedd Mercy University for her Doctoral Dissertation, The Effects of Early Foreign Language Study on English Reading Comprehension. In 2023, she received the NEASC Educator of the Year Award. In 2024, she received an AAIE Outstanding Educator Award and the ECIS Outstanding Educator of 2024 award.   About Keith Cincotta   Director of School Services andSenior Leadership Executive, International Schools Services   Keith has worked in the International Education sector for 25 years first as a School Counselor, later as a High School Principal and most recently as a Senior Leadership Executive and the Director of School Services at International Schools Services. As a school counselor in Allentown PA, Islamabad Pakistan and Dubai he worked with many survivors of abuse and was part of teams that responded to reports of abuse.    At ISS Keith is the representative to the International Task Force on Child Protection, is responsible for safeguarding initatives across ISS' managed schools and presents professional development and training sessions for educators.  Keith is a trained facilitator for Darkness to Light and has facilitated the program for school, church and community groups. Keith holds Master of Education degrees in both Counseling and Educational Leadership from Lehigh University.   https://www.linkedin.com/in/keith-cincotta-578b1a17/   About Debbie Downes   In August 2022, Debbie Downes joined The International Centre of Missing and Exploited Children as the Director of Global School Initiatives. In this role, she develops and provides child protection training, support, and resources to schools around the world. She has been supporting ICMEC's work as a regional trainer since July 2020.    Debbie has worked in international education for 18 years, first as an elementary teacher, then as school principal, and then as Accreditation and Child Protection Lead for Quality Schools International. She developed and revised handbooks, policies, and resources to support child protection efforts at a group of 36 international schools. She also supported schools with on-site and virtual professional development.    Debbie's background in child protection includes an MSW from the University of California at Berkeley and several years of experience working in the court unit of Children and Family Services in Contra Costa County, California. Debbie's overseas career began with 3 years as a health education volunteer with the Peace Corps in Kolda, Senegal. She has since lived with her husband, 2 children, and 2 rescue dogs in Thailand, Turkmenistan, Azerbaijan, Slovenia, and her current location of Minsk, Belarus.    https://www.linkedin.com/in/debbie-downes-educator/    Resources   ICMEC EdPortal International Taskforce on Child Protection  Child Protection Resources and Information CIS Global Education Blog  Child Protection Workshop Online | Improving Safeguarding Practices in Schools   International Schools Services ITFCP Managing Allegations Protocol ITFCP Safer Recruitment Checklist Make the Call: Verifying References: An Essential Practice for International School Leaders  ITFCP Student Voice: Data, Guidance, and Resources  Social-Emotional Learning and Child Self-Protection Curriculum Standards & Benchmarks   John Mikton on Social Media LinkedIn: https://www.linkedin.com/in/jmikton/ Twitter: https://twitter.com/jmikton Web: beyonddigital.org   Dan Taylor on social media: LinkedIn: https://www.linkedin.com/in/appsevents  Twitter: https://twitter.com/appdkt  Web: www.appsevents.com   Listen on: iTunes / Podbean / Stitcher / Spotify / YouTube Would you like to have a free 1 month trial of the new Google Workspace Plus (formerly G Suite Enterprise for Education)? Just fill out this form and we'll get you set up bit.ly/GSEFE-Trial

Who is the go-to resource for the lowdown on the current state of international school recruiting? Thanks to an introduction from super-connector Laura Light, we were fortunate enough to connect with one of the best-placed people for answers to our recruiting questions. Pauline O'Brien is the Global Recruitment Business Strategy Development Director at International School Services (ISS). We peppered Pauline with questions to help our listeners deepen their understanding of where things stand concerning recruiting and other trends in international education. Pauline has 20+ years of experience in professional recruiting, client service, and school board relations in international education. She has designed multi-faceted learning opportunities for international schools, which include competency-based recruiting strategies, skills-based interviewing methods, and STAR application profiles. Pauline has served on the International Task Force for Child Protection and has been a board member of Women's Business Initiative International and ACCESS in the Netherlands. Originally from Ireland, Pauline resides with her family in the Netherlands, where she studied international business in Dutch.The guiding question was, "What are recent changes and trends in international school recruiting?"Here are some of the many topics that Pauline spoke to: Pauline's background in the corporate world brings new perspectives to how international schools approach their work. Child safeguarding continues to be a key trend. Recruiting should be about evaluating candidates' skills and aptitudes.Pauline mentioned some of the services that ISS offers,  including learning materials to help with recruiting. Listen to the interview with Nadine Richards and Dana Specker Watts for more on this.We compared virtual fairs during the COVID lockdown with in-person recruitment fairs. The recruiting "season" is now year-round. ISS is working with schools to diversify their recruiting outreach. ISS offers orientation activities for first-time applicants at its fairs . Be ready with targeted, relevant questions during interviews. Our profiling tool can help with this.Veterans: avoid being overconfident - so much in recruiting has changed recently. Many international educators left China during the COVID lockdown; some are now returning.  We discussed the nature of so-called “hardship posts”. A few related trends concern health insurance, well-being, support for staff, PD, and crisis management. This episode was recorded on December 18, 2023.Contact Information: LinkedInRemember to access our Educators Going Global website for more information or to subscribe to our newsletter!Email us with comments or suggestions at educatorsgoingglobal@gmail.com Follow us on Facebook, Instagram or YouTube.Music: YouTube. (2022). Acoustic Guitar | Folk | No copyright | 2022❤️. YouTube. Retrieved October 11, 2022, from https://www.youtube.com/watch?v=YOEmg_6i7jA.

It is with great pleasure that I have invited my colleague Bruce Jones into the Virtual Studio for this episode on ‘Shaking the Global Order'. ‘The US-China relationship has been marked by growing competition and rivalry but leaders did gather for a Xi-Biden Summit on November 15th that took place near San Francisco at the margin of the APEC Summit. So what is the state of US-China relations as a result of that Summit, tensions between the two over Taiwan and in the Indo-Pacific. How are the two reshaping the global order in the face of US-China relations? Bruce Jones is a senior fellow with the Strobe Talbott Center for Security, Strategy, and Technology in the Foreign Policy program at the Brookings Institution; he also works with the Center for East Asia Policy Studies. From 2015 to 2020, Bruce served as the vice president and director for the Foreign Policy program. His research expertise and policy experience is in international security. Bruce's current research focus is on U.S. strategy, international order, and great power relations. His most recent books on the topic are “To Rule the Waves: How Control of the World's Oceans Shapes the Fate of the Superpowers” (Scribner, 2021) and “The Marshall Plan and the Shaping of American Strategy,” (Brookings Institution Press, 2017) Bruce also has had significant experience on multilateral institutions. He was a senior advisor to Kofi Annan on U.N. reform and served as deputy research director to the U.N.'s High-level Panel on Threats, Challenges and Change, as well as lead scholar for the International Task Force on Global Public Goods. So, let's join Bruce in the Virtual Studio to examine the US-China relationship and relations between the two in the Indo-Pacific.

Francois Vreÿ is an Emeritus Professor of Military Science and Research Coordinatorat SIGLA at Stellenbosch University, and he joins John to examine Houthi attacks on Red Sea shipping and their impact on Africa's maritime interests.See omnystudio.com/listener for privacy information.

In this episode, we discuss the security of deep-sea internet cables with Dr. Bruce Jones. Bruce Jones is a senior fellow with the Strobe Talbott Center for Security, Strategy, and Technology in the Foreign Policy program at the Brookings Institution; he also works with the Center for East Asia Policy Studies, and is a consulting professor at the Freeman Spogli Institute at Stanford University. His current research focus is on U.S. strategy, international order, and great power relations. His most recent books on the topic are “To Rule the Waves: How Control of the World's Oceans Shapes the Fate of the Superpowers” (Scribner, 2021); “The Marshall Plan and the Shaping of American Strategy,” (Brookings Institution Press, 2017); and “Still Ours to Lead: America, Rising Powers, and the Tension between Rivalry and Restraint” (Brookings Institution Press, 2014). Dr Jones has extensive experience and expertise on intervention and crisis management. He served in the United Nations' operation in Kosovo, and was special assistant to the U.N. special coordinator for the Middle East peace process. He was also a senior advisor to Kofi Annan on U.N. reform and served as deputy research director to the U.N.'s High-level Panel on Threats, Challenges and Change, as well as lead scholar for the International Task Force on Global Public Goods. Dr Jones holds a doctorate from the London School of Economics, and he was the Hamburg fellow in conflict prevention at Stanford University.Patreon: https://www.patreon.com/EncyclopediaGeopolitica

We kick things off with an entirely new segment we're creatively calling Industry News with Podcast Business Journal featuring James Cridland, Editor of Podnews and Podcast Business Journal. The panel covers the industry's top stories and shares what they mean for marketers. Then, Jennifer shifts to a new panel featuring Giles Martin, Steven Abraham, Kyle Jelinek, and Neal Lucey as they talk about the future of audio internationally.

Bryan interviews Scott Lawson, from Corpus Christi, TX, who is serving Influencers by organizing Virtual Journey Groups and training and equipping Virtual guides. He has also been working with International Virtual groups and serves on the International Task Force. Learn how God is inviting us to the world via technology. You may be needed to help us make disciples of all nations.

Hi everyone, and welcome to the LungFIT podcast. I am going to be taking a much needed break for the next while, so I hope you enjoy this past episode about some questions related to pulmonary rehabilitation and COVID-19. I'll be back soon with new content, but until then, thank you again for your support. On this episode, I talk about COVID-19 and pulmonary rehabilitation, including questions that health care professionals should ask themselves when they consider admitting patients who have had COVID-19 and ongoing symptoms. I mentioned some papers that I would recommend reading, that discuss some of these questions in more detail, as well as provide guidance to you as you consider caring for patients who have had COVID-19, in your pulmonary rehabilitation programs. Spruit MA, Holland AE, Singh SJ, Tonia T, Wilson KC, Troosters T. COVID-19: Interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force. Eur Respir J 2020; in press (https://doi.org/10.1183/13993003.02197-2020). This paper can be found here.   American Thoracic Society Assembly on Pulmonary Rehabilitation. “Guidance for Re-opening Pulmonary Rehabilitation Programs.” This paper can be found here.   American Physical Therapy Association Webinars on “Physical Therapy Considerations of COVID-19 in the Post-Acute Setting” aired on April 18, 2020 and “COVID-19: Clinical Best Practices in Physical Therapy Management”, aired on March 28, 2020. 

Greg shares a personal story about his 15 year old son, Max. This summer, Max  and Greg will canoe the Mississippi source to sea.  Their relationship, and their trip, are unique.  Greg's son is a former street kid from Myanmar.    When Max was 9, Greg and his wife met Max,  and through a series of circumstances, ended up taking him into their home, and ultimately adopting him. Their planned Mississippi River trip is not only a great adventure, but an endeavor to contribute to the children of Myanmar.  We take this opportunity to talk to both about their planned trip and this unique story.   Connect with Greg: linkedin.com/in/gregory-hedger-600423169 Or follow along on Greg and Max's Mississippi River Journey blog   About   Dr. Gregory Hedger has been Director of The International School Yangon, in Myanmar, since 2016. A native of Minnesota in the U.S., Greg has been an educator for over 30 years, and has served in educational leadership positions for 20 years in the role of school director at Cayman International School, at Qatar Academy, in Doha, and as superintendent at Escuela Campo Alegre in Venezuela. Greg has been involved in international education through his service on the boards of Association for the Advancement of International Education (AAIE), the Association of American Schools in South America (AASSA,) The Dubose Foundation, and his work with the International Task Force for Child Protection, his contributions to various periodicals, and his work to promote the next generation of leaders through workshops and university instruction.   Greg and his wife, Kirstin, have four children, Kaija, Sadie, Anna, and Max.   Max is 15 years old and in the 8th grade.  He usually attends The International School Yangon in Myanmar, but is currently attending Ordean East Middle School in Duluth, Minnesota, for one year.  Originally from Myanmar, Max came to live with the Hedger family when he was 9.  He is an avid mountain biker, skateboarder, nd has recently taken up skiing in a big way.   John Mikton on Social Media LinkedIn: https://www.linkedin.com/in/jmikton/ Twitter: https://twitter.com/jmikton Web: beyonddigital.org   Dan Taylor on social media: LinkedIn: https://www.linkedin.com/in/dantcz/ Twitter: https://twitter.com/DanTaylorAE Web: www.appsevents.com   Listen on: iTunes / Podbean / Stitcher / Spotify / YouTube Would you like to have a free 1 month trial of the new Google Workspace Plus (formerly G Suite Enterprise for Education)? Just fill out this form and we'll get you set up bit.ly/GSEFE-Trial

Former Senior Technical Advisor on the CDC COVID-19 International Task Force, Dr. Susan Hillis, joins Dr. Marc Siegel and discusses the impact loss of a parent or caregiver due to COVID-19 has had on children. Hear facts, data, and moving stories–and learn what you can do to help.

Dr. Emily Grieshaber (e-mail) of East Tennessee State University is interviewed by Stephen M. Shaffer regarding a presentation she gave at the 2021 AAOMPT Conference titled, “Providing Musculoskeletal Care to the Post-COVID Community.” This episode contains information that will be interesting for practitioners who want to begin to understand the complexities associated with both SARS-CoV-2 infections and COVID-19 as they relate to physical therapy practice. Additionally, to access the resources mentioned by Dr. Grieshaber during the interview use the following links: Stanford Hall consensus statement for post-COVID-19 rehabilitation, Interim Guidance on Rehabilitation in the Hospital and Post-Hospital Phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force, APTA COVID-19 Core Outcome Measures, and the Pacer Project. Find out more about the American Academy of Orthopaedic Manual Physical Therapists at the following links:Academy website: www.aaompt.orgTwitter: @AAOMPTFacebook: https://www.facebook.com/aaompt/Instagram: https://www.instagram.com/officialaaompt/?hl=enPodcast e-mail: aaomptpodcast@gmail.comPodcast website: https://aaomptpodcast.simplecast.fm

In this episode Alex R. Kemper, MD, MPH, MS, FAAP, deputy editor of Pediatrics, shares a research roundup from the January issue of the journal. Hosts David Hill, MD, FAAP, and Joanna Parga-Belinkie, MD, FAAP, also talk to Susan Hillis, CAPT, PhD, MS, senior technical advisor of the CDC COVID-19 International Task Force, about her research on children orphaned due to COVID-19. For resources go to aap.org/podcast.

Renee McGregor is a leading sports dietitian, specialising in Eating Disorders, REDs, The Female Athlete, athlete health and performance. She is regularly asked to work directly with high performing and professional athletes that have developed a dysfunctional relationship with food that is impacting their performance, health and career. Her practice and knowledge is supported by extensive experience of working in both clinical and performance nutrition, including, Olympic, Paralympic and Commonwealth teams. She is the co-founder and director of #TRAINBRAVE a campaign raising the awareness of eating disorders in sport; providing resources and practical strategies to reduce the prevalence. She is on the REDS advisory board for BASES (The British Association of Sport and Exercise Science) and sits on the International Task Force for Orthorexia. Find the show notes at sigmanutrition.com/episode389

In this weeks episode, Han is joined by Renee McGregor, a leading sports and eating disorder specialist dietician. Renee is only the RED-S advisor board and sits on the International Task Force for Orthorexia. This episode is certainly a treat for those interested in these 2 disorders. The conversation with Renee not only explores the definition and health consequences for both RED-S and orthorexia, but we also explore Renee's opinion on the predisposing characteristics of these disorders which are important to consider during recovery.For more information regarding Renee's work, you can visit her website at https://reneemcgregor.com/ or find her on Instagram for informative sports and nutrition posts at @r_mcgregor!Also, check out Renee's #trainbrave campaign which aims to inspire athletes to share their stories, raise awareness of ED's and RED-S, to provide resources and empower coaches and athletes to have open discussions about ED's and RED-S.

On this episode, I talk about COVID-19 and pulmonary rehabilitation, including questions that health care professionals should ask themselves when they consider admitting patients who have had COVID-19 and ongoing symptoms. I mentioned some papers that I would recommend reading, that discuss some of these questions in more detail, as well as provide guidance to you as you consider caring for patients who have had COVID-19, in your pulmonary rehabilitation programs. Spruit MA, Holland AE, Singh SJ, Tonia T, Wilson KC, Troosters T. COVID-19: Interim guidance on rehabilitation in the hospital and post-hospital phase from a European Respiratory Society and American Thoracic Society-coordinated International Task Force. Eur Respir J 2020; in press (https://doi.org/10.1183/13993003.02197-2020). This paper can be found here.   American Thoracic Society Assembly on Pulmonary Rehabilitation. “Guidance for Re-opening Pulmonary Rehabilitation Programs.” This paper can be found here.   American Physical Therapy Association Webinars on “Physical Therapy Considerations of COVID-19 in the Post-Acute Setting” aired on April 18, 2020 and “COVID-19: Clinical Best Practices in Physical Therapy Management”, aired on March 28, 2020. These webinars can be found here.

David Slutzky Founder and CEO, Fermata Energy Prof. Slutzky is a recognized thought leader in the field of vehicle-to-grid technology. Slutzky founded Fermata Energy with the specific intention of developing and commercializing vehicle-to-grid technology in order to make electric vehicles more cost effective and the electric power grid more stable, as well as to provide large-scale energy storage to make the transition to renewable energy happen more quickly. He has earned the reputation of being a policy wonk and serial entrepreneur committed to preservation of sensitive ecological systems, protecting the long-term integrity of our biosphere, and working to solve the challenges of global warming. In addition to more than 30 years of experience as an entrepreneur, David served as a Senior Policy Advisor at the White House and EPA during the Clinton Administration. At the White House, he coordinated the International Task Force of the President’s Council on Sustainable Development, where he focused his efforts on the environmental and labor implications of international trade agreements such as the Multilateral Agreement on Investments. Prior to Fermata Energy, David co-founded Skeo Solutions, an environmental policy consulting firm and worked as a Senior Policy Advisor at the White House and U.S. EPA. He is also on the faculty of the University of Virginia as a Research Associate Professor in the Science, Technology and Society Program at the University of Virginia School of Engineering and Applied Science. Slutzky earned his BA and pursued graduate studies in Political Philosophy at the University of Chicago, and received his law degree from the Program on Energy and the Environment at Chicago-Kent College of Law. David is also known for founding ERC, where he developed the process tool commonly known as the Phase 1 Environmental Site Assessment, and for co-founding ERIIS, the nation’s first environmental data. https://www.fermataenergy.com/ https://nexuspmg.com/

Our guest on Episode 9 is Kathy Steele who is a psychotherapist, trainer, consultant and author from Atlanta, Georgia with over 35 years experience. Kathy is the Past President and Fellow of the International Society for the Study of Trauma and Dissociation (ISSTD), and has also served two terms on the Board of the International Society for Traumatic Stress Studies (ISTSS). Kathy served on the International Task Force that developed treatment guidelines for Dissociative Disorders, and on the Joint International Task Force that has developed treatment guidelines for Complex Posttraumatic Stress Disorder. She has received a number of awards for her work, including the Lifetime Achievement Award from ISSTD, an Emory University Distinguished Alumni Award, and the Cornelia B. Wilbur Award for Outstanding Clinical Contributions from ISSTD.Kathy is considered an expert in complex trauma, dissociation and attachment and her last co-authored book: Treating Trauma Related Dissociation: A Practical Integrative Approach won the Pierre Janet Writing Award. On this episode Kathy gives some background on her career path, the treatment of dissociation over time, and explains important terms and concepts in trauma therapy. She breaks down assessment and treatment aspects of trauma and dissociation as well as break down phase oriented trauma treatment. The inner critic, wounded child parts and other important 'characters' are discussed with some insight into how to explain and work with these areas in therapy. Lastly, Kathy provides useful tips and wisdom for new therapists and ways to prevent and manage burnout and vicarious trauma. For more information about Kathy, her publications and trainings check out her website HERE

CME credits: 0.25 Valid until: 09-04-2021 Claim your CME credit at https://reachmd.com/programs/cme/covid-19-interim-guidance-management-pending-empirical-evidence-american-thoracic-society/11408/ There is little empirical evidence to guide the management of COVID-19. However, with new cases being confirmed daily and the rate still increasing, clinicians taking care of patients with COVID-19 need guidance now. That’s why, with the support of the American Thoracic Society, an international task force of clinicians from academic centers on the frontline of COVID-19 management was convened to develop interim consensus guidance which will be reevaluated as evidence accumulates. This program provides a summary of that guidance to date. Please click here to access COVID-19 Clinical Resources for Clinicians.

An interview with Dr. Noam Yarom, Dr. Charles Shapiro, Dr. Deborah Saunders and Dr. Doug Peterson on "Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline." This guideline addresses the prevention and management of MRONJ in patients with cancer. This guideline is intended for oncologists and other physicians, dentists, dental specialists, oncology nurses, clinical researchers, oncology pharmacists, advanced practitioners, and patients with cancer. Read the full guideline at www.asco.org/supportive-care-guidelines Find all of the ASCO podcasts at podcast.asco.org  TRANSCRIPT Disclaimer: 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. Hello, and welcome to the ASCO Guidelines podcast series. My name is Shannon McKernin. And today, I'm interviewing a panel of authors from "Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline." So could I have you each introduce yourselves for the listeners today? Thank you, Shannon. I'm Dr. Deborah Saunders. I'm the president of the International Society of Oral Oncology and was the section head for the Systematic Review on "Medication-Related Osteonecrosis of the Jaw," with MASCC and ISOO. I was a proud part of the steering committee and one of the authors. Thank you, Debbie. My name is Dr. Douglas Peterson. I am professor of oral medicine in the School of Dental Medicine at the University of Connecticut Health Center in Farmington, Connecticut. I am also a faculty member in the Head and Neck Cancer Oral Oncology Program at the university's Neag Comprehensive Cancer Center. I'm a member of the steering committee for this clinical practice guideline and one of the co-authors as well. In addition, and as of June 2019, I have been serving as chair elect during this next year for ASCO's Clinical Practice Guidelines committee. Thank you, Doug. My name is Noam Yarom. I'm an all medicine specialist from the Sheba Medical Center in Tel Aviv University in Israel. I'm serving as a culture of this guideline, and it is a pleasure to be with you today. Thanks, Noam. I am Dr. Charles Shapiro, professor of medicine at the Mt. Sinai Hospital in New York. And I'm co-chair of the guideline "Medical-Related Osteonecrosis of the Jaw." And I'm happy to be here. Thank you all for being here today to discuss this guideline on the podcast. So first, can you give us a general overview of what this guideline covers. Sure. So you know, ASCO and MASCC, as well as ISOO decided that it would be great to provide a practical evidence-based approach in a multidisciplinary type setting to address this important topic that impacts all of our professions, that being medication-related osteonecrosis of the jaw. It's terminology and its definition and the path that's varied and even part of this publication identifies the need for us to move forward with a concise definition and similar terminology, that being medication-related osteonecrosis of the jaw. Medication-related osteonecrosis of the jaw is defined as the presence of an exposed or bone that is probable by a probe in a patient that has a history or is undergoing present use of a bone-modifying agent. This being in the absence of any patients having received any radiation to the head and neck and the absence of metastatic lesions to the jaw. The importance of us identifying this definition and agreeing on the terminology allows us to move forward in future publication to better compare outcome and provide better prevention and treatment for our patients moving forward. And what are the key recommendations of this guideline? There are six clinical questions associated with this clinical practice guideline as well as a series of recommendations built within each of the clinical questions. Clinical question one is directed to the preferred terminology and definition for osteonecrosis of the jaw, both of the maxilla and the mandible, as associated with pharmacologic therapies in oncology patients. The panel recommends that the term medication-related osteonecrosis of the jaw, MROJ, be used when referring to bone necrosis associated with pharmacologic therapies. As Dr. Saunders has described, the definition contains three key elements-- current or previous treatment with a bone-modifying agent or angiogenic inhibitor, exposed bone, or bone that can be probed through an intra or extra-oral fistula in the maxillofacial region and that has persisted for longer than eight weeks. And third, no history of radiation therapy to the jaws and no history of metastatic disease to the jaws. Clinical question two is directed to specific steps that should be taken to reduce the risk of MRONJ. The recommendation begins with emphasizing the absolute importance of interprofessional communication of the oncology team with the dental team in advance of initiating the bone-modifying agent. For patients with cancer who are scheduled to receive a bone-modifying agent in a non-urgent setting, a comprehensive oral care assessment, including dental examination and periodontal examination and an oral radiographic exam when feasible to do so should be undertaken prior to initiating the BMA therapy. Once the dental care plan has been developed, it should be discussed with the dental team, the patient, and the rest of the oncology team and then implemented based on medically necessary dental procedures. These procedures should be performed prior to the initiation of the bone-modifying agent. Once the bone-modifying agent is implemented, there should be ongoing followup by the dentist on a routine schedule, for example, every six months following initiation of the BMA therapy. It's also important to realize that there are a series of modifiable risk factors which should be emphasized with the patient. For example, poor oral health, invasive dental procedures, ill-fitting dentures, uncontrolled diabetes mellitus, and tobacco use are all factors that have been associated with development of a MRONJ. All of these modifiable risk factors should be addressed, where appropriate, with the patient in advance of the bone-modifying agent. As far as elective dental alveolar surgery, these procedures, if they are not medically necessary, for example, extractions or alveoloplasties or implants, they should not be performed during active therapy with a bone-modifying agent being given at an oncologic dose. Now, exceptions to this may be considered when a dental specialist with expertise in prevention and treatment of MROJ has reviewed the benefits and risks of the proposed invasive procedures with the patient and the oncology team. In general, however, elective dental alveolar surgical procedures should be deferred while the patient is undergoing active therapy with a bone-modifying agent. If the dental alveolar surgery is performed, the patient should be evaluated by a dental specialist on a systematic and frequently scheduled basis, for example, every six to eight weeks until there is full mucosal coverage of the surgical site. And once again, communication between the dental team and the rest of the oncology team is absolutely paramount in assuring ongoing comprehensive care of the patient. Interestingly, there are still questions in the literature relative to whether or not there should be temporary discontinuation of bone-modifying agents prior to dental alveolar surgery. Unfortunately, there remains insufficient evidence to support or refute the need for discontinuation of the bone-modifying agent prior to dental alveolar surgery. And so the administration of the bone-modifying agent may be deferred at the discretion of the treating physician, in conjunction with discussion with the patient and the oral health provider. So it really becomes an individual judgment call by the treating physician relative to whether or not to temporarily discontinue the bone-modifying agent prior to dental alveolar surgery. Clinical question three involves the staging of MROJ. There are a number of well-established staging systems in the literature addressing severity and extent of MROJ. For example, the 2014 American Academy of Oral and Maxillofacial Surgeons Staging System is one example. Another example is the National Cancer Institute's Common Terminology Criteria For Adverse Events. And there is a 2017 International Task Force on O and J Staging System for MROJ that is available as well. So there are at least three well-established, widely utilized staging systems for MROJ. Having said this, it's important in the view of the panel that the same staging system should be used throughout an individual patient's MROJ course of care. And optimally, the staging should be performed by a clinician experienced with the management of MROJ. Clinical question four involves management of MROJ directly. Here, the recommendations talk in terms of initial treatment of MROJ, which is centered in conservative measures. Now, these conservative measures may include antimicrobial mouth rinses, antibiotics if clinically indicated, effective oral hygiene, and conservative surgical intervention such as a removal of a superficial bone spicule. In cases, however, of refractory MROJ, more advanced MROJ, aggressive surgical interventions, for example, mucosal flap elevations, bloc resections of necrotic bone may be used if MROJ is persisting and severely affects function despite conservative initial treatment. Clinical question five involves bone-modifying agents and whether they should be temporarily discontinued after a diagnosis of MROJ has been established. And once again, there is insufficient evidence to support or refute the discontinuation of the bone-modifying agents after a diagnosis of MROJ has been established. The bone-modifying agent may be deferred at the discretion of the treating physician, again in discussion with the patient and the oral health care provider. And finally, clinical question six involves what outcome measures that should be utilized in clinical practice to describe the response of MROJ lesion to treatment. During the course of MROJ treatment, the dentist, dental specialist, should communicate with a medical oncologist in an ongoing way, both the objective and subjective status of the lesion. The guideline presents a scale that can be utilized to describe the trajectory of the MROJ-- resolved, improving, stable, or progressive. The clinical course of MROJ may impact both local and systemic treatment decisions relative to the cessation or the recommencement of bone-modifying agents. So once again, it becomes very, very important that the ongoing interprofessional communication relative to the clinical course of MROJ-- resolved, improving, stable, or progressive-- be discussed with the oncology team. Great. Thank you, Dr. Peterson. So on that last note, how can oncologists, dental specialists, and dentists all work together to manage medication-related osteonecrosis of the jaw? Throughout these guidelines, we do emphasize the importance of collaboration among the cancer care team, dentist, and dental specialists in order to coordinate care and modify risk factors. It is very important that cancer care team and the dental care team speak the same language. Therefore, we spend time on clarifying the definitions, the diagnostic criteria, and staging of MROJ. As been said earlier, we have developed a new system to evaluate the response to treatment, which is based both on objective findings and symptoms. By using this scale, oncologists and dentists would be able to communicate more easily for the benefit of the patients. We emphasized the need for multidisciplinary discussion in a few critical points throughout the course of bone-modifying agent therapy. And it is most important in case of a planned oral surgery in a patient without MROJ or before aggressive surgical treatment of refractory MROJ. And how will these guideline recommendations affect patients, and what should they talk to their doctors about? There are a number of things that patients, providers, dental specialists, and medical oncologists can do to lessen the risk and prevent MROJ. Because the key to MROJ is prevention. Once MROJ is established, it's difficult to treat, impacting a patient's quality of life. So we want to prevent, reduce the risk of developing MROJ. Patients can do a number of things-- pursue good oral hygiene, stop smoking, or reduce smoking, and control their diabetes, for example. Those things lessen the risk of MROJ. Providers, dental providers, dental specialists, who are specialized in the area or providers, dentists otherwise in the community, when they encounter a patient that's contemplating bone-modifying agents, they can do what's called a complete dental screening exam, which involves a complete examination of the mouth, Panorex X-rays and X-rays as clinically indicated. We want to identify work in the mouth that needs to be repaired before initiating bone-modifying agents. That way, we don't have to deal with an emergent situation when it could be preventable prior to bone-modifying agents, because one of the single highest risk factors for MROJ is emergent dental work while you're on bisphosphonate or another anti-resorptive agent-- bone-modifying agents. So a dental screening exam is critical to prevent or reduce the risk of MROJ. And medical oncologists have a role too in communication with the dental specialists and really think hard about the indications for bone-modifying agents, whether it be for osteoporosis, whether it be for metastatic disease, and whether it be for anti-cancer effects. And finally, where can both patients and clinicians go to get more information on this topic or to find a dentist or a dental specialist? Now, as far as websites, ASCO, MASCC, and ISSO all have websites you can go to to find out more information about MROJ. Yeah, I think that's great advice. Our links for additional information are listed in the Clinical Practice Guideline as well. This is a really first step at a framework in trying to manage a side effect that affects our patients but is very multidisciplinary. And like Dr. Shapiro was saying, really the best way to prevent this is with proper communication between the dentist and the oncologist and making the patient aware of what is needed prior to commencement of these treatments. Well, it certainly sounds as though there are some important considerations for clinicians and patients. And I really hope that this guideline is widely read and makes a real impact on the management of osteonecrosis and the communication between oncologists, dental specialists, and dentists. So from me and all of our listeners, thank you all for coming on the podcast today to discuss "Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline."   Thank you. Thank you for having us. Thank you very much for this opportunity to contribute to this important discussion. Thank you for allowing me to participate in this important podcast. And thank you to all of our listeners for tuning into the ASCO Guidelines Podcast series. To read the full guideline, go www.asco.org/supportive-care-guidelines. And if you've enjoyed what you've heard today, please rate and review the podcast and refer the show to a colleague.

An interview with Dr. Noam Yarom, Dr. Charles Shapiro, Dr. Deborah Saunders and Dr. Doug Peterson on "Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline." This guideline addresses the prevention and management of MRONJ in patients with cancer. This guideline is intended for oncologists and other physicians, dentists, dental specialists, oncology nurses, clinical researchers, oncology pharmacists, advanced practitioners, and patients with cancer. Read the full guideline at www.asco.org/supportive-care-guidelines Find all of the ASCO podcasts at podcast.asco.org  TRANSCRIPT Disclaimer: 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. Hello, and welcome to the ASCO Guidelines podcast series. My name is Shannon McKernin. And today, I'm interviewing a panel of authors from "Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline." So could I have you each introduce yourselves for the listeners today? Thank you, Shannon. I'm Dr. Deborah Saunders. I'm the president of the International Society of Oral Oncology and was the section head for the Systematic Review on "Medication-Related Osteonecrosis of the Jaw," with MASCC and ISOO. I was a proud part of the steering committee and one of the authors. Thank you, Debbie. My name is Dr. Douglas Peterson. I am professor of oral medicine in the School of Dental Medicine at the University of Connecticut Health Center in Farmington, Connecticut. I am also a faculty member in the Head and Neck Cancer Oral Oncology Program at the university's Neag Comprehensive Cancer Center. I'm a member of the steering committee for this clinical practice guideline and one of the co-authors as well. In addition, and as of June 2019, I have been serving as chair elect during this next year for ASCO's Clinical Practice Guidelines committee. Thank you, Doug. My name is Noam Yarom. I'm an all medicine specialist from the Sheba Medical Center in Tel Aviv University in Israel. I'm serving as a culture of this guideline, and it is a pleasure to be with you today. Thanks, Noam. I am Dr. Charles Shapiro, professor of medicine at the Mt. Sinai Hospital in New York. And I'm co-chair of the guideline "Medical-Related Osteonecrosis of the Jaw." And I'm happy to be here. Thank you all for being here today to discuss this guideline on the podcast. So first, can you give us a general overview of what this guideline covers. Sure. So you know, ASCO and MASCC, as well as ISOO decided that it would be great to provide a practical evidence-based approach in a multidisciplinary type setting to address this important topic that impacts all of our professions, that being medication-related osteonecrosis of the jaw. It's terminology and its definition and the path that's varied and even part of this publication identifies the need for us to move forward with a concise definition and similar terminology, that being medication-related osteonecrosis of the jaw. Medication-related osteonecrosis of the jaw is defined as the presence of an exposed or bone that is probable by a probe in a patient that has a history or is undergoing present use of a bone-modifying agent. This being in the absence of any patients having received any radiation to the head and neck and the absence of metastatic lesions to the jaw. The importance of us identifying this definition and agreeing on the terminology allows us to move forward in future publication to better compare outcome and provide better prevention and treatment for our patients moving forward. And what are the key recommendations of this guideline? There are six clinical questions associated with this clinical practice guideline as well as a series of recommendations built within each of the clinical questions. Clinical question one is directed to the preferred terminology and definition for osteonecrosis of the jaw, both of the maxilla and the mandible, as associated with pharmacologic therapies in oncology patients. The panel recommends that the term medication-related osteonecrosis of the jaw, MROJ, be used when referring to bone necrosis associated with pharmacologic therapies. As Dr. Saunders has described, the definition contains three key elements-- current or previous treatment with a bone-modifying agent or angiogenic inhibitor, exposed bone, or bone that can be probed through an intra or extra-oral fistula in the maxillofacial region and that has persisted for longer than eight weeks. And third, no history of radiation therapy to the jaws and no history of metastatic disease to the jaws. Clinical question two is directed to specific steps that should be taken to reduce the risk of MRONJ. The recommendation begins with emphasizing the absolute importance of interprofessional communication of the oncology team with the dental team in advance of initiating the bone-modifying agent. For patients with cancer who are scheduled to receive a bone-modifying agent in a non-urgent setting, a comprehensive oral care assessment, including dental examination and periodontal examination and an oral radiographic exam when feasible to do so should be undertaken prior to initiating the BMA therapy. Once the dental care plan has been developed, it should be discussed with the dental team, the patient, and the rest of the oncology team and then implemented based on medically necessary dental procedures. These procedures should be performed prior to the initiation of the bone-modifying agent. Once the bone-modifying agent is implemented, there should be ongoing followup by the dentist on a routine schedule, for example, every six months following initiation of the BMA therapy. It's also important to realize that there are a series of modifiable risk factors which should be emphasized with the patient. For example, poor oral health, invasive dental procedures, ill-fitting dentures, uncontrolled diabetes mellitus, and tobacco use are all factors that have been associated with development of a MRONJ. All of these modifiable risk factors should be addressed, where appropriate, with the patient in advance of the bone-modifying agent. As far as elective dental alveolar surgery, these procedures, if they are not medically necessary, for example, extractions or alveoloplasties or implants, they should not be performed during active therapy with a bone-modifying agent being given at an oncologic dose. Now, exceptions to this may be considered when a dental specialist with expertise in prevention and treatment of MROJ has reviewed the benefits and risks of the proposed invasive procedures with the patient and the oncology team. In general, however, elective dental alveolar surgical procedures should be deferred while the patient is undergoing active therapy with a bone-modifying agent. If the dental alveolar surgery is performed, the patient should be evaluated by a dental specialist on a systematic and frequently scheduled basis, for example, every six to eight weeks until there is full mucosal coverage of the surgical site. And once again, communication between the dental team and the rest of the oncology team is absolutely paramount in assuring ongoing comprehensive care of the patient. Interestingly, there are still questions in the literature relative to whether or not there should be temporary discontinuation of bone-modifying agents prior to dental alveolar surgery. Unfortunately, there remains insufficient evidence to support or refute the need for discontinuation of the bone-modifying agent prior to dental alveolar surgery. And so the administration of the bone-modifying agent may be deferred at the discretion of the treating physician, in conjunction with discussion with the patient and the oral health provider. So it really becomes an individual judgment call by the treating physician relative to whether or not to temporarily discontinue the bone-modifying agent prior to dental alveolar surgery. Clinical question three involves the staging of MROJ. There are a number of well-established staging systems in the literature addressing severity and extent of MROJ. For example, the 2014 American Academy of Oral and Maxillofacial Surgeons Staging System is one example. Another example is the National Cancer Institute's Common Terminology Criteria For Adverse Events. And there is a 2017 International Task Force on O and J Staging System for MROJ that is available as well. So there are at least three well-established, widely utilized staging systems for MROJ. Having said this, it's important in the view of the panel that the same staging system should be used throughout an individual patient's MROJ course of care. And optimally, the staging should be performed by a clinician experienced with the management of MROJ. Clinical question four involves management of MROJ directly. Here, the recommendations talk in terms of initial treatment of MROJ, which is centered in conservative measures. Now, these conservative measures may include antimicrobial mouth rinses, antibiotics if clinically indicated, effective oral hygiene, and conservative surgical intervention such as a removal of a superficial bone spicule. In cases, however, of refractory MROJ, more advanced MROJ, aggressive surgical interventions, for example, mucosal flap elevations, bloc resections of necrotic bone may be used if MROJ is persisting and severely affects function despite conservative initial treatment. Clinical question five involves bone-modifying agents and whether they should be temporarily discontinued after a diagnosis of MROJ has been established. And once again, there is insufficient evidence to support or refute the discontinuation of the bone-modifying agents after a diagnosis of MROJ has been established. The bone-modifying agent may be deferred at the discretion of the treating physician, again in discussion with the patient and the oral health care provider. And finally, clinical question six involves what outcome measures that should be utilized in clinical practice to describe the response of MROJ lesion to treatment. During the course of MROJ treatment, the dentist, dental specialist, should communicate with a medical oncologist in an ongoing way, both the objective and subjective status of the lesion. The guideline presents a scale that can be utilized to describe the trajectory of the MROJ-- resolved, improving, stable, or progressive. The clinical course of MROJ may impact both local and systemic treatment decisions relative to the cessation or the recommencement of bone-modifying agents. So once again, it becomes very, very important that the ongoing interprofessional communication relative to the clinical course of MROJ-- resolved, improving, stable, or progressive-- be discussed with the oncology team. Great. Thank you, Dr. Peterson. So on that last note, how can oncologists, dental specialists, and dentists all work together to manage medication-related osteonecrosis of the jaw? Throughout these guidelines, we do emphasize the importance of collaboration among the cancer care team, dentist, and dental specialists in order to coordinate care and modify risk factors. It is very important that cancer care team and the dental care team speak the same language. Therefore, we spend time on clarifying the definitions, the diagnostic criteria, and staging of MROJ. As been said earlier, we have developed a new system to evaluate the response to treatment, which is based both on objective findings and symptoms. By using this scale, oncologists and dentists would be able to communicate more easily for the benefit of the patients. We emphasized the need for multidisciplinary discussion in a few critical points throughout the course of bone-modifying agent therapy. And it is most important in case of a planned oral surgery in a patient without MROJ or before aggressive surgical treatment of refractory MROJ. And how will these guideline recommendations affect patients, and what should they talk to their doctors about? There are a number of things that patients, providers, dental specialists, and medical oncologists can do to lessen the risk and prevent MROJ. Because the key to MROJ is prevention. Once MROJ is established, it's difficult to treat, impacting a patient's quality of life. So we want to prevent, reduce the risk of developing MROJ. Patients can do a number of things-- pursue good oral hygiene, stop smoking, or reduce smoking, and control their diabetes, for example. Those things lessen the risk of MROJ. Providers, dental providers, dental specialists, who are specialized in the area or providers, dentists otherwise in the community, when they encounter a patient that's contemplating bone-modifying agents, they can do what's called a complete dental screening exam, which involves a complete examination of the mouth, Panorex X-rays and X-rays as clinically indicated. We want to identify work in the mouth that needs to be repaired before initiating bone-modifying agents. That way, we don't have to deal with an emergent situation when it could be preventable prior to bone-modifying agents, because one of the single highest risk factors for MROJ is emergent dental work while you're on bisphosphonate or another anti-resorptive agent-- bone-modifying agents. So a dental screening exam is critical to prevent or reduce the risk of MROJ. And medical oncologists have a role too in communication with the dental specialists and really think hard about the indications for bone-modifying agents, whether it be for osteoporosis, whether it be for metastatic disease, and whether it be for anti-cancer effects. And finally, where can both patients and clinicians go to get more information on this topic or to find a dentist or a dental specialist? Now, as far as websites, ASCO, MASCC, and ISSO all have websites you can go to to find out more information about MROJ. Yeah, I think that's great advice. Our links for additional information are listed in the Clinical Practice Guideline as well. This is a really first step at a framework in trying to manage a side effect that affects our patients but is very multidisciplinary. And like Dr. Shapiro was saying, really the best way to prevent this is with proper communication between the dentist and the oncologist and making the patient aware of what is needed prior to commencement of these treatments. Well, it certainly sounds as though there are some important considerations for clinicians and patients. And I really hope that this guideline is widely read and makes a real impact on the management of osteonecrosis and the communication between oncologists, dental specialists, and dentists. So from me and all of our listeners, thank you all for coming on the podcast today to discuss "Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline."   Thank you. Thank you for having us. Thank you very much for this opportunity to contribute to this important discussion. Thank you for allowing me to participate in this important podcast. And thank you to all of our listeners for tuning into the ASCO Guidelines Podcast series. To read the full guideline, go www.asco.org/supportive-care-guidelines. And if you've enjoyed what you've heard today, please rate and review the podcast and refer the show to a colleague.

Thank you to this episode's sponsor, TherapyNotes. Get a 2-month free trial of TherapyNotes by going to www.TherapyNotes.com and using the promo code TherapyChat.  Welcome back to Therapy Chat! In today's podcast host Laura Reagan speaks to Kathy Steele about structural dissociation.  Kathy Steele is a psychotherapist, consultant, trainer, and author. She practices in Atlanta, Georgia, working with complex psychological trauma, dissociation, attachment issues, therapeutic impasse, therapist self-care, and many other related topics in psychotherapy. Kathy has been in private practice since 1985, and with Metropolitan Psychotherapy Associates in Atlanta, Georgia since 1988. She was Clinical Director of Metropolitan Counseling Services, a non- profit psychotherapy and training center until 2016. Kathy received her undergraduate degree from the University of South Carolina in 1978, and completed her graduate work at Emory University in 1983. She is a Past President and Fellow of the International Society for the Study of Trauma and Dissociation (ISSTD), and has also served two terms on the Board of the International Society for Traumatic Stress Studies (ISTSS). Kathy served on the International Task Force that developed treatment guidelines for Dissociative Disorders, and on the Joint International Task Force that has developed treatment guidelines for Complex Posttraumatic Stress Disorder. She has received a number of awards for her work, including the 2010 Lifetime Achievement Award from ISSTD, an Emory University Distinguished Alumni Award in 2006, and the 2011 Cornelia B. Wilbur Award for Outstanding Clinical Contributions from ISSTD. Kathy is known for her humor, compassion, respect, and depth of knowledge as a clinician and teacher, and for her capacity to present complex issues in easily understood and clear ways. She is sought as a consultant and supervisor, and as an international lecturer on topics related to trauma, dissociation, attachment, and psychotherapy. She enjoys collaborating with colleagues around the world on clinical, educational, and research projects. Kathy has (co)authored numerous book chapters, peer reviewed journal articles, and three books with her colleagues. Resources: https://www.kathy-steele.com  Download the free Therapy Chat app here  (ios only) Please consider supporting Therapy Chat by becoming a member on Patreon! Just $1 a month would make a huge impact to keep Therapy Chat going strong! To learn more head to - https://patreon.com/TherapyChat where members get special perks and swag too!  Leave me a message via Speakpipe by going to https://therapychatpodcast.com and clicking on the green Speakpipe button.  Thank you for listening to Therapy Chat! Please be sure to go to iTunes and leave a rating and review, subscribe and download episodes. You can also download the Therapy Chat app on iTunes by clicking here.  Podcast produced by Pete Bailey - https://petebailey.net/audio 

SO I’VE BEEN THINKING ABOUT THE CONVERSATION **THAT WE DID NOT HAVE THE OTHER NIGHT** AND THE DINNER **THAT BILLY DID NOT COOK THE OTHER NIGHT-** WHAT WE DID THO - WAS GO OUT TO ONE OF THE LOCAL CHAIN RESTAURANTS, ALBEIT ONE OF THE BETTER ONES TO HAVE A HAMBURGER. IT WAS KINDA NICE TO HAVE THAT BREAK FROM ALL THAT GOURMET COOKING - ADMIRING BILLS TECHNIQUE IN CREATING OUTSTANDING MEALS, SOME OF WHICH ARE ORIGINAL, SOME OF WHICH ARE JUST BETTER VERSIONS OF THE ONES WE HAVE IN RESTAURANTS. BUT I DIGRESS. IT WAS WHILE EATING THE HAMBURGER THAT I WAS EAVESDROPPING AMONG THE GUESTS SITTING AROUND US WHEN I OVERHEARD AN INTERESTING CONVERSATION ONE MORE SENIOR WOMAN COMPLAINED THAT SHE HADN’T DONE HER MAKEUP, AND THE GENTLEMEN SITTING ACROSS FROM HER ( I CAN ONLY ASSUME THAT WAS HER HUSBAND SAID “SARAH, WHAT DO YOU NEED MAKEUP FOR - WHO ARE YOU TRYING TO ATTRACT AT YOUR AGE. AT WHICH TIME THE OTHER WOMAN AT THE TABLE SAID. WELL HONEY YOU ARE LUCKY - AT YOUR AGE YOU ARE FREE NOW, YOU DON’T NEED MAKEUP ANYMORE. AT WHICH TIME SARAH SAID - ITS NOT THE MAKEUP, BUT THE FACT THAT I FORGOT TO PUT IT ON. THERE WERE SO MANY THINGS TO UNPACK IN THAT CONVERSATION - VANITY, AGING, BRAIN FUNCTION - SO I THOUGHT I’D SEARCH OUT SOME TRULY REMARKABLE PEOPLE TO ADDRESS MANY OF THOSE ISSUES. SO THAT’S WHAT WE’LL YAK ABOUT TODAY.---   Let’s face it people in western society are vain. Looking good is almost mandatory. You walk down the street in the big cities and they are teaming with fit, well clothed people with skin that is silky smooth. But often you see some men and woman, looking a bit disheveled, glasses held up by the tip of the nose. no makeup (not homeless) I just assume that they are intellectuals, professors, scientists etc. WHO DON’T FALL INTO SOCIETIES EXPECTATIONS ON BEAUTY I’ve always wondered what do those people think about Vanity. So I went and searched out someone who could give us a point of view of what the cost of vanity is. # Scilla ELWORTHSCILLA ELWORTHY [Dare to Question Why We Are So Afraid of Getting Older: Scilla Elworthy at TEDxMarrakesh 2012 - YouTube](https://youtu.be/J6zenOjPC1A)https://youtu.be/J6zenOjPC1A is the founder of the Oxford Research Group, a non-governmental Organisation she set up in 1982 to develop effective dialogue between nuclear weapons policy-makers worldwide and their critics. She served as its executive director from 1982 until 2003, when she left that role in order to set up Peace Direct, a charity THA SUPPORTS local peace builders in conflict areas. From 2005 she was adviser to Peter Gabriel, Desmond Tutu and Richard Branson in setting up The Elders. She is a member of the World Future Council and the International Task Force on Preventive Diplomacy. She has been nominated three times for the Nobel Peace Price and in 2003 she was awarded the Niwano Peace Prize for her work with the Oxford Research Group. ------# DR. THAD POLK DR. DAVID POLK - AGING IS NOT WHAT YOU THINK[Aging: It’s Not What You Think | Thad Polk | TEDxUofM - YouTube](https://youtu.be/wrTIS0uKg6o)https://youtu.be/wrTIS0uKg6o   e often talk about memory loss as we age. We’ve learned the tricks to help us out. Just ask Brad Zupp, our memory athlete. As a result, common wisdom says that age isn’t too kind to our minds abilities. But can iT brain actually be improving as we age. So why not look for someone who can explain it. Our brains are powerful pieces of machinery that give us the capacity to do amazing things. Unfortunately, common wisdom says that age isn’t too kind to our minds’ abilities. Neuroscientist Thad Polk walks through the actual effects of aging on the human brain and shows that our assumptions might not be so accurate.Dr. Thad Polk has been a member of the University of Michigan psychology faculty since 1996. he was named an Arthur F. Thurnau Professor in recognition of outstanding contributions to undergraduate education, and in 2012 Princeton Review included him on its list of the Best 300 Professors in the US. ------ # David Andrew Sinclair DAVID SINCLAIR - SLOWING DOWN AGING [David Sinclair Slowing down Aging - YouTube](https://youtu.be/9bhDgBhRgtk) https://youtu.be/9bhDgBhRgtkDR. DAVID POLK - AGING IS NOT WHAT YOU THINK[Aging: It’s Not What You Think | Thad Polk | TEDxUofM - YouTube](https://youtu.be/wrTIS0uKg6o)https://youtu.be/wrTIS0uKg6o hile we are speaking of aging. You constantly here that there is research being done that will slow down the aging process or halt it altogether - God forbid you have to live with that difficult family member forever. I tried to find someone who can explain in simple terms - what research is being done to slow down the aging process. HIS NAME IS DAVID SINCLAIR AND HE is an Australian biologist and Professor of Genetics best known for his research on the biology of lifespan extension and driving research towards treating diseases of aging. Sinclair is Co-Director of the Paul F. Glenn Laboratories for the Biological Mechanisms of Aging at Harvard Medical School. Sinclair obtained a Bachelors of Science (Honours Class I) at the University of New South Wales, Sydney, and received the Australian Commonwealth Prize. In 1995, he received a Ph.D. in Molecular Genetics then worked as a postdoctoral researcher at the Massachusetts Institute of Technology with Leonard Guarente.Since 1999 he has been a tenured professor in the Genetics Department of Harvard Medical School. Sinclair has received over 25 awards including The Australian Commonwealth Prize, A Helen Hay Whitney Fellowship, the Nathan Shock Award, a Leukemia and Lymphoma Fellow, a MERIT Awards from the National Institutes of Health, the Merck Prize, the Arminese Fellowship, the Genzyme Outstanding Achievement in Biomedical Science Award, an Ellison Medical Senior Fellow, the Bio-Innovator award, the Bright Sparks Award for Top Scientists under 40, The Denham Harman Award in Biogerontology, a medal from the Australian Society for Medical Research, and a TIME 100 honoree, TIME magazine’s list of the 100 “most influential people in the world” (2014).———— ------# Jane Caro JANE CARO[Growing old: The unbearable lightness of ageing | Jane Caro | TEDxSouthBank - YouTube](https://youtu.be/ULqf3OyemZY)https://youtu.be/ULqf3OyemZY Jane Caro has a low boredom threshold and so wears many hats; including author, novelist, lecturer, mentor, social commentator, columnist, workshop facilitator, speaker, broadcaster and award winning advertising writer. The common thread running through her career is a delight in words and a talent for using them to connect with other people. @JaneCaro@TEDxSouthBank This talk was given at a TEDx event using the TED conference format but independently organized by a local community. Learn more at [http://ted.com/tedx](https://www.youtube.com/redirect?event=video_description&v=ULqf3OyemZY&q=http%3A%2F%2Fted.com%2Ftedx&redir_token=Tr5pUh70swXaZsz0iwgFjacJeTR8MTU2Mjg1NjU2MUAxNTYyNzcwMTYx) My tits don’t hurt: Ever ---- I want to thank our sponsor for making Yak About Today possible AND THE NUMBER ONE TALK RADIO STATION IN OUR MARKET. We couldn’t do half of what we do without them. But that wouldn’t mean much if we didn’t believe in them. To my mind and many others they are simply the best practice to go to for both prevention as well as more serious eye conditions. So like i always say - go see Drs. Minotti Rhinehour, tate and o’brien because i wouldn’t trust my eyes to anyone else --- DAVID SINCLAIR - SLOWING DOWN AGING [David Sinclair Slowing down Aging - YouTube](https://youtu.be/9bhDgBhRgtk) https://youtu.be/9bhDgBhRgtkDR. DAVID POLK - AGING IS NOT WHAT YOU THINK[Aging: It’s Not What You Think | Thad Polk | TEDxUofM - YouTube](https://youtu.be/wrTIS0uKg6o)https://youtu.be/wrTIS0uKg6o SCILLA ELWORTHY[Dare to Question Why We Are So Afraid of Getting Older: Scilla Elworthy at TEDxMarrakesh 2012 - YouTube](https://youtu.be/J6zenOjPC1A)https://youtu.be/J6zenOjPC1A JANE CARO[Growing old: The unbearable lightness of ageing | Jane Caro | TEDxSouthBank - YouTube](https://youtu.be/ULqf3OyemZY)https://youtu.be/ULqf3OyemZY   ----------------------------------------------------------------- # SOCIAL MEDIA STUFF#yakabouttoday/SOCIAL Social Media Attachment for all publications “YOU CANT GO BACK AND CHANGE THE BEGINNING BUT YOU CAN START WHERE YOU ARE AND CHANGE THE ENDING. The Yak About Today broadcasts deliver on air and online conversations, interviews and stories engaging the Baby Boomer Generation and beyond with discussions, tips and information. YOU CAN FIND US ON THE STATIONS WAXE 107.9, WZTA 1370 AM AND REAL RADIO 101.7 IN FLORIDA AND OF COURSE ON ALL MAJOR PODCASTING SYSTEMS.YOU CAN ALSO GET US AT YAKABOUTTODAY.COM AND FACEBOOK AND TWITTER AND ALL SOCIAL PLATFORMS, JUST LOOK FOR YAK ABOUT TODAY. OR WRITE ME AT YAKABOUTTODAY@GMAIL.COM Hosted by an authentic conversationalist, intuitive listener and a boomer himself, David Yakir brings a genuine, down to earth and disarming personality that talks with his audience and his guests with out talking at them. David shares Engagement, Education, Enjoyment & Empowerment on air and online for the BabyBoomer Generation delivered with humor, wit and thought. Yak About Today is your GPS guide for technology, fitness, , finance entrepreneurship, entrepreneurship & all things that mean anything to you. For more information, visit: [http://yakirgroup.com/](http://yakirgroup.com/) [http://facebook.com/yakabouttoday/](http://facebook.com/yakabouttoday/) [http://twitter.com/yakabouttoday/](http://twitter.com/yakabouttoday/) [http://spanishriverconcerts.com](http://spanishriverconcerts.com)  

Renee McGregor shares on PHIT for a Queen “what is orthorexia & the movement #trainbrave”   Her background in clinical practice gave her valuable skills working with other disciplines Her love for running naturally drove her to sports nutrition Found her interest in clinical nutrition and sports dietitian blended her into specializing in eating disorders. Orthorexia is the obsession with eating correctly Trainbrave is an educational campaign to make runners aware of eating disorders and RED-S (relative energy deficiency in Sport) Found that there was a lack of resources for those that wanted to compete but weren’t elite athletes The disordered eating comes as a symptom of how to deal with discomfort Trainbrave opens the conversation not only for the athlete but the coaches as well These athletes tend to be looked over as they look “healthy”    Renee McGregor BSc (hons) PGDIP (DIET) PGCERT(sportsnutr) RD SENr   Renee is a leading Sports and Eating disorder specialist dietitian with over 15 years’ experience working in clinical and performance nutrition, with Olympic (London, 2012), Paralympic (Rio, 2016) and Commonwealth (Queensland, 2018) teams. She works with individuals, athletes of all levels and ages, coaches and sports science teams to provide nutritional strategies to enhance sport performance and manage eating disorders.  She is presently working with a number of national governing bodies and professional endurance teams including, Scottish Gymnastics, The GB 24 hour running squad, The EA Marathon development squad, pro-cyclists, and triathletes. She is regularly asked to work directly with high performing and professional athletes that have developed a dysfunctional relationship with food that is impacting their performance, health and career. She is the best-selling author of Training Food: Get the Fuel you Need, Fast Fuel: Food for Triathlon Success and Orthorexia: When Healthy Eating Goes Bad. She has spoken at many events including Stylist live, Cheltenham Literature and Science festivals, Google Talks and BBC News night. She has spoken on many podcasts including Food Psych, The Food Medic, Running for Real, Let's Get Running and Tough Girl. She is passionate about mental health and wellbeing and proud to be an ambassador for many charities involved in this field, including Head Talks and Anorexia and Bulimia Care. She is the co-founder of  #TRAINBRAVE a campaign raising the awareness of eating disorders in sport; providing resources and practical strategies to reduce the prevalence.  Her aim is to “Empower Balance in a Performance-Driven World”.  She is on the REDS advisory board for BASES (The British Association of Sport and Exercise Science) and I sit on the International Task Force for Orthorexia.  Renee has been invited to speak at several high profile events including The European Eating Disorder Society Annual Conference as the UK expert in Orthorexia, Cheltenham Literature Festival, Cheltenham Science Festival, The Stylist Show and Google. She writes for many national publications and is often asked to comment in the national press. She regularly contributes to radio and TV, including News night and BBC 5 Live.

Daimler is partnering with Bosch to bring an autonomous ride hailing service to San Jose next year. In this edition, the Director of Engineering at Bosch joins Princeton's Alain Kornhauser and co-host Fred Fishkin to outline how it will work. Plus Richard Bishop joins us fresh from an International Task Force on Vehicle Highway Automation in Denmark. And more! --- Support this podcast: https://anchor.fm/smart-driving-cars-podcast/support

This week on MIA Radio, we present a special episode of the podcast to join in the many events being held for World Benzodiazepine Awareness Day, July 11, 2018. In part 1, we chat with W-BAD Lead Operations Volunteer and Virginia Representative Nicole Lamberson who talks about the events being held for W-BAD. We hear from psychiatrist Dr Josef Witt-Doerring, who talks about a recent paper he co-authored entitled “Online Communities for Drug Withdrawal: What Can We Learn?”. We also hear from therapist and campaigner Chris Paige who discusses his own experiences taking and withdrawing from benzodiazepines. Finally, in part 2 of the interview, we get to chat with Robert Whitaker, science journalist and author of the books Mad in America and Anatomy of an Epidemic. First, I am very fortunate to have had the chance to talk with Nicole Lamberson. Nicole is Lead Operations Volunteer and Virginia Representative for W-BAD and she has kindly taken time out of her busy preparations to talk about how she became involved with W-BAD, some of the events and campaigns being held around the world and how people can get involved. Nicole has an immense passion for benzodiazepine awareness and its victims and hopes that her efforts ultimately spare many others from taking this painful, senseless, and totally preventable iatrogenic “journey”. We discuss: How Nicole first became involved with W-BAD. How discovering personal testimonies encouraged her to reach out to find out more about an awareness day held on the birthday of Dr Heather Ashton - July 11. What it feels like to be part of the benzodiazepine community. How there is is still no medical consensus about the effects of both taking and withdrawing from benzodiazepines. The W-BAD T-shirt campaign, which was organised in partnership with the Benzodiazepine Information Coalition and As Prescribed, an in-production documentary by Holly Hardman. Pamphlet distributions happening in Auckland, Paris, Boston and Torrington. That Wayne Douglas, W-BAD founder is on the Dr Peter Breggin hour on July 11 at 4pm New York time. That people can visit W-BAD events to find out more. That on social media, people can follow events using @WorldBenzoDay and the hashtag #WorldBenzoDay. That people can participate in many ways and that one of the most important ways to participate is to submit reports of adverse effects and withdrawal reactions to the appropriate regulator, links to which can be found on the W-BAD website. How important it is to share stories and personal experiences. That W-BAD is for anybody, not just those who are damaged by the drugs but also for families and friends and those recovered too. Relevant links: W-BAD [IN]VISIBLE T-shirt campaign How to participate in W-BAD Benzodiazepine Information Coalition As Prescribed by Holly Hardman (documentary film in production) International Task Force on Benzodiazepines Dr Heather Ashton The 2017 W-BAD podcast featuring Professor Malcolm Lader, Jocelyn Pedersen and Barry Haslam. Next, we chat with psychiatrist Dr Josef Witt-Doerring. Josef trained in Queensland, Australia before becoming a psychiatric resident at Baylor College of Medicine, Houston, Texas. He co-authored a paper published in Psychiatric Times entitled “Online Communities for Drug Withdrawal: What Can We Learn?” which received praise for openly addressing the issues of dependence and withdrawal and identifying the support activity that goes on in forums like Benzo Buddies and Surviving Antidepressants. We discuss: What led Dr Witt-Doerring to become a psychiatric trainee after attending medical school in Queensland, Australia. How reading Anatomy of an Epidemic led to an awareness of some of the consequences of psychiatric drug use from a critical perspective. What led to his research into online support forums for those who are seeking support for psychiatric drug withdrawal. That Josef was surprised at the amount of support activity in online forums like Benzo Buddies and Surviving Antidepressants. How the paper that Josef co-authored on learning from online communities found a great deal of support both amongst colleagues and patient advocacy organisations. How he feels that there is a general lack of awareness of dependence and withdrawal issues because the messages can be drowned out by more strident communications in marketing or promotional material. That the idea of ‘treatment resistant’ conditions is probably much more on a general doctors mind than adverse reactions or protracted withdrawal experiences. How Josef’s experiences have influenced his approach to prescribing central nervous system drugs. That he would like to think that if a doctor and patient can talk frankly and openly about the pros and cons of treatment, then that is likely to lead to a better relationship and a better outcome. That there is a dearth of support services for people struggling with the drugs, particularly at the end of treatment. How academic detailing programmes could help raise awareness and disseminate information that would lead to doctors being more confident about de-prescribing. How the language of addiction and dependence can sometimes be a barrier to recognition of drug withdrawal issues. That it may be better to look through a neurological injury lens rather than an addiction lens both in terms of understanding experiences but also to enable better treatment and support options. That the community of those affected should continue to share their stories and to raise petitions with professional organisations, such as the boards that licence psychiatrists and OBGYN’s. How, because of the huge variation in patient experience, it would be very difficult to mandate short-term prescribing. Relevant links: Online Communities for Drug Withdrawal: What Can We Learn? Benzo Buddies Benzodiazepine Information Coalition Surviving Antidepressants Malcolm Lader: Anxiety or depression during withdrawal of hypnotic treatments Our next guest is Chris Paige. Chris has a bit of an 'inside' perspective to add to the conversation for World Benzodiazepine Awareness Day in that he is a licensed therapist of over 20 years who was iatrogenically injured by a prescribed benzodiazepine. Chris has practised in a variety of settings including hospitals, schools, and foster homes and has taught at the undergraduate and graduate level. He has presented papers at national and international conferences, appeared on Dateline NBC for his work with children of divorce and had his own national magazine column called 'On The Couch with Chris Paige'. Chris is on the board the Benzodiazepine Information Coalition, a non-profit organization that advocates for greater understanding of the potentially devastating effects of commonly prescribed benzodiazepines as well as prevention of patient injury through medical recognition, informed consent, and education. Chris currently resides and practices in Florida. We discuss: How Chris first came to be prescribed a benzodiazepine in 2000. His recollections of being prescribed Klonopin (Clonazepam) for anxiety, taking between 1 and 2 milligrams per day. How, after three years use, he started to notice tremors and memory loss. That a neurologist explained that his symptoms may be medication related and advised a taper but gave no specific instructions. How Chris came off the Klonopin fairly rapidly but didn’t find it too difficult at the time. How, some years later, he was given an antibiotic for a prostate infection but rapidly developed psychiatric symptoms including anxiety, agitation and insomnia. That this led Chris to consult a doctor for some Klonopin tablets to manage this and that he took a total of 16 milligrams over the next 10 weeks. That he understands now that the antibiotic and the Klonopin compete at the same receptor in the brain, leading immediately to a tolerance to the drug. That because of this tolerance he became more sleepless, more agitated and more anxious and working was becoming increasingly difficult. How he came to be in a five-day detox programme in Vermont, where they took him off one and a quarter milligrams of Klonopin in just five days. How Chris realised that the detox approach was not right and wanted to leave. How the detox programme decided to replace the Klonopin with four different psychiatric drugs, two of which he has now ceased with two still to taper. That he felt that his brain and nervous system were severely shocked by making such rapid medication changes. How this led to Chris being admitted to psychiatric hospital which he describes as “possibly one of the most humiliating experiences he has ever endured.” How Chris felt when experiencing akathisia which was a relentless compulsion to move and gave him a feeling as if his whole body was being electrocuted and that he had been lit on fire. That he initially felt supported by friends and family but that quickly eroded when he didn't get better or accept harmful and dangerous treatment advice. That this led to the misunderstanding of his injury and it being mislabeled as an addiction problem. That ultimately the only places he found validation and support were online support forums. The losses that Chris endured during his struggles including his health, his psychotherapy practice and even his reputation. That Chris’s message is that there is hope for the future and the importance of reconnecting with the simple things in life. The lack of acknowledgement of the impact of trauma on a person’s life. Relevant links: Benzodiazepine Information Coalition Chris's profile at BIC In part 2 of this podcast, we will hear from science journalist and author Robert Whitaker.

This week on MIA Radio, we present a special episode of the podcast to join in the many events being held for World Benzodiazepine Awareness Day, July 11, 2018. In part 2 of the podcast, we interview Mad in America founder, Robert Whitaker. For many of us, Robert needs no introduction as he is well known for his award-winning book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, which was released in 2010. Robert has been a medical writer at the Albany Times Union newspaper, A journalism fellow at the Massachusetts Institute of Technology and Director of publications at the Harvard Medical School. Besides many papers, journals and articles, Robert has written five books which include Mad In America: Bad Science, Bad Medicine, and The Enduring Mistreatment of the Mentally Ill in 2001, Anatomy of an Epidemic in 2010 and Psychiatry Under The Influence: Institutional Corruption, Social Injury, and Prescriptions for Reform published in 2015. We discuss: What took Bob from writing as an industry insider covering clinical trials to founding Mad in America. How writing a story about the botched introduction of laparoscopic surgery led to an interest in how commerce was corrupting healthcare. How Freedom of Information requests led to an understanding of the corruption in the clinical trials of antipsychotic drugs. What led to writing the book Mad in America: Bad Science, Bad Medicine, and The Enduring Mistreatment of the Mentally Ill in 2001. That, when you look at the science, you see an enduring theme in psychiatry of treatments that are full of promise, but ultimately can lead to harm. That Bob came to these issues as a journalist who felt a sense of public duty to be an honest reporter of the facts and the science. The extraordinary history behind the revival of the market for benzodiazepines. How Valium became the western world’s most prescribed psychiatric drug during the late 1960s. How, in the 1970s, it became apparent that people were struggling to get off the drugs. That women’s magazines started to write about the experiences of women addicted to Valium, and it was recognised as a bigger issue than heroin addiction. That the reaction by the pharmaceutical manufacturers was to reconceptualize anxiety-related distress as depressive distress and move patients on to SSRIs. How in 1980, in the third version of the Diagnostic and Statistical Manual, a new disorder is named: Panic Disorder, leading the maker of Alprazolam, Upjohn, to get it approved specifically for the treatment of panic disorder. How the study published showed that the reduction in panic attacks in the medicated group over four weeks was greater than the unmedicated group, but the study actually ran for eight weeks, by which time there was no difference between the medicated and unmedicated groups. That in the six-week withdrawal phase of the study, 44% were not able to stop the drugs. How newspapers reported that Xanax (Alprazolam) was an efficacious, safe and non-addictive treatment for panic disorder. That what you see in the heart of the Xanax story is a betrayal of the public. The reasons why doctors often don’t review the papers that would lead them to conclude that benzodiazepines are highly problematic drugs. A paper from a new International Task Force on Benzodiazepines which seems to be a statement of intent to increase benzodiazepine prescribing. That people should keep on telling their stories of withdrawal and iatrogenic harm. The attempt in Massachusetts to pass a bill requiring informed consent. The problems inherent in using the language of withdrawal when the symptoms are protracted and that it would be more appropriate to describe this as a neurological injury. That the benzodiazepine community is doing an incredible service by alerting the public to what should be seen as a public health crisis. Relevant links: Revival of the market for Benzodiazepines Malcolm Lader: It is more difficult to withdraw people from benzodiazepines than it is from heroin International Task Force on Benzodiazepines    

The liberal international order is showing increased strain as President Trump continues to conduct U.S. foreign policy. So, much has been happening recently: the chaos of the G7 Charlevoix gathering with President Trump withdrawing the U.S. signature from the summit communiqué. The on-again off-again summit between North Korea’s Kim Jung Un and President Trump took place on June 12th leaving most grasping to understand what the two leaders had in fact agreed to at the Singapore summit. These and other actions formed the core of the podcast discussion with Bruce Jones. Bruce is the Vice President and Director – Foreign Policy at the Brookings Institution as well as being a Senior Fellow in the Project on International Order and Strategy at Brookings. Bruce wrote an insightful book on the changing liberal order – “Ours to Lead: America, Rising Powers, and the Tension between Rivalry and Restraint” in 2014 and with Carlos Pascual and Steve Stedman in 2009 he co-authored “Power and Responsibility: Building Order in an Era of Transnational Threats”. Jones has had extensive experience and expertise on intervention and crisis management. He served in the United Nations' operation in Kosovo and was special assistant to the U.N. special coordinator for the Middle East peace process. Jones also has significant experience on multilateral institutions. He was a senior advisor to Kofi Annan on U.N. reform and served as deputy research director to the U.N.'s High-level Panel on Threats, Challenges and Change, as well as lead scholar for the International Task Force on Global Public Goods. Come join Bruce and I in our discussion on ‘Shaking the Global Order'.

Hans Wagner, FSA, has 30 years of experience in insurance and consulting. He has worked in Australia, China, Europe, the United States and Asia. He is currently the chief actuary and chief risk officer for ICBC-AXA Life in Shanghai. In this episode, Wagner provides insight into his experiences working in a variety of countries and discuss his perspective on the insurance industry and actuarial profession in China. Wagner is an active volunteer and presenter for the Society of Actuaries (SOA) and serves on the SOA China Committee and International Task Force.  Listen at Your Own Risk SOA Website Did you like this episode? Please leave a review on iTunes with your feedback! Also, please subscribe to Listen at Your Own Risk on iTunes, to get notified when a new episode gets released. Thank you for listening to this week’s show, and tune in next time for another great guest.

My guest is Renee McGregor. Renee is a Performance and Eating Disorders Specialist Dietitian. As part of her very impressive career so far she has been the dietitian for athletes at the London 2012, Rio 2016 Olympic and Paralmpic Games, and the 2018 Commonwealth Games. In addition, she is a member of the International Task Force on Orthorexia. Orthorexia is a relatively new mental health condition which is characterised by a dangerous obsession with clean or ‘perfect’ eating, and its rise has been linked to the growth in wellness bloggers and influencers promoting restrictive diets on social media.In this conversation Renee gives some incredibly touching, and at times shocking, descriptions of the struggles of some of the people she has worked with, really illuminating the seriousness of the challenge of eating disorders and feeding problems and why she, I and others care so much that the information about food, diet and nutrition that is out there on social media is safe and accurate. See acast.com/privacy for privacy and opt-out information.

Host:  Jerry Johnson Guest:  Wesley J. Smith, attorney, author and Senior Fellow at the Discovery Institute, attorney for the International Task Force on Euthanasia and Assisted Suicide, and special consultant for the Center for Bioethics and Culture. 

Welcome back to Therapy Chat! This week, due to a death in the family, host Laura Reagan is away and replaying a past episode which relates complex trauma, dissociation and EMDR. This week, Laura revisits her conversation with Kathy Steele on Structural Dissociation. Kathy Steele is a psychotherapist, consultant, trainer, and author. She practices in Atlanta, Georgia, working with complex psychological trauma, dissociation, attachment issues, therapeutic impasse, therapist self-care, and many other related topics in psychotherapy.Kathy has been in private practice since 1985, and with Metropolitan Psychotherapy Associates in Atlanta, Georgia since 1988. She was Clinical Director of Metropolitan Counseling Services, a non- profit psychotherapy and training center until 2016. Kathy received her undergraduate degree from the University of South Carolina in 1978, and completed her graduate work at Emory University in 1983.She is a Past President and Fellow of the International Society for the Study of Trauma and Dissociation (ISSTD), and has also served two terms on the Board of the International Society for Traumatic Stress Studies (ISTSS). Kathy served on the International Task Force that developed treatment guidelines for Dissociative Disorders, and on the Joint International Task Force that has developed treatment guidelines for Complex Posttraumatic Stress Disorder.She has received a number of awards for her work, including the 2010 Lifetime Achievement Award from ISSTD, an Emory University Distinguished Alumni Award in 2006, and the 2011 Cornelia B. Wilbur Award for Outstanding Clinical Contributions from ISSTD.Kathy is known for her humor, compassion, respect, and depth of knowledge as a clinician and teacher, and for her capacity to present complex issues in easily understood and clear ways. She is sought as a consultant and supervisor, and as an international lecturer on topics related to trauma, dissociation, attachment, and psychotherapy. She enjoys collaborating with colleagues around the world on clinical, educational, and research projects. Kathy has (co)authored numerous book chapters, peer reviewed journal articles, and three books with her colleagues.Learn more about Kathy's work here: https://www.kathy-steele.comAdditional resources:I'm excited to invite you to a special free webinar presented by my colleague and prior Therapy Chat guest, the renowned therapist and teacher Dr. Janina Fisher, on April 14, 2023, at 12pm PDT / 3pm EDT / 7pm UTC. Sign up and you'll receive the replay if you can't attend live. Reserve your spot now: [Register Now] Undoing the Damage: Healing from the Shame of TraumaIn partnership with the Academy of Therapy Wisdom, I'm excited to invite you to a free webinar offered by my colleague, Juliane Taylor Shore. Jules is a gifted therapist who likes to geek out on neuroscience and then share it in ways that therapists can understand and apply. She'll do just that in this webinar on Memory Reconsolidation for Anxiety. Register here for free! Therapists, join the waiting list for Trauma Therapist Network membership. We now have new membership levels and options for Group Practice Owners and Canadian therapists! Get the details and join the waiting list to receive first access when membership reopens here: https://go.traumatherapistnetwork.com/join ! What is TTN? Go here to check it out!Therapists - Attend another free webinar presented by Dr. Janina Fisher. In this recorded webinar, Healing the Shame of our Fragmented Selves, Janina will address helping clients who struggle with shame and self-loathing. As a special gift, when you register for the free webinar, you'll also get access to two one-hour trainings from Dr. Fisher so you can learn the foundation of her Trauma-Informed Stabilization Treatment model right away.Therapists - get free trainings on Energy Work and Spirituality with trauma survivors from Dr. Frank Anderson and save on his training when you register here!Find Laura's most frequently recommended resources for learning about trauma here - includes recommended books and trainings.Love Therapy Chat? Leave a rating and review on Apple podcasts to help more people find the show!Get our free PDF download to learn about the 5 mistakes most people make when searching for a trauma therapist here!Thank you to TherapyNotes for sponsoring this week's episode! TherapyNotes makes billing, scheduling, notetaking, and telehealth incredibly easy. And now, for all you prescribers out there, TherapyNotes is proudly introducing E-prescribe! Try it today with no strings attached, and see why everyone is switching to TherapyNotes, now featuring E-prescribe! Use promo code "chat" at www.therapynotes.com to receive 2 FREE months of TherapyNotes!Podcast produced by Pete Bailey - https://petebailey.net/audio Advertising Inquiries: https://redcircle.com/brands

This week Kathy Steele returns to The Trauma Therapist | Podcast and I couldn’t be more happy, and honored. Kathy returns with the 2017 ISSTD Pierre Janet Writing Award under her arm she received for her new book, Treating Trauma-Related Dissociation: A Practical, Integrative Approach. Kathy has been offering consultation and training for the past 30 years in the areas of complex trauma, dissociation, and attachment. She is a sought after consultant, supervisor, and international lecturer and trainer. Kathy is a Past President and Fellow of the International Society for the Study of Trauma and Dissociation (ISSTD), and has served on the Board of the International Society for Traumatic Stress Studies (ISTSS), as well as served on the International Task Force that developed treatment guidelines for Dissociative Disorders. Currently. Kathy is in a Joint Task Force that is developing treatment guidelines for Complex PTSD. Kathy has authored and co-authored numerous book chapters, journal articles, and two award-winning books on trauma and dissociation with Dutch colleagues: The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization (Norton Series on Interpersonal Neurobiology), and her most recent work, Coping with Trauma Related Dissociation Skills Training for Patients and Therapists. This most recent work just won The Pierre Janet Writing Award from the International Society for the Study of Trauma and Dissociation last week. One of her current projects is a third book on treatment of trauma-related dissociation focused on the issues that clinicians often bring to supervision.Support this podcast at — https://redcircle.com/the-trauma-therapist-podcast-with-guy-macpherson-phd-inspiring-interviews-with-thought-leaders-in-the-field-of-trauma/donationsWant to advertise on this podcast? Go to https://redcircle.com/brands and sign up.