Podcasts about TIA

CORE RESOURCES: Rutherford's Vascular and Endovascular Therapy 10th Edition, Chapters 88, 89, 91, and 94 Atlas of Vascular Surgery and Endovascular Therapy 2nd Edition, Chapter 9 ADDITIONAL RESOURCES: Audible Bleeding Episodes Holding Pressure - Carotid Endarterectomy: https://www.audiblebleeding.com/2024/02/27/holding-pressure-carotid-endarterectomy/ Holding Pressure Case Prep - Endovascular Basics: https://www.audiblebleeding.com/2023/04/23/holding-pressure-case-prep-endovascular-basics/ Videos TCAR Technical Video: https://jnis.bmj.com/content/14/8/842 Articles Society for Vascular Surgery clinical practice guidelines for management of extracranial cerebrovascular disease:  https://www.jvascsurg.org/article/S0741-5214%2821%2900893-4/fulltext Technical aspects of transcarotid artery revascularization using the ENROUTE transcarotid neuroprotection and stent system: https://www.jvascsurg.org/action/showPdf?pii=S0741-5214%2816%2931862-6 Referenced Studies ROADSTER-1 https://pubmed.ncbi.nlm.nih.gov/30611582/ ROADSTER-2 https://pubmed.ncbi.nlm.nih.gov/32811386/ https://pubmed.ncbi.nlm.nih.gov/35381327/ TCAR Surveillance Project https://jamanetwork.com/journals/jama/fullarticle/2757579?utm_source=openevidence&utm_medium=referral https://pubmed.ncbi.nlm.nih.gov/36172943/   OUTLINE:   CAROTID ARTERY DISEASE 1. Pathophysiology/etiology Carotid artery disease is primarily driven by atherosclerotic plaque deposition.  Risk factors: hypertension, hyperlipidemia, diabetes, smoking, and advanced age. Nonatherosclerotic etiologies: fibromuscular dysplasia, carotid dissection, vasculitic disease, carotid webs, and trauma. When the endothelium is damaged, monocytes migrate to the site and differentiate into macrophages that take up oxidized LDL particles to become foam cells. Meanwhile, an inflammatory response occurs where activated platelets release thromboxane A2, platelet derived growth factor, and inflammatory cytokines that promote further platelet aggregation and vascular inflammation. Smooth muscle cells migrate and proliferate, forming the structural framework of the atheroma.  Within the lesion, necrotic debris and lipid accumulate, creating a vulnerable plaque. Plaque rupture exposes this material to the bloodstream, serving as a nidus for thrombus formation which can lead to ischemic events. Carotid bifurcation is particularly prone to plaque formation due to turbulent blood flow. Embolization of plaque from this area can result in TIA or ischemic stroke.  2. Presentation Patients are often asymptomatic and stenosis is incidentally found on imaging.  Symptomatic patients present with neurologic symptoms including unilateral motor and sensory loss, aphasia (difficulty finding words), dysarthria (difficulty speaking), amaurosis fugax (temporary monocular vision loss due to embolus to the ophthalmic artery), transient ischemic attacks Physical exam findings may be notable for auscultation of a carotid bruit. Patients may also have evidence of retinal artery embolization on fundoscopic examination (Hollenhorst plaque) or asymptomatic cerebral infarction.  3. Diagnosis USPTF recommends against screening for asymptomatic carotid artery stenosis.  In patients with no risk factors, SVS recommends against screening for asymptomatic carotid artery stenosis. However, they do recommend screening for asymptomatic clinically significant carotid bifurcation in certain groups of patients with multiple risk factors.  These risk factors include patients with clinically significant peripheral vascular disease, patients 65 and older with history of CAD, smoking, hypercholesterolemia, and patients prior to coronary artery bypass.  Relevant findings on physical exam or imaging findings may warrant screening, but screening is not recommended for the presence of neck bruit alone without other risk factors, as this finding has a low sensitivity and specificity for detecting clinically significant carotid artery stenosis.  Carotid duplex ultrasound: first-line imaging modality for both screening and initial evaluation of stenosis, noninvasive, low-cost CTA: rapid, high-resolution, three-dimensional imaging of vascular anatomy, risk of contrast and radiation exposure MRA: high-quality, three-dimensional imaging without radiation or contrast, expensive with longer acquisition time, can overestimate stenosis in severe disease DSA/angiography: gold standard, expensive, invasive, not generally recommended for routine diagnostic evaluation or screening 4. Classification Carotid artery stenosis is classified by degree of luminal narrowing. NASCET method: standard in current practice. Compares the minimal residual lumen at the point of greatest stenosis to the diameter of the normal distal internal carotid artery.  Classification of stenosis: Mild: 70 bpm, and ACT >250 seconds to optimize cerebral perfusion and minimize thrombotic risk. Clamp the carotid artery just proximal to the arterial sheath to establish active flow reversal.  Flow controller settings: Low setting High setting Flow-stop button: allows for temporary cessation of flow (used when we inject contrast).  Confirm flow reversal via two different ways:  The first way is to stop flow to the venous return sheath with the stopcock, clearing the line with hep saline injection, and then opening the stopcock and seeing the blood returning to the controller in a reverse fashion. The second way is to perform an angiogram with a small amount of contrast injection while holding the flow-stop button. Using the angio we want to make sure that contrast is flowing retrograde in the cervical ICA thereby confirming flow reversal.    Carotid artery stenting, balloon angioplasty, and completion angiogram At this point, a standard carotid angioplasty and stenting procedure is performed. ENROUTE transcarotid Neuroprotection System device:  inner diameter of 8F and an outer diameter of 10F Has its own carotid artery stent system but is also compatible with all FDA-approved carotid stents.  Final angiogram is performed to confirm stent position, vessel patency, and absence of complications including vasospasm at the distal end of the stent and filling defects from protrusion of atheromatous material through the stent    Cessation of flow reversal and sheath removal Allow the flow reversal to run for a few minutes after the final balloon angioplasty to clear any debris.  Antegrade flow is restored by releasing the carotid clamp and closing the stopcocks on the neuroprotection system.  The patient is auto-transfused the blood from the flow line back to the venous system.  As the arterial access system is removed and the puncture site is closed with the U-stitch.  IV protamine is administered to reverse the heparin. Standard closure is performed at the incision site. Meanwhile, hemostasis is achieved after removal of the femoral vein sheath with brief manual compression.  Postop care/complications Postop care All patients after a TCAR should be monitored in the ICU setting for 24 hours, as an embolic stroke, hypotension with or without bradycardia, or hypertension can occur.  Should a TIA or stroke be observed, a carotid duplex scan and CT angiogram should be immediately obtained to assess the stent site and the presence of an embolic or thrombotic filling defect, dissection, or occlusion.  Dual antiplatelet therapy: continue for 45 days to 12 months Aspirin and statin therapy: continued indefinitely Surveillance duplex imaging: 4 weeks, 6 months, and 12 months, and annually thereafter. Postop complications Hematoma Stroke Myocardial infarction Cerebral hyperperfusion syndrome Sudden and excessive increase in cerebral blood flow to previously hypoperfused brain tissue is met with vasculature that cannot constrict appropriately from chronic vasodilation Leads to breakthrough hyperperfusion. This results in cerebral edema, intracerebral hemorrhage, and neurological symptoms.  Cranial nerve injury Hypoglossal nerve (CN XII) injury: ipsilateral tongue deviation. It is the most commonly injured cranial nerve.  Vagus nerve (CN X) injury: hoarseness and possible vocal cord paralysis.  Glossopharyngeal nerve (CN IX) injury: soft palate dysfunction.  Recurrent laryngeal nerve injury: voice hoarseness and inability to cough as it innervates all of the voice box muscles except for the cricothyroid muscle Marginal mandibular nerve injury: ipsilateral lip droop, injury is rare in TCAR.  Stent restenosis Pseudoaneurysm Access site infection

Lynn Gravley, the newly appointed chairman of the Transportation Intermediaries Association (TIA) and founder of NT Logistics, joins us to break down the real side of the freight industry! Lynn shares his journey from being a broke, freshly minted college graduate to building a thriving managed transportation business. He dives into how managing full networks differs from traditional freight brokerage, the massive role of data analytics and Power BI dashboards, and why aligning with the TIA is a game-changer for building authority. If you are ready to stop fighting fires and start optimizing your logistics network, tune in now!   Connect with Lynn Website: https://www.ntlogistics.com/ / https://www.tianet.org/  LinkedIn: https://www.linkedin.com/in/lynn-gravley/  

We used to say OG's or Old Head...today it's called "Unc." Are you in your Unc or Tia era? We talk about how we're dealing with it and be accepting of it.

Ever looked around your house and thought, "How did it get like this? I used to have it all together"? You are not alone, and according to this week's guest, that mess is not a character flaw. It is a sign your life has outgrown your system. And that is fixable. Angie sits down with Tia Toso, founder of Room for Serenity, a home organizing service in the Twin Cities. Tia isn't the kind of organizer who swoops in, makes everything pretty, and leaves you with a bin system you will never maintain. As a mom herself, she coaches families through the decisions so the change actually sticks. In this episode you will learn why there is no quick hack to organizing when you have kids, how to organize for function instead of for the perfect Instagram shelf, how to get your spouse and kids genuinely on board, and a low-pressure way to declutter a little at a time. Most of all, Tia reframes the guilt and shame so many of us carry, reminding us we were built to live in community, not to handle it all alone. If you have a counter that hasn't seen daylight in weeks, press play. Follow Mom Essentials, leave a review, and visit theparenttoolbox.info for more. Connect with Tia: https://www.roomforserenity.com/book-free-consult http://instagram.com/room_for_serenity  http://www.linkedin.com/company/roomforserenity Essential Minute: https://link.doterra.com/aHuOcj Family Planner: https://www.theparenttoolbox.info/the-calm-family-planner  

We're back with a deep dive on one of our favorite recent romances, Seven Days in June by Tia Williams! We talk about yearning in contemporaries, about books that have a powerful sense of place, about dual timelines, about secondary characters, about lines that stick with us years later, and about how fated mates works as a trope in a contemporary romance.Tia also has a new book out this month, The Missed Connection. Get it wherever you get your books.Listen to our Season 3 episode with Tia Williams about writers in romance and head over to talk about Seven Days in June or any of her other books on the Fated Mates Discord, accessible to our Patreon subscribers. By joining the Patreon, you meet other Fated Mates listeners and get an extra monthly episode from us. Support us and learn more at fatedmates.net/patreon.Read Seven Days in June at Amazon, Barnes & Noble, Kobo, Apple Books, wherever you get your books, or with your monthly subscription to Kindle Unlimited.NotesSorry, we're a Knicks podcast now, everyone. Sarah because of New York and Jen because of Villanova. Sarah did look up that Knickerbocker thing, but we never got back to it. Learn more about how those trousers became a symbol of NYC here. Sports curses are bad, just ask Red Sox fans! Spike Lee has really been through it, Jalen Brunson's interview after the game just shows you a man trying to deal with his feelings.The World Cup, we just don't know anything about that yet, but we're gonna get up to speed on that, just like all the people of the world getting up to speed on America. Also, feels important to romance that we bring you the news that the Tartan Army cleared Boston out of beer.We had Tia Williams on the podcast back in season 3 when Seven Days in June was released. Although there is not a sequel to Seven Days, Shane and Eva are secondary characters in the YA romance with Audre that came out in 2025. Find out more about Tia, and see all her books at her website.Come see Sophia Benoit in conversation with us in NYC (June 23) and Chicago (June 24) to celebrate the release of her first historical romance, The Very Definition of Love.SponsorsFrederick Smith, author of Love is a Contact Sport, available in print, ebook, audiobook from Amazon, Barnes & Noble, Kobo, or wherever you get your books.Little Brown & Company, publishers of Lu Chekowsky's Don't Buy What I'm Selling: On Breaking Up with Advertising and Finally Learning to Love My Whole, Fat Self, available in print, ebook, audiobook from Amazon, Apple Books, Barnes & Noble, Kobo or wherever you get your books.The What in the Smut? Podcast, available wherever you get your podcasts.W by Wattpad Books, publishers of Nicole Alfrine's Brain Games. Available in print and ebook from Amazon, Apple Books, Barnes & Noble, Kobo, or wherever you get your books.The RestFor even more info about this episode, and to explore everything Fated Mates has to offer, visit: https://fatedmates.net/2026/6/16/s0838-seven-days-in-june-by-tia-williams If you wish you had six more days in a week of people talking about romance, may we suggest joining our Patreon? Aside from an additional episode every month you get access to our Discord, where other romance readers are talking about books they love (and many other things!) all the time. It's so fun! Learn more about the Patreon and go join those cool people who love romance as much as you do at patreon.com/fatedmates. Beyond your favorite podcast app, you can find us on Instagram, Threads, Blue Sky, Tumblr, and probably some other places, too, if you look hard enough. If you've never listened to our Stop Book Banning episode, there's no better time than now.

Greg Bluestein hosts a special edition of The Atlanta Journal-Constitution's Politically Georgia podcast with Tia Mitchell and Patricia Murphy after Georgia's primary runoff elections delivered two major Republican verdicts. Rick Jackson defeated Lt. Gov. Burt Jones in the GOP race for governor despite late support from Donald Trump and Brian Kemp, while Mike Collins beat Derek Dooley in the Senate runoff after Trump backed Collins and Kemp helped build Dooley's campaign. The episode looks at what the results say about Kemp's political machine, Trump's uneven influence, Republican unity and the general election fights ahead against Keisha Lance Bottoms and Jon Ossoff. Greg, Tia and Patricia also break down key down-ballot races and the uncertain future of redistricting in a special legislative session. Have a question or comment for the show? Call or text the 24-hour Politically Georgia Podcast Hotline at 770-810-5297. We'll play back your question and answer it during our next Monday Mailbag segment. You can also email your questions at PoliticallyGeorgia@ajc.com. Learn more about your ad choices. Visit megaphone.fm/adchoices

Primary stroke prevention is a critical opportunity for neurologists, with most stroke risk driven by modifiable factors such as hypertension and lifestyle behaviors. This episode highlights practical tools and strategies, including Life's Essential 8 and contemporary risk calculators, while also exploring evolving approaches to shared decision making and secondary prevention. In this episode, Katie Grouse, MD, FAAN, speaks with Mitchell S. Elkind, MD, MS, FAAN, author of the article "Stroke Prevention" in the Continuum® June 2026 Cerebrovascular Disease 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. Elkind is the Chief Science Officer for Brain Health and Stroke at the American Heart Association in Dallas, Texas, and a professor of neurology and epidemiology at Columbia University in New York, New York. Additional Resources Read the article: Stroke Prevention 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 Guest: @MitchElkind Full episode transcript available here Dr Grouse: Neurologists have generally been more involved in secondary stroke prevention, but primary stroke prevention is increasingly recognized as an important topic of discussion for neurologists. Today, I have the opportunity to interview Dr. Mitchell Elkind, who wrote the article on stroke prevention in the newest Continuum issue on cerebrovascular disease.  Dr Jones: This is Dr. Lyell Jones, Editor-in-Chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about earning CME, subscribing to the journal, and exclusive access to interviews not featured on the podcast.  Dr Grouse: This is Dr. Katie Grouse. Today, I'm interviewing Dr. Mitchell Elkind about his article on stroke prevention. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Welcome to the podcast, and please introduce yourself to the audience.  Dr Elkind: Thank you so much, Katie. So, my name is Mitch Elkind, and I'm the Chief Science Officer for Brain Health and Stroke at the American Heart Association and a stroke neurologist by background.  Dr Grouse: Well, I just want to start by saying that I really enjoyed reading this article. I think this is just a really wonderful article I recommend strongly. Such a high yield, an important topic for a lot of us who see patients who are interested in learning about their stroke risks or need help with, uh, stroke prevention after having a stroke. So, I wanted to start. What's changed in the last couple of years? You know, what are some big highlights that you really want to stress that are different from maybe the last time we reviewed this topic?  Dr Elkind: Sure. Well, there's been a lot of development in the field of secondary stroke prevention, for one thing. But even beyond that, I think we increasingly appreciate how important it is to control what we call the social drivers of health on the earlier side, primordial or primary prevention. And that has been a big advance, I'd say. And I would also say, I think it's really important for neurologists to understand some of those questions about primordial and primary prevention. You know, we tend to get involved with patients after they've had a stroke or maybe a TIA, some kind of event. But sometimes we find people who are following for, you know, non-stroke related conditions who have risk factors also. And we can really play an important role in identifying those risk factors and helping to prevent a first stroke or vascular event as well. So, I think it's real important for us to be doctors even before we're neurologists. So, you know, Katie, about ninety percent of stroke risk is modifiable, so we can do a great job as neurologists in preventing stroke. And one of the most important things that we can do is to identify and treat high blood pressure. And recently, actually, the American Heart Association, American College of Cardiology guidelines on the management of hypertension have said that treatment of high blood pressure not only prevents stroke, but it can also help to prevent cognitive decline and dementia. And this is the first time that we've had a class of recommendation one and level of evidence A, the highest level of recommendation we give for the use of blood pressure treatment to prevent dementia. And that's largely based on the results of some large trials that have come out recently showing that you can prevent dementia with blood pressure control. So that's a really exciting link, I think, between cardiovascular risk factor control and subsequent brain health. It just illustrates the role that neurologists can play in, so many conditions outside of stroke as well.  Dr Grouse: That's a really great point, and I want to get a little more into the idea of primordial stroke prevention. Can you tell us a little bit more about what that might be?  Dr Elkind: So primordial prevention refers to addressing how we can prevent risk factors from occurring in the first place, and how can we improve the environments in which people live. You know, we know that only about twenty percent of health outcomes is dependent on what happens between the patient and their doctor in the office. About eighty percent of it is due to what happens in the environments in which we live, work, pray, and play. And so that's what we mean when we refer to the social drivers of health. What is the neighborhood like where somebody lives? Do they have access to healthy food? Do they have places where they can go to exercise? Is there air pollution in the area that may affect their health? You know, one really interesting fact that's become apparent in the last few years is that air pollution is a major risk factor for stroke. Something like a sixth of all strokes can be attributed to the quality of air. And so, what are the things we can do at the broader public policy, community level to reduce the risk of risk factors like high blood pressure and diabetes even before somebody has an event that brings them to the attention of the doctor? So that's what we're thinking about with regard to primordial prevention. It's the earliest stage in prevention.  Dr Grouse: And that's really fascinating. You know, I think an area that we haven't, as neurologists, really put a lot of our time thinking about, but clearly a very important thing. I really appreciated reading your article about how you incorporated the fact that, you know, a lot of these risk factors overlap very, very closely with all the risk factors for various types of cardiovascular events. And I would imagine that the work you've done as the Chief Clinical Science Officer for the American Heart Association has informed a lot of the way you've thought about-Trying to bring all these risks together and think a little bit more holistically about the whole thing. Could you tell us a little bit more about that and the work that you've done on the American Heart Association's Life's Essential 8 score?  Dr Elkind: Sure. I can't take credit for it. It's really work that was done by others at the Heart Association, particularly a cardiologist and epidemiologist named Don Lloyd-Jones. But many other volunteers participated. Life's Essential 8 is our approach to primary stroke prevention and cardiovascular prevention more broadly. We say Life's Essential 8 because it includes four health behaviors and four health factors that people can observe to reduce their risk of cardiovascular disease. The four factors are kind of things like know your numbers, your blood pressure, your blood sugar, your body mass index, right, which is a combination of weight and height, and your cholesterol level. So, know those numbers and keep them within the recommended ranges, and talk to your doctor if they're not. And then four lifestyle behaviors. So, one of them is to eat a healthy diet, and typically that means the Mediterranean diet. It means getting regular exercise, and we recommend 150 minutes a week of moderate to vigorous physical activity. Of course, it means abstinence from smoking or other tobacco products. And the last one, the eighth one, which I was so excited about when we added this, is sleep, recommending at least seven hours of sleep a night. So, I was really excited about this because we used to talk about Life's Simple 7, and then the last iteration of our recommendations included this recommendation for adequate sleep because of the mounting evidence of the importance of sleep to cardiovascular health. But sleep is really a brain function, right? And so, it was really the first, in a way, specific brain function that was added to our recommendations. So that's Life's Essential 8. People can read about it online at heart.org and recommend it to your patients as a simple way for people to understand the best approach to reducing their risk of cardiovascular disease, including stroke.  Dr Grouse: I checked it out myself after reading the article. It's very accessible to patients. It's a great education tool. And they can, you know, see their own score and use that in their own way to, to think about what their risks are and how they can help mitigate and then rescore themselves down the line. There's also, though, on the kind of more the clinician side, the PREVENT calculator as well. Could you tell us a little bit more about how we could use that in approaching this patient population?  Dr Elkind: Yeah. So, I think of Life's Essential 8 as being a patient-focused tool that people can use. PREVENT is really more for clinicians. Anybody can look it up online and enter your data into it. There's a risk calculator online. But the basic idea behind PREVENT and other similar risk calculators is that it's a way to estimate somebody's risk of having a cardiovascular event like stroke or a heart attack or even heart failure by entering information about your health. And we used to think, we used to use something called the ASCVD, atherosclerotic cardiovascular disease risk calculator, or the Framingham score. Framingham Heart Score, for example, was another one. PREVENT is the latest version, and it has several advantages over those earlier types of risk predictors. For one thing, it predicts risk at younger ages as well. It goes down to age 30. It predicts risk over a longer duration of time, so over 30, 10 or 30 years. It eliminates the use of race as an item to put into the calculator and substitutes for that socioeconomic status, so it's not a race base, but a measure of social disadvantage. And it also includes kidney elements, kidney measures. It includes renal function, for example, that weren't included in prior measures, and it can also be used to predict heart failure, which was not part of the original calculators. Another major advantage of the PREVENT study is that it was based on real-world data from about three million patients, many, many more than the 50,000 or so that the earlier risk calculators were based on. So, it has a much more robust data set and therefore allows a bit more precision in the ability to predict future risk of events. And typically, primary care doctors would enter their patient's data, calculate a risk, and then based on the results of the risk calculator, they can make recommendations about what type of medications a person should take or what other strategies they could use to reduce their risk. And so that's the role that PREVENT plays, is really being focused more for the clinician than the patient.  Dr Grouse: Really great tool for us to be aware of. You earlier alluded to the fact that neurologists are in the situation where we sometimes are helping patients with this primary prevention. But you also make a case for why it's in the patient's best interest for us to be involved in, in these conversations when we can, when we have the opportunity. Can you tell us more about that?  Dr Elkind: Shared decision-making is really important because we know that people aren't going to lead the healthiest possible lives if they're not invested in their care. And so, a doctor telling somebody what to do if the patient doesn't want to do it is gonna have limited benefit.So we emphasize the importance of shared decision-making as much as possible. And I think that where this comes up a lot is actually in the situation of, for example, atrial fibrillation, where patients will often be put on a blood thinner. And many people are fearful of blood thinners. They worry about the risk of bleeding. Maybe they know a relative who's had a bleeding complication from a blood thinner, and so they may be disinclined to try it. And so, it's really important to have these discussions about the risks and the benefits of medication and engage the patient in thinking about this. And there are even tools and visual aids that people can look to to help explain some of these complicated concepts to patients. So, these are the kinds of things that reflect implementation science as a way to improve adherence. We know what works in a clinical trial setting often, but the challenge is translating that into the real world and getting our patients to use the medications that we believe scientifically have been shown to be of benefit. I've actually been surprised sometimes at conversations I've had with people, in some cases, healthcare professionals who resist going on blood thinners because of their fear of the complications. And I feel like the evidence is there. Why don't they believe me? And that's why it's really important to have the conversation. Even our peers and colleagues can sometimes question the evidence, and it's important for us to be aware of that.  Dr Grouse: Absolutely. I think that sounds very reasonable to me, and hopefully these tools will help us with making some of these decisions with our patients. Now, turning our attention a little bit to secondary prevention. So, you know, someone's already had a stroke or a TIA, sort of thinking about what we can do to optimize their risk factors for further strokes. You know, I think there has been some changes that have happened, I think, in the last few years that might be affecting some of the decisions we're making and some of the advice we're giving our patients. I wanted to talk a little bit about GLP-1 receptor agonist medications. Is the data there to support use of this either in secondary prevention or even in primary prevention in the case of stroke?  Dr Elkind: There is evidence that supports the use of GLP-1s for stroke prevention. We need more data, though. We need trials that focus only on patients with stroke, for example, there have been studies in patients with cardiovascular disease broadly that include stroke patients. But if you look at the subcategory just of stroke patients alone, the data in that subgroup alone don't always show a benefit. And so, we need more data that's focused on stroke patients alone. So, I think the data are continuing to emerge, but we need more still.  Dr Grouse: Is there any development in the thought about whether we should be putting patients on antiplatelet therapies for incidental, incidentally identified strokes? For instance, if you got an MRI for migraine or for other reasons and you found one, no history of any stroke-like symptoms. Should we be putting these patients on aspirin or any other types of therapies?  Dr Elkind: That's a really great question. And again, it's an area where there's some controversy and really, there's really no definitive data that would support using antiplatelet therapy in people with incidentally discovered infarcts or what we call, you know, whispering strokes or silent strokes. Many stroke neurologists will use antiplatelet agents. This is one of those areas where it's so important to identify the risk factors. As we were saying before, patients who have other neurological disorders like migraine or epilepsy may turn out to have cardiovascular risk factors like diabetes and high blood pressure. That's why it's so important for neurologists to be able to treat those patients or refer them to specialists who can. Patients who have incidentally discovered lesions similarly are a group where we should be looking for risk factors. So, I don't think of it only in terms of do we put them on an antiplatelet or not, but really more holistically, can we identify their other risk factors and address those? Should the patient's information be entered into a risk calculator like PREVENT, for example, so that we can come up with a more global or holistic measure of their cardiovascular risk and address that as appropriate? Because if they are at risk for stroke, they're also at risk for cardiac events, including heart attack, heart failure, sudden cardiac arrest, and so forth. So, I think of it as a, as a great kind of teachable moment or an opportunity to catch somebody and bring them into the healthcare system more broadly and address those other potential risk factors.  Dr Grouse: Speaking of, of risk factors that we often like to think about and work up when possible, in cases where it seems certainly possible the patient had an embolic stroke, but perhaps we've done a few weeks or four weeks of cardiac monitoring, have not found any evidence of atrial fibrillation. What's new and what's the current recommendations for doing further monitoring when there's high suspicion for cardioembolic stroke?  Dr Elkind: This is a really active area of investigation, and guidelines suggest that we should do some cardiac monitoring for atrial fibrillation after an unexplained stroke, but it's not clear how much we should do. Studies generally show that the longer you follow somebody on a cardiac monitor after stroke, the more likely you are to detect atrial fibrillation. It could be as high as thirty percent after a few years. And that's great. And if you detect atrial fibrillation, people usually end up being recommended for a blood thinner. But how extensively we should monitor remains unknown. And I think a lot of the investigation recently has been around the question of, are there other ways to get that information rather than waiting six months or a year for the person to develop atrial fibrillation?It's a little bit funny logically to think a person has a stroke today, a year later you discover atrial fibrillation on the monitor, and you say, "Oh, now I know what caused your stroke a year ago." Right? The temporality, the causality perhaps is off in that case. And so, wouldn't it be better if we could tell what somebody's risk of having another cardioembolic stroke is, or the likelihood that they have atrial fibrillation is at the time that you first see them for the stroke, you know, in the hospital, for example. And so, there's some really new technologies that have evolved like AI or artificial intelligence interpretation of EKGs that can give a really good indication of which people are gonna go on to develop atrial fibrillation. And so, I think we need some more trials in that area to demonstrate that we can detect the risk of AFib and treat that even before it appears on one of those delayed monitors. That's an area that I think is very exciting right now. There's also a further question with regard to how to treat these patients, which is that sometimes atrial fibrillation is a consequence of the stroke itself. So, we can think about what people call known AF, meaning atrial fibrillation that's known about before the stroke even occurs, versus AF that's detected after a stroke, or AF-DAS, people will say. Those may have very different implications for the risk of recurrence and what the person's cardiovascular status is. So, I think what we've learned over the last few years is that atrial fibrillation, it used to be like the slam dunk for a stroke neurologist. It was the easy thing. You know, you had a stroke, you have AFib, you should be on a blood thinner. Now we know that there's lots of different kinds of AFib. There's AFib before stroke, there's AFib after stroke, there's burden of atrial fibrillation. So, some people may have 30 seconds of AFib, some people may have several hours, some people may be in it continuously. It comes and goes, and that can make it challenging to manage. So, we have a lot more work to do to understand this problem better.  Dr Grouse: That also gets me into some other interesting areas that I think there's still some question, you know, how aggressive should you be? How often is it a case of is this correlated or is this causative? For instance, when a patent foramen ovale is, is discovered in patients with cryptogenic stroke. Are there any tools or new developments to help us understand whether these PFOs should be closed in these cases?  Dr Elkind: PFO and stroke is a great story that's been going on for decades. And again, we've made tremendous progress in the last several years. So, it's true that about 20% or so of people have a PFO, and because of that, it can be really hard to say with any certainty whether an individual patient sitting in front of you, that the PFO was the cause of their stroke. Rarely we can have a really high degree of certainty. You know, if somebody has, uh, a DVT, for example, and shortly after that maybe they have pulmonary embolism and then a stroke, and we can say, "Oh, clearly this was a paradoxical embolism," went to the lungs and then some crossed over and went to the brain. That happens really infrequently. Most of the time you're faced with a patient who has a PFO and a stroke, and they may have some other risk factors. There are some tools that we can use to help figure out the likelihood that a PFO is related to a stroke. One of those is called the ROPE score or the risk of paradoxical embolism score that was developed by David Thaler and, uh, David Kent from Tufts and a group of other investigators as well. That score allows one to say what the likelihood is that the PFO was causative of the stroke, and it's based on a person's risk factors such that the younger you are, the more likely it is the PFO caused the stroke. And the absence of risk factors make it more likely that the PFO caused the stroke. So, the higher your ROPE score indicating the fewer other reasons you have a stroke, the more likely the PFO is to be causative. So that can be helpful in identifying patients who may have had a stroke due to their PFO. There are other features that are identified in something called the PASCAL score, which is a way of assessing the degree of shunting and whether or not there's an atrial septal aneurysm that can be used as additional factors that lead to the likelihood that a PFO was causative rather than just incidental. So, by putting this kind of information together, we can kind of do precision neurology or precision prevention by identifying which patients with a PFO are really the ones we need to worry about and do procedures like closure.  Dr Grouse: I look forward to hearing more and learning more as more advances are made in these areas. Dr Elkind: Thank you.   Dr Grouse: And thank you so much for joining us today to talk about your article.   Dr Elkind: Oh, I appreciate it. Thank you for giving me the opportunity. I really enjoyed it.  Dr Grouse: Again, today I've been interviewing Dr. Mitchell Elkind about his article on stroke prevention. This article appears in the June 2026 Continuum issue on cerebrovascular disease. Be sure to check out Continuum Audio episodes from this and other issues, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

Is social media morally neutral? Is digital discipleship possible in our over-digitized world? We explore doomscrolling, guardrails, and sharing the gospel online.For the study resources and manuscript go to messiahbible.org

Bob Kerr returns to break down his Tax Notes article on the IRS's Centralized Authorization File, the decades-old system that processes Forms 2848 and 8821 almost entirely by hand, now buried under 7 million forms a year at roughly 500 staff years and $50 million to run. He, Roger, and Annie get into why the backlog keeps growing, how practitioners can get ahead of it by putting 8821s on file early, and why transcripts belong in your current-year filing, not just your representation work.SponsorsPadgett -  Contact Padgett or Email Jeff PhillipsGet NASBA Approved CPE or IRS Approved CELaunch the course on EarmarkCPE to get free CPE/CE for listening to this episode.Read Bob's Article https://www.taxnotes.com/tax-notes-federal/practice-and-procedure/high-costs-irss-centralized-authorization-file-system/2026/04/06/7vjccChapters(00:00) - Welcome and Setup (02:36) - Why CAF Matters Now (06:54) - CAF Explained POA vs TIA (10:42) - Choosing 8821 vs 2848 (13:46) - Backlogs and Real Impacts (15:45) - Manual Processing Volume Surge (18:54) - Million Hours and 50M Cost (21:23) - Deadlines Snowball Effect (24:01) - CAF Volume Spiral (24:59) - Early Transcripts Benefits (28:33) - Client Use Cases (30:27) - Why IRS Can't Keep Up (39:13) - Train Clients and Set Expectations (43:33) - Transcripts Beyond Representation (44:32) - VITA Volunteering Insights (48:56) - Wrap Up and Thanks Follow the Federal Tax Updates Podcast on Social Mediatwitter.com/FedTaxPodfacebook.com/FedTaxPodlinkedin.com/showcase/fedtaxpodConnect with the Hosts on LinkedInRoger HarrisAnnie SchwabReviewLeave a review on Apple Podcasts or PodchaserSubscribeSubscribe to the Federal Tax Updates podcast in your favorite podcast app!This podcast is a production of Earmark MediaThe full transcript for this episode is available by clicking on the Transcript tab at the top of this pageAll content from this podcast by SmallBizPros, Inc. DBA PADGETT BUSINESS SERVICES is intended for informational purposes only.

"What if the way we pick politicians is the real problem? Here's a bold idea that flips the script on politics.Tom Joseph's American Main Street Party is creating a new way to choose leaders — without the money, power, or insider deals. It's a tech-driven, transparent process designed to give every voter a real voice.Imagine a political system where your vote actually shapes the candidate — not just the most funded or connected. And what if we could fix gerrymandering that keeps corrupt districts in place?This isn't just talk. It's a movement rooted in the founders' original ideals — equality, fairness, and democracy for all: The future of politics is in your hands. Are you ready to be part of the change?Link in bio to learn more and get involved.Become a supporter of this podcast: https://www.spreaker.com/podcast/this-is-america-podcast--4182415/support.A Pod by the People for the People.

In this episode, we kick things off with a massive milestone for autonomous trucking as ⁠Volvo Autonomous Solutions plans to remove safety drivers from its trucks in early 2027⁠ and begin fully driverless operations on U.S. highways. The company currently runs commercial freight daily in Texas with safety drivers aboard, but projects it will have over three hundred autonomous trucks operating by the end of 2027, with industrial scaling beginning in 2028 and revenue approaching three billion dollars within five years. Over on the rails, ⁠agricultural retailers are raising serious alarm bells about the proposed Union Pacific-Norfolk Southern mega-merger⁠ and its impact on the agribusiness sector. The Agricultural Retailers Association, which represents more than five thousand retail locations nationwide, warns that freight rail rates have risen over forty percent in the past twenty years—seventy percent faster than truck rates—and that further consolidation among the four Class I carriers controlling ninety percent of rail traffic directly threatens supply chain reliability for moving fertilizer, chemicals, and fuel to America's farms. Finally, we explore how ⁠the Transportation Intermediaries Association is pushing FMCSA for federal clarity on approved carrier selection standards⁠ following the landmark Montgomery versus Caribe Transport II Supreme Court decision. With more than ninety percent of authorized motor carriers currently operating without an FMCSA safety rating, the TIA is requesting a federal rulemaking that would establish objective criteria to help brokers and shippers determine whether the use of a given carrier is reasonable based on demonstrable safety performance. ⁠Follow the FreightWaves NOW Podcast⁠ ⁠Other FreightWaves Shows⁠ Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome back to a Friday edition of What The Truck?!Malcolm Harris and Michael Vincent kick off the show with their signature banter before diving into some of the biggest stories shaping freight, transportation, and supply chain today.In this episode:* Amazon's latest move into the LTL market and what it could mean for established carriers* Craig Fuller's analysis of Amazon's freight strategy and whether acquisitions like Forward Air make sense* The Transportation Intermediaries Association's (TIA) push for FMCSA guidance following the Montgomery case* How rising liability concerns and insurance costs could impact brokers, carriers, and the future of the industry* The growing role of technology, compliance, and risk management in modern truckingPlus, Chief Business Development Officer Adam Kahn of Netradyne joins the show to discuss:* How safety technology is transforming fleet operations* Netradyne's partnership with one of the nation's largest Domino's franchise operators* The impressive 66% reduction in at-fault crashes following implementation* Driver coaching, AI-powered safety insights, and building a stronger safety cultureThe crew also talks freight fraud, cargo theft, supply chain AI, LNG export developments, entrepreneurship, and plenty of Friday fun along the way. Watch on YouTube Visit our sponsor - KOONER FLEET MANAGEMENT SOLUTIONS Subscribe to the WTT newsletter Apple Podcasts Spotify More FreightWaves Podcasts #WHATTHETRUCK #FreightNews #supplychain Learn more about your ad choices. Visit megaphone.fm/adchoices

Welcome back to a Friday edition of What The Truck?!Malcolm Harris and Michael Vincent kick off the show with their signature banter before diving into some of the biggest stories shaping freight, transportation, and supply chain today.In this episode:* Amazon's latest move into the LTL market and what it could mean for established carriers* Craig Fuller's analysis of Amazon's freight strategy and whether acquisitions like Forward Air make sense* The Transportation Intermediaries Association's (TIA) push for FMCSA guidance following the Montgomery case* How rising liability concerns and insurance costs could impact brokers, carriers, and the future of the industry* The growing role of technology, compliance, and risk management in modern truckingPlus, Chief Business Development Officer Adam Kahn of Netradyne joins the show to discuss:* How safety technology is transforming fleet operations* Netradyne's partnership with one of the nation's largest Domino's franchise operators* The impressive 66% reduction in at-fault crashes following implementation* Driver coaching, AI-powered safety insights, and building a stronger safety cultureThe crew also talks freight fraud, cargo theft, supply chain AI, LNG export developments, entrepreneurship, and plenty of Friday fun along the way. Watch on YouTube Visit our sponsor - KOONER FLEET MANAGEMENT SOLUTIONS Subscribe to the WTT newsletter Apple Podcasts Spotify More FreightWaves Podcasts #WHATTHETRUCK #FreightNews #supplychain Learn more about your ad choices. Visit megaphone.fm/adchoices

In this episode, we kick things off with a massive milestone for autonomous trucking as Volvo Autonomous Solutions plans to remove safety drivers from its trucks in early 2027 and begin fully driverless operations on U.S. highways. The company currently runs commercial freight daily in Texas with safety drivers aboard, but projects it will have over three hundred autonomous trucks operating by the end of 2027, with industrial scaling beginning in 2028 and revenue approaching three billion dollars within five years. Over on the rails, agricultural retailers are raising serious alarm bells about the proposed Union Pacific-Norfolk Southern mega-merger and its impact on the agribusiness sector. The Agricultural Retailers Association, which represents more than five thousand retail locations nationwide, warns that freight rail rates have risen over forty percent in the past twenty years—seventy percent faster than truck rates—and that further consolidation among the four Class I carriers controlling ninety percent of rail traffic directly threatens supply chain reliability for moving fertilizer, chemicals, and fuel to America's farms. Finally, we explore how the Transportation Intermediaries Association is pushing FMCSA for federal clarity on approved carrier selection standards following the landmark Montgomery versus Caribe Transport II Supreme Court decision. With more than ninety percent of authorized motor carriers currently operating without an FMCSA safety rating, the TIA is requesting a federal rulemaking that would establish objective criteria to help brokers and shippers determine whether the use of a given carrier is reasonable based on demonstrable safety performance. Follow the FreightWaves NOW Podcast Other FreightWaves Shows Learn more about your ad choices. Visit megaphone.fm/adchoices

Hello, Audio Visitors!This week, it's all about solo trips with our friend Tia!Episode 228:What We Love About Solo Trips with Our Friend Tia Listen here:https://linktr.ee/ofmiceandmainstreetmenCheck out links to the shop and travel agency:OfMiceAndMainStreetMen.comShare this episode with your friends and help us spread the gospel of Of Mice & Main Street Men! Thank you for listening! Cheers!Sean & Tristan #disneypodcast #waltdisneyworld  #waltdisney #disneyfans #ofmiceandmainstreetmen 

Click to Text Thoughts on Today's EpisodeWhen a friend described drooping eyes, slurred words, and fuzzy thinking at brunch — and then brushed it off as anxiety — I knew something wasn't right. That conversation sparked this important Common Sense episode on recognizing the warning signs of stroke, TIA, and heart attacks, and why acting fast can make all the difference. I hope this episode gives you a little more confidence and a little less hesitation if you ever need it. Share it with someone you love. It might matter more than you know.In This Episode:Why women are more likely to dismiss their symptoms — and the cost of waitingThe FAST acronym for stroke and TIA: F — Face droopingA — Arm weaknessS — Speech difficultyT — Time to call 911What a TIA (transient ischemic attack) is and why feeling better doesn't mean you're in the clearAdditional stroke warning signs beyond FASTHow heart attacks present differently in women — including jaw pain, back pain, nausea, fatigue, and shortness of breath with no chest pain at allWhy you should call 911 instead of driving yourselfA personal reflection on loss and the what-ifs we carryEpisodes Discussed:500th Episode: ​5 Uncomfortable Lessons from 500 Episodes​For more information on heart attacks and stroke visit:American Heart Association — heart.org — covers both heart attack and stroke, very thorough, well-organized for general audiencesAmerican Stroke Association — stroke.org — technically a division of AHA but has its own dedicated stroke content including FAST informationMy latest recommended ways to nourish and move your body, mind and spirit: Nourished Notes Bi-Weekly Newsletter30+ Non-Gym Ways to Improve Your Health (free download)Connect with Amy: GracedHealth.com Instagram: @GracedHealthYouTube: @AmyConnell

Pinch me! I got to welcome back one of my absolute favorites, Tia Williams! We reunited to celebrate her latest novel, The Missed Connection, a steamy summer romance guaranteed to turn up the heat.Filled with chance encounters, heart, chemistry, and just the right touch of mystery, this novel delivers all the signature elements readers have come to love from Tia. We caught up about her writing process, book-to-screen adaptations, beauty products, and so much more.And if you haven't explored Tia's backlist yet, consider this your sign. Her catalog is a beach reader's dream and the perfect summer spritz - light, refreshing, and impossible to stop sipping before diving into The Missed Connection.

How should Christians view war and conflict? We explore the Old Testament, Jesus, pacifism, and Augustine's just war theory. Join us in building a theology of war.For the study resources and manuscript go to messiahbible.org

Greg Bluestein and Tia Mitchell take on listener questions ahead of Georgia's upcoming runoffs and a special legislative session. They dig into the Rick Jackson ad that leans on Brian Kemp's words without an actual endorsement, and size up how both Republican governor's race candidates are racing to claim the MAGA lane while also courting Kemp's political brand. Greg and Tia also weigh in on Keisha Lance Bottoms and Jon Ossoff's early joint campaigning, what the black women's vote actually delivered for Stacey Abrams in 2018, and how Georgia's leadership committee fundraising law created a money advantage that's still generating legal fights this cycle. Have a question or comment for the show? Call or text the 24-hour Politically Georgia Podcast Hotline at 770-810-5297. We'll play back your question and answer it during our next Monday Mailbag segment. You can also email your questions at PoliticallyGeorgia@ajc.com. Learn more about your ad choices. Visit megaphone.fm/adchoices

This week on the Lin. Woods Gospel Entertainment Podcast, Lin. sits down with award-winning filmmaker Tia A. Smith, a visionary storyteller whose remarkable career journey has taken her from radio broadcasting to producing content for BET, TV One, VH1, and now the big screen.Tia opens up about the path that led her to become a respected filmmaker, the challenges she's faced as a woman navigating the entertainment industry, and the determination that has fueled her success. She also discusses her latest film, The Heir, which recently earned international recognition with an award at the prestigious Cannes Film Festival in France.In this inspiring conversation, Tia shares valuable lessons learned throughout her career, the importance of perseverance, and practical advice for aspiring filmmakers looking to break into the industry. Whether you're a film lover, creative entrepreneur, or someone pursuing a dream, this episode is packed with wisdom, encouragement, and behind-the-scenes insights from one of today's rising filmmaking talents.Connect with Lin. Woods on Social Media:Instagram & Tik Tok: @Lin Woods.Facebook & LinkedIn: @Lin. WoodsX/Twitter: @linwoods#LinWoodsGospelEntertainmentPodcast #Podcasts #blackfilmmakers #WomenInFilm #faith #inspiration 

We're premiering the video for ‘Abiotic Factors' – Patricia Wolf's opening dispatch from Gothic, Colorado and the invisible forces that determine whether anything grows at all… Tia and Wil's Music To Watch Seeds Grow By series – the ambient/new-age/planty cassette label has in nine editions, tried to make a compelling case that the best way to understand ambient is to get your hands in some soil and think about it properly. Each artist chooses a plant that inspires their music and can be sown in the month of the release. Simple. Seasonal. You may have noticed it already. For the ninth edition – the third of Season Two – they've brought in Portland, Oregon-based musician and field recordist Patricia Wolf, whose album Yarrow takes its name from Achillea millefolium, a flowering plant whose broad geographic range spans North America and Eurasia, which also happens to make it the perfect conceptual thread to connect Portland (where the music was written and recorded) to London (where the cassette was pressed and will land through your letterbox alongside a packet of yarrow seeds and a fact card about the plant). A transatlantic weed of the most beautiful kind. Wolf is one of the most interesting people quietly operating at the edges of sound art. Her recent arc has taken her from grief (I'll Look For You In Others, 2022) to a kind of luminous rebirth (See-Through, 2022), then to birds – literal birds, in Iceland, for a documentary score (Hrafnamynd, 2025) – and now, with this album, to plants. Specifically, to the invisible forces that determine whether plants live or die at all. Yarrow was created in response to Wolf's artist residency at the Rocky Mountain Biological Laboratory in Gothic, Colorado, as part of the Art-Science Exchange Project in the summer of 2024. She worked closely with ecologists Dr Paul CaraDonna, Dr Amy Iler, Dr Jane Ogilvie, Dr Nickolas Waser, Dr Mary Price, and Dr Will Petry, spending weeks embedded in long-term research on plants, pollinators, and their interactions as the climate changes. This is not, in other words, an ambient album about plants in the vague, pastoral sense. It's an album about plants in the way a botanist might describe them: as dynamic organisms in constant, often invisible negotiation with their environment. Which brings us to ‘Abiotic Factors', the album's opening track and the subject of today's premiere. Abiotic factors – for those of us who skipped that particular biology lesson – are the non-living environmental conditions that determine whether an organism can exist at all: light availability, temperature, rainfall, wind, soil composition. They are the infrastructure beneath the visible world, the silent set of forces that a plant cannot choose but must simply work with, adapt to, or perish. As a concept for an opening track, it's contemplative and a perfect orientation into the album… which you'll all hear in its entirety soon little seedlings. The video was shot closer to home – in Wolf's Portland neighbourhood - through the lens of Edward Pack Davee, the filmmaker behind the Hrafnamynd documentary Wolf scored last year. Watch here: https://www.theransomnote.com/art-culture/video-premiere-patricia-wolf-abiotic-factors/

Get out your physical media collections, fire up the record player, and get ready to unlock some serious childhood magic. This week, we are taking a trip past the stars and straight to the movies that defined a generation of Disney fans. We are thrilled to welcome Hollywood legend, voiceover maestro, and a true cornerstone of the Magical World of Disney, IKE EISENMANN (Escape to Witch Mountain, Return to Witch Mountain, Wrath of Khan, Magical World of Disney, Author), to the show! From floating coat hangers to navigating the cosmos, Ike has done it all. He sits down with DizRadio to look back at an incredible multi-decade career and celebrate the release of his brand-new autobiography, You'll Never be a Star. Ike chats, Getting into the Business, The Magic of Witch Mountain, Star Trek Secrets, Meeting The Rock, The Art of Looping and his All-New Autobiography and a heartwarming look at what it was really like to grow up on the Disney lot and survive the entertainment industry with your soul intact. Jonathan from the D-Team steps up to the microphone to geeks out over some classic Witch Mountain trivia. Growing up with Tony and Tia's adventures, these films weren't just Saturday night entertainment; they were a blueprint for imagination. He reflects on what these movies meant to a generation of kids who preferred practical movie magic over modern CGI, and he shares a deeply personal story about fulfilling a lifelong goal fueled by the inspiration of those very films. So enjoy the Nostalgia, the Magic, the Wonder, and the Memories with The DizRadio Show "A Pop Culture Celebrity Guest Show"!

In this episode, Lyell K. Jones Jr, MD, FAAN, speaks with Cheryl Bushnell, MD, MHS, who served as the guest editor of the June 2026 Cerebrovascular Disease issue. They provide a preview of the issue, which publishes on June 3, 2026. 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. Bushnell is a Professor of Neurology and Director of the Center for Transformative Stroke Care at Wake Forest University School of Medicine in Winston-Salem, North Carolina. Additional Resources Read the issue: continuum.aan.com Subscribe to Continuum®: shop.lww.com/Continuum Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @LyellJ Guest: @CBushnellMD  Full episode transcript available here Dr Jones: One of the core tenets of our field is that we learn neurology one stroke at a time. But what do we have to learn about preventing them altogether? The science of stroke prevention, acute treatment, and recovery are evolving rapidly, and it's hard to keep up. Today, we're speaking with Dr. Cheryl Bushnell, guest editor of our latest Continuum issue on Cerebrovascular Disease, to discuss these topics and much more.  Dr Jones: This is Dr. Lyell Jones, editor-in-chief of Continuum. Thank you for listening to Continuum Audio. Be sure to visit the links in the episode notes for information about subscribing to the journal, listening to verbatim recordings of the articles, and exclusive access to interviews not featured on the podcast.  Dr Jones: This is Dr. Lyell Jones, editor-in-chief of Continuum: Lifelong Learning in Neurology. Today, I'm interviewing Dr. Cheryl Bushnell, who is Continuum's guest editor for our latest issue on Cerebrovascular Disease. Dr. Bushnell is a professor of neurology and the director of the Center for Transformative Stroke Care at the Wake Forest University School of Medicine in Winston-Salem, North Carolina, where she specializes in the care of stroke patients and their social and functional determinants of recovery and health, and is an internationally recognized expert on those topics. Dr. Bushnell, welcome. Thank you for joining us today. Why don't you introduce yourself to our listeners?  Dr Bushnell: Absolutely. Thank you for the invitation. It's really an honor to be here. So, as you mentioned, I am the director of the Center for Transformative Stroke Care at Wake Forest. It's a really fun transition for me to be involved with different care models for stroke, and I think a lot of the Continuum topics are directly relevant to some of the things that I'm doing now as an administrator and sort of a facilitator of new research. So, thanks again for having me.  Dr Jones: Yeah, and, and you have a wonderful perspective, and we're gonna pull that out today in our interview questions, and I'm looking forward to sharing that with our listeners. But before we get to the questions, we're gonna start off today's podcast with another Continuum Audio trivia question for our listeners. Anticoagulation has played a critical role in secondary ischemic stroke prevention for a long time now. While direct oral anticoagulants have taken on a greater role in the treatment of prevention of stroke, there are still some use cases for vitamin K antagonists like warfarin. The trivia question for our listeners is this: How was warfarin discovered, and how did it get its name? Stick around and we'll share the answer to that question toward the end of our interview today. So, Dr. Bushnell, let's get right to it. You alluded to your various roles, and your leadership in the field has been exemplary. The interventions for acute ischemic stroke have really exploded over the last decade or so, and they get a lot of attention and discussion, but prevention and recovery are just as important in the care of these patients. Tell us a little more about how you approached this issue, about the article topics you chose, etc.  Dr Bushnell: Well, once I was chosen to lead the guest editorship, I wanted to come up with a group of topics that were maybe a little bit different from previous issues. So, I kind of looked at the previous issues and saw, as you said, an emphasis on acute stroke, and that's really important because it has been evolving. But my thought was, how about what happens to patients after they get the intervention and they're discharged home? And because a lot of trainees may not get to see these patients ever again, or it's months before they might see them, or if they're readmitted, which is what we don't want to see, but that certainly is a lot of the exposure is in the inpatient setting. So, I thought I would kind of transport the education into the outpatient and transitional setting, as well as prevention, not only secondary, but primary prevention, with an emphasis on brain health. Some of the populations that may not get as much attention. So, sex differences, stroke in women, pregnancy, the transitions of care, and also the emphasis on holistic view of patients and their challenges, which includes the non-medical factors that drive health, otherwise known as social determinants of health.  Dr Jones: I appreciate that perspective, and obviously th-this is an area of your deep expertise, and it's great to have an issue that really digs into some of those topics a little more deeply. As an educator, I'm really glad you mentioned that about the trainee's perspective. You know, especially junior neurology trainees that are in the hospital all the time. They're seeing patients in the middle of a cerebrovascular catastrophe. But there's a long tail of recovery, right? And they'll get to see that in continuity clinic, but it's a good message to share from an evidence and, um, experiential perspective in the issue. So, appreciate that perspective. You've just read all these articles and edited them. Was there anything that you ran across that was a surprise to you?  Dr Bushnell: Well, I personally chose a lot of the authors based on my knowledge of their work. So, I wouldn't say that it was completely surprising, but I do think that I was just genuinely impressed with the quality of the writing and the synthesis of information. I just was incredibly proud of the work that these co-authors have put together. I'd say that that was-- it wasn't surprising so much as just a sense of pride that I had with the product that's coming out. But of course, there have been some new trials that had to be incorporated at the last minute, some of which were presented at the International Stroke Conference just a few weeks ago.  Dr Jones: Yeah. We try to be as up-to-date as we can, and I will completely agree with you. We have some really good writers in our field, and it's really just a pleasure when you read an article that's by an expert, and it's a joy to read. I can tell you it's one of the best parts of this job, and you get to learn a lot. I think one of the more challenging scenarios that I hear about from colleagues in recent years has been optimal management of patients with asymptomatic extracranial atherosclerosis. The pivotal trials that inform how we manage those patients were from a long time ago, decades ago, predating a lot of the more intensive medical management tools that we have today. In that scenario, Dr. Bushnell, what's the latest on that, and what should our listeners know?  Dr Bushnell: Well, obviously, the CREST 2 trial has been long awaited. It's been going on for over ten years, I believe. Of course, it's, uh, two different trials all in one, the carotid stenting and angioplasty versus intensive medical management. And of course, each of the carotid vascularization arms of the trial also had intensive medical management. And then the other trial is the carotid endarterectomy as the form of revascularization. And it interestingly did not show any benefit of carotid endarterectomy compared to intensive medical management. But of course, the somewhat surprising result was that carotid angioplasty and stenting truly was superior, although it was a small number of events in the trial overall. But that stenting plus intensive medical management was somewhat better than intensive medical management alone. And I think stenting has come a long way in terms of safety, and so I think that's been part of the evolution of the field. I do wanna say that I'm a huge fan of the intensive medical management, and I think that what the protocol does in terms of blood pressure management, cholesterol management is very much above and beyond what's done in private practice even. And the health coaching for all the other things related to diabetes and weight loss and smoking cessation and physical activity, that is what we need to be doing to actually decrease the risk of stroke, and I think that it's very effective. I can't say enough about the design of the study for that reason, that everyone gets the intensive medical management, and then you just layer on the type of revascularization on top of it. So, I wouldn't have been surprised if this was a completely negative trial overall. They just happened to have some better outcomes in the stenting arm.  Dr Jones: I recall a few years ago when the series of endovascular therapy trials for acute stroke came out, and I think there was a, a period of time where the field had to adapt to that. I wonder what you think about with the CREST 2 findings on stenting. I mean, is that gonna be a big change? Because obviously atherosclerosis is highly prevalent. Is that gonna be a big change? Is the field ready for that? How much adjustment do we have in store?  Dr Bushnell: I'm not sure it's gonna be a really big change. If you read the editorial that accompanied the trial in the New England Journal, just a few patients in either direction would have changed the outcome. I kind of look at it as an absolute difference that's relatively small. So, I'm not sure that it will have a huge impact on the field. I do think that the specialists who insert the stents may have some differences of opinion of who should be stented and who shouldn't. Because I think, you know, all of the specialists who do procedures were involved with the trial. But I would say there's a larger percentage of vascular surgeons who were involved, and so I'd say they may have a change of their practice. And neurologists may not even get involved at all.  Dr Jones: Right.  Dr Bushnell: That was one of the challenges for getting patients in the trial is that, you know, not all of us see the asymptomatic carotid stenosis, that they tend to get referred to vascular surgery. So, I think maybe in a corner of the practices of vascular surgeons is where you might see the differences.  Dr Jones: Your point about the way the trial was designed or the trials were designed, that intensive medical management is really important, and we have huge gaps in that. In our specialty, it's, you know, we have probably an opportunity in primary care even to address that. And that leads me to my next question. You know, given your perspective and your expertise, what do you think is the biggest practice gap in the care of patients with stroke or with cerebrovascular disease of any kind?  Dr Bushnell: I think by far the biggest gap is transitions of care and access to follow-up in a specialty clinic after discharge and continuous secondary prevention. We only call it secondary prevention because it happened to come after a stroke, but I really feel like we should just focus on prevention and call it that. There are a lot of people who are trying to kind of, get us away from primary versus secondary prevention. And, and Mitch Elkind is phenomenal and had a beautiful chapter weaving in prevention and brain health. So, I highly recommend that people, if they don't read any other chapters of the Continuum to read his, because I think that it's getting to your point about where the gaps are, and I think prevention is the biggest one. I think we could do so much more in models of care to ensure that there is a pathway once patients are discharged. We have no quality metrics. We have no measurement of how well people are doing after they're discharged. We have all of these fancy things and sophisticated acute treatments, but all of those are for naught if somebody goes home and they fall and they have a severe head injury or hip fracture because they weren't properly supervised or they didn't have the help that they needed at home. So, you got me on my soapbox here for a second, but that is definitely what I see as the gap.  Dr Jones: That's an important soapbox, an important gap, and obviously, if it was a simple problem, we could solve it. But it's obviously something that education is a valuable tool for that, and that's part of why we are including so much content in this issue of Continuum. So, if we put that aside as a gap that we would love to close, when you look into the near future or distant future, Dr. Bushnell, and what's the next big thing on the horizon? New interventions, new prevention tools, or something else entirely? What do you think?  Dr Bushnell: There are two things that I would mention. One is sort of the new category of anticoagulants, antithrombotics, the factor XIa inhibitors. We had an amazing presentation of the oceanic stroke trial at the International Stroke Conference, and this is probably going to be a game changer for the arsenal of antithrombotic therapies that we can offer to patients that do not have a reason for anticoagulation. So, they, they don't have atrial fibrillation, for example, or something else that requires anticoagulation. And so, the factor XI, asundexian, is the drug that they used in that trial. The safety profile is pretty amazing. There was very little bleeding complications and a great benefit in those patients with some degree of atherosclerosis, but, you know, of course, not enough to require carotid revascularization, but then also, um, small vessel disease and cryptogenic stroke. I think those are the three categories of patients, and that's a lot of the strokes that we see all benefited from this new drug. So, I think that's gonna be exciting. There, of course, it has to go through the FDA approval process, and so it might take a little bit of time before that's on the market, and we don't know how much it's gonna cost, but I think it is a, a major breakthrough. And of course, there are other similar medications in that category that are coming. And then I think the other thing is the emphasis on brain health and lifestyle factors and the things that we can do to prevent stroke and dementia because they are the same, essentially. Those are really important. And when we have someone in the hospital with a stroke or a TIA in particular, it's a great teaching opportunity for those patients to say, "Hey, here's what you can do to protect your brain." These are things that we always tell people to prevent a stroke, but just think about it as protecting your brain and keeping your brain as healthy as possible.  Dr Jones: That's a great message, and one that you get to share with patients directly. You're joining us today for this interview. You're on stroke service, so you're actively involved in caring for patients with stroke. What in your practice is the most rewarding aspect of caring for these patients? What is it that you find most rewarding?  Dr Bushnell: I've been involved in a clinical trial that has focused on managing blood pressure and also coaching and other aspects of stroke recovery. I think that has probably been the most rewarding aspect of my career. Until I was involved with this trial, I didn't necessarily do intensive blood pressure monitoring, but I'm seeing the benefits of having data from home, what those blood pressures are over a span of time. I see the immediate or intermediate effects of the blood pressure medication changes that I've made, and I see how the patients respond. So, I have to say that this is not part of usual practice, but I think it should be. And I think it's been incredible from the perspective of a neurologist who is really intensively trying to make the patients' lives better. And it's not just what I do, it's what the health coaches do as part of this intervention. And again, very similar to intensive medical management. So, I, I feel like I've been living it in a slightly different setting than in the CREST 2 trials. But there are other trials that have used the intensive medical management as approach as well. But I would say that's the most rewarding. I've seen people who've lost weight, who are physically fit, who are able to get off of blood pressure medications practically by the end of six months, and that's amazing. And then they continue doing it because they see the benefits.  Dr Jones: You've had a front row seat to a lot of that. That's really got to feel rewarding.  Dr Bushnell: It is, absolutely.  Dr Jones: You know, when you put it that way, it makes me want to go home and check my blood pressure, which I haven't done in a while. But I think that's a message to all of our listeners that we do have plenty of opportunity for risk factor optimization and following the evidence that has been generated and is being generated. Huge opportunity, not only at the population level, but I think the, um, individual patient level too. Okay, so now we're back to our Continuum Audio trivia question, and I'll repeat it for our listeners. How was warfarin discovered, and how did it get its name? Dr. Bushnell and I were talking about this earlier, so I'll just go ahead and share the answer. So, in the early 20th century in the U.S. Midwest, there were epidemics of a hemorrhagic disease in cattle, of all places, and this was eventually traced to moldy cattle feed that was made from sweet clover. And in 1940, researchers at the University of Wisconsin discovered that the anticoagulant in the sweet clover was a compound that was later synthesized for therapeutic use in 1954 as warfarin. And the name came from, uh, the support for the research. The research support came from the Wisconsin Alumni Research Foundation, or WARF, and the end of the word came from the underlying compound, which was coumarin. So that was a little bit of trivia that I had never heard. It's not in the issue, everyone, so you're getting something extra here on the podcast. But been using the drug forever. It still has its uses, even though it's become less advantageous than some of the newer agents. But-- And of course, Dr. Bushnell already knew that when I brought it up, but I just thought that was an interesting bit of history. Well, Dr. Bushnell, thank you for joining us. Thank you for such a great conversation about the latest in cerebrovascular disease. I learned a lot today. I learned a lot in reading these wonderful articles. I hope our listeners learned a lot today as well. I'm really grateful for your hard work on the issue, which I think will come in handy for junior readers and subscribers, as well as our more experienced neurologists as well. Sometimes it's hard to keep up with a rapidly changing subspecialty of our field. So, thank you for joining us today.  Dr Bushnell: Thank you for having me. It's been my pleasure.  Dr Jones: Again, today we've been speaking with Dr. Cheryl Bushnell, guest editor of Continuum's most recent issue on cerebrovascular disease. Please check it out, and thank you to our listeners for joining today.  Dr Monteith: This is Dr. Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use the link in the episode notes to learn more and subscribe. Thank you for listening to Continuum Audio.

Have a question you'd like April to answer on the show? Send us a text!Welcome to Holistic Horseworks Live, where founder April Love helps horse owners uncover the hidden causes behind behavioral problems, physical compensation patterns, and unresolved pain through holistic bodywork and intuitive horse care.

Dive into Generative AI ethics from a Christian perspective! We discuss ChatGPT, technology limits for kids, originality, plagiarism, and the Bible.For the study resources and manuscript go to messiahbible.org

Greetings in love, light, and wisdom as one.  For the month of June we have a channeling session from the members of Ashtar Command where we look at potentials to be explored with the tools brought up in the session. Tia begins things with a funny exchange on the topic of tea and how on her home planet they had something that tasted better than what I called tea. We next get into something that changed my astral travel ability was being on my back to get out of my body. Using it to stay awake to bring on lucid dreaming helped with that effort. The next topic would become the theme for the night which was light, sound devices and how they work to change a persons frequency. We would take on the topic next with our second speaker who was Kiri. With her, we look at the effects on the brain of computers in the long exposure times that we were going through. They explained that up on the base they had a solution that we would catch up with later. Then she gives us a synopsis of the cats in our house down here and house somewhere negative and some could astral project. Then we finally get to the LS devices and how using biofeedback would make the experiments go even better if there was that interchange of information. The last topic we discuss is the gene pool of our little family on the base and how healthy it was. Thanks to their technology, even first cousins who have babies with no problems. That brings on Omal to finish up the first side and he assures us that the electrical fields generated by the cords all around us do not have a harmful effect on our bodies. We next go over a group that we were studying and he points out that knowledge is more precious than any gym on our planet. They were trying to generate money from their sharing of knowledge. We move on to a friend of ours coming for the summer from Sedona named Linda who he had last spoken to when he was channeling through someone name Roger. She had joined a group I was a part of and we would hear her on some of our later archives. We then look at the LS devices and their potential as the side runs out. From there we go on to the various skills and how the devices would help.   For full transcripts of this session and more information about Hades Base and the 6th dimension, please visit our website:  http://hadesbasenews.com  The sessions lasted from 1992 to 2001 with this one being taped on 05/31/94. Side one includes:   1.)(0:00)- Tia and I look at a lazy way to astral project that requires little prep work and a light, sound device to use in conjunction with the new process. we finish with a question on Heinlein and a book of his.   2.)(8:13)-  Kiri gives a breakdown of the various cats in the house and their attributes such astral travel. We follow that up with her technical take on the light, sound devices and a question about the gene pool. 3.)(20:50)- The first half of Omal's time is used to assure us that the electrical fields we are exposed to are not causing irreparable harm. He also gives his take on the LS device and how it will stimulate R.E.M..

Greetings once more in love, light, and wisdom as one.    On-side to we returned to the same subject and we look at them for possibly helping the shielding and PK. It's all about lucid visualization that's available when we can tap into the deeper parts of the brain. This would produce a dreamlike affect that would allow us to stay away while dreaming. Before he leaves we get into a fund thing about Star Trek and Dr. McCoy's eyebrow. Karra uses up the rest of the side to go over some of the things I was doing for my health and hoping for instant results. She advised slowing down and looking at the scenery. The topic then is about dreams and one that I had she happened to be monitoring. She then helped me figure out who it was I was trying to teach. You think talk about free energy machines and the magnets that would be used to create such a device. What we were looking at is solar options to run the car without gas. We next talk about the LS devices and the potential for healing. What we work on is being able to see the issue in our mind to then re-create it later on in the physical sense. Therefore we are again going over lucid visualization to make the healing happen. We move on from there to Mark's dream of healing someone else. We had been doing some programming of Mark's dreams and this is the first result we were hearing other. We have a shorter night and so we cut it short at that point with Tia coming on at just the last moment. Another excellent entry into the Ashtar Command archives. For full transcripts of this session and more information about Hades Base and the 6th dimension, please visit our website:  http://hadesbasenews.com  The sessions lasted from 1992 to 2001 with this one being taped on 05/31/94. Side two includes:   1.)(0:00)- Omal starts with a discussion on lucid dreams and shields and then moves on to the other skills such as PK. From there we work on expanding the energy used after seeing it done with the mind. 2.)(9:38)- Karra and I compare noes on a dream I had that she was monitoring. We next revisit the topic of generating free energy before moving on the how the LS device could be used for lucid visualization.

What does it take to crack down on cargo theft, chameleon carriers, and unregulated dispatch services? In this episode, Chris Burroughs from the Transportation Intermediaries Association (TIA) is back to discuss the real cost of silence on Capitol Hill and why your voice matters now more than ever! We're diving straight into the Build America 250 Act, what the Supreme Court's Montgomery v. Caribe ruling actually means for broker liability, and how the FMCSA's new MOTUS registration system is set to purge fraudulent entities from the marketplace. If you want to protect your freight business, stay ahead of tightening carrier vetting standards, and learn how to manage risk in a shifting legal landscape proactively, you can't afford to miss this conversation on why the brokerage community must band together and control the narrative   About Chris Burroughs Chris Burroughs is the President and CEO for the Transportation Intermediaries Association (TIA). He brings over 18 years of Congressional affairs experience to TIA. As the former Vice President of Government Affairs for TIA, he led the Government Relations department including the legislative, regulatory, PAC, and internal policy committee functions. Chris served as the staff liaison for the Highway Logistics Conference, the Intermodal Logistics Conference, and several other policy committees within TIA. Chris additionally served on the Board of Directors for the Unified Carrier Registration (UCR) as the Subcommittee Chairman of Industry Advisory Subcommittee and sole representative of the 3PL industry. During his time on Capitol Hill, Chris gained invaluable knowledge of the legislative process. He began his career working on the House Transportation & Infrastructure Committee in 2006 and then later the House Natural Resources Committee. In 2009, Chris joined the Twenty-First Century Group, a bipartisan government affairs firm, as their Director of Government Affairs. In this position, Chris advocated on behalf of multiple clients involved in the transportation, telecommunications, health care, tax, and defense arenas. Additionally, he represented TIA on their issues of interest on Capitol Hill. Chris lives in Gainesville, Virginia with his wife Stacey and children Kelly, Christopher, and Connor. Chris earned a BS degree in Political Science from Shepherd University located in Shepherdstown, West Virginia.  

Stroke is often thought of as something that happens later in life — but more young adults are experiencing strokes, and many don't recognize the warning signs until it's too late.In this episode of Baptist Health Talk, host Sandra Peebles speaks with Dr. Felipe De Los Rios La Rosa, cerebrovascular neurologist and director of the stroke program at Baptist Health Miami Neuroscience Institute, about why stroke risk is rising among younger adults and what people can do to protect themselves.You'll learn:• Why strokes are becoming more common in adults under 55 • How recreational drug use, alcohol, vaping and marijuana may affect stroke risk • Why being young, active or healthy does not make you immune • The FAST warning signs everyone should know • What a TIA or “mini stroke” really means • Why calling 911 quickly can make a major difference • Practical steps that may help lower your stroke riskDr. De Los Rios also explains why stroke symptoms can be missed in younger people, how sudden changes in speech, vision, balance or strength should never be ignored, and why prevention should start earlier than many people think.

We are living in an age completely saturated by one word: politics. If you're a believer in Jesus Christ, what is your response: Engage or Abstain? And how does that decision affect our theology?For the study resources and manuscript go to messiahbible.org

Greg Bluestein and Tia Mitchell answer listener questions about Georgia's post-primary landscape, including Keisha Lance Bottoms' sweeping Democratic win, the money gap between Republican and Democratic candidates, and legal questions around newly passed legislation. They also examine how self-funded candidates use personal loans and what those numbers signal in the governor's race. In segment two, Greg and Tia feature Q&A recorded live at the Politically Georgia happy hour at Manuel's Tavern with Patricia Murphy, including questions about judicial elections, political power and the AJC's coverage of Georgia's changing suburbs. Have a question or comment for the show? Call or text the 24-hour Politically Georgia Podcast Hotline at 770-810-5297. We'll play back your question and answer it during our next Monday Mailbag segment. You can also email your questions at PoliticallyGeorgia@ajc.com. Learn more about your ad choices. Visit megaphone.fm/adchoices

Tia from the Alien Effect podcast joins The Order this episode to discuss a sequel: Ghost Rider Spirit Of Vengeance! For more from The Alien Effect, click HERE!

Joe and Taylor are back together to break down RuPaul's Drag Race All Stars 11 Episode 3, “Shop Till You Drop.” Before diving into the competition, Taylor opens up about the frightening family emergency that caused his absence last week and shares an update on his mother's health following a TIA. Then it's time to unpack the final Orange Bracket showdown. The queens tackle a spooky home shopping acting challenge, the MVQ point strategy reaches a boiling point, and Morgan McMichaels continues to quietly produce some of the best television of the season. Joe and Taylor debate whether the right queens won the challenge, whether Dawn actually won the lip sync, and whether RuPaul made the correct final call sending A'Keria and Dawn into the semifinals. Plus: Mystique Summers Madison's increasingly tense behavior Why Morgan McMichaels came out looking like the consummate professional Morphine's stunning Phantom of the Opera runway The problem with Lucky Starzzz's performance style The hidden strategy behind the MVQ points Why A'Keria may be the most well-rounded queen in the bracket And Joe compares Drag Race Philippines craftsmanship to the Louvre runway looks Learn more about your ad choices. Visit podcastchoices.com/adchoices

Presenting Sponsor Thirdzy!  https://thirdzy.com/JAZZYPromotion Code for 15% off: JAZZYSupport Carolyne with the purchase of your CrossFit Games Tickets, Use Code cfgprevost10 at checkoutEveryday we take a break from the busy work day to catch our breath, hang out with friends and talk about the world of Sports, Entertainment and specifically CrossFit. Today we talk about the sickness, wellness, fitness continuum, Tia ready for the Games now after giving birth? French Throwdown recap.

Tia Lynn, aka Sexy Biz Babe, is back, and we're going there. In this episode, Tia joins us to explore the real world of sex parties and play spaces (spoiler: it's not what you think), how confidence in life directly mirrors confidence in the bedroom, the power of knowing your "no" before you need it, and why your intuition is the most underrated safety tool you have. Plus: Skirt Club, vetted events, and finding your community.✨ Special Offers: ✨Splash Blanket! | Use code Jordan15ProDx Health | Use JordanDnelle to save 25%Thank you to our Sponsors: Splash Blanket, Prodx, PhexxJump to the Good Stuff:05:53 – Intro & Meet Tia06:46 – Defining YOUR edge08:00 – Breaking shame & building confidence12:21 – Confidence in the bedroom14:21 – How Tia discovered play parties16:05 – Finding your community18:04 – Skirt Club 10121:57 – What actually happens at a sex party31:07 – Vetted vs. unvetted parties32:27 – Red flags & green flags34:46 – Confidence & practicing your "no"36:51 – Tia's consent story42:05 – Defining pleasure42:42 – Where to find TiaPleasure Highlights:Taboo is your edge, no one else'sBedroom confidence = life confidencePlay parties are community-firstNo expectations = better experienceVetted parties prioritize consentPractice your "no" before you need itEven confident people freeze, trust your bodySpeaking up protects the everyoneSex-positive friendships are realPleasure is joy in your bodyConnect with Tia Lynn:Instagram @SexyBizBabeInstagram @SexyBizBabePodcastTED Talk: “Break Out of Shame, Own Your Confidence”Enhance your self-awareness by acknowledging and understanding your behavior patterns, and foster a deeper connection with your inner self. Get the Unleashing My Power: A Women's Empowerment and Gratitude Journal to reclaim your power through daily gratitude. Learn more HERE.Connect with Jordan D'Nelle:Facebook @‌jordandnelleInstagram @‌jordandnelle Instagram @‌TheVVVPodcastTikTok @‌jordandnelleYoutube @jordandnellejordandnelle.comEmail: JordanDnelle@VaginasVulvasandVibrators.comLove this Episode? Join Patreon: patreon.JordanDnelle.comLeave a review on iTunes.Subscribe & Follow on socials!Listen and Subscribe to the Podcast:Apple PodcastSpotify PodcastYoutube @jordandnelle*Disclaimer: This podcast is for informational and/or entertainment purposes only and is not a substitute for medical advice, diagnosis, or treatment. The views and opinions expressed are my own, or those of my guests, and do not necessarily reflect the views of any organizations or institutions with which I am affiliated.Vaginas, Vulvas, and Vibrators, the unapologetic women's sexual wellness podcast, normalizing pleasure, bodies, and sexual health through expert, shame-free conversations.PHEXXINDICATIONPhexx® is an on-demand prescription birth control used to prevent pregnancy. Phexx is not effective when used after sex.IMPORTANT SAFETY INFORMATIONRare cases (0.36%) of bladder and kidney infection have been reported. If you have a history of urinary tract problems that keep coming back, you should not use Phexx.Contact your healthcare provider if you are experiencing genitourinary side effects such as vaginal burning, itching, discharge, genital discomfort (including in male partners), yeast infection, urinary tract infection or bacterial vaginosis.Phexx does not protect against any sexually transmitted infections, including HIV. Avoid using Phexx with a vaginal ring.Avoid Phexx if you or your sexual partner is allergic to lactic acid, citric acid, potassium bitartrate, or any of the Ingredients in Phexx. Stop using Phexx If you develop an allergic reaction.For more information about Phexx, talk to your healthcare provider and see full Product Informationat www.phexx.com.Please report side effects by contacting Evofem Biosciences® toll-free at 1-833-EVFMBIO or contact FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.EVFM-PHX-000068

Oracy, alongside literacy and numeracy, is being encouraged in schools. Amy Gaunt, from the charity Voice 21, explains to Michael Rosen how children are learning to talk, and through talk. How does talking about a subject help children learn about it? And how does an oracy rich classroom help the less able as well as the more confident? We also hear from Tia, who went to a school that works with Voice 21. Tia describes her experience with oracy.Produced by Sally Heaven for BBC Audio Bristol, in partnership with the Open University. Subscribe to the Word of Mouth podcast and never miss an episode: https://www.bbc.co.uk/sounds/brand/b006qtnz

Biomechanist Katy Bowman speaks with physical therapist Dr Anietie (Tia) Ukpe-Wallace about pelvic health, movement, and self-care.They discuss Tia's recent book, Tending To Your Womb, a guide to caring for the uterus and pelvic tissues through awareness, movement, and practical self-care strategies. In this episode, Katy and Tia focus on movement-based approaches for uterine retroversion, a pelvic misalignment that can contribute to sacral pain, sciatic symptoms, and constipation.They also explore clitoral atrophy — a reduction in tissue size, tone, and flexibility that can occur during menopause — and share movement and self-care practices to help maintain mobility and function.Tune in and join in for a guided pelvic clock movement sequence taught by Tia.Enhanced Show Notes and Full Transcript0:00 Intro & New Dynamic Collective6:56 Meet Dr. Tia Ukpe-Wallace9:49 Misalignments of the uterus15:30 Symptoms of a retroverted uterus: constipation, sacral pain & sciatica19:55 The pelvic clock: join in with a guided practice!27:43 Clitoral atrophy in menopause & movement-based approaches35:24 Self-care: not indulgence, but simple body maintenance42:25 Where to find Tia Ukpe-Wallace46:34 Listener question on prolapse, sponsored by Earth RunnersBooks, Links and Resources:Tending to your Womb: Self-Care for Every Stage of Your Reproductive Journey, No Matter the Outcome by Anietie Ukpe-Wallace About Tia Ukpe-WallaceTia on Instagram @selfcarephysio Connect, Move & Learn:Join Our Newsletter: Movement Colored GlassesFollow Katy on SubstackTry Katy's Virtual Studio Free for 7 days!Made Possible By Our Wonderful Sponsors:Freet Barefoot: creators of comfortable barefoot shoes built for natural movement, flexibility, and durability— use code DNA10 for 10% off. Earth Runners:  makers of minimalist earthing sandals designed for natural foot movement and connection to the ground— use code DNA10 for 10% off.ScreenFit™: a complete online vision training program —take $200% off with code NUTRITIOUSMOVEMENTMy Happy Feet: Toe-spacing socks that gently realign toes for comfortable shoe recovery—take 20% off with code MYDNAIkaria Design: The Soul Seat® offers height-adjustable, multi-position sitting—get 10% off new chairs and desks with code DNA10Movemate: Active standing boards with smoothly articulating wooden slats. Designed to keep you moving without interrupting your focus.Venn Design: Beautifully upholstered ball-shaped Air Chairs and floor cushions that encourage dynamic sittingThoughts/questions email us at podcast@nutritiousmovement.comYour Voice on the Podcast: Read The Credits 

Audra and Mason are joined by Amy Goodman, an award-winning investigative journalist, author, and host and executive producer of "Democracy Now!", and Carl Deal, documentary filmmaker and director/producer of "Steal This Story, Please." "Steal This Story, Please!" is centers around Amy Goodman's 30 year career as an independent journalist taking on soldiers, politicians, and corporate media in a fearless pursuit of truth.  Amy, Carl, and Tia will be at the Milwaukee premiere for a Q&A at noon on Sunday, May 10th, 2026 at the Oriental Theatre. The film will continue showing throughout the week. Use discount code "STEAL" at checkout. Tickets can be found here. For more information and other showings visit https://stealthisstory.org/

In this episode, Tia Levings returns to talk about her new book I Belong to Me - a guide to healing and recovery after high-control religion and other controlling environments. Tia walks through what she calls the steps before the steps: the audacity, the centrality, the willingness to want something different before you're even ready to name what happened to you. We talk about why language can free you and trap you at the same time, how cult-hopping happens and why, what developmental stages get stolen in high-control systems, and how somatic and body-based modalities opened up healing that talk therapy alone couldn't reach. This is a grounded, honest conversation about what it looks like to start to become the protagonist of your own story.Tia Levings is the New York Times Bestselling author of A Well-Trained Wife, her memoir of escape from Christian Patriarchy and I Belong to Me: A Survivor's Guide to Recovery and Hope after Religious Trauma. She writes about the realities of religious trauma, evangelical patriarchy, and the Trad wife life, decoding the fundamentalist influences in our news and culture. Her work and quotes have appeared in Teen Vogue, Salon, Newsweek, and the HuffingtonPost. She is an experienced interviewee, speaker, and podcast guest, and has appeared in the hit Amazon docu-series, Shiny Happy People. Based in Raleigh, North Carolina, she is mom to four incredible adults and likes to travel, hike, paint, and daydream. Find her on social media @TiaLevingsWriter.Tia's Book:I Belong to MeTia's Recommendation:Heart the LoverEverything in ColorConnect with Joshua: jjohnson@shiftingculturepodcast.comGo to www.shiftingculturepodcast.com to interact and donate. Every donation helps to produce more podcasts for you to enjoy.Follow on Facebook, Instagram, Twitter, Threads, Bluesky or YouTubeSupport the podcast and the ministry that my wife and I do around the world. Just click on the support the show link below NEW PODCAST: American Evangelicals - A History PodcastA thoughtful, deep dive into one of the most talked-about movements in American history.Support the show

Learn what healing looks like after 40 years of identity collapse in Christian patriarchy. Tia Levings is a New York Times bestselling author, featured in Amazon's "Shiny Happy People," who escaped Christian fundamentalism, recovered from religious trauma, and now decodes why patriarchal family structures mirror the theocratic policies taking shape in American government right now. In this episode, Tia walks us through: The mechanics of silence culture and why it protects abusers How to identify when you're in a high-control group (it's rarely obvious) Why women brought into patriarchal power structures become scapegoats What healing actually looks like (not spiritual bypassing, not "I'm grateful it happened") The healing modalities that work for complex PTSD after religious trauma How modern politics is the scaled-up version of the family systems she lived in This is a warm, grounded conversation about one of the most urgent cultural issues we're not talking about clearly enough. Books mentioned: A Well-Trained Wife: My Escape from Christian Patriarchy (https://amzn.to/4tTCvug) I Belong to Me: A Survivor's Guide to Recovery and Hope After Religious Trauma — released May 5, 2026 (https://amzn.to/4epEiCy) Find Tia: Website: https://tialevings.com/ Substack: https://tialevings.substack.com/ Social: @TiaLevingsWriter Viral first appearance on Culture Changers Podcast "What Christian Patriarchy Doesn't Want You To Know" - https://youtu.be/aU6CcgskrUE Rather watch on YouTube? https://youtu.be/tCeYbmwcnXA Ready for your own megaphone for change - the podcast that grows? Schedule a free clarity call with me here: https://allisonhare.com/freecall Be sure to rate, review, and follow this podcast on your player and also, connect with me IRL for more goodness and life-changing stuff.Schedule a FREE podcast clarity call with me - Your future audience is out there. Talk to them!Sign up for the free weekly emailAllisonHare.comFollow me on Instagram, LinkedIn, Facebook, and YouTube.DOWNLOAD the free podcast equipment guide- No guesswork, no google rabbit holes, start recording todayReb3l Dance Fitness - Try it at home! Free month with this link.Feedback and Contact:: allison@allisonhare.com

Greg Bluestein and Tia Mitchell break down the political fallout from a sweeping U.S. Supreme Court ruling that weakens a key section of the Voting Rights Act and could reshape Georgia's political maps. They examine why Republicans are already eyeing new congressional and legislative districts, why Gov. Brian Kemp says new maps won't come before the 2026 elections, and which Democratic-held seats could be most vulnerable in a future redraw. Then Greg and Tia speak with Georgia State University constitutional law professor Eric Segall about what the ruling means for minority representation, why he believes the decision could have long-term consequences beyond Congress, and where legal fights could move next. Have a question or comment for the show? Call or text the 24-hour Politically Georgia Podcast Hotline at 770-810-5297. We'll play back your question and answer it during our next Monday Mailbag segment. You can also email your questions at PoliticallyGeorgia@ajc.com. Learn more about your ad choices. Visit megaphone.fm/adchoices

In today's episode of the To Birth and Beyond podcast, Jessie is joined by pelvic health physical therapist, Dr. Anietie Ukpe-Wallace (Dr. Tia). Together, they talk about Dr. Tia's new book called “Tending to Your Womb,” and digging into everything from pregnancy loss and societal expectations around it, to what Dr. Tia is teaching her 11-year-old daughter about her body and why self-care is a main pillar of her work (and what she means by “self-care”).- - - - - - - - -If you liked this episode of To Birth and Beyond, tell your friends! Find us on iTunes and Spotify to rate/review/subscribe to the show.Want more? Visit www.ToBirthAndBeyond.com, join our Facebook group (To Birth and Beyond Podcast), and follow us on Instagram @tobirthandbeyondpodcast! Thanks for listening and joining the conversation!Resources and References Pre/Postnatal Fitness Specialist Academy Interest List (Reopening June 2026)Self-Care Physio websitehttps://www.uphill-books.com/book/tending-to-your-womb/#buy-nowShow Notes 0:58 - The all new and improved Pre/Postnatal Fitness Specialist Academy (PFSA) is reopening for enrollment in June 2026!2:23 - Jessie introduces today's special guest and what we'll be talking about!3:25 - Dr. Tia shares how her book came to be and why it was important for her to write7:12 - Dr. Tia discusses what has changed in the understanding and societal expectations around pregnancy loss since she experienced it 13 years ago15:45 - Jessie asks Dr. Tia what she is teaching her daughter about her body right now21:26 - Dr. Tia explains what self-care really means to her, and why it's a pillar of her work31:52 - Dr. Tia shares the most challenging parts of writing the book36:18 - Dr. Tia discusses how writing the book has changed her work40:22 - If someone is listening who is struggling with their reproductive journey, Dr. Tia's got some guidance for you!44:42 - Dr. Tia shares where you can find her on the internet!46:22 - Jessie wraps up the episode

Have a comment? Send us a text! (We read all of them but can't reply). Email us: Will@faithfulpoliticspodcast.comWhat does religious trauma actually look like inside high-control Christian environments?In this episode of Faithful Politics, we sit down with Tia Levings, author of A Well-Trained Wife and I Belong to Me, to unpack her experience inside Christian fundamentalism and her journey out. Tia shares what life looked like inside a patriarchal, high-control religious system and how those environments shape identity, relationships, and personal agency.We explore how theology, culture, and authority structures work together in these spaces. Tia explains how belief systems are reinforced through obedience, how questioning is discouraged, and how survivors often internalize blame for harmful outcomes. She also discusses how movements like the Institute in Basic Life Principles and figures like Doug Wilsoninfluence broader religious and political culture.The conversation goes deeper into the concept of religious trauma and how it can mirror symptoms associated with PTSD. Tia walks through common patterns survivors experience, including loss of identity, fear responses, and difficulty trusting themselves after leaving. She also explains why rebuilding a sense of self is often harder than leaving the environment itself.We also examine the connection between high-control religion and broader political movements, including Christian nationalism. Tia highlights how these belief systems scale beyond individual households into larger cultural and political influence.Finally, Tia shares what healing looks like. Her latest book, I Belong to Me, focuses on recovery, autonomy, and rebuilding identity after leaving high-control environments. This episode offers a practical and honest look at what it takes to move forward.Buy the book, I Belong to Me A Survivor's Guide to Recovery and Hope after Religious Trauma: https://bookshop.org/a/112456/9781250374271Guest BioTia Levings is an author and advocate focused on life inside high-control religious environments and the recovery that follows. She is the author of A Well-Trained Wife: My Escape from Christian Patriarchy and I Belong to Me. Her work centers on religious trauma, deconstruction, and helping survivors rebuild identity and autonomy after leaving fundameSupport the show

Welcome back, you filthy animals, to another raw, no-limits episode of Nikky After Dark — your favorite place for the hottest, most explicit gay sex confessions, BBC breeding sessions, crossdresser gangbangs, first-time anal, public hookups, and filthy cuckold fantasies. I'm your host Nikky, and tonight we're diving deep into three ultra-raw, dripping-wet stories packed with passionate kissing, poppers-fueled shower fucking, cum-soaked panties, huge tits getting shared, thick uncut BBC creampies, and a crossdresser getting railed then cleaned out and pounded by a gorgeous trans woman.Story Teasers (full episodes get way dirtier):• A straight guy on a wild Vegas bar crawl follows a much older, hung stranger from the bathroom to his hotel room. In the dark shower he takes his very first cock, deep passionate kissing, heavy poppers, and wakes up the next morning wearing nothing but a cum-soaked lacy thong — his first gay experience turned into an unforgettable night of anonymous hotel gay sex.• A busty wife sunbathing topless in her Arizona backyard gets caught by the older Black neighbor. Her husband happily shares her massive 38DD tits and watches as the neighbor regularly breeds her with his thick uncut BBC. Includes hot creampie photos sent straight to hubby's phone — pure interracial cuckold breeding at its steamiest.• A crossdresser in full femme mode gets railed hard by a hung stud in a dark corner of a San Diego club. Then his gorgeous trans friend Tia takes him home, sucks the stranger's load out of his freshly fucked ass, and fucks him senseless while the neighbors watch through the door — intense crossdresser, trans, and public sex action.These are just the teasers. The full uncensored audio confessions go much deeper with graphic dirty talk, multiple loads, detailed sensations, and zero limits.Join the community: Discord → https://discord.gg/uqqxsCSDfwSupport Nikky & Unlock More Heat • Patreon: Exclusive full-length confessions, bonus audio, steamy Q&As and early access at Patreon.com/DearNikky — join the inner circle for maximum spice.• Nectar.ai: Dive into your wildest AI fantasies anytime at Nectar.ai — perfect for fans who crave even more immersive gay, BBC, crossdresser, and cuckold experiences. Featured Release Dear Nikky: Sex Confessions From People Just Like You is available now — raw, unfiltered erotic stories you'll love.Content Warning This episode contains extremely explicit sexual content including graphic descriptions of gay sex, first time anal, poppers, BBC breeding, creampie, cuckold, interracial, huge tits, crossdressing, trans sex, public sex, infidelity, passionate kissing, cum play, and more. All stories depict enthusiastic consent between adults.Listener discretion advised — 18+ only. We do not air content involving bestiality, incest, underage, rape, non-consensual acts, or racial slurs.Get Involved Submit your own secret fantasy or real confession: Nikky@dearnikky.com or anonymously at DearNikky.com/confessions. By submitting you confirm you're 18+, the sole creator, and the material contains no prohibited themes. Say hello, share your naughtiest thoughts, or just chat: Nikky@dearnikky.comSocials: Twitter/X (@DNikky162), Instagram (@DNikky162), Facebook (@DearNikky) Love the show?Leave a review on Apple Podcasts, Spotify, Spreaker or wherever you listen — it helps new listeners find these hot confessions.Thank you for listening, you filthy animals. Stay nasty.

What happens to your identity when the system that formed you was built to erase it? In this deeply personal and clear-eyed conversation, New York Times bestselling author Tia Levings returns to A World of Difference with her new book, a survivor's guide that meets you wherever you are on the road to recovery. Whether you were raised in high-control religion, are navigating the aftermath of leaving, or are simply trying to understand why you still silence yourself in rooms where it feels unsafe to speak, this episode is for you. In This Episode: Why personhood itself becomes the problem inside high-control religious systems, and what it costs to live there How "quiet is good, quiet is safe" becomes a form of self-policing that follows you long after you leave What relearning "no" looks like for someone who had consent conditioned out of them Why recovery isn't a tidy upward arc, and the danger of skipping the transition period The pull to cult-hop and how healing your sense of internal belonging makes you less vulnerable to manipulation The moment Tia first knew, truly knew, that she belonged to herself About Tia Levings: Tia Levings is the New York Times bestselling author of A Well-Trained Wife and her new book I Belong to Me: A Survivor's Guide to Recovery and Hope After Religious Trauma. Her work decodes the fundamentalist influences in news and culture, and has appeared in Teen Vogue, Salon, Newsweek, and the Huffington Post. She appeared in the hit Amazon docu-series Shiny Happy People and is based in Raleigh, North Carolina. Timestamps: 00:00 — Introduction & Cold Open 01:07 — How Tia showed up differently writing I Belong to Me 03:22 — Living in a framework where your personhood is the problem 06:25 — "Quiet is good, quiet is safe" — two kinds of silencing 08:27 — Relearning "no" after having it conditioned out of you 11:30 — Suffer well: how doctrine functions as a control mechanism 14:20 — Die to self, the JOY acronym, and reclaiming a disappeared self 17:20 — Why leaving isn't as simple as just leaving 20:01 — What recovery actually looks like — the swamp, the crash, the transition 23:55 — Cult-hopping, fawning, and staying wary of gurus 31:23 — "I had no self" — building identity and belonging to yourself 37:49 — Outro and final reflections Find Tia Levings at: Pre-order I Belong to Me and get Tia's thank-you gifts Social media: @TiaLevingsWriter (all platforms) Subscribe, leave a review at https://www.aworldofdifferencepodcast.com/reviews/new/, and share this episode with someone who needs it. Visit https://www.aworldofdifferencepodcast.com for more resources. Learn more about your ad choices. Visit megaphone.fm/adchoices

A fun chat that covers Nia Long on KeKe's podcast, the new Michael movie, Emma Grede (again), the relationship between protein and fiber and a little funny moment about MJB's Burger King commercial.She's still very upset about it. Y'all better quit playing with her and that jingle.Why girls night out is so important and how we can microdose that joy on this episode of Tia's Table.Got something you want to say about this episode? Send me a text!Support the showAre you getting our newsletter? Join the TVF Sisterhood by subscribing to our monthly newsletter. You'll get the same positive vibes, recipes and workout tips you love from the podcast delivered right into your inbox. You can subscribe here.Ready for change? You can develop healthy habits and make your fitness journey your new lifestyle with the TVF app. Receive coaching, motivation, track nutrition and workouts and get access to monthly challenges for $25/month. Join the app community here.IG: @TiaVFitnesswww.tiavfitness.comSalad Fund - $TiaVFitness

Send us Fan MailTia Levings is back, and this time she's brought the book so many of you have been waiting for — I Belong to Me, a survivor's guide to recovery and hope after religious trauma, and the follow-up to her memoir A Well-Trained Wife.After thousands of women slid into her DMs asking how did you heal, how do I find myself again, Tia sat down and wrote the guide she wished she'd had. In this conversation, we get into what religious trauma actually is and why therapists are only now starting to name it, how spiritual bypassing uses faith language to invalidate your pain, and why the period right after you leave a high-control church or marriage is actually when you're most vulnerable — not most free. We also talk about why your voice and your sexuality are twin wounds that heal together, how to start building boundaries when you've never been allowed to have any, and why real recovery eventually means sitting with your own complicity — not to shame yourself, but to finally choose something different. If you've ever wondered was what I went through actually trauma, and can I actually heal from it — this episode is for you.TO SUPPORT US: Join our Patreon for as little as $5 a month to support our work (and get access to the book club!)And check out our Merch, or any of our courses!Give to the Good Fruit Faith Initiative of the Bosko FoundationJoin our email list!LINKS MENTIONED: I Belong to Me by Tia Levings — Release Date: May 5th — Pre-Order Now!Listen to Tia's first episode with us on her book The Well Trained WifeSupport the showJoin Sheila at Bare Marriage.com!Check out her books:The Great Sex Rescue She Deserves BetterThe Marriage You Want and the Study Guide The Good Girl's Guide to Great Sex and The Good Guy's Guide to Great SexAnd she has an Orgasm Course and a Libido course too!Check out all her courses, FREE resources, social media, books, and so much more at Sheila's LinkTree.

Some battles follow you long after you leave the military. On this episode of The ToosDay Crüe, hosts Jake Holland and Stephen LaMonica sit down with US Army Veteran Tia May, a telecommunications systems operator who joined the Army in 2001 and faced challenges that pushed her mental health to the edge. During her time in service, Tia experienced disrespect from fellow soldiers and constant body size shaming. The emotional toll built up over time, leading her to turn to alcohol to cope. Nightmares, anxiety, and the weight of unresolved trauma eventually brought her close to a breaking point. But her story didn't end there. Tia found an unexpected path toward healing—motorsports. What started as an outlet became a lifeline. Getting behind the wheel gave her focus, adrenaline, and a sense of control that helped quiet the chaos she was battling internally. Now, Tia is using motorsports as a platform for mental health advocacy, helping raise awareness and encouraging veterans to find their own paths toward healing. Her mission is simple but powerful: get veterans out on the track, open the conversation about mental health, and prove that recovery is possible. Life in the Army as a telecommunications operator The mental health challenges many soldiers face but rarely talk about Coping with trauma, nightmares, and alcohol The breaking point that forced change How motorsports became therapy Using racing to help other veterans find healing

Hybrid episode (narrative & interivew). The Hittite Queen, Maat-Hor-Neferura, may have been surprised to find she wasn't the only King's Great Wife. In fact, Ramesses had already turned to other women to be his Queens. Notably, his eldest daughter Bint-Anat ("Daughter of Anat") became King's Great Wife, along with several of her younger siblings. Why did Ramesses "marry" his own offspring, and what does that mean for the royal family? Also, we meet Ramesses' oft-forgotten sister, Tia. In Part 2, we are joined by Prof. Peter Brand to discuss life in the pharaonic palaces. How did they organise their royal households, what terms survive to illuminate this world? And how can Egyptologists understand life in Ramesses' great family? Music by Luke Chaos & Keith Zizza, used with permission. Logo image: Bint-Anat as King's Great Wife, from Ramesses' colossal statue now in the Grand Egyptian Museum. Learn more about your ad choices. Visit megaphone.fm/adchoices

Nominations for the Rock & Roll Hall of Fame; You, Me & Tuscany debuts; Nia Long does Playboy; The Testaments on HULU; Tia & Tamera have separate dramas; Gucci was kidnapped (by idiots) in January; That TLC tour is still happening;  Usher on tour with Chris Brown. Thanks to our sponsors:  Let Rocket Money help you reach your financial goals faster. Join at rocketMoney.com/ratchet   Shop Everyday Cotton, and all of my favorite bras and underwear at http://www.skims.com/ratchet  #skimspartner When life feels overwhelming, therapy can help. Sign up and get 10% off at betterhelp.com/ratchet  ABOUT ME: http://www.demetrialucas.com/about/ STAY CONNECTED:  IG: demetriallucas Twitter: demetriallucas FB: demetriallucas YouTube: demetriallucas Learn more about your ad choices. Visit podcastchoices.com/adchoices