Thank You from the Louisiana Medical Clinic

Timothy B Sonnier President/CEO LMC would like to thank the Southern Pain Society and Dr. Murphy for letting us be a part of the Southern Pain Conference in New Orleans for the last 2 years. The educational material that we have acquired from this relationship has...

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Abstract- Top Legal Risks for the Pain

Barry Straus, MD, JD What are the top legal risks you need to consider when practicing pain medicine? Different legal risks require different strategies for risk management. The top risks are not necessarily malpractice and regulatory. This talk will go over the legal...

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President’s Message: New Year Resolutions

Thomas Davis, MD  The new year brings about reflections of our past year and goals for the next. Just as many of us have personal goals for the new year, we at the Southern Pain Society (SPS) have new goals. As we have since 1989 we are planning this year’s...

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Neurology and Psychiatry (combined) Cases

Lawrence Robbins, M.D., Associate Professor of Neurology, Chicago Medical School Case #1: Bipolar, Migraine, Chronic Daily Headache (CDH), IBS Caitlin (28 y.o.) has had depression since age 14, finally diagnosed at age 26 as the mild end of the bipolar spectrum (Other...

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President’s Message: When Was That Taught?

Harry J. Gould, III MD, PhD It has been more years than I care to admit since I graduated from medical school. As most of us have realized, with time, advances are made, with experience, skills are refined and as practitioners, we adapt to change and challenge and improve in our ability to care for patients. An unfortunate corollary to the essential fine-tuning of the evolving practitioner, especially in specialty […]

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President’s Message–Looking Ahead to 2022

Harry J. Gould, III MD, PhD

Once again, it is time to begin a brand new year.  Since I stepped into the role of president of the Southern Pain Society, we as a society have experienced moments of promise with the release and early encouraging responses to vaccines to thwart the COVID-19 pandemic. These advances fostered the hope of resuming in person meetings, but the resurgence of the pandemic due to the delta variant dictated

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Long Haul COVID-19

Olivia Lee and Lawrence Robbins, MD Introduction Over 325 million doses of COVID-19 vaccines have been distributed in the United States, and much of the country is looking forward to a return to normalcy. For many, the widespread access to vaccines signaled the...

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ANA2021 Registration Is Now Open!

ANA2021's Virtual Annual Meeting is set for October 17-19 with an Opening Symposium on October 16 and registration is now open! All full registrations include access to the ANA2021 Meeting Recordings package, ensuring you won’t miss out on the latest neurological...

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Back to the Basics: Managing Pain Months After COVID-19

A year ago, the United States was in the midst of understanding and dealing with the complexities of the “Opioid Epidemic”, what until then had been considered the greatest healthcare crisis in U.S. history. Although improvements in some aspects of the crisis were starting to be realized as a result of the development of best evidence-based practice guidelines and the implementation […]

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In Memory and Appreciation: Dr. John Satterthwaite

It is with deep sadness that we recognize the life and contributions of  John Satterthwaite, MD who transitioned from this earthly world last month.  John’s perspective on the history and devotion to the mission of SPS were priceless. Many have no doubt that the SPS would not exist today it were not for the careful nurturing and stewardship of John during the last 34 years […]

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Casey A. Murphy, MD Receives Award

Dr. Hu Rosomoff, the founding President of SPS, would take any opportunity to speak during each Annual and Board meeting until his health prevented him from attending.  Hu was a veritable fountain of clinical wisdom, as well as a provider of historical perspective into the Society.  Now, as the “Old Guy”

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Chaos, Migraine, and Evolution

Lawrence Robbins, MD  INTRODUCTION Migraine often results in disability and diminished quality of life. Despite this, our species remains particularly vulnerable to migraine. Why is this so?  Evolution may provide answers. The study of evolution and disease is not...

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President’s Column July, 2020–Virtual Annual Meeting

Last year we began planning our 2020 Southern Pain Society meeting,  “Perspectives, Concerns and Options for Managing Pain.”  Little did anyone realize that national events of 2020 would necessitate many concerns and needs. We have worked to change our perspective as we explored options for safely coordinating an exciting conference to share timely and innovative pain management information. 

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Cluster Headaches and Treatment Update

Cluster headache is among the most severe pains known to mankind. It is characterized by excruciating, debilitating pain lasting from 15 to 180 minutes, or occasionally longer. Pain is usually located around or through one eye or on the temple. The series of headaches usually lasts several weeks to several months, once or twice per year. Clusters may occur every other year or less frequently.

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COVID-19 and the SPS Annual Meeting

As COVID-19 continues to influence individual and corporate function worldwide, The Southern Pain Society leadership is working diligently to ensure the best plan for our upcoming Annual Meeting in September. We would like all to know that while information on the current unprecedented pandemic is evolving quickly, your health and safety remains our primary concern.

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Determination of Adverse Effects In Clinical Trials

The efficacy of new drugs is usually reasonably accurate. We have multiple scales for efficacy, and the studies are powered for clinical effect. However, the studies often produce inaccurate adverse event or adverse effect profiles. To determine the likely adverse effects, post-approval we have to piece together multiple lines of evidence. The physician online chat boards have been very helpful.

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SPS Treasurer Transition

As you may know or have read in our President’s Column, Dr. John Satterthwaite has stepped down from his long-standing role as SPS Treasurer and will remain on the board as a non-voting member. We are grateful for his 34 years at the financial helm of the organization and appreciate his wisdom, historical perspective and recommendations that have kept SPS healthy, financially sound and robust.

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Reducing Harm from Opioids – Lessons Learned

Wilmington is a community in southeastern North Carolina known for its beautiful beaches, historic river-walk district, and the largest domestic television and movie production facility outside of California. In April of 2016, this city also became recognized for something else. Castlight Health released “The Opioid Crisis in America’s Workforce.”

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Thank You, John Satterthwaite!

Developing this president column is no small task. It is written to pay tribute to our friend and mentor Dr. John Satterthwaite who recently stepped down from serving as the treasurer of the Southern Pain Society during the last 34 years.  John nurtured and guided SPS while significantly impacting many SPS members in ways that can never be repaid. As Dr. Mordi Potash said so well: “it is an absolute truism that there would not be a Southern Pain Society in existence in 2020 if not for John Satterthwaite.” This was echoed by Lori Postal who recently wrote John Satterthwaite has served the Southern Pain Society as a “trusted mentor, historian, voice of reason and steward of our finances.”

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Personality and Pain: Which Came First?

The relationship between personality and pain can easily be traced to ancient Greece. In the late 19th century psychodynamic theorists saw a connection between emotional factors and the experience of chronic pain. Engel maintained that, while physical pain may result from pathophysiology, the interpretation of pain is a psychological phenomenon and that certain diagnoses were relatively common in people with chronic pain.

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The 2019 Southern Pain Society Conference – A Most Memorable Event

The 2019 Southern Pain Society (SPS) conference was held September 13-15 in New Orleans.  We enjoyed reconnecting with previous conference attendees and meeting many first-time attendees. It was great to have a new attendee share that “this is great–so much better than I ever expected.” It would be difficult to find someone who didn’t learn at least a few new things.

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Disparities in Pain and Pain Care: Combating Bias in Practice

In a post in a previous issue of this newsletter, titled “Gender disparities in Pain and Pain Care,” we explored the evidence that women are not only at higher risk for pain and pain conditions but that their pain appears to be underestimated and, in some cases, undertreated compared with men’s pain. Similar patterns are evident in diagnosis and treatment of pain in racial/ethnic/SES minority patients.

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Hypnotically Enhanced Addictions Treatment

As a member of the Board of Directors of the Southern Pain Society, I want to share with the membership a recent workshop I presented to the Canadian Federation of Clinical Hypnosis in Banff, Canada.  The workshop was titled “Hypnotically Enhanced Addictions Treatment: Drug Abuse, Alcoholism and Alcohol Abuse, Gambling Addiction, Smoking Cessation, and Obesity, with a Focus on Drug Dependence during this Opioid Crisis.”

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Gender Disparities in Pain and Pain Care

In a widely-shared article published in the Atlantic in 2015, titled “How Doctors Take Women’s Pain Less Seriously,” author Joe Fassler tells of his wife Rachel’s visit to the ER after she is suddenly stricken with excruciating abdominal pain, later revealed to be a life-threatening ovarian torsion. . The article tells of their agonizing 14-hour wait in the ER while Rachel’s pain is dismissed, undertreated, and misdiagnosed.

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Ajovy and Emgality: Efficacy and Side Effects

All patients had the diagnosis of chronic migraine. Almost all patients had utilized Botox for their chronic migraine. Each patient had utilized at least 3 preventive medications in the past. Many of these patients remained on a daily preventive. Approximately 60% of the patients were considered to have refractory chronic migraine.

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President’s Message, July 2019

As a result of the opioid crisis, during the last few years we have faced many changes that we never expected. Patients and families have been devastated. Some are dealing with Opioid Use Disorder, while others are dealing with pain and withdrawal after abruptly stopping prescription opioids. Shocking are notes posted on physician’s doors stating: “We do not prescribe opioids.”

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President’s Message on the American Pain Society

The members of the Board of Directors of the Southern Pain Society were saddened to read about the possible need for the American Pain Society to cease operations.  We have long appreciated the scientific contributions and clinical guidelines for pain management made by the APS. 

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President’s Message, April 2019

Thinking about our coming Annual Meeting, I’m reminded of the complexity of the challenges we face. Along with the attention the opioid crisis is receiving, those of us working daily with patients living with pain know that for many of them there is a simultaneous pain crisis.  As pain professionals we have a responsibility to help to “clean up” what many consider to be  “the mess” that resulted from the opioid crisis and now the consequential pain crisis.

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Self Compassion

In this third of a series of writings about compassion and pain management, this article focuses on self-compassion.  The premise is that it is essential for health care providers to have compassion for self as the foundation to empathically and compassionately care for patients, while promoting compassionate satisfaction and preventing compassion fatigue.Self-compassion is connecting care and support for self during times of personal suffering.

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Chronic Migraine: 6 Months of Therapy with Erenumab (Aimovig)

Migraine is a relatively common illness, affecting 12% of the population. Chronic migraine (CM) is a frequently encountered subset of migraine, and presents certain difficulties in treatment. Those with CM have at least 15 headache days per month, with at least 8 days being migrainous in nature. Many do not do well with the usual preventive approaches, and suffer from refractory chronic migraine (RCM).

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Recruiting: Pain Psychologist Behavioral Medicine Institute

Behavioral Medicine Institute (BMI) is a 20+ member, multi-specialty group practice based in Knoxville with a long-established referral base and innovative practice models including embedded clinicians in local medical practices. We are currently seeking a skilled and motivated clinician to add to our team of psychologists working embedded in a local, anesthesiology-based pain center which has received a Center of Excellence award from the American Pain Society. The opportunity is full time, we offer a supportive, collegial atmosphere…

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Chronic Pain and the People We Love

A few nights ago, I was talking with my wife about something fairly benign – probably weekend plans or paying the light bill – when she suddenly got a look on her face that I know very well. It was that solemn, glaze-eyed look that says, “I’m so over this.” Like any good spouse would do, I asked, “What’s wrong? Are you ok?” Her eyes snapped to and she gave a slight smile accompanied by the quietly murmured, “I’m fine.” This was obviously not the case so I interpreted her response to mean that something was wrong…

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President’s Message, January 2019

As we enter this last year of the second decade of the 21st century, clinicians working with patients who experience pain confront the challenge of providing safe and effective pain management while facing numerous barriers to doing so. During the past few years pain management in the US has been dramatically affected by the opioid crisis. This is true for patients and clinicians alike. It is tempting to lament the resultant changes, barriers  and difficulties; however, without appropriate action such lamenting will only deter from working to improve pain management options and care. 

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Cognitive Behavioral Therapy for Chronic Pain

Individuals living with chronic pain often present with myriad complaints and a decrease in quality of life driven, in many cases, by a lack of adaptive coping skills. Frequently, patients apply conventional wisdom, opting to reduce their activity levels and “resting” as a response to their pain and, in doing so, further reduce their functional capacity and involvement in daily life. …CBT for Chronic Pain (CBT-CP) can help patients to break free from the chronic pain cycle. Evidence suggests that this intervention improves patients’ functioning and quality of life.

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Catastrophizing and the Meaning of Pain: Why It Matters

The cognitive model is a widely accepted and well published framework for understanding the crucial role that internal thoughts and attitudes play in the daily experience of emotion and behavior. More specifically, the model proposes that over the course of our lifetime, we all develop patterns of thought that influence our understanding of the world around us and the meaning we place on events in our lives. . . Among these dysfunctional patterns is catastrophizing–the tendency to draw erroneous and often irrational conclusions from a situation.

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The Homebound Adolescent Headache Patient

It is not uncommon for adolescents with severe headaches to be absent from school for long periods of time. Each child is unique, with multiple variables that include: frequency and severity of headaches, response to medication, psychological make-up, history of abuse, resilience and functioning, catastrophizing, stresses and response to stress, family and friends support system, and school support. In addition, family dynamics plays a role. The parents’ psychological condition is also an important factor.  

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Is Compassion Fatigue the Adversary of Compassionate Pain Management?

Compassion has been discussed as the possible ghost of pain management.  Intrinsic in that possible relationship is the potential ingredient known as compassion fatigue which is described by Sinclair and colleagues (2017) as “a work-related stress response in healthcare providers that is considered a ‘cost of caring’ and a key contributor to the loss of compassion in healthcare.”  The stress response involved in compassion fatigue is believed to evolve while caring for patients, clinicians repeatedly experience, in a secondary manner, the traumatic events and/or suffering of patients.

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Is Compassion the Ghost of Pain Management?

Historically, the interactions between health care providers and patients involved a therapeutic component that enhanced the beneficial effect of the medications and treatments which were provided. Today, when they sense empathy and compassion from clinicians, patients continue to report greater satisfaction, less anxiety, and feeling safer, with improved outcomes demonstrated. Although compassion clearly is important in health care, it is often misunderstood.

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Atlanta 2018–Our Most Relevant Conference

Barely a week goes by without at least one, often multiple, mainstream news articles about the practice of pain management. Just the other day, there were a number of stories about a huge federal multi-state crackdown on “rogue prescribing” of opiate pain medications by 76 doctors which led to them being arrested for fraud and a long list of other charges. We also read of a dramatic increase in raids on nationally prominent specialists in opiate dependence who prescribe buprenorphine.

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CGRP Antagonists: Long-term Side Effects

The monoclonal antibodies (mAbs) targeting calcitonin gene-related peptide (CGRP) are a valuable addition to our preventives. However, there are significant conceivable long-term adverse effects associated with them. We will have a better feel for the true risks in 10 years. For each patient, we have to decide whether the benefits outweigh the possible risks. With luck, it may come to pass that the biologics targeting CGRP carry very few long-term risks.

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Personality Disorders: Recognition and Management in a Pain Clinic

Patients with moderate-to-severe personality disorders (PD) Are frequently seen in medical practices. It is increasingly important to recognize, limit and manage those with aggressive types of PD. Likewise, it is crucial to recognize those who fit the bipolar spectrum. In particular, the mild end of the spectrum is often missed. The clinical stakes for missing bipolar are enormous. This article delves into recognizing and managing patients whose pain treatment is complicated by psychological concerns.

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Thrown Off the Pendulum

In the two years that have passed since the CDC Opioid Guideline was released, many pain management thought leaders have conceptualized this guideline as a pendulum that was to swing patient care from an extreme of opioid permissiveness to a more thoughtful middle-ground of opioid allowance within limitations. That middle ground was supposed to permit opioid prescribing in chronic pain for well-selected and well vetted patients whose dosing is within reasonable limits. Are the guidelines working?

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Medication Overuse Headache: Inaccurate and Overdiagnosed

Medication overuse headache (MOH) is very frequently diagnosed; however, the MOH diagnosis is often overused. Patients are labeled as having MOH when what they actually suffer from are refractory headaches, without medication overuse (MO). Current diagnostic criteria for MOH only require abortive medication use on 10 or 15 days of each month (depending upon the medication). No evidence is needed showing that the abortive actually causes an increase in headache.

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Migraine Treatment: A Comprehensive Guide

Migraine is a very common and disabling illness. Picking an agent that is best for each individual patient requires considering the patient’s history, lifestyle, comorbid conditions, and individual preferences. A recurring headache that is of moderate or severe intensity, and is triggered by migraine-precipitating factors, usually is considered to be migraine. Precipitating factors can include stress, certain foods, weather changes, smoke, hunger, fatigue, hormones, and so on.

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In the Spotlight: Geralyn Datz, PhD

One of the biggest challenges with using a solitary approach such as pharmacotherapy, including opioid therapy, for the patients with pain, is that chronic pain is best treated through a multimodal approach. Pain affects the whole person. Patients and practitioners need to learn techniques to adapt to and manage the pain, not just take it away temporarily. There is a push to teach active self management strategies, such as sleep restoration, pacing, conquering worry and anxiety, and how to minimize depression in the face of pain.

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Highlights of the 2017 Annual Meeting

We had a spectacular meeting in September at the Crowne Plaza Hotel in New Orleans.  We collaborated with the Southern Headache Society and included breakout sessions for both chronic pain and headache providers. The opening session on Friday afternoon included talks and panel discussions around the relationship between payors and providers, patient disability issues and managing chronic pain in the cognitively impaired patient. 

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SPS President’s Newsletter Column – Summer 2017

One of the ways I like to unwind is to watch HBO on my cellphone or tablet. Whether it’s Real Time, Last Week Tonight, Westworld, or Game of Thrones, I am captivated by HBO’s shows! One show, VICE – and its online companion, VICE News –  has recently featured several stories that have to do with opioids and pain management. The stories do a great job of capturing the multi-faceted aspects of this issue. They also show how strict and unyielding policy solutions to current controversies in opioid-based pain management can make misery out of the lives of countless people.

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Functional Restoration: Use, Value & Structure – Newsletter

The Opioid Epidemic has forced providers and insurers to re-evaluate the way chronic pain is treated both short and long term. As a result, there has been a renewed interest in non-medical based treatments that restore pain patients, particularly injured workers, to health and optimal function. Chronic pain is a common presentation in work injury. Functional restoration is a non-medication based option that can restore patients with pain to higher function and return to work. True functional restoration includes Cognitive Based Therapy (CBT) and intensive physical therapy.

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20 Years of the Integrative Healing Arts Network – Newsletter

News reports are replete with stories about the problems of opioid use disorder (OUD) and overdose deaths.  The Healing Arts Network of New Hanover Regional Medical Center has a successful 20-year track record of managing pain with a multi-modal approach, including a variety of medications, {appropriate use of opioids, non-opioid analgesics, co-analgesic agents) and non-pharmacologic interventions.  Many people may be interested in non-pharmacologic interventions but don’t know much about them, where to find practitioners or how to afford them. 

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President’s Message May 2017 – Member Posts

“I would not recommend that you go into pain medicine… find something else rewarding to do.” The honesty of that statement just exploded from my mouth – like it has been welling up to be spoken (or shouted) for many months. I am at my clinic at Tulane University...

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Innovation: Opioid Substance Use Disorder

During 2014, patients were admitted more frequently with diagnoses of soft tissue abscesses, epidural abscesses, and endocarditis. Two common denominators…were a history of self-administering opioids intravenously and now needing IV antibiotics for prolonged periods of time. This combination posed a challenge for health care providers.

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Reflections from Outgoing President Geralyn Datz, PhD

It is with excitement that I look forward to the new year of 2017. But also some sadness as I step away from the role as president. It has been a wonderful two years with the organization serving in this role… I marvel at what has happened both within the society and within health care as a whole during my term.

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Summer Newsletter

Dr. Mordecai Potash, MD has the lead article on Medical Marijuana in the Southern US. He is also a featured speaker at our annual meeting coming up in September. Hope you will join us!

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April Newsletter

Our Spring Newsletter highlights articles on the opioid epidemic, the Alabama Blue Cross and Blue Shield policy draft and update on our September meeting

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Fall Newsletter

Our Fall Newsletter highlights information from our recent SPS Annual Meeting, along with interesting articles and our new board of directors.

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