Podcasts about oregon health science university

Originally published April 15, 2021: Did you know that sitting for more than 30 minutes at a time can negatively affect your body in ways comparable to smoking a pack of cigarettes a day? For those with conditions like diabetes or chronic pain, inactivity only makes things worse. In this episode, Dr. Allen Lycka sits down with expert physical therapist Colin Hoobler to explore how simple, consistent movement can significantly improve your physical and mental well-being—especially as we age.   Whether you're managing a health condition or simply looking to build healthier habits, Colin shares practical guidance on how to get moving safely—at home or elsewhere—and how to find trustworthy sources of support. If you're over 50, the stakes are even higher, but so are the potential rewards. Learn how to reduce your health risks, elevate your mood, and start a routine that works for your life.   Guest Bio: Colin Hoobler, DPT, MPT, MS, BS, brings over two decades of experience in physical therapy, with a strong focus on fall prevention and chronic disease management in older adults. He's served as a guest professor at top institutions including Oregon Health & Science University and has educated future healthcare professionals on using exercise as medicine. Colin created and hosted The Fitness Show on PBS and served as NBC's regional health expert. He's also a longtime health columnist for The Oregonian, founder of the non-profit CARE (Coalition for Active Resident Engagement), and host of the Choose Your Age podcast. A former competitive bodybuilder, Colin brings both scientific expertise and personal passion to the conversation about aging well and staying active.   Social media links Colin Hoobler: Facebook - https://www.facebook.com/colin.hoobler.75 X - https://twitter.com/colinhoobler?lang=en LinkedIn - https://www.linkedin.com/in/colin-hoobler-622aab1a3/ Website - https://www.conniepheiff.com/ and https://talentconcierge.co/   Thanks for listening to the show! It means so much to us that you listened to our podcast! If you would like to continue the conversation, please email me at allen@drallenlycka.com or visit our Facebook page at http://www.facebook.com/drallenlycka. We would love to have you join us there, and welcome your messages. We check our Messenger often.   This show is built on “The Secrets to Living A Fantastic Life.” Get your copy by visiting: https://secretsbook.now.site/home   We are building a community of like-minded people in the personal development/self-help/professional development industries, and are always looking for wonderful guests for our show. If you have any recommendations, please email us!   Dr. Allen Lycka's Social Media Links Facebook: http://www.facebook.com/drallenlycka Instagram:  https://www.instagram.com/dr_allen_lycka/ X:  https://X.com/drallenlycka YouTube:  https://www.youtube.com/c/DrAllenLycka/ LinkedIn:  https://www.linkedin.com/in/allenlycka/   Subscribe to the show. We would be honored to have you subscribe to the show, just use the podcast app on your mobile device.   Leave a review! We appreciate your feedback, as every little bit helps us produce even better shows. We want to bring value to your day, and have you join us time and again.  Ratings and reviews from our listeners not only help us improve, but also help others find us in their podcast app. If you have a minute, an honest review on iTunes or your favorite app goes a long way! Thank you!

Sandeep A Saha, MD, MS, FHRS, Oregon Heart Center PC is joined by Saket Sanghai, MD, FHRS, Oregon Health & Science University, and Naga Venkata Krishna Chand Pothineni, MD, Kansas City Heart Rhythm Institute, to discuss how the study evaluated the effectiveness of implantable loop recorders (ILRs) in detecting arrhythmias in patients with hypertrophic cardiomyopathy (HCM). Traditional monitoring methods, like Holter monitors, often miss intermittent arrhythmic events in HCM patients. ILRs, offering continuous long-term monitoring, were found to identify clinically significant arrhythmias that might otherwise go undetected. The findings suggest that ILRs can play a crucial role in risk stratification and management of HCM patients, potentially guiding decisions regarding interventions such as implantable cardioverter-defibrillator (ICD) implantation. Overall, ILRs enhance the detection of arrhythmias in HCM, leading to improved patient care.    https://www.hrsonline.org/education/TheLead https://www.jacc.org/doi/10.1016/j.jacep.2025.03.005 Host Disclosure(s): S. Saha: Honoraria/Speaking/Consulting Fee: Medtronic Membership on Advisory Committees: Medtronic Inc. Contributor Disclosure(s): S. Sanghai: Research: Siemens Healthcare Stocks (Publicly Traded): Apple Inc., Alphabet Inc., Amazon Stock Options (Publicly Traded): Intel K. Pothineni: Honoraria/Speaking/Consulting Fee: Medtronic, Inc., Biosense Webster, Inc., Boston Scientific

In this episode of Prescription for Success, host Dr. Randy Cook speaks with Dr. Elizabeth "Lizzie" Lieberman, an orthopedic surgeon specializing in adult reconstruction and a core faculty member at Oregon Health & Science University. Dr. Lieberman shares her journey into medicine, reflecting on her unconventional path—initially resistant to following in her father's (a urologist) footsteps before finding her passion in orthopedics. She discusses the challenges of entering medical school off the waitlist, the exhilaration of surgical rotations, and the pivotal moment she realized orthopedics was her calling. A significant portion of the conversation focuses on diversity in medicine, particularly the underrepresentation of women in orthopedic surgery. Dr. Lieberman, an advocate for inclusivity, highlights systemic biases and the importance of mentorship and early exposure to shift demographics. She also offers her "prescriptions for success," emphasizing a growth mindset, embracing discomfort, and the power of assuming good intent in professional interactions. Her insights serve as both inspiration and a roadmap for aspiring surgeons navigating similar challenges in medicine.   -+=-+=-+=-+= Join the Conversation! We want to hear from you! Do you have additional thoughts about today's topic? Do you have your own Prescription for Success? Record a message on Speakpipe   Unlock Bonus content and get the shows early on our Patreon Follow us or Subscribe: Apple Podcasts | Google Podcasts | Stitcher | Amazon  | Spotify --- There's more at https://mymdcoaches.com/podcast Music by Ryan Jones. Find Ryan on Instagram at _ryjones_, Contact Ryan at ryjonesofficial@gmail.com Production assistance by Clawson Solutions Group, find them on the web at csolgroup.com

Embryo donation is an incredible path to parenthood, offering hope to those who may not have other options. In this episode, I'm joined by Dr. Paula Amato, a reproductive endocrinologist and professor at Oregon Health & Science University, to discuss her personal and professional experiences with embryo donation. Dr. Amato shares her unique perspective as both a fertility doctor and someone who has gone through the process herself. We talk about the medical and ethical considerations of embryo donation, who it can benefit, and how families can navigate this journey. Dr. Amato also discusses the emotional aspects of embryo donation, including what it means for donors and recipients, and how transparency can play a role in shaping the future of donor-conceived children. In this episode, we cover: Dr. Paula Amato's professional background and personal connection to embryo donation The medical, ethical, and legal aspects of embryo donation Who embryo donation can help and what the process involves Emotional considerations for both donors and recipients The role of transparency and disclosure in donor-conceived families The future of embryo donation in reproductive medicine Read the full show notes on my website. You can read her article here: https://www.fertstert.org/article/S0015-0282(21)02289-5/fulltext IVF Class: Do you have questions about IVF? Click here to join me for The IVF Class. The next live class call is on Monday, March 10, 2025, at 4pm PST, where I'll explain IVF and Egg Freezing, and there will be time to ask your questions live on Zoom. Other ways to reach me: Visit my YouTube channel for more fertility tips! Subscribe to the newsletter to get updates. Join Egg Whisperer School. Request a Consultation with me. Dr. Aimee Eyvazzadeh is one of America's most well-known fertility doctors. Her success rate at baby-making gives future parents hope when all hope is lost. She pioneered the TUSHY Method and BALLS Method to decrease your time to pregnancy. Learn more about the TUSHY Method and find a wealth of fertility resources at www.draimee.org.

Chris Hoekstra, PT, DPT, PhD, OCS, FAAOMPT Chris received his PhD in biomedical informatics from Oregon Health & Science University, School of Medicine, his Masters of Science and Doctor of Physical Therapy degrees from Pacific University and undergraduate degree in biology from Willamette University.  He is board certified in orthopedics and Fellow of the American Academy of Orthopedic Manual Therapy.  Additionally, he completed a post-doctoral fellowship in clinical informatics through the National Library of Medicine.   He has worked as a physical therapist, clinic director, Health IT consultant, and more recently Chief Clinical Transformation Officer for Therapeutic Associates Inc.  In that role he has overseen the company's strategy related to the use of organizational data in business and clinical decision making, clinical and business information systems selection and optimization, quality improvement efforts, and value-based care initiatives. With Hychara Health, Chris oversees product development, program and project management, and sales and marketing strategy.  Additionally, he has worked with company subject matter experts to create an advisory services practice.   He is also an Assistant Professor in the Department of Medical Informatics and Clinical Epidemiology of the Oregon Health & Science University School of Medicine, where he teaches courses in organizational behavior and qualitative research.  He also continues his research focused on usability and end-user adoption of health information technology.  Additionally, he is a member of a multi-disciplinary AHRQ and NLM- funded research team with research focused on establishing safe training and effective use of medical scribes.   Chris has dedicated his career to improving clinicians' and business leaders' use of information in their daily decision making.  His work and research focus on refining a sociotechnical framework that integrates information systems with organizational strategy, team dynamics, workflow design, and information visualization to allow practices and providers to thrive in the changing value-based healthcare landscape.   Outside of his professional work, Chris has been active as a youth football coach for > 14 years, a Reserve Deputy Sheriff for nine years, and most recently an operations officer with a Military Police battalion of the Tennessee State Guard.  Additionally, he has served on numerous community and professional advisory boards. 

Blood-based biomarkers for dementia diagnosis are emerging and rapidly evolving. These fluid biomarkers should be used when the results will impact management decisions, including patient and family counseling, symptomatic therapies, and disease-modifying therapies. In this episode, Allison Weathers, MD, FAAN, speaks with Joseph F. Quinn, MD, FAAN, an author of the article “Fluid Biomarkers in Dementia Diagnosis,” in the Continuum® December 2024 Dementia issue. Dr. Weathers is a Continuum® Audio interviewer and associate chief medical information officer at the Cleveland Clinic in Cleveland, Ohio. Dr. Quinn is a professor in the Department of Neurology at Oregon Health & Science University in Portland, Oregon. Additional Resources Read the article: Fluid Biomarkers in Dementia Diagnosis Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Transcript Full interview transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Weathers: This is Dr Allison Weathers. Today, I'm interviewing Dr Joseph Quinn, author along with Dr Nora Gray, of Fluid Biomarkers in Dementia Diagnosis from the December 2024 Continuum issue on dementia. Welcome to the podcast and please introduce yourself to our audience. Dr Quinn: Sure. I'm Joe Quinn. I'm a neurologist at the medical school in Oregon, Oregon Health Science University, and I work in neurodegenerative disease, Alzheimer's disease, and Parkinson's disease.  Dr Weathers: Certainly some really weighty topics. But again, as I said, today we want to focus on a really fascinating one, the concept of fluid biomarkers in dementia diagnosis. And we'll perhaps get into monitoring of treatment as well. So, this search for reliable biomarkers in the diagnosis of dementia, certainly not a new topic, but you and your co-author Dr Nora Gray did a really fantastic job in the article right from the get-go, laying out the urgency around this now that there are FDA of treatments that depend on pathologic diagnosis. And it feels like they're more and more announced by the day. Even as I was preparing for this interview a few days ago, the FDA approval for donanemab was announced, with the news making every major media outlet. Well, there are several really critical points made by you both in the article. What do you feel is the most important clinical message of your article? What do you want our listeners to walk away with as their one key takeaway?  Dr Quinn: I think we still have the best evidence for CSF biomarkers, cerebrospinal fluid biomarkers, really making a diagnosis with some confidence. PET scans are available for visualizing amyloid and Tau now, but they're so expensive and they're not covered. So, the spinal tap information is what most of us around here really rely on when we want to be sure about what's going on. The blood tests are very promising, very exciting, but as you probably know, there's a lot of different opinions about this out there. Some people are sure that it's a done deal and that we now have a blood test for Alzheimer's disease. After I sent the article off, I opened up my issue of Neurology and there was an editorial saying these blood tests will never work. So, there's different ends of the spectrum on this and we tried to strike a balance with that. So they're very promising. I think before the article is due for revision, things are going to be different. But right now, spinal fluid is probably where we have the most confidence. Dr Weathers: I think that's a really solid takeaway to start our discussion with. And then, I think you both did really strike that very delicate balance in what is right now an area where, as I said, you know, things still are changing by the day. I know for our listeners who do subscribe, and I hope that most of them do, Table 9.1, clinically useful CSF biomarkers for the differential diagnosis of dementia, is one that I personally think I will frequently return to. You and Doctor Gray did just a wonderful job organizing these very complex concepts into an easy read and really powerful tool, especially for use at the bedside. Along the lines of knowing which biomarker to use, how frequently routine care are you ordering these tests on your patients? And do you anticipate this changing the media future? Is this another one of those things that by next week, we'll have a different kind of answer in how we use these tests? Dr Quinn: Yeah, as you said in your preliminary comments, the whole picture has been changed by the approval of these antibody therapies for Alzheimer's disease, lecanumab and just last week, donanemab. Prior to the approval of those two medications, I didn't use spinal fluid tests routinely, but I relied on them when I really needed to make a diagnosis with certainty of something really important hung in the balance. If we were trying to rule out some other treatable, more treatable problem. You know, for example, if it was a question of whether somebody primarily had a psychiatric problem or a neurodegenerative disease, this is something that would really allow me to objectify things. And- but that was a minority of people that I would see for dementia evaluation. You know, now that the two therapies are approved, I'm not actively engaged in administering those therapies very frequently but I can see already that the, the patients that I am discussing this with that spinal fluid is where we're probably going to rely for making a diagnosis of the amyloid burden in the in the living patient until PET scans are approved. If amyloid PET scans are- not approved, but covered by insurance, then those will probably replace the spinal fluid. So those tests in that table, A beta 42, tau, p-tau, one of them that's relatively new is this test for aggregated alpha-synuclein. Those I order with some frequency when I'm in those circumstances.  Dr Weathers: That's really helpful for our listeners to hear from an expert such as yourself and to think about as they encounter similar patients. Whenever discussing complex topics such as this one, I'm always curious about, what is the most common misconception or pitfall regarding the use of biomarkers for the diagnosis of Alzheimer's and other dementia that you encounter?  Dr Quinn: With respect to the blood biomarkers, you know, we were saying a moment ago that there's a lot of evidence available, but the jury is still out to some degree as to how reliable they are. And I think an important message with respect to those blood biomarkers is that they really are confounded by comorbidities. Remember, we're dealing with an elderly population, so comorbidities like hypertension and renal insufficiency and those kinds of things are relatively common and they can really throw off the blood biomarkers in a more dramatic way than cerebrospinal fluid biomarkers. The other fact, and I can't remember how well we cited this in the article, was that the blood biomarkers don't perform as well in underrepresented minorities. And you know, all of us are appropriately paying more attention to that problem in our practice of medicine. And for these blood biomarkers, that's a real issue. And whether the inferior performance in underrepresented groups is due to more comorbidity or just due to genetic differences is unclear at this time. So those are really important cautions. We mentioned the renal insufficiency and, I think, some of the other comorbidities, but it's a reason to really be careful with the blood biomarkers.  Dr Weathers: I think a really important point, especially again, kind of going back to what we were talking about at the beginning of our discussion, there's so much excitement around them. There's so much potential. People think we finally have that kind of silver bullet of diagnosis. So, I think really something to keep in mind.  What about in the use of their- in monitoring the efficacy of treatments?  Dr Quinn: So that's I think a little earlier in its history in terms of what biomarkers would be useful for monitoring. But the donanemab trial really relied on blood biomarkers as outcome measures and really showed some interesting phenomena. One of them was that plasma neurofilament light, which is all the rage now and all over neurology, people are measuring plasma neurofilament light. It's a nonspecific marker of neuronal damage that makes it out into the serum. So, you can measure it in serum and detect CNS damage in the serum. And intuitively, you would think that would be a good measure of efficacy, but in terms of detecting a treatment effect with donanemab, it didn't perform very well. Conversely, GFAP, which is a marker of astrocyte activation, which I would not have predicted was going to be a sensitive marker for treatment efficacy, performed well in at least the donanemab trial. So, I think it's early in the history of using these markers as outcome measures in clinical trials. And I think we're going to continue to learn as each therapy comes along and as these things come to pass.  Dr Weathers: Don't make any assumptions yet? Would that be a good way to sum that up?  Dr Quinn: I think that's, yes. I think that's very fair that that we have to be careful about these things.  Dr Weathers: OK. So, in summary, I think, does it sound like it's fair to say that the pitfall might be to say it's too early to make any assumptions or any conclusions quite yet? Dr Quinn: That's right. And, and I think, you know, we're going to need to monitor these therapies. I think all of us in neurology have become very accustomed to how you do that in multiple sclerosis, right? We've got MRI scans to be used to monitor therapy, maybe NFL is going to be an appropriate assay there as well. But, you know, there we've all had the experience of a chronic disease and seeing how well your therapy is doing, changing therapy if it fails. So, we're absolutely going to need those things in in Alzheimer's disease and other neurodegenerative diseases, but it's a little early for us to be sure exactly what the right measures are to make those important decisions. Dr Weathers: And a lot more work to be done for sure. As I mentioned, this is a topic of such great interest and I know, you know, certainly most of our listeners are neurologists or people in our world, medical students and trainees. I know I have one regular nonneurologist listener, my father. He really gets a kick out of listening to my interviews. Even though he is a retired sales manager from IBM and most of the time the topics of discussion are pretty different from his usual favorite podcasts. But this one he will be particularly interested in and I'm sure I will get a list of questions about, particularly because my grandfather unfortunately had Alzheimer's disease. So, I'm sure one of his questions will be about the use of these biomarkers in asymptomatic patients. How do you counsel family members of patients when they inquire about the use of biomarkers for that youth case? What is their utility in presymptomatic testing? Dr Quinn: We know from studies like the Alzheimer's disease neuroimaging initiative and other biomarker studies that some of these markers will be sensitive to pathology. Even in asymptomatic people, that pathology appears long before people develop symptoms. Despite that, I don't recommend that asymptomatic people get any of the testing right now because we do not have evidence that early intervention at the completely asymptomatic stage is valuable. And those clinical trials are underway. There are trials underway right now for people who don't even meet the memory deficit required to have a diagnosis of mild cognitive impairment, people who are entirely cognitively intact, but who on one biomarker study or another have evidence of pathology burden. And the interventions are being started early. And in a few years, we'll know the answer to that. Right now, for somebody to find out that they have pathology without any ability to act on it, I think is not valuable. So, I discourage people from pursuing that.  Dr Weathers: And that is really important guidance. Thank you. I know you have, as you mentioned, a beginning in a really diverse neurologic background with expertise, as you said, not only in dementia, but also in Parkinson's disease. And you didn't even mention this, but I know expertise in stroke as well, but your research has been primarily in Alzheimer's. What drew you to dementia and to this specific the aspect of it? How did you become an expert in biomarkers?  Dr Quinn: Well, I'll start with the dementia part. So, you know, I was always just interested intuitively in trying to understand how, you know, the brain mediates the mind. So as an undergraduate, I got started working in a lab that was working on the cholinergic system in the brain, which was still being sorted out at that time. It is important in Alzheimer's disease, but it was really where the focus was. And that's what got me interested in Alzheimer's disease, which incidentally is what got Alzheimer interested in Alzheimer's disease. You know, he was very interested in trying to find the biological footprints of all these different neurological and psychiatric diseases. And he usually came up empty-handed until he came across the patient with Alzheimer's disease where there were actual footprints in the brain that he thought was pointing towards what was going on. And we're still wondering about that a hundred years later, I guess that's how I got interested in dementia and Alzheimer's disease. I think I have always spent part of my time as a clinician. I think that's what got me interested in biomarkers, that this problem has always been there that, you know, we've got quite, you know, research criteria for making diagnosis and all that sort of thing. But we've really needed some biological evidence to help us firm this up even before the availability of the therapies. And that's what got me interested in- I'm making another point. I thought that computer research biomarkers are going to help point me towards the causes of the disease, and unfortunately that part hasn't entirely panned out. We've got some research in that area on micro-RNA biomarkers that maybe will bear some fruit down the road, but that's been a tougher, tougher nut to crack. Dr Weathers: But it's so incredibly important work. Well, this has been wonderful. I really enjoyed our conversation, and I always like to end on a hopeful note. What developments in the biomarker space are coming on the horizon are you most excited about? Dr Quinn: I'm hoping that these biomarkers that allow us to evaluate disease efficacy, blood biomarkers that don't require extraspinal taps and that sort of thing. I hope that all comes to pass. And I do think that there is a lot of research underway looking at biomarkers in a novel way that I think could help point us to new targets for therapy, things that you and I haven't even thought of yet. Those are the two things. I guess you asked me for one, I gave you two.  Dr Weathers: Oh I think very fair. I agree. Both of those would certainly be wonderful and, and I'm excited as well. Well, thank you, Dr Quinn, for taking the time to speak with me this evening.  Dr Quinn: A pleasure. Thank you for having me. Thank you for inviting me to do the piece. It was really a great experience.   Dr Weathers: Again, today I've been interviewing Dr Joseph Quinn, who's written with Doctor Nora Gray on fluid biomarkers and dementia diagnosis. This article appears in the December 2024 Continuum issue on Dementia. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.

Vascular cognitive impairment is a common and often underrecognized contributor to cognitive impairment in older individuals, with heterogeneous etiologies requiring individualized treatment strategies.  In this episode, Katie Grouse, MD, FAAN speaks with Lisa C. Silbert, MD, MCR, FAAN, an author of the article “Vascular Cognitive Impairment,” in the Continuum December 2024 Dementia issue. Dr. Grouse is a Continuum® Audio interviewer and a clinical assistant professor at the University of California San Francisco in San Francisco, California. Dr. Silbert is is co-director at Oregon Alzheimer's Disease Research Center, a Gibbs Family Endowed professor of neurology, a professor of neurology at Oregon Health & Science University, a staff neurologist, director of Cognitive Care Clinic, and director of the Geriatric Neurology Fellowship Program at Portland Veterans Affairs Health Care System in Portland, Oregon. Additional Resources Read the article: Vascular Cognitive Impairment Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Full transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Grouse: This is Dr Katie Grouse. Today I'm interviewing Dr Lisa Silbert about her article on vascular cognitive impairment, which is part of the December 2024 Continuum issue on dementia. Welcome to the podcast and please introduce yourself to our audience.  Dr Silbert: Hi Katie. Thanks for having me here today. Like you mentioned, my name is Lisa Silbert. I am a behavioral neurologist at Oregon Health and Science University and my research focus is in the area of vascular contributions to cognitive impairment and dementia. Dr Grouse: It's such a pleasure to have you and I really enjoyed reading your article. Just incredibly relevant, I think, to most practicing general neurologists, and really to any subspecialty. I'd like to start by asking, what do you think is the main takeaway point of your article for our listeners?  Dr Silbert: Yeah. I think, you know, the field of vascular cognitive impairment has changed and evolved over the last several decades. And I would say the main take-home message is that vascular cognitive impairment or vascular dementia is no longer a diagnosis that is only considered in someone who's had acute decline following a clinical stroke. That we have to expand our awareness of vascular contributions to cognitive impairment and consider other forms of the disease that can cause a more subacute or slowly progressive form of cognitive impairment. And there are many, many forms of vascular cognitive impairment that present in a more slowly progressive manner. The other thing I would say as a major take-home message is that we know that cerebrovascular disease is a very common copathology with other forms of dementia and that it lowers one 's threshold for manifesting cognitive impairment in the context of multiple pathologies. And so, in this way, vascular cognitive impairment should be considered as a contributing and potentially modifiable factor in any dementia.  Dr Grouse: I found that last point just really, really fascinating. And also, you know, the reminder that a combination of pathologies are more common than any one. To your initial point, I'm actually curious, could you kind of outline for us how you approach diagnosing vascular cognitive impairment?  Dr Silbert: Yeah. So with everything in neurology, a lot of it comes down to the initial history taking. And so part of the work up always includes a very detailed history of the presentation of cognitive impairment. Any time there is an acute change in cognition, vascular contribution should be considered, particularly if it's in the context of a clinical stroke or some kind of event that might have lowered cerebral blood flow to the brain. And then having said that, I already mentioned there are many forms of vascular cognitive impairment that can mimic neurodegenerative disease in terms of its course. So being more slowly progressive. And so because of that neuroimaging, and in particular MRI, has become an extremely valuable tool in the workup of anyone who presents with cognitive impairment in order to evaluate contributions from cerebral vascular disease. And so, MRI is a really helpful tool when it comes to teasing out what may be contributing to a patient's clinical syndrome, as well as their other comorbid medical issues, including stroke risk factors and other kind of medical conditions that might contribute to reduce cerebral blood flow. Dr Grouse: I'd love to talk a little bit more about that. You know, as is often the case with neurologic disease associated with vascular pathology, the importance of prevention, you know, focusing on prevention of vascular diseases is so important. What are some things that we can make sure to focus on with our patients and, you know, particularly anything new to be aware of in counseling them? Dr Silbert: Yeah, I'm really glad you asked me that question because like I mentioned, you know, cerebral vascular disease is so common, it lowers one's threshold for cognitive impairment in the face of other age-related brain pathologies. And so, it's really important for all of us to focus on preserving our cognitive health, even starting in midlife. And so, there are a number of areas that I counsel my patients on when it comes to preserving cerebral health and maximizing cerebrovascular health. And so, these stem from the American Heart Association's Life's Essential 8 because we know that preserving cardiovascular health is likely going to also preserve cerebral vascular health. And so, some of the things that I'm very commonly discussing with my patients are controlling stroke risk factors such as blood pressure, blood sugars and cholesterol, maintaining a healthy weight, and then also working towards a lifestyle that includes a healthy diet, no smoking, regular exercise. And then new within the last couple years is also the recommendation that people get adequate sleep, which is something that hasn't been focused on previously. Dr Grouse: I was really interested in reading your article to learn about enlarged perivascular spaces and the role as a mediating factor in the interaction between through a vascular dysfunction and development and progression of neurodegenerative pathology. Can you elaborate on this further? Dr Silbert: So, this is an area that's still largely unknown in the field, and it's an area where there's a lot of emerging work being done. The short answer is, we really don't know with great certainty how it directly connects with accumulating Alzheimer's pathology. But there is some evidence to suggest that the perivascular space is involved in the clearance of toxic solutes from the brain, including Alzheimer's disease pathology. And so there's a lot of work looking at how potentially cerebrovascular risk factors might affect the clearance of those toxic solutes through the perivascular space, including pulse pressure changes that might occur with accumulating cerebrovascular disease and other potential contributors. But one thing I can say with more certainty is that the, you know, location of perivascular spaces is thought to help distinguish those who might have cognitive symptoms due to cerebrovascular disease versus due to cerebral amyloid angiopathy. Or I guess I should say location is helpful in terms of recognizing vascular contributions to cognitive impairment that's due to arteriolosclerosis versus that due to cerebral amyloid angiopathy. In so much that… when we see a lot of perivascular spaces in the basal ganglia in the subcortical structures, that is thought to be more associated with arteriolosclerosis and hypertension type related vascular cognitive impairment. Whereas when we see multiple perivascular spaces within the centrum semiovale, that tends to be more associated with cerebral amyloid angiopathy. Dr Grouse: That's so interesting. And on the topic ofcerebral amyloid angiopathy, you did go into this a good deal. And you know, I think I encourage everybody to revisit the article to remind themselves about, you know, the findings that can increase the suspicion of tribal amyloid angiopathy. However, you also talked about transient focal neurologic episodes, which I think is just a great reminder that, you know, these can occur in this setting and definitely not to miss. Tell us more about what to look for with these types of episodes.  Dr Silbert: Transit focal neurologic episodes can be very difficult to tease apart from a transient ischemic attack. And these transient focal neurologic episodes due to CAA can present in a number of different ways. And I think the important take home message for that is that in people who have neuroimaging evidence of CAA to inform them that they are at increased risk for having these focal neurologic episodes and that if they do present to a hospital or an emergency department with any kind of neurologic event, that those treating them are aware that they have evidence of CAA on their neuroimaging because the treatment of course is quite different. So, it's someone presenting with ATIA who has transient neurologic symptoms might be considered urgently to get a thrombolytic or, you know, TPA, whereas someone who has known cerebral amyloid angiopathy or suspected CAA, they likely already have microbleeds on their neuroimaging and in those cases thrombolytics and TPA would be contraindicated and not helpful in terms of the etiology of their neurologic symptoms. Dr Grouse: That's a really good point to make. And I think also in your article you mentioned the use of aspirin if you're suspecting ATIA versus a, you know, a transient amyloid related focal neurologic episode. You know, one you would treat with aspirin and the other one you wouldn't.  Dr Silbert: That's right.  Dr Grouse: Another sort of interesting topic you delved into was cerebral microinfarct and how this can also contribute to vascular impairment. Could you elaborate a little more on that? Dr Silbert: Yeah. So cerebral microinfarcts are kind of the hidden cause of or a hidden cause of vascular cognitive impairment. And it's extremely challenging because by definition they are not visible on routine clinical neuroimaging. It's something that we are more aware of based on pathological studies and neuroimaging studies that have been done at ultra-high field strength like 7T MRI. And so, we are just learning more about how prevalent they are in certain conditions and how we can only look at these after death when we're looking at brain tissue and then go back and realize that these play a significant role in cognitive decline when someone is alive. It's important to understand that we're probably only appreciating kind of the tip of the iceberg when we're evaluating a patient and looking at their neuroimaging. That what we're actually seeing on MRI are only the things that are actually quite relatively big and obvious. And that a lot of these neuroimaging features of vascular cognitive impairment are actually associated with pathologic features that we're missing such as microinfarcts. But the hope is that by treating all individuals, particularly those who already have signs of vascular cognitive impairment, by modulating their stroke risk factors and focusing on maintaining brain health, that those will, interventions will also reduce the incidence of microinfarcts. Dr Grouse: What do you think is the greatest inequity or disparity you see in treating patients with vascular cognitive impairment? Dr Silbert: I think the greatest disparity is- really starts way before I treat a patient. That relates to really focusing on healthy lifestyle factors early in life and being able to, you know, afford fruits and vegetables, and having the advantages of being able to exercise regularly, and just being aware that all of these things are extremely important before older age. So, these are things that, you know, I think more education and awareness and greater access to healthcare will definitely improve access to. Even preventative healthcare is a disparity and not available across all of the population and geographic locations. So, I think of the- all the dementias, vascular cognitive impairment probably has the greatest association with health and social disparities in terms of primary prevention and access to care.  Dr Grouse: All really important things to consider. I have to say when, you know, reading your article, dare I say I came away with a little bit of hope thinking, you know, even with, you know, how little we still, you know, or how much we still need to do to really learn how to fight Alzheimer's and, you know, prevent it and, and, you know, help with its progression. The idea that in so many cases, even just doing what we can to prevent the vascular or cognitive impairment can really help any type of dementia. That was really a strong message for me. Do you mind elaborating on that a little more?  Dr Silbert: No, not at all. I agree. I really am hopeful about the prevention and treatment of dementias and through the treatment and prevention of cerebrovascular disease. I think that is a true reality, just like, you know, as we were discussing before, the treatment and prevention of cerebrovascular disease really should be a part of the treatment of any type of cognitive impairment and recommendations for prevention of cognitive impairment. This is the, you know, one thing we know is largely modifiable and preventable in most cases. I think the, really the key thing is just education and making sure that people understand that these are things that really need to be, they need to be engaged in in midlife and that it's much harder to reverse these- the damages once you have them in later life. Having said that, I do think that there's greater awareness of maintaining healthy lifestyle and maintaining awareness of stroke risk factors. And I think we're already starting to see a reduction in dementia worldwide in several large population-based studies, and probably that is due to more attention to the modifying stroke risk factors. So, I agree with you, it's very encouraging.  Dr Grouse: Is there anything exciting on the horizon that you can tell us about that we should all be keeping our eyes out for? Dr Silbert: Yeah. So, you know, I'm really interested in this connection between vascular cognitive impairment and Alzheimer's disease. And it's a real area of exciting new research. And so I think we're going to have more answers as to how, whether and how, cerebrovascular disease is directly linked to accumulating neurodegenerative disease or neurodegenerative pathologies. The other area that's, I think, really exciting, that's moving forward, is the in the area of blood-based biomarkers for vascular cognitive impairment. As these emerge, we'll be able to really identify those at greatest risk for vascular cognitive impairment, but also identify novel mechanisms that lead to VCI that can be targeted for therapeutic intervention. Dr Grouse: Well, I'm really excited to see what's coming down the pipeline and what more we'll learn in this area. So, thank you so much for everything you've done to contribute to this field. Dr Silbert: Yeah.  Dr Grouse: I wanted to ask a little bit more about you. What drew you to this work?  Dr Silbert: Well, actually, so my very first published manuscript in medical school was a case report and review on MELAS, which is mitochondrial encephalopathy with lactic acidosis and strokelike syndrome. And so, I was really fortunate to have Dr Jose Biller, who is a renowned expert in stroke and cerebrovascular disorders, as my mentor for that paper. And so, that got me really interested in neuroimaging findings of cerebral vascular disease. And so when I was a fellow at Oregon Health and Science University, I was then really fortunate to  be able to work with Jeffrey Kaye's oldest old population. And in working with that population, I really became interested in their neuroimaging findings of these white matter lesions and just realizing how prevalent they were in that population, you know, it just led me to start investigating their clinical significance and etiology, which kind of led me along this path. Dr Grouse: You know, Lisa, thank you so much. I really learned a lot from your article, and I think our listeners will definitely find that it was very helpful for their practice. Thank you so much for joining us. Dr Silbert: Thank you so much, Katie. It's been really fun.  Dr Grouse: Again, today I've been interviewing Dr Lisa Silbert, whose article on vascular cognitive impairment appears in the most recent issue of Continuum on dementia. Be sure to check out Continuum audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/AudioCME. Thank you for listening to Continuum Audio.

If you're an ASOPRS Member, Surgeon or Trainee and are interesting in hosting a podcast episode, please submit your idea by visiting: asoprs.memberclicks.net/podcast About the Guests: Dr. Roger A. Dailey, MD, FACS: He is a renowned ophthalmologist and faculty member at Oregon Health & Science University, specializing in oculoplastics. Dr. Dailey has a vast professional history, starting his residency in 1983, and has made significant contributions to the development of oculoplastic procedures and education. Dr. Jack Wobig, MD, MBA, FACS: A retired ophthalmologist with a rich legacy in oculoplastic and orbital surgery. Dr. Wobig was a key figure at OHSU and spent decades in private practice and teaching, contributing significantly to the field through his research and collaborations, most notably with Lester Jones. Dr. Andrew Harrison, MD: An oculoplastic and orbital surgeon at the University of Minnesota, Dr. Harrison is well-versed in advanced surgical techniques. He completed his fellowship with Dr. Wobig and Dr. Dailey and continues to advance the field through both his surgical practice and academic contributions. Episode Summary: In this engaging episode of the ASOPRS podcast, hosts Dr. Roger Dailey and Dr. Andrew Harrison are joined by the legendary Dr. Jack Wobig to delve into the rich history and evolution of oculoplastic surgery. The conversation hones in on Dr. Wobig's remarkable career, including his professional journey, collaborations with Lester Jones, and the innovative development of the Jones tube for lacrimal duct surgeries. This episode not only offers a window into the pioneers of oculoplastics but also provides valuable insights for future surgeons. Throughout the discussion, the guests highlight various milestones in the field of oculoplastics, emphasizing the importance of anatomical precision and collaboration in surgical innovations. The trio reminisces about shared experiences, with anecdotes that underscore the transformative impact of their mentors and colleagues. By examining the past and contemplating future challenges and opportunities, the episode paints a comprehensive picture of the field's trajectory. Insights into educational practices, the expanding global impact of Aesoppers, and the evolving dynamics of surgical training provide both a nostalgic and forward-looking view on the practice of oculoplastics. Key Takeaways: Historical Insights: Exploration of Dr. Jack Wobig's collaboration with Lester Jones in developing the Jones tube and its impact on lacrimal surgery. Evolution of ASOPRS: Discussion on the early days of ASOPRS, its formation, and Dr. Wobig's presidency, highlighting the challenges and growth in training and standards enforcement. Educational Influence: Reflections on the importance of international exposure and collaboration in shaping successful careers in oculoplastics. Retirement Advice: Dr. Wobig shares perspectives on retirement, the value of lifelong learning, and the fulfillment derived from a meaningful career and rich family life. Lifelong Relationships: Emphasis on the importance of maintaining connections with colleagues and fellows, fostering a family-like environment within the surgical community.

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Lisa C. Silbert, MD, MCR, FAAN, who served as a guest editor of the Continuum® December 2024 Dementia issue. They provide a preview of the issue, which publishes on December 2, 2024. Dr. Jones is the editor-in-chief of Continuum: Lifelong Learning in Neurology® and is a professor of neurology at Mayo Clinic in Rochester, Minnesota. Dr. Silbert is co-director at Oregon Alzheimer's Disease Research Center, a Gibbs Family Endowed professor of neurology, a professor of neurology at Oregon Health & Science University, a staff neurologist, director of Cognitive Care Clinic, and director of the Geriatric Neurology Fellowship Program at Portland Veterans Affairs Health Care System in Portland, Oregon. Additional Resources Continuum website: ContinuumJournal.com Subscribe to Continuum: shop.lww.com/Continuum More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology, clinical review and CME journal from the American Academy of Neurology.  Thank you for joining us on Continuum Audio, a companion podcast to the journal.  Continuum Audio features conversations with the guest editors and authors of Continuum who are the leading experts in their fields. Subscribers to the Continuum Journal have access to exclusive audio content not featured on the podcast. If you're not already a subscriber, we encourage you to become one. For more information, please visit the link in the show notes.  Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum: Lifelong Learning in Neurology. Today I'm interviewing Dr Lisa Silbert, who recently served as Continuum's co-guest editor for our latest issue on dementia alongside Dr Lianna Apostolova. Dr Silbert is a professor in the Department of Neurology at Oregon Health and Science University of the School of Medicine in Portland, Oregon, where she's also the director of the Neuroimaging Core and now the co-director of the Alzheimer's Disease Research Center. She also serves as director of the dementia clinic at the VA Portland Healthcare System. Which, Dr Silbert, sounds like a lot of work? Anyway, welcome. I really appreciate you taking the time to join us today and co-guest editing this issue. Why don't you introduce yourself a little bit to our listeners?  Dr Silbert: Well, thank you so much for interviewing with me today and for inviting me to be the guest, co-guest editor of this issue. It's a really exciting time for dementia care and dementia research. As you already said, my name is Lisa Silbert. I'm in Oregon Health and Science University in Portland, Oregon. I've been involved in caring for dementia patients and their families for over twenty years now and been involved in a lot of really exciting research during that time. But I would say now is probably the most dynamic time in dementia research and care that I've seen. So, it's really, really exciting to be here.   Dr Jones: It really is an interesting time. So, I look back  in our last issue of Continuum focusing on dementia came out in 2022, which doesn't sound like that long ago, but a lot has changed, right? With the anti-amyloid monoclonals for Alzheimer's disease, new biomarkers and so on. And as the guest editor, you have this unique view, Dr Silbert, of the issue and the whole topic of dementia. As you were reading these really outstanding articles, what was the biggest “aha” moment for you or the biggest change in practice that you saw that's come up over the last couple of years?     Dr Silbert: I think, you know, in reading through the different manuscripts or chapters in this issue, it really struck home the advances that have been made throughout all the different areas of dementia. Not just- so, we hear a lot about Alzheimer's biomarkers and Alzheimer's treatments on the horizon, which is really exciting, but this is happening across other dementias as well. There's biomarkers on the horizon for a Lewy body disease and potentially for some of the frontaotemporal dementias. And so that to me really struck home as this is really, across the board, a change in the entire field that we're looking at.  Dr Jones: That is exciting. And I'd like to come back to some of those biomarker developments because I think that's an area where we've really been lacking in neurology as a specific way to diagnose those disorders. I think a topic which you just alluded to that a lot of our listeners and readers are thinking about are those antiamyloid monoclonal therapies for Alzheimer's disease. So, addicanumab, lecanumab and most recently the approval of donanemab. For these drugs specifically, how are you using them in your practice and how should our listeners be thinking about these drugs?  Dr Silbert: These are, you know, relatively new, really exciting new and emerging therapies for Alzheimer's disease. They are shown to remove amyloid from the brain. Patients who have clinical manifestations of Alzheimer's disease, and that is those in the stages of mild cognitive impairment or mild dementia. We are using lecanemab at Oregon Health and Science University through our therapeutics and clinical units. It's a really exciting time and it's a time where we have to be, also, cautious about who undergoes these therapies. So being really informed about the use, who's appropriate to undergo these therapies, what kind of safety tests need to be undergone, how do you assess risk in individual patients so that you can counsel them.  So, all of these factors need to be weighed in when you're making a decision about whether or not to treat a patient with a monoclonal antibody therapy. And specifically, we do neuroimaging to assess whether there are already the presence of microhemorrhages in the brain. We do genetic testing to look for APOE 4 genotypes that can increase the risk of Aria, which is amyloid-related imaging abnormalities. And all of these factors go into how we counsel patients and discuss whether or not to pursue treatment with monoclonal antibodies.    Dr Jones: So certainly a complex patient selection process and drug administration and monitoring of therapy for those patients.  And that- it brings to mind for me how we already have too few neurologists in the US. And now for a really prevalent disorder, Alzheimer's disease, we're making it a lot more complicated to deliver these new disease-modifying therapies. What do you think or what do you see as the role of the neurologists in caring for patients with dementia? And do these developments change that role?  Dr Silbert: For now, I think these developments make it even more important in a way that neurologists are involved in making a very specific clinical diagnosis of which dementia is playing a factor in the patient 's clinical presentation. I think one thing to note is with these emerging biomarkers, a lot of them can be positive before there are clinical symptoms and multiple etiologies are also very prevalent. And so just having one positive biomarker, it doesn't necessarily tell you what's going on with an individual patient. You need to take the whole picture into consideration. So, I think a really detailed evaluation by the neurologist, especially with these emerging therapies that have potential risks, is extremely important right now. Just getting a test is really not sufficient. You really have to take the entire clinical picture into account and know the ins and outs of the risks involved in these disease-modifying therapies.  Dr Jones: Which brings us back to something you mentioned earlier, right? Which is good news. We have on the horizon new potential biomarkers for other neurodegenerative causes of dementia. I can foresee and maybe I'm, you know, being an alarmist here, Dr Silbert, but if we have sensitive biomarkers for other neurodegenerative conditions, we know patients often have copathologies. Is that going to help clarify things? Is it going to confuse us? How is that going to work?  Dr Silbert: Well, I think ultimately, it's going to help clarify things. Because there are multiple pathologies that are common in age related cognitive impairment, any kind of additional specific input that we can get with different biomarkers is going to be helpful in putting the pieces together to come up with what's happening clinically with each individual patient. Ultimately, I think these biomarkers, they're not- any one biomarker isn't going to be a solution to diagnosis, but putting them together to help improve early and accurate diagnosis is really the goal here. Having a very early diagnosis, having a very accurate diagnosis will improve our ability to give prognosis and also improve effective treatment strategies moving forward. I think that these biomarkers have the promise in facilitating that for us.  Dr Jones: And progress is always a good thing. We just have to learn how to adapt and use the evidence appropriately. There have been and I think most of our listeners will be familiar with some of the controversies related to these, these new disease-modifying drugs for Alzheimer's disease. Do you want to walk us through a couple of those, and what are your thoughts about those controversies?  Dr Silbert: Yeah, these new therapies, they're very exciting for everyone in the field, but they, like you mentioned, they're not without their controversies. I think one controversy or one potential downside to these therapies is access to them. Like you already mentioned there, there's really not enough neurologists out there. There's not enough behavioral neurologists out there. There's limitations to infusion centers, sites and prescribers. Access to these therapies is is significantly limited. They are requiring infusions quite frequently. So, if you're not living near specialty care, you're not really able to feasibly undergo these kinds of treatments. Another controversy is the fact that the treatment effects are considered by some to be fairly modest when looking at the clinical data and in association with that, there are risks involved. Like I already mentioned, there's the amyloid-related imaging abnormalities, which sounds kind of like a benign thing, but they really consist of microhemorrhages that can lead to bigger hemorrhages and edema in the brain. These risks are relatively small - they are seeing more commonly in those who have a specific genotype, an APOE E 4 genotype - but they're risks nonetheless.  And so, there's controversy about the risk-benefit ratio and access to care with these new therapies.  Dr Jones: It's very exciting, but we should be cautious, right? I recall a few years ago as a program director, a neurology residency program director, interest in different areas of neurology would often follow developments in those areas, right? Lots of interest in autoimmune neurology when those developments would proceed in neuro oncology, etc. And I wonder if the therapeutic advances in in behavioral neurology and neurodegenerative cognitive disorders, I wonder if that's going to stimulate interest among our trainees to pursue behavioral neurology? Do you have a view on that or have you seen much change in interest in in this field?  Dr Silbert: You know, we are seeing a lot more interest in our trainees. The residents are very interested in these new therapies and how to apply them. And I'm really excited about that.  I'm hopeful that this will stimulate interest in the field. And we need those specialists, we need those sub specialists to undergo fellowship training in behavioral neurology and geriatric neurology so that we have more access to the subspecialty care and delivering these new therapies. So, I agree with you, I'm hopeful about it and I am seeing new interest in our trainees about these new therapies.  Dr Jones: We can hope so. And all the other fellowship directors will be anxious if neurology residents start leaving to go into behavioral neurology. But there's certainly demand. And I know that under the best of circumstances, dementia is so common. It's something that we have to care for in partnership with primary care and community resources. And these disease-modifying therapies capture a lot of attention, but it's really a small part of the continuum of care of these patients. And Dr Silbert as an expert, you know, if we put that disease-modifying therapy to the side for a second and just said, well, what are the biggest gaps in the care for patients with dementia? What do you see as those biggest gaps and, and what can we do to fix them at not just a neurology level, but at a societal level?  Dr Silbert: That's a big question. And you know, what I see almost every day are gaps in the support mechanisms for families who are caring for patients with dementia. These caregivers are under a lot of stress and oftentimes they just don't have the resources to take care of somebody who at some point will often need twenty-four hour care and supervision. Caregivers are older, usually of older age themselves and have their medical issues as well. And then we're just not doing a good job as a nation in in supporting patients and their families with like supportive care and respite care that's really needed. So, you know, I'm not just seeing and treating patients with dementia, but I'm seeing and I'm really trying to support and care for those who are taking care of patients with dementia. To me, that's the biggest gap in our system. Dr Jones: Yeah. And as I look through this issue of Continuum, we touched on not only the conventional topics in dementia and behavioral neurology. I'm really happy in hindsight that we have invited some discussion of the psychiatric symptoms in dementia, which I think are really important and often underrecognized and maybe undermanaged or mismanaged, and really also focusing on the caregiver burden and support services. We do have an article dedicated to that as well, and I think that'll be useful to our readers and listeners when we when we publish those podcasts. We we've heard this year especially a lot of public conversation about cognitive impairment and dementia. I sometimes wonder if that public attention is helpful and constructive for the population of patients with dementia. Sometimes I wonder if that conversation is counterproductive. What's your take on that?  Dr Silbert: You know, I think it's- it can be a mixed bag, but ultimately, it's in the conversation. We're talking about it. And I think that's only a good thing. There's more public awareness of it.  There is more interest in therapies. So, I think at the end of the day, talking about it, making it more prevalent in the ether, it stimulates the conversation and discussion. And even if there's controversies about it, we're talking about it. And I think that's kind of the first step in acknowledging that we need more support, we need more therapies.  Dr Jones: Yeah, I agree. And I think often patients with neurologic disorders and their caregivers and families often appreciate being seen.   Dr Silbert: Yeah, no, absolutely true. So, I'd say in regards to the monoclonal antibody treatments, you know, despite the controversies with these new treatments, I think there's a real promise and a real hope and a real excitement across a lot of behavioral neurologists, including myself, that this is just the beginning. That even if these first line, first generation therapies maybe have downsides, that there'll be second generation and third generation variations on these kinds of treatments that are going to be more accessible, have less side effects and hopefully be more clinically effective. And, and down the line, the other real hope for the field is that these maybe second generation therapies will actually delay the onset or prevent clinical manifestation of the disease. And that's the real goal here.  Dr Jones: And that's a great segue to the to the next thing I wanted to ask you about and you, you may have already answered the question. We talked about how we have and will have new biomarkers which will help us with diagnosis. We have hopefully the first phase in increasingly effective disease modifying therapies for Alzheimer, maybe prevent Alzheimer's disease. Wouldn't that be great? Are there any other things on the horizon that you see maybe for other neurodegenerative disorders from a therapeutic perspective? What do you, what do you think the next big thing will be in that area?  Dr Silbert: Well, that's a great question. I think, you know, there's a lot of exciting research in Lewy body dementia and targeting alpha synuclein pathologies. We really need biomarkers.  So, we're ways off from therapeutics, but I think there's a lot of exciting progress in that area.  Dr Jones: So, like many areas of neurology, there are rewarding and challenging aspects to the care of these patients. What  do you- what's the most rewarding aspect of your practice, Dr Silbert?   Dr Silbert: You know, a lot of… I hear from trainees over the years that, you know, they can't imagine or it's difficult for them to think about caring for patients who have a neurodegenerative disease that has no cure. But I feel like that's a lot of what neurologists do. We don't necessarily cure all diseases, but we treat the patient throughout their disease process. And to me that is extremely satisfying. You know, I enjoy listening to patients' stories and hearing about what they have been through over the years. And I really feel, like, appreciated for the care that I provide in giving not just an accurate diagnosis, which a lot of people come in lacking, but talking about future planning and, really, treatment throughout the course of the disease. And I was in clinic yesterday and talking to one of my patients' caregivers, and we were talking about a particularly difficult behavioral manifestation that her husband was going through. And we were talking through how to manage it. And she said to me, you know, Dr Silbert, I really feel like I have a partner in going through this disease. And you know, that's kind of what it's all about for me. So, to me, it's extremely rewarding field. It's also a very exciting field, especially right now with all these new biomarkers and treatments. So, I just think there isn't a better area of neurology to be involved in right now.   Dr Jones: What a great place to land and end the interview. And I hope our listeners and our readers really do enjoy this issue. It's really a fantastic, not just an update, but a survey of a very dynamic aspect of the field of neurology. And Dr Silbert, I want to thank you for joining us and thank you for such a thorough and fascinating discussion on caring for patients with dementia.    Dr Silbert: It was my pleasure. Thank you.    Dr Jones: Again, we've been speaking with Dr Lisa Silbert, co-guest editor, alongside Dr Leanna Apostolova for Continuum 's most recent issue on dementia. Please check it out, and thank you to our listeners for joining us today.  Dr Monteith: This is Dr Teshamae Monteith, associate editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio. 

Extreme heat in the US led to deaths and hospital admissions among community-dwelling older adults with low incomes. Hyunjee Kim, PhD, of the Oregon Health & Science University, and Jose F. Figueroa, MD, MPH, of Harvard University, discuss these findings with JAMA Health Forum Editor John Ayanian, MD, MPP, and Deputy Editor Melinda Buntin, PhD. Related Content: Heat Waves and Adverse Health Events Among Dually Eligible Individuals 65 Years and Older The Alarming Risks for Dually Eligible Beneficiaries During Heat Waves

If you're an ASOPRS Member, Surgeon or Trainee and are interesting in hosting a podcast episode, please submit your idea by visiting: asoprs.memberclicks.net/podcast About the Guests: Dr. Bradford Lee Associate Clinical Professor at the University of Hawaii School of Medicine and private practitioner in Honolulu. Chair of the DEI (Diversity, Equity, and Inclusion) Committee for ASOPRS. Dr. Andrea Kossler Associate Professor of Ophthalmology, Stanford University School of Medicine Director of Oculofacial Plastic Surgery and Orbital Oncology at Stanford University. Board member of the Women in Ophthalmology and LATINOUS. Dr. Cesar A. Briceño Chief of Oculoplastics at Shea Eye Institute, University of Pennsylvania. Assistant Dean for Diversity and Cultural Affairs at the Perelman School of Medicine, UPenn. Dr. Eydie G. Miller-Ellis Chief of the Glaucoma Service at the University of Pennsylvania. Co-director of the RAB Venable Excellence in Research Project for the NMA. Dr. John Ng Division Chief and Professor of Oculofacial Plastic, Orbital, and Reconstructive Surgery at Casey Eye Institute, Oregon Health & Science University. Incoming Vice President of Aesoppers and future President. Episode Summary: Dive into an engaging panel discussion on Diversity, Equity, and Inclusion (DEI) within the sphere of ophthalmology, specifically exploring its role in oculoplastic surgery. Hosted by Dr. Bradford Lee and Dr. Andrea Kossler, this episode of Top offers profound insights into the initiatives promoting more inclusive and equitable practices in ophthalmology associations and medical education institutions. With esteemed panelists like Dr. Cesar Briceño, Dr. Eydie G. Miller-Ellis, and Dr. John Ng, the conversation shifts focus on innovative programs like the DEI Committee for ASOPRS, which prioritizes inclusion, access, and diversity for both practitioners and patients. The episode explores the intersection of DEI and patient care, highlighting how diverse medical professionals contribute to an enriched healthcare delivery model, thereby mitigating disparities in vision health care. The insightful contributions also touch upon the importance of justice within DEI efforts, as well as the significance of recognizing intersectionality among trainees and patients, which brings emphasis to the unseen and complicated layers impacting healthcare accessibility and delivery. Key Takeaways: The DEI Committee for ASOPRS is actively fostering inclusion and access through travel and research grants, as well as mentorship programs to promote diverse career pathways in ophthalmology. Diversity improves patient care outcomes by fostering a workforce that understands and respects varied cultural and socioeconomic backgrounds. Institutions must strive to create equitable support systems for trainees from diverse backgrounds to ensure they can excel in specialized fields like oculoplastic surgery. Addressing intersectionality is crucial in understanding the multifaceted barriers faced by diverse groups, ensuring a more comprehensive approach in medical research and education. Programs like the RAB Venable Excellence in Research Project aim to increase genetic representation in clinical trials, crucial for advancing targeted treatments. Listeners are encouraged to delve deeper into this vital discussion on DEI within ophthalmology by tuning in to the full episode. Stay connected for more insightful and enlightening conversations from our series.  

It is ADHD Awareness Month, and we are committed to providing resources and information that increase understanding about ADHD. Today, let's revisit an episode with Dr. Joel Nigg about lifestyle activities that can improve ADHD symptoms. Dr. Joel Nigg, Professor of Psychiatry and Behavioral Neuroscience at Oregon Health and Science University, is the author of the book Getting Ahead of ADHD. In this episode, he offers great insight, describes some ADHD research studies, and gives actionable steps to take now to help children thrive at school and in life.  We discuss things to look for regarding ADHD symptoms and some simple changes in our daily routines as families that can make a huge impact. Dr. Nigg is doing fantastic work with the OHSU Center for ADHD Research and I am thrilled to revisit this podcast episode. Show Notes: [2:55] - There has been an increase in parents seeking evaluations for ADHD after seeing children learn from home. [3:47] - Dr. Nigg shares some data that shows the impact of distance learning during the COVID-19 pandemic across the world. [5:01] - For those already diagnosed with ADHD, services were challenging during the pandemic and school closures. [6:25] - You lose the advantage of a teacher's perspective when learning from home. Demands at home from a parent are much different than those in the classroom. [7:42] - Dr. Nigg recommends seeking services for the difficulties the child is experiencing  [10:39] - A valuable goal is to think hard about structuring your day to fit self care in. [12:23] - Another factor that impacts mental health is sleep and the quality of rest. [15:00] - The key is to shift the thinking around sleep to be positive. Counselors can help with this transition. [19:52] - Family rules for a screen-free bedtime are hard to follow, but they are important. [20:54] - Dr. Nigg addresses the claim that high levels of screen time causes ADHD. [22:25] - Media content needs to be monitored for children and teens even though it is a part of their social experience. [25:16] - Children with ADHD are more inclined to experience depression and anxiety. [29:33] - Children need to be prepared for possible changes again as they go back to school. [32:27] - Medical centers around the world have websites with tons of resources. They will also have current and updated recommendations and guidelines. [33:36] - Dr. Nigg's book is a great resource for parents of children with ADHD. About Our Guest: Joel Nigg, Ph.D., is a Professor of Psychiatry and Behavioral Neuroscience, Vice Chair for Psychology, and Director of the Center for ADHD Research at Oregon Health & Science University in Portland, Oregon. He obtained his AB at Harvard College, MSW at The University of Michigan, and PhD in Clinical Psychology at the University of California at Berkeley. He is a licensed clinical psychologist with clinical experience in multiple settings. He is a leading researcher in the area of developmental psychopathology with a focus on ADHD. He is the author of 2 books on ADHD including a recent book written for parents: Getting Ahead of ADHD: What Next-Generation Science Says about Treatments that Work and How you can Make them Work for Your Child. His work has been funded continuously by NIMH for over 20 years. The recipient of several awards, Dr. Nigg has served on the editorial boards of several leading scientific journals. Connect with Dr. Joel Nigg: Joel Nigg, Ph.D Home Page Twitter  |  Facebook Links and Related Resources: Getting Ahead of ADHD: What Next-Generation Science Says about Treatments that Work and How you can Make them Work for Your Child by Dr. Joel Nigg Is ADHD Overdiagnosed? What are the signs of ADHD? Understanding ADHD Assessments Join our email list so that you can receive information about upcoming webinars - ChildNEXUS.com The Diverse Thinking Different Learning podcast is intended for informational purposes only and is not a substitute for medical or legal advice, diagnosis, or treatment. Additionally, the views and opinions expressed by the host and guests are not considered treatment and do not necessarily reflect those of ChildNEXUS, Inc or the host, Dr. Karen Wilson.  

Una ecocardiografía es un examen que emplea ondas de sonido para crear imágenes del corazón. Se utiliza en pacientes pediátricos para ayudar a diagnosticar defectos en el corazón presentes al momento del nacimiento. ¿Cuáles son las diferencias e indicaciones de este estudio vs. una resonancia magnética cardiovascular? En este episodio contamos con el Cardiólogo Pediatra César González de Alba para explicarnos más detalles sobre estos estudios de imagen cardiovascular avanzada. El Dr. González de Alba es originalmente de Torreón, Coahuila, México. Realizó su residencia en pediatría general en Driscoll Children's Hospital - Texas A&M, seguido por un fellowship en cardiología pediátrica y congénita en Oregon Health & Science University, y un fellowship en imagen cardiovascular avanzada en Children's Hospital Colorado - University of Colorado. El Dr. González de Alba mantiene un gran interés en la educación de sonografistas, residentes y subespecialistas, así como en la investigación en la mecánica del corazón y características del miocardio en resonancia cardiovascular magnética. ¿Tienes algún comentario sobre este episodio o sugerencias de temas para un futuro podcast? Escríbenos a pediatrasenlinea@childrenscolorado.org.

Dr. Mark Tager, MD is a speaker and the author of Feed Your Skin Right: Your Personalized Nutrition Plan for Radiant Beauty and is the CEO of San Diego-based ChangeWell Inc.  Mark attended Duke University Medical School and trained in family practice at The Oregon Health & Science University. As a physician, he is well-grounded in aesthetic, lifestyle, regenerative, and integrative medicine. Mark founded one of the first integrative medicine centers in the U.S., the Institute of Preventive Medicine, and served as corporate Medical Director for Electro Scientific Industries and as Director of Health Promotion for Kaiser Permanente Oregon. He has been actively involved in training and consulting projects in aesthetics, stem cells, medical malpractice prevention, skin care, and advanced cardiac biomarkers.   Together Dr. Tager and I discuss supplement health for beauty. Patients may come to a practitioner with questions about balancing their hormones, losing weight, or boosting their energy, but almost inevitably they are also interested in optimizing their beauty.  Dr. Tager outlines the personalized nutrition questions that practitioners can ask to start the conversation, highlights the essential supplements that can optimize skin health, details the importance of blood flow, Vitamins D, C, and E, and shares insights from simple and powerful skin nutrigenomic testing and SNPs. He also offers clinical pearls regarding collagen and microneedling and shares a wealth of additional supplemental areas for optimizing skin health that can meet the needs of every patient. I'm your host, Evelyne Lambrecht, thank you for designing a well world with us. Chapters: 00:00 01:52 Dr. Mark Tager performs his life's work at the intersection of integrative, functional medicine and aesthetics. 03:50 The four questions behind Dr. Tager's newest book Feed Your Skin Right. 04:50 Personalized nutrition questions that practitioners can ask patients regarding skin health in the realm of functional medicine. 08:54 The key pieces to an optimal diet in maintaining healthy skin including increased Vitamin C and fiber intake. 16:47 Insights from simple and powerful skin nutrigenomic testing and SNPs. 19:15 Shining a light on the effect of dark chocolate on skin health. 20:27 The importance of blood flow to the skin through exercise for optimal health. 23:06 Top supplement recommendations for skin health including bioactive collagen peptides and Omega-3. 28:06 Clinical pearls regarding collagen and microneedling. 30:05 The importance of Vitamin C and Vitamin D in skin health and optimal absorption. 33:01 Mitochondrial health completions and the overlay of drug nutrient completions. 34:10 The simple value of getting enough sleep every night and employing time-restricted eating. 35:00 Two key elements to integrating the Designs for Beauty tools into any practitioner's work. 41:45 Vitamin E is used both topically and orally for skin health and beauty. 43:37 Additional supplemental areas for optimizing skin health including research supporting topical peptides. 48:45 Dr. Mark shares his changed opinion on collagen, his three personal supplements, and his preferred health practices.   Episode Resources: Dr. Mark Tager - https://www.drtager.com/ Designs for Beauty - https://www.designsforbeauty.com/ Design for Health Resources: Designs for Health - https://www.designsforhealth.com/ Nutrition Blog: Ten Nutrients to Help Your Skin Glow from the Inside Out - https://www.casi.org/ten-nutrients-help-skin-glow-from-the-inside-out Research Blog: Summer Glow: Tips to Tone Your Face and Support Skin Health - https://www.casi.org/summer-glow-tips-to-tone-face-support-skin-health Nutrition Blog: What's Happening on the Outside Could be Caused from Something on the Inside - https://www.casi.org/node/1122 Research Blog: Nitric Oxide – Say Yes to “NO” - https://www.casi.org/node/957 Nutrition Blog: Collagen: A Clinical Look at Hair and Skin Health - https://www.casi.org/collagen-clinical-look-at-hair-and-skin-health Research Blog: Skin Health: The Benefits of Collagen Peptides - https://www.casi.org/benefits-of-collagen-peptides Nutrition Blog: Resveratrol to Support Healthy Aging and Skin Elasticity - https://www.casi.org/resveratrol-support-healthy-aging-skin-elasticity Visit the Designs for Health Research and Education Library which houses medical journals, protocols, webinars, and our blog. https://www.designsforhealth.com/research-and-education/education

Subscribe, Rate, & Review Future Fossils on YouTube • Spotify • Apple Podcasts✨ About This EpisodeThis week on Future Fossils we speak with Helané Wahbeh (LinkedIn), Director of Research at The Institute of Noetic Sciences, adjunct assistant professor in the Department of Neurology at Oregon Health & Science University, and author of over ninety peer-reviewed publications as well as the book The Science of Channeling. Our main course: a recent review in Frontiers of Psychology entitled, “What if consciousness is not an emergent property of the brain? Observational and empirical challenges to materialistic models”. In this conversation we take a thirty-thousand foot view of the history and future of the science of consciousness, the socioeconomic impediments to unflinching consciousness research, and the overwhelming weight of transcultural experience that make this such a promising domain for fundamental investigation.Enjoy, and thanks for listening!✨ Support This Work• Become a patron on Substack or Patreon• Buy original paintings and prints or commission new work• Buy the books we discuss from my Bookshop.org reading list• Help me find backing for my next big project Humans On The Loop• Join the conversation on Discord in the Holistic Technology & Wise Innovation and Future Fossils servers• Make one-off donations at @futurefossils on Venmo, $manfredmacx on CashApp, or @michaelgarfield on PayPal• Buy the show's music on Bandcamp — intro “Olympus Mons” from the Martian Arts EP & outro “Sonnet A” from the Double-Edged Sword EP✨ Related EpisodesDig into an extensive back catalog of consciousness-research-flavored episodes (psi phenomena, non-ordinary states, psychedelic neuroscience, oracular praxes, time and consciousness, etc.) at the Future Fossils Consciousness Research Spotify playlist or through the following Substack links:03 Tony Vigorito05 Mitch Schultz20 Joanna Harcourt-Smith27 Niles Heckman and Rak Razam30 Becca Tarnas37 The Ungoogleable Michaelangelo45 Kerri Welch57 Conner Habib and Mitch Mignano58 Shane Mauss69 Tim Freke78 Archan Nair88 Dennis McKenna99 Erik Davis100 The Teafaerie103 Tricia Eastman112 Mitsuaki Chi113 Sean Esbjörn-Hargens117 Eric Wargo119 Jeremy Johnson124 Norman Katz125A Stuart Kauffman (patrons only)126 Phil Ford and J.F. Martel127 Cory Allen131 Jessica Nielson and Link Swanson132 Erik Davis150 Sean Esbjörn-Hargens156 Stuart Davis170 The Ungoogleable Michaelangelo171 Eric Wargo176 Sophie Strand and Richard Doyle and Sam Gandy179 Scout Wiley 186 Solo: A Manifesto for Weird Science218 Neil Theise222 Andrés Goméz Emilsson This is a public episode. If you'd like to discuss this with other subscribers or get access to bonus episodes, visit michaelgarfield.substack.com/subscribe

This episode of the Plant Medicine Podcast welcomes Dr. Angela Carter (they/them) to discuss the intersection of the LGBTQIA2S+ community and psychedelics. Dr. Carter is a queer, transgender, and genderqueer naturopathic primary care physician who also works as a midwife, sexual assault examiner, and health equity advocate in Portland, Oregon. They also serve as both the vice-chair and the equity in training subcommittees co-chair of the Oregon Psilocybin Advisory Board. In addition to these positions, Dr. Carter serves as the chair of the Transgender Health Program Community Advisory Board at Oregon Health & Science University. They also volunteer with many organizations including the Fireside Project, Black Rock City Emergency Services, and Queerdome.  Dr. Carter begins this conversation by sharing exciting new research currently being conducted which involves LGBTQIA2S+ individuals and psychedelic therapies. While this particular area of research remains small, it is growing and the fruits of these studies will be an important step for better understanding how these new therapies can serve gender and sexuality minorities, and help facilitators understand the unique concerns of people in the LGBTQIA2S+ community. Dr. Carter illustrates these types of concerns by discussing the prevalence of gender binaries within psychedelic spaces. They describe how in a clinical setting it is prevalent to have both a male and a female facilitator, but this leaves no room for gender-nonconforming people to guide experiences—something which could be preferable if the patient themselves shares this identity.  Dr. Carter also discusses this gender binary in traditional contexts. It is common for ayahuasca ceremonies to provide separate spaces for men and women, again leaving no space for gender-nonconforming people. This reification of the gender binary and the often patriarchal organization of the ayahuasca ceremony can have serious impacts on the set and setting, especially for people in the LGBTQIA2S+ community. Dr. Carter emphasizes the importance of making space for folks in the community so that they are able to receive therapy, attend ceremonies, and participate in integration with others who share similar identities. This shared identity, they emphasize, ensures that LGBTQIA2S+ people don't feel out of place in contexts that ought to be healing. Dr. Carter closes by discussing how members of the LGBTQIA2S+ community experience disproportionate rates of mental illness, further illustrating the crucial importance of equity in accessing psychedelic medicine.    In this episode: Problems of representation and access for LGBTQIA2S+ individuals in the psychedelic space Current research being done on the intersection between psychedelic therapies and unique issues faced by gender and sexuality minorities Preparations to take before guiding a psychedelic experience for LGBTQIA2S+ people, particularly if you do not come from the community How plant medicines could have unique benefits for the LGBTQIA2S+ community Issues of poverty faced by marginalized peoples and how to support equity of access to emerging psychedelic therapies   Quotes: “For some people that idea of melding, of becoming one and losing all of those unique pieces of themselves, doesn't fit their paradigm of a spiritual connecting experience.” [10:47]  “It's precious, that centering of our community—to be able to sit with people who just understand.” [19:42]  “Psychedelics offer the opportunity for connection of the self to something greater, something outside, a bigger community, spirituality, and really do a huge amount to heal peoples' relationships with substances.” [25:20]  “Marginalized communities have been really impacted, largely, by the war on drugs, which has put millions of people in jail for drug offenses and stolen their ability to make income, stolen their ability to connect with community and we really need to heal that.” [33:34]   Links: Chacruna Institute Queering Psychedelics 2019 Conference Queerdome on Facebook  Portland Psychedelic Society Psychedelic Medicine Association Porangui

Dr. Ilana Braun and Dr. Eric Roeland join us on the ASCO Guidelines podcast to discuss the latest evidence-based recommendations on cannabis and cannabinoids in adults with cancer. They discuss nonjudgmental patient-clinician communication, the relatively narrow cancer-related indications for which there is actionable clinical evidence for cannabis and/or cannabinoids, and key information for adults with cancer and their clinicians. Dr. Braun and Dr. Roeland also review the limited evidence regarding cannabis and cannabinoid use in adults with cancer and the outstanding questions and importance of research in this area. Read the full guideline, “Cannabis and Cannabinoids in Adults with Cancer: ASCO Guideline” at www.asco.org/supportive-care-guidelines. TRANSCRIPT This guideline, clinical tools, and resources are available at http://www.asco.org/supportive-care-guidelines. Read the full text of the guideline and review authors' disclosures of potential conflicts of interest in the Journal of Clinical Oncology,  Brittany Harvey: Hello, and welcome to the ASCO Guidelines podcast, one of ASCO's podcast hosts delivering timely information to keep you up to date on the latest changes, challenges, and advances in oncology. You can find all of the shows, including this one, at asco.org/podcasts.  My name is Brittany Harvey, and today, I'm interviewing Dr. Ilana Braun from Dana-Farber Cancer Institute, and Dr. Eric Roeland from Oregon Health & Science University, co-chairs on “Cannabis and Cannabinoids in Adults with Cancer: ASCO Guideline.”   Thank you both for being here Dr. Braun and Dr. Roeland. Dr. Ilana Braun: Thanks so much for having us, Brittany. Dr. Eric Roeland: Thanks, Brittany. Brittany Harvey: Then, just before we discuss this guideline, I'd like to note that ASCO takes great care in the development of its guidelines and ensures that the ASCO Conflict of Interest Policy is followed for each guideline. The disclosures of potential conflicts of interest for the guideline panel, including Dr. Braun and Dr. Roeland, who have joined us here today, are available online with the publication of the guideline in the Journal of Clinical Oncology, which is linked in the show notes. Then to jump into the content of this guideline, first, Dr. Roeland, could you give us an overview of both the scope and purpose of this guideline?  Dr. Eric Roeland: Sure, Brittany. I think it's important for everyone to recognize just how common the issue of cannabis or cannabinoid use is amongst people living with cancer. And I think clinicians in academia as well as through community sites, we are asked about the use of cannabis on a daily basis. And so our target audience is really to focus on clinicians providing care to adults with cancer, but also the health systems in which we work because this is a very complex issue, as well as the people living with cancer and their caregivers, as well as researchers dedicated to this field. Brittany Harvey: So as you mentioned, this is a complex issue, and I'd like to review the key recommendations of this guideline. This guideline provides recommendations across three clinical questions that the expert panel targeted. So, starting with the first question, what is recommended for patient-clinician communication regarding cannabis or cannabinoids?  Dr. Ilana Braun: Given the high prevalence of medicating with cannabis or cannabinoids that Eric references, somewhere in the neighborhood of 20% to over 40% of adults with cancer consume cannabis products, ASCO's guideline offers the following common-sense, good practice statement: In the clinic, providers should routinely and non-judgmentally inquire about cannabis consumption or consideration of cannabis, and either guide care or direct adults with cancer to appropriate resources. In other words, the guideline works to fully destigmatize this conversation. The guideline goes on to offer suggestions for taking a cannabinoid and cannabis history. This includes the goals of use, how the products are sourced, what formulations are being used (including the ratios of active ingredients like THC and CBD), the inactive ingredients (for instance coconut oil), whether it is herbal or synthetic, and whether the product is pharmaceutical grade or non-pharmaceutical grade. And then other questions like routes of administration, dosing schedules, perceived benefits and risks, and whether the products are being used adjunctively or as a replacement for standard treatments. It is also probably important to query potential contraindications, such as a history of cannabis use disorder or psychosis.  Brittany Harvey: Thank you for reviewing those good practice statements. Those are key for non-judgmental communication and taking an accurate and complete history.  So following those statements, the expert panel next addressed the question: Does use of cannabis and/or cannabinoids by adults improve cancer-directed treatment? What recommendations did the expert panel provide for this section? Dr. Eric Roeland: When we think about the use of cannabis or cannabinoids in treating the underlying cancer, it's incredibly important to recognize the excitement that patients and clinicians have around the potential promise. Much of this data is generated from preclinical models. However, when we're engaging patients consuming cannabis or cannabinoids to augment their cancer-directed treatment, we could find no evidence to support its use. And so we do not recommend that patients be using it to augment treatment, nor do we recommend that patients should be using it instead of their cancer-directed therapy. And I think this is a major challenge for multiple oncologists, where their patients may be using these with a goal of treating their cancer, and then present with very advanced cancer and/or multiple poorly controlled symptoms. Dr. Ilana Braun: And I think that there are some areas of particular concern. For instance, there were two oncologic cohort studies that suggest that cannabis, which we know is an immune modulator, may actually worsen immunotherapy outcomes. These outcomes included median time to progression and overall survival. There are obvious limitations of preliminary observational data, and we now need to gather prospective, gold-standard data. But for the time being, the guideline recommends that clinicians should advise against adults receiving immunotherapy from medicating or considering medicating with cannabis and cannabinoids. And then I think there are some additional reasons for concern. First of all, this type of therapy tends to be very expensive and not covered by insurance and there are some risks for drug-drug interactions, in terms of pharmacodynamic ones, Cannabis may exacerbate neuropsychiatric side effects of opioids and even benzodiazepines. In terms of pharmacokinetic drug-drug interactions, it's not a particularly risky substance, but there are three to be wary of in particular: warfarin, buprenorphine, and tacrolimus all have high-risk interactions with cannabinoid products.  Brittany Harvey: I appreciate you both for reviewing these recommendations and evidence regarding the use of cannabis and/or cannabinoids regarding cancer-directed treatment.   So then the last clinical question, Dr. Braun, what is recommended regarding use of cannabis and/or cannabinoids in managing cancer treatment-related toxicities and/or symptoms? Dr. Ilana Braun: The first thing to make clear is that high-quality clinical evidence evaluating the utility of cannabis and cannabinoids for adults with cancer is limited as Eric has said. The evidence that does exist weakly supports a practice of using cannabis and cannabinoids to address refractory chemotherapy-induced nausea and vomiting when standard treatments have failed. For other potential oncologic indications, like management of cancer-related pain, there is weak, negative, conflicting, or no evidence. But that being said, a 2017 monograph published by the National Academies of Science, Engineering, and Medicine concluded that there is substantial evidence that cannabis is an effective treatment for chronic non-cancer pain, and I'm sad to say, that chronic non-cancer pain happens too in adults with cancer. Brittany Harvey: Thank you for reviewing those recommendations as well.  So you've both touched on this a little bit in that patients are often asking clinicians for recommendations regarding cannabis and/or cannabinoids, but in your view, what is the importance of this guideline, and what should clinicians know as they discuss these recommendations with their patients? Dr. Eric Roeland: Probably one of the most important points is for clinicians to ask and to be open and to create a space where our patients are telling us about what they're using. I think we've all had patients that we've been surprised that have been using cannabis or cannabinoids in conjunction with other medications that may increase the risk of unwanted side effects or risks, including sedation or falls. I also find it challenging that many patients are receiving recommendations for the use of cannabis or cannabinoids directly from friends or family instead of through their medical providers. Therefore, I think one of the very first things is to just make sure that you're asking about it and then inquiring what the goal of their use is.  When we talk about the use of cannabis, we also need to recognize the difference between the available data that can guide us in evidence-based recommendations, as well as the enthusiasm and available access that patients have to cannabis that has really outpaced our ability to research it. So it's important to recognize these tensions that we're living with in clinic day-to-day. Brittany Harvey: Absolutely. Those points are key for clinicians as they discuss this complex issue with their patients.  Following that, how will these guideline recommendations affect adults with cancer? Dr. Ilana Braun: One really important takeaway from these guidelines is that they clearly state that cannabis and cannabinoids are medicinal, and for a medical community to clearly articulate this point is notable. I suspect they will provide encouragement, legitimacy, confidence, and even a script to oncology clinicians who were previously reticent to inquire, document, and provide clinical recommendations around non-pharmaceutical cannabis and cannabinoids. It may have a similar effect even at the institutional level in terms of supporting these practices. At the same time, I suspect they will encourage those who are recommending oncologic use of cannabinoids and cannabis for myriad cancer-related indications to adopt a more circumscribed approach. The reason I say this is that the cancer-related indications for which there is actionable clinical evidence at this time are quite narrow. So all this to say, I believe these guidelines will lead to greater transparency around cannabis decision-making in the clinic, as Eric mentions, but also lead to a possible narrowing of indications for which cannabis is clinically recommended.  Dr. Eric Roeland: Another major role of the use of these guidelines in clinical care is informing clinicians and patients about cannabis. Cannabis has been used by humans as a plant for thousands of years, and although it's a very complex plant with hundreds of parts, the two parts that researchers have studied most are delta nine-tetrahydrocannabinol, or THC, and cannabidiol, or CBD. In rough terms, THC can cause a high feeling, while CBD typically does not. And there are multiple types of products that have different ratios of THC and CBD. So it's critical for people to understand what those ratios are, how many milligrams of those things there are, as well as what are the programs within your region to measure or quantify what's actually in the products you're consuming. If a person with cancer medicates with cannabis, most oncologists would prefer that they use it by mouth, such as an edible, rather than inhaling or smoking cannabis given concerns about potential impact on lung function. One challenge when consuming cannabis by mouth is that it can take up to two hours to have its full effect. So patients should be very careful not to take too much or to stack their doses, which can cause sedation, confusion, and even increase the risk of falls. Whereas when patients are consuming cannabis by breathing in a smoke or vapor, they typically feel the effects almost right away, which is why patients sometimes prefer smoking or vaping as their preferred route of administration. Brittany Harvey: Understood. Definitely. We hope these guidelines provide key information and clarity for both adults with cancer and their clinicians.  So then, finally, you've both mentioned that there is limited evidence regarding cannabis and cannabinoid use in adults with cancer. So what are some of the outstanding questions regarding cannabis and cannabinoids in cancer care? Dr. Eric Roeland: Thanks, Brittany. I think the questions also align with priorities for future research, and we need to recognize that the lack of evidence aligns with some of the challenges of funding research in this space. However, ongoing future research priorities include what is the nature of healthcare disparities pertaining to medical cannabis use by adults with cancer, and what are effective means to address these disparities? We also wonder, what are the optimal strategies to maximize communication in the oncology clinic regarding medical cannabis and/or cannabinoid use? And when we're thinking about cannabis and/or cannabinoids for cancer treatment specifically, we still need to know do cannabis and/or cannabinoids possess clinically meaningful anticancer activity in humans. We also need to understand what are the drug-drug interactions with our standard-of-care cancer treatments, including cytotoxic chemotherapy, targeted therapy, immunotherapy, radiation, and combinations of all the above. We also are wondering what the effect of cannabis and/or cannabinoids on outcomes in adults with cancer receiving some of our newer therapies, including antibody-drug conjugates and some of our newer vaccine therapies.  Dr. Ilana Braun: I might add that collating the existing research as the guideline did is a very good first step and should serve to highlight where the gaps in knowledge lie. This guideline discusses some of the unique challenges to conducting cannabis and cannabinoid research, including limitations in funding source and study drug, red tape procedures, and issues around legalization. I believe it will take a group of highly determined and creative researchers to move the needle forward in this area, but we must. Brittany Harvey: Definitely. Thank you both so much for all of your work developing this guideline and creating these evidence-based recommendations. And thank you for taking the time to come on the podcast today and teach us all a little bit more about cannabis and cannabinoids in cancer care. And thank you for your time, Dr. Braun and Dr. Roeland.   Dr. Ilana Braun: Thanks so much, Brittany. Brittany Harvey: And thank you to all of our listeners for tuning in to the ASCO Guidelines podcast. To read the full guideline, go to www.asco.org/supportive-care-guidelines. You can also find many of our guidelines and interactive resources in the free ASCO guidelines app, which is available in the Apple App Store or the Google Play Store. If you have enjoyed what you've heard today, please rate and review the podcast, and be sure to subscribe so you never miss an episode. The purpose of this podcast is to educate and 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.  

Thomas is joined by neuroscientist, education philosopher, and social entrepreneur Dr. Sará King, and clinical professor of psychiatry, co-director of the Mindful Awareness Research Center at UCLA, and Executive Director of the Mindsight Institute Dr. Dan Siegel. They discuss the concept of Intrapersonal Neurobiology - an interdisciplinary approach to understanding how our minds create our experiences, with an emphasis on the benefits of what Dr. Siegel refers to as “self-expanding emotions” - empathy, compassion, gratitude, and awe. They dive deep into the idea of the collective nervous system, how we can learn to experience it, and how that can help us shift from defining the self as a solo entity to understanding humanity as fundamentally interconnected. In doing this, Dr. King and Dr. Siegel posit that we can create a stronger sense of belonging, increase our sustainability, and assist in the evolution of the planet instead of its destruction. ✨ Thomas' Art of Attunement course is 50% off - for a limited time.   

In this enlightening episode of "Interviews With Innocence," we have the privilege of hosting Dr. Helané Wahbeh, the esteemed Director of Research at the Institute of Noetic Sciences and an adjunct assistant professor in the Department of Neurology at Oregon Health & Science University. Dr. Wahbeh, who is also a clinically trained naturopathic physician and holds a Master of Clinical Research along with two post-doctoral research fellowships, brings a wealth of knowledge and experience to our discussion. Today, Dr. Wahbeh will delve into her pioneering research in the fields of mind-body medicine, stress, PTSD, and extended human capacities, highlighting how these areas connect with our physiological health and healing processes. She will share her unique insights on channeling and its implications in understanding consciousness and spirituality, especially in relation to children and their innate connection to the spiritual realm. Dr. Wahbeh's noetic approach to channeling offers a fascinating perspective on how we can tap into our deeper consciousness and the potential benefits this can have for our spiritual growth. Her research not only sheds light on the healing power of spirituality but also underscores the importance of children as conduits to the spiritual world, helping us reconnect with our inner selves and the universe at large. Join us as we explore these profound topics with Dr. Wahbeh, gaining insights into how spirituality and consciousness research can enhance our understanding of the world and our place within it, especially through the lens of our interactions with the young and spiritually attuned.

This week's show is with Dr. Helané Wahbeh. Helané is the Director of Research at the Institute of Noetic Sciences and an adjunct assistant professor in the Department of Neurology at Oregon Health & Science University. Dr. Wahbeh is clinically trained as a naturopathic physician and research trained with a Master of Clinical Research and two post-doctoral research fellowships. Recently named President of the Parapsychological Association, she has published on and spoken internationally about her studies on complementary and alternative medicine, mind-body medicine, extended human capacities, stress, posttraumatic stress disorder, and their relationships to physiology, health, and healing. Dr. Wahbeh is especially known for her research around — and noetic approach to — channeling. She is the author of some 90+ peer-reviewed publications, the new book The Science of Channeling: Why You Should Trust Your Intuition and the Force That Connects Us All and Free To Be Me: A Journey of Transformation through Generational Healing. In this show, Helané and Lian explored the topics of telepathy, precognition, and intention - specifically through the lens of harnessing those abilities in the healing arts. Helané shared research on telephone telepathy, where people accurately guess who is calling them above chance, and the power of bringing focused positive intention to support others' health. They also spoke about the unique ways individuals express their intuitive wisdom - although these are abilities we can see in many humans, some do have a genetic propensity to be especially strong in certain abilities - and that's something we can train and hone too. We'd love to know what YOU think about this week's show. Let's carry on the conversation…  please leave a comment below. What you'll learn from this episode: Telepathy is the communication of impressions from one mind to another that is independent of recognized channels of sense. Research shows that telephone telepathy is a common phenomenon, with people accurately guessing who is calling them above chance. Intention plays a significant role in healing and can be used to support others' health and well-being. The Noetic Signature explores the unique ways individuals express their intuitive gifts, but it's important to recognise that it seems that everyone has the capacity to tap into this wisdom. Using focused positive intention can influence the physical world and contribute to creating a world of peace, love, and freedom for all. Resources and stuff that we spoke about: Institute of Noetic Sciences Research Free To Be Me: A Journey of Transformation through Generational Healing The Science of Channeling: Why You Should Trust Your Intuition and the Force That Connects Us All Be Mythical is soon opening the doors to our new academy of alchemical arts - UNIO: The Academy of Sacred Union... To get your special invitation register HERE. Thank you for listening! There's a fresh episode each week, if you subscribe then you'll get each new episode delivered to your phone every week automagically (that way you'll never miss an episode): Subscribe on Apple Subscribe on Android Thank you! Lian and Jonathan

In this episode, host Shikha Jain, MD, speaks with Avital O'Glasser, MD, about the challenges facing non-traditional scholarship, amplifying diverse voices in medicine and more. •    Welcome to another exciting episode of Oncology Overdrive :58 •    About O'Glasser 1:15 •    The interview 2:36 •    Jain and O'Glasser on their friendship and how they met. 2:52 •    What is non-traditional scholarship, and why is it so difficult for academics to adopt to these practices? 5:16 •    Jain and O'Glasser on the added value of non-traditional scholarship in academia and engagement. 11:25 •    How can engaging in non-traditional scholarship be leveraged and disseminated along with more “traditionally” recognized ways of CME? 13:33 •    O'Glasser on Daniel Cabrera's More Than Likes and Tweets: Creating Social Media Portfolios for Academic Promotion and Tenure and Ernest Boyer's The Scholarship of Engagement. 17:19 •    Jain and O'Glasser on utilizing digital abstracts in presenting data and pushing back on non-promotable work.  18:30 •    How can physicians make sure that information reaches its desired audience through non-traditional scholarship, or provide more educational opportunities about this work?  22:29 •    About An Evolution of Empowerment: Voices of Women in Medicine and Their Allies, co-edited by Jain and O'Glasser, and their process in creating this publication. 24:28 •    Do you think we'll collaborate on another book? 32:22 •    If someone could only listen to the last few minutes of this episode, what would you want them to take away? 35:47 •    How to contact O'Glasser 36:45 •    Thanks for listening 38:08 Avital O'Glasser, MD, FACP, FHM, is a hospitalist and associate professor of medicine at Oregon Health & Science University.  Her clinical practice focus is perioperative medicine, and she is also the assistant program director for social media and scholarship for OHSU's Internal Medicine Residency Program.   We'd love to hear from you! Send your comments/questions to Dr. Jain at oncologyoverdrive@healio.com. Follow Healio on X, formerly known as Twitter, and LinkedIn: @HemOncToday and https://www.linkedin.com/company/hemonctoday/. Follow Dr. Jain on X, formerly known as Twitter: @ShikhaJainMD. O'Glasser can be reached on the Women In Medicine blog. Disclosures: Jain and O'Glasser report no relevant financial disclosures. 

A growing number of people living with MS are turning to cannabis for symptom management. But which MS symptoms have responded to being treated with cannabis? Where should someone buy medical cannabis? And is using medical cannabis even legal? Dr. Michelle Cameron returns to the podcast to discuss the risks and benefits of using cannabis for symptom management. Dr. Cameron is a neurologist and physical therapist, as well as a professor in the Department of Neurology at Oregon Health & Science University. We're also sharing some long overdue good news from United Airlines for passengers who use wheelchairs.  We'll tell you about the first adaptive clinical trial for people living with progressive MS in Australia. We'll give you the details of the FDA's clearance of an artificial intelligence platform designed to analyze MRI scans to detect and monitor MS disease activity. And we're sharing promising results from a Phase 1 clinical trial that focused on using neural stem cells to stop disease progression among people living with secondary progressive MS. We have a lot to talk about! Are you ready for RealTalk MS??! This Week: Cannabis and MS   :22 United promises friendlier skies for wheelchair users 1:04 PLATYPUS adaptive clinical trial to begin in Australia  3:47 FDA approves artificial intelligence platform for detecting MS disease activity in MRI scans  5:34 Neural stem cell Phase 1 clinical trial shows encouraging progress  6:47 Dr. Michelle Cameron discusses the risks and benefits of using cannabis to manage MS symptoms  9:07 Share this episode  24:01 Have you downloaded the free RealTalk MS app?  24:22 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/327 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com STUDY: Phase 1 Clinical Trial of Intracerebroventricular Transplantation of Allogenic Neural Stem Cells in People with Progressive Multiple Sclerosis https://www.sciencedirect.com/science/article/pii/S1934590923003934 Join the RealTalk MS Facebook Group https://facebook.com/groups/realtalkms Download the RealTalk MS App for iOS Devices https://itunes.apple.com/us/app/realtalk-ms/id1436917200 Download the RealTalk MS App for Android Deviceshttps://play.google.com/store/apps/details?id=tv.wizzard.android.realtalk Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 327 Guest: Dr. Michelle Cameron Privacy Policy

In episode 59, we are fortunate enough to be joined by Dr. Rebecca Brossoit. She talked about a recent paper (Brossoit et al., 2023) that explored the impacts of a broad workplace intervention targeting supervisor support and sleep training on sleep and workplace safety. They found that the intervention improved safety largely through improved sleep quality!You can find Dr. Brossoit here. You can also find more resources on Total Worker Health here. You can also find more from the Oregon Healthy Workforce center here. Also, the project that provided the data for the paper received a variety of funding listed below:The U.S. Army Medical Research Acquisition Activity, 820 Chandler Street, Fort Detrick, Maryland, 21702-5014, United States, is the awarding and administering acquisition office. The published work was supported by the Office of the Assistant Secretary of Defense for Health Affairs, through the Psychological Health and Traumatic Brain Injury Research Program—Comprehensive Universal Prevention/Health Promotion Interventions Award, under Award W81XWH-16-1-0720 (to Leslie B. Hammer). Opinions, interpretations, conclusions, and recommendations are those of the author and are not necessarily endorsed by the Department of Defense. The published work was also partly supported by the Oregon Institute of Occupational Health Sciences at Oregon Health & Science University via funds from the Division of Consumer and Business Services of the State of Oregon (ORS 656.630 to Leslie B. Hammer). Additionally, work on the published article was supported by Grant T03OH008435 (to Tori L. Crain and Jordyn J. Leslie) awarded to Portland State University, funded by the Centers for Disease Control and Prevention and the National Institute for Occupational Safety and Health (NIOSH). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of NIOSH, Centers for Disease Control and Prevention, or Health and Human Services (HHS). The remarks made in this interview by Dr. Brossoit are solely the responsibility of Dr. Brossoit and do not necessarily represent the official views of the funding agencies. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit healthywork.substack.com

Dr. Matt Chia and Dr. Ezra Schwartz (@ezraschwartz10) continue the exploration of how vascular surgeons and patients communicate. They discuss how we share stories with one another and what may get lost in translation.   We are excited to welcome Katie Wright (@Translucentone) and Dr. Sherene Shalhub (@ShereneShalhub) to discuss the patient experience of living with Vascular Ehlers-Danlos Syndrome or vEDS.   Katie Wright is the vEDS Natural History Study project coordinator in the Division of Vascular Surgery at Oregon Health & Science University, a podcaster, and a patient advocate. They served as the Director of the Marfan Foundation's vEDS Division, The VEDS Movement until this past March, and they sit on the VEDS Collaborative (@vEDSCollabo) and Aortic Dissection Collaborative (@ADCollab) advisory board. Katie was diagnosed with vEDS in 2017 at the age of 28. Shortly after diagnosis, they started raising awareness and fostering community through YouTube videos. Katie then began a podcast titled Staying Connected, a space to share the stories of other patients and patient families. In 2018, Katie started volunteering on the advisory board of the vEDS Collaborative, a patient-centered research collaborative group led by Dr. Sherene Shalhub.    Dr. Sherene Shalhub is the inaugural John M. Porter Chair in Vascular Surgery and Division Head of the Division of Vascular and Endovascular Surgery at Oregon Health & Science University. She is also the Vice Chair of Regional Strategy & Surgical Operations for the Department of Surgery. Dr. Shalhub's research interests focus on improving healthcare and outcomes for those with genetic vascular conditions. She is the lead investigator for the vEDS Collaborative Natural History Study and the PCORI-funded Aortic Dissection Collaborative. Dr. Shalhub obtained an MPH followed by her medical degree at the University of South Florida. Dr. Shalhub completed her general surgery training at the University of Washington. She then pursued fellowships in trauma research and vascular surgery at the University of Washington.   Resources:   The VEDS Movement  VEDS Collaborative & Natural History Study If you are interested in taking part in the study or would like more information, please contact the study team VEDSColl@ohsu.edu Donate to the vEDS Natural History Study here. Aortic Dissection Collaborative for Patient-Centered Research | BeCertain.org Staying connected Episode: What Medical Professionals Should Know about VEDS Splenic artery pathology presentation, operative interventions, and outcomes in 88 patients with vascular Ehlers-Danlos syndrome Open repair of abdominal aortic aneurysms in patients with vascular Ehlers-Danlos syndrome Audible Bleeding Exam Prep Aortopathies Episode with Dr. Shalhub Free Chime Sound Effects Download - Pixabay   Follow us @audiblebleeding Learn more about us at https://www.audiblebleeding.com/about-1/ and provide us with your feedback with our listener survey.

Dani speaks with Dr. Desi McCue, Senior Director of Operations at The Center for Women's Health at Oregon Health & Science University and current President of Northwest Organization of Nurse Leaders.  They discuss workplace violence and the impact of tailored programs and mindset shifts on improved outcomes, nurse staffing laws, pathway to leadership, and how professional organizations shaped her as a nurse leader.   

Eliza Hallett, M.S., (Oregon Health & Science University, Portland, Oregon) joins Dr. Dixon and Dr. Berezin to discuss the challenges faced by staff and behavioral health service providers, including low wages, traumatic work environments, low wages, and physical and administrative infrastructure. Workforce crisis in behavioral health care [01:33] How representative of the country is Oregon? [03:45] Who were you talking to? [05:32] A figure on radio [06:30] Generating a theoretical framework from the responses [08:01] Qualitative methods [09:30] The five factors [10:33] Wages [14:05] Infrastructure [14:40] Are these issues unique to behavioral health services? [19:11] Legislative changes in Oregon [21:25] Feeling supported matters [23:39] Did the pandemic exacerbate the problem? [27:04] Take home [29:08] Access the complete Behavioral Health Workforce Report to the Oregon Health Authority and State Legislature here. Transcript   Figure 1.  Factors influencing turnover and attrition in the public behavioral health system workforce in Oregona a Interviewees identified factors across three levels—system, organizational, and individual—that contribute to the direct drivers of workforce turnover and attrition.   https://ps.psychiatryonline.org/pb-assets/podcasts/transcripts/PS/PS_Chung_August_2023_transcript.pdf   Subscribe to the podcast here. Check out Editor's Choice, a set of curated collections from the rich resource of articles published in the journal. Sign up to receive notification of new Editor's Choice collections. Browse other articles on our website. Be sure to let your colleagues know about the podcast, and please rate and review it wherever you listen to it. Listen to other podcasts produced by the American Psychiatric Association. Follow the journal on Twitter. E-mail us at psjournal@psych.org

It's In the News, a look at the top stories and headlines from the diabetes community happening now. Top stories this week: Abbott acquires Bigfoot, a new study looks at low-dose aspirin to prevent type 2, researchers look into whether the AI ChatGPT can answer FAQs about diabetes, Beyond Type Run is back for the NYC Marathon, and more! Our previous episode with Bigfoot Biomedical: https://diabetes-connections.com/?s=bigfoot Join us for Moms' Night Out! (use promo code School30 to save) Please visit our Sponsors & Partners - they help make the show possible! Take Control with Afrezza  Omnipod - Simplify Life Learn about Dexcom  Learn about Edgepark Check out VIVI Cap to protect your insulin from extreme temperatures Learn more about AG1 from Athletic Greens  Drive research that matters through the T1D Exchange The best way to keep up with Stacey and the show is by signing up for our weekly newsletter: Sign up for our newsletter here Here's where to find us: Facebook (Group) Facebook (Page) Instagram Twitter Check out Stacey's books! Learn more about everything at our home page www.diabetes-connections.com  Reach out with questions or comments: info@diabetes-connections.com Hello and welcome to Diabetes Connections In the News! I'm Stacey Simms and these are the top diabetes stories and headlines happening now XX In the news is brought to you by Edgepark simplify your diabetes journey with Edgepark XX Our top story this week – Abbott scoops up Bigfoot Biomedical. The deal is expected to close later this year – no financial terms yet disclosed. Abbott and Bigfoot have worked together since 2017 on a connected insulin pen system. Bigfoot Unity exclusively works with Abbott's FreeStyle Libre® Long time listeners will recall that Bigfoot was founded in 2015 around serving people with type 1 diabetes with a closed loop pump system that Byran Mazlish had developed for his wife and son. Mazlish was very secretive at first about the algorithm – this was before people were sure the FDA wouldn't crack down on them – so a journalist nicknamed him Bigfoot. Along the way, the company pivoted to CGM connected SmartPens. I believe Bigfoot was my third interview, back in 2015 – I'll ink up all of the interviews I've done with them in the show notes. https://diabetes-connections.com/?s=bigfoot https://www.prnewswire.com/news-releases/abbott-to-acquire-bigfoot-biomedical-furthering-efforts-to-develop-personalized-connected-solutions-for-people-with-diabetes-301918254.html XX Low-dose aspirin reduces the risk for type 2 diabetes among older adults and slows the increase in fasting glucose levels over time, new research finds. The data come from a secondary analysis of ASPREE, a double-blind, placebo-controlled trial of healthy adults aged 65 years or older, showing that 100 mg of aspirin taken daily for about 5 years did not provide a cardiovascular benefit but did significantly raise the risk for bleeding. It's a big study, more than 16-thousand people. This new analysis shows that individuals taking aspirin had a 15% lower risk for developing type 2 diabetes and that the medication slowed the rate of increase in fasting plasma glucose, compared with placebo, during follow-up. However, lead author Sophia Zoungas, MBBS, PhD, head of the School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, says, "Major prescribing guidelines now recommend older adults take daily aspirin only when there is a medical reason to do so, such as after a heart attack… Although these new findings are of interest, they do not change the clinical advice about aspirin use in older people at this time." https://www.medscape.com/viewarticle/996058 XX A class-action lawsuit filed against Medtronic (NYSE: MDT)+ alleges that the company's insulin delivery devices shared patient data with third parties. The lawsuit — filed by the plaintiff “A.H.” in U.S. District Court in Central California — levels allegations against Medtronic and its MiniMed and InPen devices. It addresses MiniMed's transmission and disclosure of personally identifiable information and protected health information to Google and other third parties. Per the lawsuit, the data was transmitted via tracking and authentication technology, including Google Analytics, Crashlytics, Firebase Authentication and related tools. A.H. says these technologies, installed on the website and/or mobile applications, include the InPen iOS and Android applications. “Information about a person's health is among the most confidential and sensitive information in society, and its mishandling can have serious consequences, including embarrassment, discrimination, and denial of insurance coverage,” the lawsuit reads. A Medtronic spokesperson issued the following statement via email: We have strong processes, technologies, and people in place to safeguard and protect our information and systems, the information of our business partners, and most importantly, the privacy and safety of the patients and healthcare providers that use our products.” https://www.massdevice.com/lawsuit-patient-data-sharing-medtronic-diabetes/ XX Interesting new way to look at type 2 – not weight loss or medication, but about reducing how much blood glucose goes up and stays up after eating and drinking. University of Virginia Daniel Cox says this is called Glucose Everyday Matters, or GEM – aims to prevent blood sugar spikes via educated food and drink selection. This is coupled with physical activity to hasten recovery when blood-sugar spikes do occur. So someone might indulge in a piece of fruit or a small, sweet treat, knowing how it will affect them, and then go for an evening stroll to help even out their blood sugar. Sounds really simple, but in its first study, it helps almost 70-percent of people put their type 2 into remission without weight loss or medication. The National Institutes of Health has provided $3.5 million for a large-scale clinical trial Cox himself went from an A1C of 10.3 at the time of diagnoses to reading consistently under 6.0 for the past 13 years on no medication using his approach. https://newsroom.uvahealth.com/2023/08/31/radical-new-approach-to-managing-type-2-diabetes-receives-3-5-million/ XX Final preparations are in place to initiate the first clinical site for DIAGNODE-3 in the United States, and additional sites are expected to be initiated over the coming months. Approximately 10-12 clinical sites across the US are planned to be initiated, expanding the DIAGNODE-3 trial in the US and eight European countries to approximately 60 clincal sites in total. DIAGNODE-3 is designed to confirm the efficacy and safety of the antigen-specific immunotherapy Diamyd® in patients aged 12 to 29 years recently diagnosed with type 1 diabetes and carrying the genetic HLA DR3-DQ2 marker. Approximately 40% of all screened patients carry the genetic HLA DR3-DQ2 haplotype. This proportion aligns well with expectations based on previous Diamyd® clinical trials and published epidemiological research. Supported by published retrospective analyses and prospective clinical trials, the presence of the genetic HLA DR3-DQ2 haplotype determines the likelihood of responding to Diamyd® therapy, and serves as one of the main inclusion criteria in the DIAGNODE-3 trial. "Patient recruitment is a complex and central element in any trial and it is encouraging to see a significant and continuous uptick in the screening rate and that the observed frequency of the genetically defined responder group enrolled into DIAGNODE-3 confirms our previous observations", says Ulf Hannelius, President & CEO of Diamyd Medical. "This shows the operational and clinical feasibility of our precision medicine approach to Type 1 Diabetes and we look forward to expanding the trial to the United States". https://finance.yahoo.com/news/registrational-phase-iii-trial-type-142600082.html XX A low-carbohydrate diet during pregnancy may have some benefits in gestational diabetes, but overall, low-carbohydrate diets are not associated with any significant differences in outcomes. That was the conclusion of a presentation at the ADA Scientific Sessions. That was back in June but I just learned about it, so I'm passing along to you in case you missed it as well. During a debate at the American Diabetes Association Scientific Sessions, Amy M. Valent, DO, MCR, associate professor in the division of maternal-fetal medicine in the department of obstetrics and gynecology at Oregon Health & Science University, said identifying Teri L. Hernandez, PhD, RN, associate dean of research and scholarship in the College of Nursing and professor in the department of medicine and the division of endocrinology, metabolism and diabetes at the University of Colorado Anschutz Medical Campus, agreed that the first line of therapy with gestational diabetes is nutrition. However, Hernandez said, low-carbohydrate diets are not the only approach in gestational diabetes treatment with nutrition. Currently, dietary advice for treating gestational diabetes is inconsistent, and current professional guidelines have limitations and biases, according to Valent. Different diet strategies include low-carbohydrate, low glycemic index and total energy restriction eating plans, according to Valent. Valent said ACOG guidelines recommended a low-carbohydrate diet for gestational diabetes until the most recently revised edition in January. Valent reviewed several major landmark studies demonstrating that gestational diabetes treatment can decrease pregnancy complications such as preeclampsia and large for gestational age infants. “These studies were in the era where treatment of diabetes in pregnancy involved recommending a low-carbohydrate diet,” Valent said. “The concern with lowering carbohydrates is the risk of consuming lower nutrient-dense foods and resulting in the body to produce ketones, which may be associated with negative effects on the developing baby.” “Pregnancy is dynamic. Nobody's the same today as they were yesterday. They're going to be different 1, 2 or 3 weeks from now, and the nutritional demands and the fetal growth and development stage are going to be different,” Valent said. “So, nutritional demands are going to vary.” Hernandez also added that women and girls tend to be priced out of good nutritional patterns, which is an issue not only in the pregnancy field, but also in the global community. According to Hernandez, it is important to create ways moving forward to identify what nutritional patterns are best that are also affordable for families, especially in lower-income settings. https://www.healio.com/news/womens-health-ob-gyn/20230905/experts-debate-benefits-of-lowcarb-diets-for-gestational-diabetes XX XX Commercial – Edgepark XX Can ChatGPT help answer questions about diabetes? In a recent study published in the journal PLoS ONE, researchers tested chatGPT, a language model geared for discussion, to investigate whether it could answer frequently asked diabetes questions. In the present study, researchers evaluated ChatGPT's expertise in diabetes, especially the capacity to answer commonly requested questions related to diabetes in a similar manner as humans. The 'Frequently Asked Questions' section of the Diabetes Association of Denmark's website, viewed on 10 January 2023, included eight questions. The researchers designed the remaining questions to correlate to particular lines on the 'Knowledge Center for Diabetes website and a report on physical activity and diabetes mellitus type 1. Across the 10 questions, the proportion of correct responses ranged from 38% to 74%. Participants correctly identified ChatGPT-generated replies 60% of the time, which was over the non-inferiority threshold. Males and females had 64% and 58% chances of accurately recognizing the artificial intelligence-generated response, respectively. Individuals who had past contact with diabetes patients had a 61% chance of precisely answering the questions, compared to 57% for those who had no prior contact with diabetes patients. In contrast to the initial premise, participants could discern between ChatGPT-generated and human-written replies better than tossing a fair coin. While ChatGPT demonstrated some potential for accurately answering frequently asked questions, issues around misinformation and the lack of nuanced, personalized advice were evident. As large language models increasingly intersect with healthcare, rigorous studies are essential to evaluate their safety, efficacy, and ethical considerations in patient care, emphasizing the need for robust regulatory frameworks and continuous oversight. https://www.news-medical.net/news/20230905/Can-ChatGPT-be-a-diabetes-consultant-Study-probes-the-potential-and-pitfalls.aspx XX SAN MATEO, Calif., Aug. 24, 2023 /PRNewswire/ -- On November 5, diabetes nonprofit Beyond Type 1 will join more than 550 official charity partners and philanthropists raising awareness and funds while participating in the world's largest marathon, the TCS New York City Marathon. This year, the organization is expanding its 50-person team, Beyond Type Run, to include people living with type 1 or type 2 diabetes, as well as caregivers to those living with diabetes. "Since 2017, we've featured more than 200 runners on our teams who've exemplified what it means to survive and thrive with diabetes," said Beyond Type 1 CEO Deborah Dugan. Beyond Type 1 announces the 2023 NYC Marathon team to raise awareness and funds for people living with diabetes As a part of the Beyond Type Run team, runners will be advocating to raise awareness and funds for Beyond Type 1's portfolio of educational resources, awareness campaigns and peer-to-peer support programs for people impacted by diabetes. This advocacy is elevated through the NYRR Official Charity Partner Program, which offers opportunities for nonprofit organizations to raise funds to support their missions and services. Dexcom and Tandem Diabetes Care are presenting sponsors of Beyond Type Run for a fourth consecutive year. The TCS New York City Marathon Official Charity Partner Program has raised more than $440 million for more than 1,000 nonprofit organizations since its establishment in 2006. https://www.prnewswire.com/news-releases/team-of-50-individuals-impacted-by-diabetes-prepare-for-the-2023-tcs-new-york-city-marathon-301909163.html XX MNO update On the podcast next week.. tandem diabetes celebrity panel from friends for life – Hollywood, the NFL and NASCAR. Last week's episode was Benny off to college That's In the News for this week.. if you like it, please share it! Thanks for joining me! See you back here soon. ----  

Director of Research at the Institute of Noetic Sciences, Helané Wahbeh is an adjunct assistant professor in the Department of Neurology at Oregon Health & Science University. Dr. Wahbeh is the author of some 90+ peer-reviewed publications and the book The Science of Channeling: Why You Should Trust Your Intuition and the Force That Connects Us All - available at https://amzn.to/3K8wfda She is clinically trained as a naturopathic physician, and research-trained with a master's of clinical research and two postdoctoral research fellowships. Her research domains include extended human capacities, complementary and alternative medicine, mind-body medicine, stress, and post-traumatic stress disorder (PTSD). Dr. Wahbeh's extensive meditation training includes the Mindfulness-Based Stress Reduction Teacher Training by Jon Kabat-Zinn, a four-year Meditation Teacher Training with CoreLight, and a 19-year regular meditation practice. She was recently named President of the Parapsychological Association. https://noetic.org/ or https://ions.org/ *Enjoying this? Also listen to Sandra's other show on iHeartRadio and the Coast to Coast AM Network: https://bit.ly/ShadesoftheAfterlife **Join the supportive and loving, We Don't Die Listeners Facebook group at https://www.facebook.com/groups/wedontdielisteners/ ***Would you like to be a Patron of the show? Consider donating $1 or more per episode to help operating costs of the show (I keep the show commercial-free on purpose) please visit: https://www.patreon.com/wedontdieradio or simply give at https://www.paypal.com/paypalme/SandraChamplain  

Music plays an important role in all of our lives. But listening to music or playing an instrument is more than just a creative outlet or hobby — it's also scientifically good for us. Research shows that music can stimulate new connections in our brains; keeping our cognitive abilities sharp and our memories alive.In a new book entitled Every Brain Needs Music: The Neuroscience of Making and Listening to Music, Prof. Larry Sherman explores why we all need music for our mental wellbeing — and how it can even help us later in life.Sherman is professor of neuroscience at Oregon Health & Science University.

Scientists have documented five cases, worldwide, of people being cured of HIV through stem cell transplants. But researchers aren't entirely clear on how the method works. New research from Oregon Health & Science University is helping to explain the mechanics behind the potential cure.A nonhuman primate study recently found that transplanted stem cells help kill HIV-infected cells by recognizing them as foreign invaders, much like they do for certain types of cancer. Researchers also found that HIV leaves the body in a series of stages, which could explain why some patients appear to be cured, but then experience a recurrence. OHSU professor Jonah Sacha led the study and joins us with more details on what the findings could mean for human patients.

In Episode 16 of The CM Mentors Podcast, Matt Graves and Kyle Grandell chat with Adam Hoots, Lean Construction Shepard at Construction ACHE Solutions and Clemson Professor, in our first YouTube Live Stream experiment. Thanks to Everyone who showed up and participated! This was a fun one and keep your eye out for more Live Streams to come. Listen on your Favorite Podcast platform orWatch the interview here:About Adam:Adam began his career in the construction industry as a plumber's helper and then as a red-line architect's helper while attending the University of South Florida. Over the past 20 years, he has steadily advanced his career and has held a variety of roles within the industry. Adam has successfully completed more than $1.5 billion in pre-construction and construction services for a diverse group of industries, including: healthcare, higher education, industrial, life science, retail, and hospitality. Most projects have been in life science and high-tech laboratory construction for clients, such as: Stanford University, Oregon Health Science University, National Institute of Standards & Technology (NIST) and the University of Florida (NIMET). A highly technical builder, Adam excels in efficiency, action, visual communication, and continuous improvement using Lean principles. As an avid, life-long learner, Adam has earned numerous credentials. His achievements include Lean Construction Coaching Professional (LCCP), Green Globes Certified, LEED Accredited Professional in Building Design and Construction, BCSP STS-C, AGC CM Lean, Takt Master, and Scrum Master. Adam is passionate about elevating and empowering the construction industry partners and those around him. He works hard to drive respect to our skilled craft professionals, and intentionally creates environments where capability development and innovation are encouraged. He serves on several community boards, including Skilled Trades Alliance (www.skilledtradesalliance.net), kidSney (www.kidSney.org), National Kidney Foundation (www.kidney.org), RECAB (Regional Education Center for Advisory Board - Greenville, SC) and SC Career Kids (www.sccareerkids.com). Adam is proud to continue his service to the construction industry through his coaching business Construction ACHE Solutions, and by teaching Construction Scheduling at Clemson University.To Connect with Adam:Adam's LinkedIn: https://www.linkedin.com/in/adam-hoots-4645519/Construction ACHE Solutions: https://constructionachesolutions.com/Be on the lookout for Adam's new book releasing soon! Here's a little teaser of the Old Dawg and the Lean Geek: Get full access to Construction Yeti at constructionyeti.substack.com/subscribe

Pediatricians see an array of patients with unique and individual needs, and each child requires their own specialized and unique care plan. As the rate of children diagnosed with autism continues to increase, it's important that pediatricians adapt and tailor visits to the needs of their patients. In this episode, we discuss some of the simple changes primary care providers can make to ensure patients with autism feel seen, comfortable and understood in their medical home.  Guest: Katharine Zuckerman, MD, is a general pediatrician and associate professor at Oregon Health & Science University. Dr. Zuckerman is also a member of the of the AAP Council on Children with Disabilities Executive Committee.    For more information on Children's Hospital Colorado, visit: childrenscolorado.org  

Earlier this month, the World Health Organization announced it was tracking a new COVID-19 “variant of interest,” XBB.1.16, which has spread to more than 30 countries, including the U.S. The variant, which is also known as Arcturus, genetically resembles the Omicron strain which drove a surge of infections and hospitalizations in Oregon that peaked in late January last year. According to a forecast prepared by Peter Graven, the lead data scientist at Oregon Health & Science University, the Arcturus variant and another variant, XBB.1.9, will drive a wave of new hospitalizations in Oregon that will peak at around 500 patients in late June. Still, Graven expects the state's hospital system to be able to handle any surge fueled by Arcturus which appears to be associated with relatively mild cases of infection. Peter Graven joins us to talk about the outlook for COVID and other respiratory illnesses such as RSV and the flu.

In Oregon, people released from prison were 10 times more likely to overdose on opioids compared to the general population, according to a new study that tracked prison release and overdose data from 2014 to 2018. The risk of overdose doubled during the first two weeks of release, and formerly incarcerated women were almost twice as likely as men to experience an opioid overdose. A team of scientists from Oregon State University, Oregon Health & Science University and the Oregon Department of Corrections shared these findings which were published in the Journal of Substance Use and Addiction Treatment. The study looked at both fatal and non-fatal opioid overdoses using data collected from the Department of Corrections, state Medicaid insurance claims for emergency room and hospital admissions, as well as death certificates. Joining us are Dan Hartung, a professor in the College of Pharmacy at Oregon State University and Elizabeth Waddell, an associate professor at the OHSU-PSU School of Public Health, to talk about the research and new efforts in Oregon to expand access to substance use treatment both during and after incarceration.

Skin disease and alcohol use disorder may not be related conditions, but new research from Oregon Health & Science University suggests they could be treated by the same medication. Researchers ran animal studies and found that apremilast, which is normally used to treat psoriasis and psoriatic arthritis, had an effect on alcohol consumption. In human studies conducted at the Scripps Research Institute in California, participants who received apremilast reduced their alcohol intake from five to two drinks per day, on average.Angela Ozburn is an associate professor of behavioral neuroscience at OHSU and a senior author of the study. She joins to tell us more.

A national Adderall shortage is affecting patients in Oregon who rely on the medication to manage symptoms related to ADHD. We check in with Craigan Usher, the program director for Child and Adolescent Psychiatry Training at Oregon Health & Science University to learn more about how the shortage is affecting patients in Portland.

In honor of our TWO YEAR PODAVERSARY we are re-publishing our episode on Women and Heart Attacks where we interviewed Staci Ross and Kim Newlin after Staci suffered a heart attack. In that episode, we walked through Staci's heart attack experience as well as how Kim (a friend and nurse) helped her identify her symptoms and get immediate care. Heart attacks are the leading killer of women world-wide. Yet, women sometimes downplay or disregard apparent symptoms.   We hope you will pass this episode along to the women you love. Help women identify their symptoms and learn strategies to advocate for themselves.  Music by Epidemic Sound.  Experts :  Kim Newlin, R.N. and Staci Ross, M.A., L.M.F.T. Resources : American Heart Association, New England Journal of Medicine, British Heart Foundation, Lancet,  Oregon Health & Science University, mysisters.org, Tisch Center for Women's Health at NYU's Langone Medical Center, Harvard Researcher Dr. Catherine Kreatsoulas Tools : (below) TC4G (TRADING COMFORT FOR GROWTH): American Heart Association - Women: https://www.goredforwomen.org/en/ Youtube recommendation from Kim- “Just A Little Heart Attack”: https://www.youtube.com/watch?v=t7wmPWTnDbE What's your Heart Health? Link to the Tool: Essential 8 https://www.heart.org/en/healthy-living/healthy-lifestyle/lifes-essential-8

Cisplatin is a common chemotherapy drug used to treat several types of cancer in both adults and children. While effective, the drug can build up in the inner ear and cause permanent damage. The resulting hearing loss can affect young patients, potentially causing delays in learning and social-emotional development. Until recently, there were few options to prevent or slow that hearing loss. Sodium thiosulfate (STS), a drug studied for years by researchers at Oregon Health & Science University, has been shown to counteract the toxic effects of cisplatin in the inner ear. The FDA has recently approved its use for patients as young as 1 month old.OHSU audiologist Kristy Knight joins us to explain what the treatment could mean for pediatric cancer patients. We also hear from Jennifer Boesche, a Beaverton mother who petitioned the FDA to approve STS after it helped slow her daughter's treatment-based hearing loss.

Dr. Mark Tager, MD, is CEO of San Diego-based ChangeWell Inc., an organization that trains and coaches certified nutritionists, licensed aestheticians and other healthcare practitioners to enhance their craft. As a physician, he is well grounded in aesthetic, lifestyle, regenerative and integrative medicine. As a medical student at Duke University Medical Center, he created one of the first training programs for medical students in nutrition. He has been actively involved in training and consulting projects in aesthetics, stem cells, medical malpractice prevention, skincare, and advanced cardiac biomarkers. A prolific author and speaker, he has written eleven books, the latest being Feed Your Skin Right: Your Personalized Nutrition Plan for Radiant Beauty. Mark attended Duke University Medical School and trained in family practice at The Oregon Health & Science University. A veteran of more than 1,000 presentations, Mark shares his skills and passion to empower those who attend his trainings. He brings a wealth of experience to his professional development work. As a consultant and change agent, he has worked with a broad spectrum of organizations, from Fortune 100 companies to small non-profits. --- Send in a voice message: https://anchor.fm/skincareanarchy/message Support this podcast: https://anchor.fm/skincareanarchy/support

The Oregon Nursing Education Academy, a new program by Oregon Health & Science University, aims to address both the national and regional shortage in nursing faculty. Susan Bakewell-Sachs is a professor and the Dean and Vice President for Nursing Affairs at the university. Joanne Noone is a professor in the OHSU School of Nursing. She also leads the new academy. They join us with more about the program and issues facing the industry.

The Filtrate:Joel TopfJordy CohenNayan AroraSophia AmbrusoSpecial Guests:Boback Ziaeian @boback Assistant Professor of Medicine David Geffen School of Medicine at UCLA returns for his second episode (SODIUM-HF). His Google Schoolar page is better than yours. David Ellison @dhekidney is professor of medicine at Oregon Health Science University and head of the Oregon Clinical & Translational Institute. Show Notes:Ultrafiltration in Decompensated Heart Failure with Cardiorenal Syndrome (The CARESS Trial)Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure (The UNLOAD trial)Diuretic Strategies in Patients with Acute Decompensated Heart Failure (The DOSE Trial)Diuretic Strategies for Loop Diuretic Resistance in Acute Heart Failure (The 3T Trial)Sequential nephron blockade with a thiazide diuretic has a 1 B-NR (non-radomized) grade in the AHA/ACC Heart Failure Guidelines (7.2)Three important acute decompensated heart failure with SGLT2i:1. Sotagliflozin in Patients with Diabetes and Recent Worsening Heart Failure (SOLOIST-WHF Trial)2. The SGLT2 inhibitor empagliflozin in patients hospitalized for acute heart failure: a multinational randomized trial (The EMPULSE Trial)3. Effects of Early Empagliflozin Initiation on Diuresis and Kidney Function in Patients With Acute Decompensated Heart Failure (EMPAG-HF)Interpreting the Kansas City Cardiomyopathy Questionnaire in Clinical Trials and Clinical Care: JACC State-of-the-Art ReviewCardiologist Sues Epic Over Copyright InfringementOutcomes associated with a strategy of adjuvant metolazone or high-dose loop diuretics in acute decompensated heart failure: a propensity analysis.Acetazolamide to increase natriuresis in congestive heart failure at high risk for diuretic resistance (PubMed)Efficacy and Safety of Spironolactone in Acute Heart Failure (ATHENA Trial)Joel with a video on acetazolamide for altitude sickness. The Butchering Art: Joseph Lister's Quest to Transform the Grisly World of Victorian Medicine(Amazon)

Videos: Ontario College of Physicians and Surgeons state unvaccinated are meantally ill (0:48) Pandemic Amnesty': Do you Forgive and Forget? (8:19) Experts try to calm the angry AI, w Elon Musk Part 2 –  (8:00) MEP Clare Daly – Speech from Nov 23 (1:12) How Long Would Society Last During a Total Grid Collapse? (14:56)   The ultimate stress buster: L-theanine Columbia University Medical Center,  November 16, 2022 Honestly, who would have thought that stress can cause heart damage equivalent to smoking five cigarettes? This is according to a study conducted by Columbia University Medical Center and published in the American Journal of Cardiology.  The study reveals how an amino acid known as L-theanine reduces both stress levels and heart rate.  As a way to increase stress levels, scientists asked 12 participants to solve a mentally stressful task in four double blind trials. L-theanine was given to participants in one of the four trials before dealing with the stressful task.  In the second group, study subjects took L-theanine midway through the work.  In the third and fourth variations, subjects were respectively given a placebo and nothing at all before attempting the task. In comparison to the placebo group, there was a reduced amount of immunoglobulin (a stress marker in saliva released by the immune system after exposure to viruses, bacteria, and other foreign entities) and a lower heart rate in participants who took L-theanine. The researchers explained that L-theanine works by suppressing the sympathetic nervous system responsible for the ‘fight or flight' response during emergency situations. This is achieved by blocking a chemical known as glutamate (L-glutamic acid) that carries electric signals transmitted from nerve cells to the rest of the body cells. The conclusion was that L-theanine plays a major role in terms of influencing psychology (mind) and physiology (body) function during stressful situation. Greater flavonoid intake associated with less arterial calcification Edith Cowen University (Australia), November 23 2022.  The December 2022 issue of Arteriosclerosis, Thrombosis, and Vascular Biology reported a study that uncovered a relationship between greater consumption of plant compounds known as flavonoids and decreased calcification in the abdominal aorta, which supplies blood to the abdominal organs and lower limbs.  Greater abdominal aortic calcification has been associated with an increased risk of stroke, heart attack and dementia.  The study included 881 participants in the Perth Longitudinal Study of Ageing Women. Dietary questionnaire responses were analyzed to determine total and individual flavonoid intake.  Women whose total flavonoid intake was among the top 25% of participants had a 36% lower risk of extensive abdominal aortic calcification than women whose intake was among the lowest 25%. Among women whose intake of individual flavonoids known as flavan-3-ols and flavonols was among the top 25%, respective risks were 39% and 38% lower.  Those who consumed 2–6 cups per day of black tea (the main source of total flavonoid intake in this study), had a 16%–42% lower risk of extensive abdominal aortic calcification than women who were not tea drinkers.  “In most populations, a small group of foods and beverages—uniquely high in flavonoids—contribute the bulk of total dietary flavonoid intake,” first author Ben Parmenter noted. “The main contributors are usually black or green tea, blueberries, strawberries, oranges, red wine, apples, raisins/grapes and dark chocolate.”  “Out of the women who don't drink black tea, higher total non-tea flavonoid intake also appears to protect against extensive calcification of the arteries,” he continued. “This implies flavonoids from sources other than black tea may be protective against abdominal aortic calcification when tea is not consumed.” “Abdominal aortic calcification is a major predictor of vascular disease events, and this study shows intake of flavonoids, that could protect against abdominal aortic calcification, are easily achievable in most people's diets,” he concluded. Researchers discover that vitamin C improves health for children of pregnant smokers Oregon Health & Science University, November 22, 2022 Researchers at Oregon Health & Science University have found that vitamin C supplementation to pregnant women unable to quit smoking significantly improves airway function and respiratory health in their offspring at 5 years of age. While previous studies have shown that vitamin C improves airway function in infants, this is the first study to demonstrate that the improvement in airway function can be maintained through preschool age. The study published this week in JAMA Pediatrics. Despite anti-smoking efforts and a steady decrease of smoking among the adult population over the past decade, the addictive properties of tobacco products can make quitting smoking incredibly challenging for many individuals. Roughly 10% of American women continue to smoke in pregnancy, each year resulting in about 400,000 infants being exposed to smoke in-utero, or in the uterus. In-utero smoke exposure from maternal smoking during pregnancy can be dangerous for a developing baby and is linked to poor health outcomes, including impaired fetal lung development, decreased airway function and an increased risk for wheezing and asthma. Additionally, decreased airway growth early in life causes increased risk for serious lifelong conditions, such as chronic obstructive pulmonary disease, which is now the third leading cause of death worldwide. For this study, participating women were enrolled in a double-blind, randomized controlled trial to receive either vitamin C (500 mg/day) or a placebo. Statistical analyses showed that the effect of vitamin C supplementation to pregnant smokers prior to 23 weeks of gestation consistently resulted in significantly better airway function in their offspring at 5 years old. While the findings may improve the health of the many children who face in-utero smoke exposure, these findings may have even broader implications: The results may potentially lead to better understanding of—and treatments for—the health impacts of other smoke exposures, including indoor and outdoor air pollution, vaping and wildfires. Decades of air pollution undermine the immune system, lymph nodes study finds Columbia University Irving Medical Center, November 23, 2022 The diminished power of the immune system in older adults is usually blamed on the aging process. But a new study by Columbia immunologists shows that decades of particulate air pollution also take a toll. The study found that inhaled particles from environmental pollutants accumulate over decades inside immune cells in lymph nodes associated with the lung, eventually weakening the cells' ability to fight respiratory infections. The findings—published Nov. 21 in Nature Medicine—offer a new reason why individuals become more susceptible to respiratory diseases with age. The Columbia researchers weren't initially looking at air pollution's influence on the immune system. More than ten years ago, they began to collect tissues from deceased organ donors to study immune cells in multiple mucosal and lymphoid tissues. Such cells have been largely inaccessible to researchers studying the immune system where sampling is limited to peripheral blood. “When we looked at people's lymph nodes, we were struck by how many of the nodes in the lung appeared black in color, while those in the GI tract and other areas of the body were the typical beige color,” says Donna Farber, Ph.D., the George H. Humphreys II Professor of Surgical Sciences at Columbia University , who led the study. And as the researchers collected more tissue from younger donors, they also noticed an age difference in the appearance of the lung's lymph nodes: Those from children and teenagers were largely beige while those from donors over age 30 looked were tinged with black and got darker with increasing age. “When we imaged the lung's blackened lymph nodes and found they were clogged with particles from airborne pollutants, we started to think about their impact on the lung's ability to fight infection as people age,” Farber says. In the new study, she and her colleagues examined tissues from 84 deceased human organ donors ranging in age from 11 to 93, all nonsmokers. They found that the pollutant particles in the lung's lymph nodes were located inside macrophages, immune cells that engulf and destroy bacteria, viruses, cellular debris, and other potentially dangerous substances. The macrophages containing particulates were significantly impaired: they were much less capable of ingesting other particles and producing cytokines—chemical “help” signals—that activate other parts of the immune system. Macrophages in those same lymph nodes that did not contain particulates were unimpaired. “We do not know yet the full impact pollution has on the immune system in the lung,” Farber adds, “but pollution undoubtedly plays a role in creating more dangerous respiratory infections in elderly individuals and is another reason to continue the work in improving air quality.” Biologist explains how cannabinoids cause tumor cells to commit suicide Compultense University (Spain): November 17, 2018 A molecular biologist from Compultense University in Madrid, Christina Sanchez, has been studying the molecular activity of cannabinoids for over a decade. Through her studies, she and colleagues found that tetrahydrocannabinol , (THC) which is the main psychoactive part of cannabis, kills tumerous cells while allowing healthy cells to be. It was an unexpected discovery when Sanchez and crew were studying brain cancer cells to grasp a better understanding of how they function. They observed that when cells were exposed to THC, the tumeral cells stopped growing then destroyed themselves. This occurred both in lab tests and animal trials. Sanchez first reported her miraculous findings back in 1998. According to Sanchez ,”After the discovery of this compound that is called THC, it was pretty obvious that this compound had to be acting on the cells, on our organism, through a molecular mechanism.” Research finds that the human body is designed to use cannabis compounds. In the eighties, research first showed the human body contains two targets for THC. One is the endocannabinoid system which processes THC through an endogenous framework. Then the various cannabinoid receptors throughout the body that use them. In conjunction, the body benefits from cannabinoids via these two natural systems. Cannabis is the only place in nature where some certain cannabinoids are found. Sanchez continues, “The endocannabinoids, together with the receptors and the enzymes that synthesize, that produce, the endocannabinoids and that degrade the endocannabinoids, are what we call the endocannabinoid system. We now know that the endocannabinoid system regulates a lot of biological functions: appetite, food intake, motor behavior, reproduction, and many, many other functions. And that's why the plant has such a wide therapeutic potential.” Cannabis cannabinoids, when consumed, work with the body's natural endocannabinoid system and bind to the receptors in the same manner as endogenous cannabinoids. The effects cancer-wise as demonstrated in animal models of breast and brain cancers is that the cancerous cells self destruct. A big advantage of cannabinoids is their unique ability to specifically target tumor cells with no effect on normal cells. This gives cannabinoids the advantage over chemotherapy which targets way more then the actual target Spending Time in the Forest or the Field: Investigations on Stress Perception and Psychological Well-Being University of Freiburg (Germany), November 16, 2022 Research suggests that stays in a forest promote relaxation and reduce stress compared to spending time in a city. The aim of this study was to compare stays in a forest with another natural environment, a cultivated field. Healthy, highly sensitive persons  aged between 18 and 70 years spent one hour in the forest and in the field at intervals of one week. The primary outcome was measured using the Change in Subjective Self-Perception (CSP-14) questionnaire. Secondary outcomes were measured using the Profile Of Mood States (POMS) questionnaire and by analyzing salivary cortisol.  The medicinal use of forests is of increasing interest worldwide. Forest air is refreshing because trees clean the air of pollutants such as nitrogen oxides and sulfur oxides, produce oxygen, and release volatile bioactive terpenes into the air . Research from Japan, South Korea], China, Taiwan, Australia, the United States, Italy, Norway, Iceland, Finland, and Austria suggests that spending time in the forest promotes relaxation, lowers stress hormones and blood pressure and strengthens the immune system. Most studies compared stays in the forest to stays in the city. Accordingly, forests potentially contribute to the prevention of stress-related diseases. Controlled studies have shown positive effects in high blood pressure, chronic heart failure, COPD and chronic neck pain. In addition, spending time in the forest seems to improve psychological well-being. Spending time in forests reduced adrenaline and noradrenaline in urine, cortisol in saliva and self-rated stress perception; it also induced relaxation in controlled trials. This indicates that forest stays can reduce stress. The available data also indicate that “forest bathing”, i.e., walking, standing or sitting in a forest with the purpose of relaxation, perceiving the environment and inhaling phytoncides stabilizes the autonomic nervous system by reducing the sympathetic and activating the parasympathetic tones. With regard to the immune system, which is linked to stress response and vegetative nerve system, an increase in the activity of natural killer cells and the expression of anti-cancer proteins such as perforin, granzyme A/B, granulysin could be demonstrated. In view of these findings, forests could make an important contribution to the prevention of stress-related diseases. As shown in previous studies, the stressful environment of a city was most often compared to a forest; it remains unclear whether forests have specific effects or are just acting as natural environments. Therefore, we wanted to compare two natural but polar-opposite environments. In cultivated fields, sensory impressions are different from the forest. In order to maximize profitability, fields are mostly structured into rectangular shapes and usually mainly one type of plant is found, while in a natural forest, different types of plants grow side by side. Accordingly, visual, auditory and olfactory impressions are less diverse in fields than in forestsThe play of light and shadow that characterizes the forest atmosphere is not found in fields. The plants are usually not tall enough to provide shade, whereas the height of the trees in the forest can provide a sense of shelter. Field paths are more often sealed than forest paths, which changes haptic perception when walking on them. Thus, there are significant differences in the types of sensory impressions between forests and fields.  Highly sensitive persons (HSP), due to their subtle perception, intensely perceive stimuli that others might not even consciously notice. These stimuli may consist of the behavior or moods of other people, the media, medications, pain, and hunger [32]. They perceive stimuli, positively or negatively, to a higher degree, which may, on the one hand, lead to a prolonged reaction time, and on the other hand to more intense feelings and emotional excitability. Our main outcome results show that, as soon as one hour after entering the forest, participants felt a sense of security, relaxation and inner connectedness. In summer, forest interventions had a better effect on vitality. Our study was the first to use the CSP-14 questionnaire, and the comparisons between field and forest interventions were also novel. Forest interventions significantly lowered perceptions of depression, anxiety, hostility, fatigue, confusion and total mood disturbance, and greatly increased vigor. This study shows that forests are not the only kind of natural environment that can promote psychological well-being. The characteristics and qualities of natural environments might influence people's mood and well-being differently. There might also be differences dependent on the preferences of the respective individuals. We regard it as meaningful to study these different effects of nature on the human soul and body in more detail. In addition, future studies examining the effects of different natural environments on human health should respect seasonal aspects and weather conditions.

In this two part interview, Dr. Gammon Earhart, PT, PhD, Director of the Program in Physical Therapy at Washington University in St Louis and Dr. Steven Ambler,  PT, DPT, PhD, MPH, Associate Director of Professional Curriculum in Physical Therapy at Washington University in St Louis revist the HET Podcast to once again discuss the competency-based curriculum, and the lessons they have learned along the way, and more, with host Dr. F Scott Feil. Biography: Dr. Gammon Earhart, PT, PhD, is a physical therapist and neuroscientist whose work focuses on the neural control and rehabilitation of movement, particularly gait and balance, in Parkinson disease. Dr. Earhart completed her physical therapy training at Arcadia University, her PhD at Washington University in St. Louis and a postdoctoral fellowship at Oregon Health & Science University. She is currently Professor of Physical Therapy, Neuroscience, and Neurology at Washington University School of Medicine, where she also serves as the Director of the Program in Physical Therapy at Washington University in St Louis. As director of the program in physical therapy, Dr. Earhart oversees the education, practice, and research missions of the program. She is past President of the American Physical Therapy Association Section on Research. Dr. Earhart has authored over 100 scientific publications and garnered grant support for her research from many sources including the National Institutes of Health, Parkinson's Disease Foundation, American Parkinson Disease Association and Davis Phinney Foundation. Dr. Earhart's research on the benefits of dance for people with PD has been featured in the New York Times, in Oliver Sacks' book Musicophilia, on National Public Radio, and in numerous other media outlets. Gammon's achievements have also been recognized by various honors including the Outstanding Faculty Mentor Award from Washington University in St. Louis, the Friedman Award for Outstanding Contributions to the Advancement of Geriatric Care, the Arcadia University Alumni Achievement Award, and the Eugene Michels New Investigator Award from the American Physical Therapy Association. If you would like to reach out to Dr. Gammon Earhart, please feel free to do so via: Email. Dr. Steven Ambler, PT, DPT, PhD, MPH, CPH, OCS is the Associate Director of Professional Curriculum in Physical Therapy and Associate Professor of Physical Therapy & Orthopaedic Surgery at Washington University in St Louis. Dr. Ambler received his Doctorate of Physical Therapy from Washington University in St Louis in 2005, his Master's of Public Health in 2014 and PhD in Higher Education in 2016 from University of South Florida. Dr. Ambler is actively involved in the American Physical Therapy Association, American Educational Research Association, and Federation of State Boards of Physical Therapy. Dr. Ambler's research interests are focused on access and affordability in higher education. Specifically, the return on investment in academic physical therapy. Dr. Ambler has received the Dean's Teaching Award from the Morsani College of Medicine at the University of South Florida and the Emerging Leader Award from the American Physical Therapy Association. If you would like to reach out to Dr. Steven Ambler, please feel free to do so via: Email and Twitter Resources Mentioned: Washington University in St Louis Program in Physical Therapy HET Podcast - March 2, 2020 - (Part 2) Competency Based Curriculum in DPT Education (Featuring Drs. Gammon Earhart & Steven Ambler) HET Podcast - February 29, 2020 - (Part 1) Competency Based Curriculum in DPT Education (Featuring Drs. Gammon Earhart & Steven Ambler) Special thanks to our sponsor, The NPTE Final Frontier, www.NPTEFF.com, and if you are taking the NPTE or are teaching those about to take the NPTE, use code "HET" for 10% off all purchases at the website...and BREAKING NEWS!!!! They now have an OCS review option as well... You're welcome! You can also reach out to them on Instagram Feel free to reach out to us at:  Website  |  Facebook | Twitter |  Youtube Instagram: HET Podcast  | Dawn Brown | F Scott Feil | Dawn Magnusson | Farley Schweighart | Mahlon Stewart | Lisa Vanhoose For more information on how we can optimize and standardize healthcare education and delivery, subscribe to the Healthcare Education Transformation Podcast on Apple Podcasts or wherever you listen to podcasts.

In this two part interview, Dr. Gammon Earhart, PT, PhD, Director of the Program in Physical Therapy at Washington University in St Louis and Dr. Steven Ambler,  PT, DPT, PhD, MPH, Associate Director of Professional Curriculum in Physical Therapy at Washington University in St Louis revist the HET Podcast to once again discuss the competency-based curriculum, and the lessons they have learned along the way, and more, with host Dr. F Scott Feil. Biography: Dr. Gammon Earhart, PT, PhD, is a physical therapist and neuroscientist whose work focuses on the neural control and rehabilitation of movement, particularly gait and balance, in Parkinson disease. Dr. Earhart completed her physical therapy training at Arcadia University, her PhD at Washington University in St. Louis and a postdoctoral fellowship at Oregon Health & Science University. She is currently Professor of Physical Therapy, Neuroscience, and Neurology at Washington University School of Medicine, where she also serves as the Director of the Program in Physical Therapy at Washington University in St Louis. As director of the program in physical therapy, Dr. Earhart oversees the education, practice, and research missions of the program. She is past President of the American Physical Therapy Association Section on Research. Dr. Earhart has authored over 100 scientific publications and garnered grant support for her research from many sources including the National Institutes of Health, Parkinson's Disease Foundation, American Parkinson Disease Association and Davis Phinney Foundation. Dr. Earhart's research on the benefits of dance for people with PD has been featured in the New York Times, in Oliver Sacks' book Musicophilia, on National Public Radio, and in numerous other media outlets. Gammon's achievements have also been recognized by various honors including the Outstanding Faculty Mentor Award from Washington University in St. Louis, the Friedman Award for Outstanding Contributions to the Advancement of Geriatric Care, the Arcadia University Alumni Achievement Award, and the Eugene Michels New Investigator Award from the American Physical Therapy Association. If you would like to reach out to Dr. Gammon Earhart, please feel free to do so via: Email. Dr. Steven Ambler, PT, DPT, PhD, MPH, CPH, OCS is the Associate Director of Professional Curriculum in Physical Therapy and Associate Professor of Physical Therapy & Orthopaedic Surgery at Washington University in St Louis. Dr. Ambler received his Doctorate of Physical Therapy from Washington University in St Louis in 2005, his Master's of Public Health in 2014 and PhD in Higher Education in 2016 from University of South Florida. Dr. Ambler is actively involved in the American Physical Therapy Association, American Educational Research Association, and Federation of State Boards of Physical Therapy. Dr. Ambler's research interests are focused on access and affordability in higher education. Specifically, the return on investment in academic physical therapy. Dr. Ambler has received the Dean's Teaching Award from the Morsani College of Medicine at the University of South Florida and the Emerging Leader Award from the American Physical Therapy Association. If you would like to reach out to Dr. Steven Ambler, please feel free to do so via: Email and Twitter Resources Mentioned: Washington University in St Louis Program in Physical Therapy HET Podcast - March 2, 2020 - (Part 2) Competency Based Curriculum in DPT Education (Featuring Drs. Gammon Earhart & Steven Ambler) HET Podcast - February 29, 2020 - (Part 1) Competency Based Curriculum in DPT Education (Featuring Drs. Gammon Earhart & Steven Ambler) Special thanks to our sponsor, The NPTE Final Frontier, www.NPTEFF.com, and if you are taking the NPTE or are teaching those about to take the NPTE, use code "HET" for 10% off all purchases at the website...and BREAKING NEWS!!!! They now have an OCS review option as well... You're welcome! You can also reach out to them on Instagram Feel free to reach out to us at:  Website  |  Facebook | Twitter |  Youtube Instagram: HET Podcast  | Dawn Brown | F Scott Feil | Dawn Magnusson | Farley Schweighart | Mahlon Stewart | Lisa Vanhoose For more information on how we can optimize and standardize healthcare education and delivery, subscribe to the Healthcare Education Transformation Podcast on Apple Podcasts or wherever you listen to podcasts.

Spasticity is one of the most common symptoms of MS, impacting up to 80% of the people living with MS. It can feel like mild muscle tightness that you wish would just go away or it can be so painful and debilitating that it keeps you from moving. Dr. Michelle Cameron joins me in this episode to discuss what spasticity is and how to best manage it. Dr. Cameron is a neurologist and physical therapist, a professor in the Department of Neurology at Oregon Health & Science University, Interim Chief of Neurology at the VA Portland Healthcare System, and Co-Director of the VA MS Center of Excellence West. We're also talking about a new framework for thinking and talking about MS that's been proposed by an international panel of MS experts. We'll tell you about a study that looked at polypharmacy and MS (Of course, we'll also tell you what polypharmacy is and why you should be aware of it!) We'll share the details around the discovery of human antibodies that have been shown to prevent Epstein-Barr infection (And we'll explain why this could be incredibly important) If you're an MS caregiver, or you know one, I'm asking for just 5 minutes of your time. We're celebrating National Caregivers Month by breaking down the details of the National Family Caregiving Strategy that was recently submitted to Congress. And we're celebrating the indomitable quality of the human spirit by sharing the story of Eric Domingo Roldan and his mom, Sylvia. We have a lot to talk about! Are you ready for RealTalk MS??! Thanksgiving is two days away!  :22 This Week: Managing Spasticity  1:02 Experts propose a new framework for thinking about and talking about MS  2:07 Polypharmacy and MS  5:55 Researchers identify antibodies that prevent Epstein-Barr Virus infection  9:02 If you're an MS caregiver, or you know one, can I have 5 minutes of your time?  11:30 The 2022 National Family Caregivig Strategy   13:55 Eric Domingo Roldan and his mom, Sylvia, make it into the Guinness Book of World Records  16:34 Dr. Michelle Cameron discusses spasticity and MS 18:40 Share this episode  33:55 SHARE THIS EPISODE OF REALTALK MS Just copy this link & paste it into your text or email: https://realtalkms.com/273 ADD YOUR VOICE TO THE CONVERSATION I've always thought about the RealTalk MS podcast as a conversation. And this is your opportunity to join the conversation by sharing your feedback, questions, and suggestions for topics that we can discuss in future podcast episodes. Please shoot me an email or call the RealTalk MS Listener Hotline and share your thoughts! Email: jon@realtalkms.com Phone: (310) 526-2283 And don't forget to join us in the RealTalk MS Facebook group! LINKS If your podcast app doesn't allow you to click on these links, you'll find them in the show notes in the RealTalk MS app or at www.RealTalkMS.com Multiple Sclerosis Progression: Time for a New Mechanism-Driven Frameworkhttps://www.thelancet.com/journals/laneur/article/PIIS1474-4422(22)00289-7/fulltext Tremlett's MS Research Explained: Polypharmacy and Multiple Sclerosis: A Population-Based Study https://tremlettsmsresearchexplained.wordpress.com/2022/10/27/polypharmacy-and-multiple-sclerosis-a-population-based-study/ STUDY: Polypharmacy and Multiple Sclerosis: A Population-Based Study https://journals.sagepub.com/doi/full/10.1177/13524585221122207 RealTalk MS Episode 229: Evidence Shows MS Is Triggered by the Epstein-Barr Virus with Dr. Kassandra Munger and Dr. AJ Joshi https://realtalkms.com/229 RealTalk MS Episode 231: Evidence Shows EBV Triggers MS: Understanding the Impact of this Breakthrough Research with Dr. Bruce Bebo https://realtalkms.com/231 STUDY: Epstein-Barr Virus gH/gL Has Multiple Sites of Vulnerability for Virus Neutralization and Fusion Inhibition https://cell.com/immunity/fulltext/S1074-7613(22)00544-1 Take the iConquer MS Caregiver Survey https://realtalkms.com/caregiver 2022 National Strategy to Support Family Caregivers https://acl.gov/sites/default/files/RAISE_SGRG/NatlStrategyToSupportFamilyCaregivers.pdf Eric Domingo Roldan's Instagram Handle @eeRiicbcn Join the RealTalk MS Facebook Group https://facebook.com/groups/realtalkms Download the RealTalk MS App for iOS Devices https://itunes.apple.com/us/app/realtalk-ms/id1436917200 Download the RealTalk MS App for Android Deviceshttps://play.google.com/store/apps/details?id=tv.wizzard.android.realtalk Give RealTalk MS a rating and review http://www.realtalkms.com/review Follow RealTalk MS on Twitter, @RealTalkMS_jon, and subscribe to our newsletter at our website, RealTalkMS.com. RealTalk MS Episode 273 Guest: Dr. Michelle Cameron Tags: MS, MultipleSclerosis, MSResearch, MSSociety, RealTalkMS Privacy Policy

Whew, it can be so hard to focus these days, with all the craziness happening in the news and world around us! But our jobs need to get done and our families need to be fed, so how can we hunker down and stay focused and positive?Dr. Sonja K Billes is our HER resident neuroscientist, taking us down the deep dark journey into our minds. Dr. Billes is the founder of August Scientific and has a Ph.D. in Neuroscience from Oregon Health & Science University. She has over 20 years of experience in biomedical research and 13 years of experience as a medical writer in the pharmaceutical and drug development industries.She joins Dr. Pam to talk about nootropics, the pros and cons of caffeine, and the research behind popular stress-relieving herbs like ashwagandha.

Whew, it can be so hard to focus these days, with all the craziness happening in the news and world around us! But our jobs need to get done and our families need to be fed, so how can we hunker down and stay focused and positive?Dr. Sonja K Billes is our HER resident neuroscientist, taking us down the deep dark journey into our minds. Dr. Billes is the founder of August Scientific and has a Ph.D. in Neuroscience from Oregon Health & Science University. She has over 20 years of experience in biomedical research and 13 years of experience as a medical writer in the pharmaceutical and drug development industries.She joins Dr. Pam to talk about nootropics, the pros and cons of caffeine, and the research behind popular stress-relieving herbs like ashwagandha.

  Click here for Spear Live December 2-3 2022. Podcast Website Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram Connect with Melissa on Linkedin Dental Digest Podcast Facebook Jack Ferracane is Professor and Chair of Restorative Dentistry, and Division Director of Biomaterials and Biomechanics at Oregon Health & Science University, Portland, Oregon.  Dr. Ferracane earned his Ph.D. in Biological Materials from Northwestern University.  He is a founding fellow and past-President of the Academy of Dental Materials.  He is a past-President of the American Association for Dental Research.  He is the recipient of the Wilmer Souder Award from the Dental Materials Group of the IADR, the Founders Award from the Academy of Dental Materials, and the Hollenback Award from the Academy of Operative Dentistry. He is an honorary member of the American College of Dentists and the Oregon Dental Association. He has authored or co-authored several textbooks on dental materials and operative dentistry, and has published extensively on biomaterials. His research is funded by the NIH/NIDCR as well as private industry.  He also is actively involved in the establishment and operation of networks designed to conduct dental clinical research in the private practice setting. 

Click here for Spear Live December 2-3 2022. Podcast Website Follow @dental_digest_podcast Instagram Follow @dr.melissa_seibert on Instagram Connect with Melissa on Linkedin Dental Digest Podcast Facebook Jack Ferracane is Professor and Chair of Restorative Dentistry, and Division Director of Biomaterials and Biomechanics at Oregon Health & Science University, Portland, Oregon.  Dr. Ferracane earned his Ph.D. in Biological Materials from Northwestern University.  He is a founding fellow and past-President of the Academy of Dental Materials.  He is a past-President of the American Association for Dental Research.  He is the recipient of the Wilmer Souder Award from the Dental Materials Group of the IADR, the Founders Award from the Academy of Dental Materials, and the Hollenback Award from the Academy of Operative Dentistry. He is an honorary member of the American College of Dentists and the Oregon Dental Association. He has authored or co-authored several textbooks on dental materials and operative dentistry, and has published extensively on biomaterials. His research is funded by the NIH/NIDCR as well as private industry.  He also is actively involved in the establishment and operation of networks designed to conduct dental clinical research in the private practice setting. 

Moderna Clinical Trials Terribly Flawed — and FDA Knew It, Former Pharma Executive Tells RFK, Jr. South African FM: ‘Patronizing bullying' not acceptable Prescription Playground: Why so many children are now taking ADHD drugs | 60 Minutes Australia   HEALTH NEWS Chili peppers for a healthy gut: Spicy chemical may inhibit gut tumors How Tart Cherries Reduce Inflammation and Oxidative Stress Uncovering the links between diet, gut health and immunity Southern-style diet ‘increases death risk' in kidney disease patients Could Hibiscus Tea be Better than High Blood Pressure Drugs? Can breast milk feed a love of vegetables? Chili peppers for a healthy gut: Spicy chemical may inhibit gut tumors University of California, San Diego   August 1, 2022 Researchers at the University of California, San Diego School of Medicine report that dietary capsaicin — the active ingredient in chili peppers — produces chronic activation of a receptor on cells lining the intestines of mice, triggering a reaction that ultimately reduces the risk of colorectal tumors. The receptor or ion channel, called TRPV1, was originally discovered in sensory neurons, where it acts as a sentinel for heat, acidity and spicy chemicals in the environment. TRPV1 was quickly described as a molecular ‘pain receptor.'  But Raz and colleagues have found that TPRV1 is also expressed by epithelial cells of the intestines, where it is activated by epidermal growth factor receptor or EGFR. EGFR is an important driver of cell proliferation in the intestines, whose epithelial lining is replaced approximately every four to six days. “These results showed us that epithelial TRPV1 normally works as a tumor suppressor in the intestines,” said de Jong. In addition, molecular studies of human colorectal cancer samples recently uncovered multiple mutations in the TRPV1 gene, though Raz noted that currently there is no direct evidence that TRPV1 deficiency is a risk factor for colorectal cancer in humans. The current study suggests one potential remedy might be spicy capsaicin, which acts as an irritant in mammals, generating a burning sensation in contact with tissue.  The researchers fed capsaicin to mice genetically prone to developing multiple tumors in the gastrointestinal tract. The treatment resulted in a reduced tumor burden and extended the lifespans of the mice by more than 30 percent. The treatment was even more effective when combined with celecoxib, a COX-2 non-steroidal anti-inflammatory drug already approved for treating some forms of arthritis and pain. “Our data suggest that individuals at high risk of developing recurrent intestinal tumors may benefit from chronic TRPV1 activation,” said Raz. “We have provided proof-of-principle.” How Tart Cherries Reduce Inflammation and Oxidative StressNorthumbria University (UK),  August 4, 2022Michigan researchers had previously shown that a cherry-enriched diet not only reduced overall body inflammation, but also reduced inflammation at key sites (belly fat, heart) known to affect heart disease risk in the obese.This study offers further promise that foods rich in antioxidants, such as cherries, could potentially reduce inflammation and have the potential to lower disease risk.”

Two daily doses of the tart cherry concentrate was associated with significantly lower levels of interleukin-6 (IL-6) and high-sensitivity C-reactive protein (hsCRP), compared to placebo, according to findings published in Nutrients.

”This is the first study to investigate the impact of cherries on systemic inflammatory and oxidative stress induced by a series of metabolically challenging cycling bouts. Despite both groups demonstrating a similar drop off in performance and no differences in time trial performance, the results show that both oxidative stress and inflammatory responses were attenuated with Montmorency cherry concentrate supplementation versus placebo.” 

”With millions of Americans looking for ways to naturally manage pain, it's promising that tart cherries can help, without the possible side effects often associated with arthritis medications,” said Kerry Kuehl, M.D, Dr.PH., M.S., Oregon Health & Science University, principal study investigator. “I'm intrigued by the potential for a real food to offer such a powerful anti-inflammatory benefit — especially for active adults.”

Darren E. Huxley, MD says that a natural alternatives to pain medications are proving effective without unwanted side effects. “In this case we have cherries, another potent, natural antioxidant proving to be as, if not more effective than pain medications because of the ability for sustained long-term use without side effects in common anti-inflammatory drugs.Tart cherries have also been shown to contain naturally high levels of melatonin, a key compound in the human sleep-and-wake cycle, and new research in the European Journal of Nutrition confirms that melatonin from tart cherries is absorbed by humans.

In 2001, Burkhardt et al. even observed that the Montmorency variety, in particular, contains about six times more melatonin than the Balaton variety.  Uncovering the links between diet, gut health and immunity University of Sydney, August 5, 2022 A preclinical study from the University of Sydney has found a high-protein diet can change the microbiota of the gut, triggering an immune response. Researchers say the study takes us a step closer to understanding the way diet impacts gut health and immunity. “The focus of our work is on how the gut microbiota—the trillions of bacteria that inhabit the gut—affects the immune system,” said Associate Professor Laurence Macia from the University's Charles Perkins Center and Faculty of Medicine and Health. Traditionally, however, scientists have focused on the role of dietary fiber in maintaining a healthy gut. In this first-of-its-kind study, published in Nature Communications, the team from the Charles Perkins Center used sophisticated modeling to explore the impact of 10 diets with a different makeup of macronutrients—protein, fats and carbohydrate in mice. Mice fed a high protein diet increased their production of bacterial extracellular vesicles, complex cargo containing bacterial information such as DNA and protein. The body subsequently viewed this activity as a threat and triggered a sequence of events where immune cells traveled into the gut wall. “Here we found protein had a huge impact on the gut microbiota and it was not so much about the type of bacteria that were there, but the type of activity. In essence, we discovered a new way of communication between the gut bacteria and the host which was mediated by protein,” said Associate Professor Macia. While it is too early to say if this research might translate in humans, the researchers say activation of the immune system can prove either good or bad news. “By increasing antibodies in the gut you may see strong protection against potential pathogens, for example salmonella, but on the downside, an activated immune system could mean you are at increased risk of colitis, an inflammatory bowel disease, or autoimmune conditions like Crohn's,” said lead author and post-doctoral researcher Jian Tan. The results appear consistent with the population impacts of modern-day diets, with the Western world seeing lower rates of gastrointestinal infection but higher rates of chronic disease.  Southern-style diet ‘increases death risk' in kidney disease patients University of Alabama  1 August 2022 New research published in the National Kidney Foundation's American Journal of Kidney Diseases suggests that eating a “Southern-style diet” is linked with higher death rates in kidney disease patients. Investigating the influence of diet on kidney disease patients, the researchers studied  3,972 participants with stage 3-5 chronic kidney disease who had not started dialysis. Analyzing the dietary habits of the participants, the researchers found that those who regularly consumed foods familiar to Southern diets had a 50% increase in risk of death across the 6.5-year follow-up period. Foods that the authors identify as being part of a Southern diet include processed and fried foods, organ meats and sweetened beverages. Could Hibiscus Tea be Better than High Blood Pressure Drugs? Tufts University,  August 4th, 2022 Naturally healing foods, including hibiscus, don't carry the side effects of pharmaceuticals and can often offer similar (or better) benefits, without padding the pockets of Big Pharma companies. This is one example of a natural solution for high blood pressure. When it comes to high blood pressure, a completely preventable condition, there are many natural solutions. Things like cayenne pepper, apple cider vinegar, and celery are just a few alternatives, along with broad dietary and lifestyle changes. But many people aren't aware of the blood pressure lowering benefits of hibiscus. Dr. Diane McKay presented her own research on hibiscus Dr. McKay, of Tufts University, conducted a study on 65 people between the ages of 30 and 70 who had been diagnosed with prehypertension or mild hypertension. After receiving hibiscus tea daily for six weeks, participants experienced reduced diastolic, systolic, and mean arterial pressures when compared with those who received a placebo. The effects were most pronounced in those with the highest beginning baseline blood pressures. In another study, scientists received a surprise when looking at the effects of hibiscus tea on blood sugar. The study compared the effects of hibiscus and black teas and found that both impacted cholesterol levels. While the black tea positively influenced HDL levels, hibiscus tea helped keep LDL, HDL, and overall cholesterol at healthy levels. Can breast milk feed a love of vegetables?  Monell Chemical Senses Center, August 4, 2022  Want your preschooler to eat veggies without a fuss? Try eating veggies while you're breast-feeding. That's the message from a new study of lactating mothers and their breast-fed babies. The study found that those infants who took in veggie-flavored breast-milk were less likely to turn away from similar-tasting cereal when they graduated to more solid food. “Every baby's sensory experience is unique, but the flavor of their first food, beginning in utero, is dependent on what mom is eating,” said Julie Mennella. She is a biopsychologist at the Monell Chemical Senses Center in Philadelphia, and led the study. “The way I see it is: Mother's milk is the ultimate in precision medicine,” Mennella said. When an expectant mother eats vegetables, they flavor her amniotic fluid—and later, her breast-milk—and those flavors get passed along to her baby. As a result, the researchers said, if the baby learns early how veggies taste, he or she will be less apt to squawk when offered that first spoonful. For her study, Mennella randomly assigned 97 breast-feeding mothers to one of five groups. For a month, three groups drank a half-cup of carrot, celery, beet or vegetable juice before nursing. One group began when babies were two weeks old, another at 1-1/2 months of age and the third at 2-1/2 months. A fourth group of moms drank juice for three months, starting when their babies were two weeks old. A fifth group—the “control” group—did not use juice. The takeaway: Babies who'd been exposed to vegetable flavors in breast-milk preferred carrot-flavored cereal over plain cereal or cereal with the unfamiliar taste of broccoli. Only 8 percent rejected all of the foods, the findings showed.