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39 episodes with alfs
5 episodes with alfs
2 episodes with alfs
2 episodes with alfs
2 episodes with alfs
2 episodes with alfs
2 episodes with alfs
Nelver - Proud Eagle Radio Show #572 [Pirate Station Online] (14-05-2025) ✅ Subscribe to Telegram channel: https://t.me/nelvermusic All episodes: https://band.link/proudeagle YouTube Video: https://youtu.be/Yzy-2LfSNWM Tracklist: 01. Feed The Fire - Circles 02. Toronto Is Broken - SOMEWHEREIBELONG (feat. REEBZ & Sebotage) 03. streetflicker - Don't Wanna 04. KNGHT - Time 05. Voicians - Lost 06. Teni - Money (goddard. Remix) 07. James Hiraeth & Grace Barton - See Me Now 08. Feint - Flicker 09. Erio & Rokschoon - Walk The Line 10. Degs & Hologram & 4K - Pressure 11. Grafix & Nu-La - Vital Signs 12. coil circuit - Range 13. Lukher - Clockwork 14. Alphas Wear Grey - Make it Smooth 15. Silloh - Dungeons 16. Telm & Wilson - Will-O-Wisp 17. Re:growth - Close To Me 18. Kursiva - Lost It 19. Dizrupt & MKJAY - Reap 20. Molecular - Got Game 21. Baboon - Confusion 22. Minor Forms - Used To It 23. ZeroZero - You Tell Me 24. Workforce - Overnight Express [feat. SP:MC] (Break Remix) 25. Nelver & Duoscience - Return 26. Molecular & Klinical - Know That 27. Melinki - Radical Sound 28. Dub Elements & MIDNIGHT CVLT & Coppa - Keep The Energy Up 29. Albees - 1990 30. Acris - Unseen Forces 31. Alfs & Merdz - Siren 32. Afex - Moment 33. Nelver - Search Within 34. Exposure - Searching 35. N.O.C.K - Infinite 36. Nymfo & Rider Shafique - Dark Sun 37. Kipsy - Walk In The Park 38. Nelver - Away 39. Nelver & Alpha Rhythm - Raindrops 40. Revan & Satl - Warble Music 41. Jrace & Albert White - Hold On (Erice Remix) 42. Nelver - Someone Else 43. Furney - Swanko 44. Aleyum & Philth & Lance - Hooked 45. Nelver - What You Are 46. Dephzac - Sunshine 47. Nelver - Just Me 48. A.P.O.L.L.O - Far Away 49. HK Sage - The Farewell Letter 50. Nelver - Our Time 51. Nelver & Aperio - Constellations 52. Science of Man - Fools (Dont lose it) 53. CRSV - Hopes & Dreams 54. Nelver - Silence 55. Wez Walker - Pass The Blame 56. Zero T & Onj & Minor Forms - No Way 57. Nelver - Time Forward Weekly updated Playlist "Proud Eagle" on Spotify: https://spoti.fi/2W5vkVa Follow Nelver: https://www.instagram.com/nelvermusic/ https://vk.com/nelver https://spoti.fi/2ThGKDT https://soundcloud.com/nelver https://www.facebook.com/nelverdnb/ https://www.mixcloud.com/Nelver/ https://twitter.com/Nelvermusic #nelvermusic #drumandbass #newmusic #electronicmusic #dnbculture #vibes #mood #exclusive #trending #viral #proudeagle
Ensuring the safety and security of residents in assisted living facilities (ALFs) is a top priority for many healthcare employers. Unfortunately, the theft of residents' valuable possessions remains a troubling issue that may undermine trust and well-being of essential healthcare workers.
In hiring lifelong “Washington guy” and veteran Beltway lobbyist Clif Porter as its next president and CEO, the American Health Care Association has perhaps a more insightful view into presidential and congressional politics than ever before. In his first interview since his promotion, Porter opened up with McKnight about his unique leadership style, caring for his mother and, among many other vital topics, how he expects the US presidential election will unfold for the long-term care sector. “If there's a (Kamala) Harris administration, obviously, there's concerns it would continue in the direction President Biden has,” he cautions in this McKnight's Newsmakers podcast. But, he quickly adds, there are also possible reasons for hope whether Donald Trump or Harris wins the White House. Porter also forecasts who is favored to win each chamber of Congress and how the races generally have tightened over the last few months. In addition to that, this “new” hire, who is currently AHCA's senior vice president of governmental affairs, opens up to McKnight's Executive Editor James M. Berklan about how the Supreme Court's Chevron ruling may affect providers, the role of music in his life, and what his vision for the future of long-term care is after his upcoming run as the most visible and prominent spokesman for the long-term care sector in all the land.
The rumors were true! We're capable of picking movies that aren't based on Journey to the Center of the Earth. But only because we respect the Japanese so much! It's time for us to chat Miyazaki again with his 1984 feature Nausicaa of the Valley of the Wind! But first! We chat about our favorite movies from the year 1983! Not, not 1984, the year of Nausicaa's release. Parker has his reasons, I suppose. So #DonloydNow and enjoy this bite-sized Junk Food Supper. We got all this plus a list of what's legally outlawed in Cinci, easy-snazzy tunes, the wrath of the math, the Ted Raimi beef revisited, the CM Punk beef rehashed, a bland-ass Rumble, odds that are not surmountable, your up-to-date Sumo News update, the most honorable deaths in Japan, things you can see on YouTube (if you're a perv), pre-internet flea marketing for ALFs, a pleasant conversation about Brian DePalma, a heated conversation in regards to David Cronenberg, belches, sneezes, gleeks and so much more!! Direct Donloyd Here Got a movie suggestion for the show, or better yet an opinion on next week's movies? Drop us a line at JFDPodcast@gmail.com. Or leave us a voicemail: 347-746-JUNK (5865). Add it to your telephone now! JOIN THE CONVERSATION! Also, if you like the show, please take a minute and subscribe and/or comment on us on iTunes, Stitcher, Blubrry or Podfeed.net. Check us out on Facebook and Twitter! We'd love to see some of your love on Patreon - it's super easy and fun to sign up for the extra bonus content. We'll hang-glide with pokemons for your love and support. With picks like these, you GOTTA #DonloydNow and listen in!
Welcome to the first episode of Home Health Chronicles: The good, the bad, and the ugly. This episode is just myself giving a quick intro to who I am, why I started this podcast and my IG , ALFs vs Homes, and then the one meme/post I have been struggling to make for over a year. I can't wait to continue to discuss all things home health in future episode with you all as guests!
What separates the Alfs from the Meegos? Is a hotdog a sandwich? And what's the best way to learn geography? We map out the answers to these questions and more as we watch Season 3, Episode 16 of Family Matters.Alex Diamond, David Kenny, and John McDaniel heard that the long-running network sitcom Family Matters ends with side character Steve Urkel going to space. And the best way to figure out how that happened - obviously - is to watch the last episode first and make our way backwards through nearly ten years of television.Join our countdown to number one (and our slow descent into madness) in all the places you expect internet people to be:Website: jumpingtheshuttle.spaceEmail: jumpingtheshuttle@gmail.comInstagram: @JumpingTheShuttle / @ThatAlexD / @dak577Twitter: @JumpingShuttle / @ThatAlexD / @dak577TikTok: @JumpingTheShuttle / @ThatAlexD / @dak577Brought to you by Smooth My Balls
Vi tittar på Alfs tid på Tynningö i Stockholms skärgård med hjälp av en bok som en lyssnare tipsade om. Och så ser vi hur Gio P:s utsaga förändras ju närmare hon kommer att bryta upp från sin man...Av och med Tobias Henricsson/PRS Media.Sponsra Palmemordet på Patreon: https://www.patreon.com/palmemordetSponsra Palmemordet via Swish: 070-7715864 (märk insättningen "Palmemordet")Kontakta Palmemordet: zimwaypodcast@gmail.comAnmälningsformuläret till Palmemordskonferensen 2024 som arrangeras av Mattias Kressmark och Jonas Nyman: https://docs.google.com/forms/d/e/1FAIpQLSc2SkrlMDlY6fi7zLA_m909fuKaJ_JDO_MMPrymAldoSQbSUA/viewform Hosted on Acast. See acast.com/privacy for more information.
Jornada no Advento 23 • Episódio 13 • Tarde • Vitor Alfs by
Se video av dette intervjuet på Pusterom.comHuset til Alf og Judith Eikevik ble tvangssolgt denne uken etter en 17 år lang konflikt med Bergen kommune rundt bygging av et svømmebasseng. Byggesøknaden ble levert inn i 2006, og skulle ta 3 uker. Da de aldri hørte tilbake fra kommunen, begynte de å bygge. Ekteparet føler de har tatt eierskap for dette, men mener kommunen ikke viser den samme ydmykheten etter en rekke graverende feil. De har fått støtteerklæringer fra folk både i Bergen og andre deler av landet, som sier de har blitt «terrorisert» av byggesaksavdelingene i kommunene. Eikevik undrer seg over at byggesaker ikke foreldes, mens for eksempel grov feilbehandling på sykehus foreldes etter få år. De mener dette viser en systematisk skjevhet i samfunnet mellom enkeltindividet og myndighetene.Alf Eikevik sitt firma: • Eikeviks Svømmebasseng Service ASDokumentasjon fra Alf Eikevik som omhandler saken (PDFer): • Eikevik - Oppsummering av saken (2014) • Bergen kommune - Orientering vedrørende behandling (2013) • Statens kartverk Bergen - sluttrapport (2013) • Kontaktlogg - Byråd Anna Elisa Tryti (Ap) (2017) • Eikevik - Bystyret, å rette baker for Smed (2023)› Nyhetssaker om Alf og Judith sin sak: • tv2.no: Kommunen ber Alf rive bassenget – men det er lettere sagt enn gjort • bt.no: Alf Eikevik har kranglet med kommunen i 17 år. Nå går huset på tvangssalg. • ap.no: Enebolig med svømmebasseng selges for 500.000 • bt.no: – Uholdbart å plage folk på denne måten • vg.no: Mister huset og kastes ut: − Det er uhorvelig bittert • vg.no: Nå går Judith og Alfs hus under hammeren • vg.no: Anders (35) er problemhusets nye eier: − Litt overrasket› Annet: • nrk.no: Blåser liv i skolebibliotek med bøker fra loppemarkedLast ned episodenInnspilt: 2023-11-14Publisert: 2023-11-17Støtte Antijantepodden?Liker du arbeidet vi gjør, og vil bidra til at vi lager flere episoder?Finn ut hvordan du kan gi noe tilbake ved å gå til antijantepodden.com!Meld deg på vårt nyhetsbrev
Alf Enerström pekades ut som Palmehatare, och förekom under lång tid i utredningen. Hans sambo, Gio P, följde i hans spår och de drev tillsammans en hätsk hatkampanj mot Olof Palme. I dagens avsnitt får ni en sammanfattning av Alfs liv, och får också höra en del av det som han skrivit samt vad som skrivits om honom.Citaten ur artiklar m.m. kan innehålla språk och värderingar som kan anses stötande. Podden står inte bakom dessa, och återger dem bara för att ge er en så komplett bild av Alf och Gio som möjligt.Av och med Tobias Henricsson/PRS Media.Sponsra Palmemordet på Patreon: https://www.patreon.com/palmemordetSponsra Palmemordet via Swish: 070-7715864 (märk insättningen "Palmemordet")Kontakta Palmemordet: zimwaypodcast@gmail.com Hosted on Acast. See acast.com/privacy for more information.
Mit der Parole „Follow the Science” wird im Namen der Wissenschaft weltweit großes Unheil angerichtet. Kritiker reagieren darauf häufig so, dass sie die „wahre Wissenschaft“ beschwören und deren Missbrauch beklagen. Doch dieses Verfahren ist heikel. So einfach sind die Dinge nämlich nicht. Der Soziologe Klaus Alfs erinnert an einschlägige Begründungsprobleme des wissenschaftlichen Selbstverständnisses, welche in der öffentlichen Diskussion ignoriert werden oder unbekannt sind.
In Episode 22 of our captivating podcast series, we bring you an intriguing conversation with Shaddrick Hasten, a former CEO of the Florida Assisted Living Association (FALA) and attorney. Join us as we explore the challenges faced by Assisted Living Facilities (ALFs) and gain valuable insights from Shaddrick's unique dual perspective. As a former insider of the Agency For Health Care Administration, Shaddrick discusses his transition from prosecuting ALFs to defending them. We delve into the complex world of healthcare administration, uncovering the hurdles ALFs encounter daily and Shaddrick's approach to challenging the agency with legal representation. This episode offers more than just insights. Brace yourself for a surprise revelation about the upcoming FALA CEO, adding an element of anticipation and intrigue to our discussion. Whether you're an industry professional, a caregiver, or simply curious about the inner workings of healthcare administration, this episode is a must-listen. Gain a deeper understanding of the challenges faced by ALFs, explore the unique perspective of an attorney who has worked on both sides.
Mvemba is joined by Major General Todd Wasmund, Commanding General of the Southern Europe Taskforce Africa. They discuss the goals and objectives of the 11th ALFS, Africa's security landscape, and the evolving partnerships between the United States military and African armies.
Welcome to episode 21 of the ALF Boss podcast, where we bring you informative discussions about the ins and outs of assisted living operations. In this episode, we have the pleasure of speaking with Karen Livio, a seasoned ALF industry professional with over 20 years of experience Currently the administrator of Cobblestone Manor and Mariner Palms assisted living. Together, we explore the unique challenges faced by smaller ALFs, and discuss strategies for successfully managing multiple tasks across all departments. We also examine the ongoing staffing crisis in the industry. Karen shares her insights on the current state of the market in the Hernando County area, reflecting on how much it has changed over the years and what that means for ALFs in the region. Whether you're an ALF owner, operator, or simply interested in learning more about the industry, this episode offers valuable insights and practical tips for managing and thriving in the challenging world of assisted living operations. Join us on the ALF Boss podcast for another engaging discussion.
Welcome to episode 19 of the ALF Boss podcast, where we bring you insightful discussions about assisted living operations topics. In this episode, we sit down with Pliar Carvajal CEO of Innovation Senior Living, a seasoned professional in the ALF industry with over 20 years of experience. Together, we delve into the topic of the affordable middle market of ALFs, exploring the unique challenges and opportunities that arise in serving this market. We also examine the ongoing staffing crisis in the industry and discuss potential solutions for attracting and retaining quality staff. But that's not all. Pilar shares her valuable insights on the importance of mental health care for facility administrators, highlighting the often-overlooked mental and emotional toll that comes with running an ALF. Whether you're an ALF owner, operator, or someone interested in learning more about the industry, this episode is sure to provide you with valuable insights and an engaging listening experience. Join us on the ALF Boss podcast for another exciting episode.
In Australia, the Aboriginal people perform a ceremony known as a corroboree. A group of men walk around a totem pole while singing and dancing. Another group of people, the Alfs, play music on steel drums. The maxillipeds dance to the rhythm. The starlings fly overhead. And the bangers cook food on the ground.
According to the Florida Department of Elder Affairs, an Assisted Living Facility (“ALF”) is a residential care facility that provides housing, meals, personal care and supportive services to older persons and disabled adults who are unable to live independently. ALFs are intended to be a less costly alternative to more restrictive institutional settings for individuals who do not require 24-hour nursing supervision. Florida ALFs can range in size from a single resident to hundreds and may contain individual apartments or suites that a resident shares with others. An ALF is a “Community residential home”, which is a dwelling licensed to service residents who are clients of the Department of Elderly Affairs (“EA”), the Agency for Persons with Disabilities (“APD”), the Department of Juvenile Justice (“DJJ”), or the Department of Children and Families (“DCF”) or licensed by the Agency for Health Care Administration (“AHCA” or “Agency”) which provides a living environment for 7 to 14 unrelated residents who operate as the functional equivalent of a family, including such supervision and care by supportive staff as may be necessary to meet the physical, emotional and social needs of the residents. Examples of residents include: frail elders; a person who has a handicap; a person who has a developmental disability; a non-dangerous person who has a mental illness; a child who is found to be dependent; or a child in need of certain services. There are many requirements to opening and operating a Florida licensed Assisted Living Facility. This podcast does not attempt to highlight all of the legal requirements and should only be considered an educational overview. There are many legal considerations and requirements that were not addressed in this podcast. It is in your best interest to contact an experienced health care attorney if you are considering opening or purchasing an ALF so that they can help you navigate the process. Web: www.JonesHealthLaw.com Phone: (305)877-5054 Instagram: @JonesHealthLaw Facebook: @JonesHealthLaw Youtube: @JonesHealthLaw --- Support this podcast: https://podcasters.spotify.com/pod/show/joneshealthlaw/support
Warum Mani drei Jahre lang Stress hatte und Keanu Reeves nie einen Platz in seinem Herzen finden wird. Wie die Zunge eines Geistes viele Frauen beglückt und ein Fuß einen Tumult auslösen kann. Wieso eine 37-jährige Frau ihren Schulabschluss nachholt, weshalb wir lieber keine ALFs entdecken sollten und warum sich die Menschheit wieder zurückentwickelt. Das alles und noch mehr erfahrt ihr hier! Timecodes: 1:04 Einleitung 7:58 Du bist schräg 12:54 Weirde Pokedex-Einträge 29:07 Movietober ca. 42:00-50:00 SPOILERWARNUNG!! 55:35 Der Fuckie-Preis des Monats 1:06:44 Abschlussworte
Hur upptäcker man alla sina gåvor, vad räknas som gåvor och hur får jag fatt i mina, är frågor jag tänker att vi i olika tider av livet kan ställa oss. Alf upptäckte att det fanns få böcker om ens en på ämnet och kände sig manad att skriva en bok efter en uppmuntran från oväntat håll. I del 2 fortsätter samtalet på temat där Alf får relevanta frågor kring tro, relationer, identitet och gåvor, som knyter väl an del första delen där Alf delade hur boken blev till och dess innehåll. I det här avsnittet berättar jag om något nytt och spännande som du kan läsa mer om, följ mig på instagram på @emmeliahlander och fyll i formuläret om det här är något för dig. >> Till formuläret https://forms.gle/Mp1xHzuWXYCUr9co8 Det här avsnittet är ett gästsamtal som vi haft i Sisters Collective där vi ibland bjuder in gäster på olika teman och områden. Då ses vi i zoom och man får möjlighet att interagera, ställa frågor och delta i samtalet. Jag hade bestämt att jag ville ge mina systermedlemmar boken Upptäck alla mina gåvor som sommarpresent och även denna föreläsning. Nu vill jag att även du som tar del av det här avsnittet ska få möjligheten att lyssna till Alfs klokskap och det vi pratade om, tillsammans med ett fint erbjudande från Semnos förlag som givit ut boken. Du kan köpa den till 20% rabatt med koden: PEACE för att du lyssnar till podden, passa på att bunkra upp presenter att ge vidare. >> Till Boken https://www.semnos.com/bocker/upptack-alla-dina-gavor/ Vill du komma i direkt kontakt med Alf kan du höra av dig till oss så skickar vi din förfrågan vidare. Ta del av reflekterande och coachande frågor och fördjupning genom vårt Peppbrev som släpps i samband med poddavsnittet. >> Prenumerera på Peppbrevet https://www.theperfectpeace.se Hör du detta avsnitt senare. Finns det alltid resurser att ta del av på vår webbsida. Vill du sätta igång idag? Gå vår kostnadsfria minikurs i form av e-mail och video fylld med undervisning, praktisk övning samt coaching på området att få sin tid att räcka till. Något som vi alla kan kämpa med i den här tiden. >> Ta del av gratis minikurs: Stärk ditt inre & väx i ditt uppdrag https://www.theperfectpeace.se/fp/strala
Hur upptäcker man alla sina gåvor, vad räknas som gåvor och hur får jag fatt i mina, är frågor jag tänker att vi i olika tider av livet kan ställa oss. Alf upptäckte att det fanns få böcker om ens en på ämnet och kände sig manad att skriva en bok efter en uppmuntran från oväntat håll. Del 1 som handlar om hur boken blev till och dess innehåll får du del av här, i nästa avsnitt kommer vi fördjupa oss och gå in på olika frågeställningar inom dessa områden så missa inte del 2. Det här avsnittet är ett gästsamtal som vi haft i Sisters Collective där vi ibland bjuder in gäster på olika teman och områden. Då ses vi i zoom och man får möjlighet att interagera, ställa frågor och delta i samtalet. Jag hade bestämt att jag ville ge mina systermedlemmar boken Upptäck alla mina gåvor som sommarpresent och även denna föreläsning. Nu vill jag att även du som tar del av det här avsnittet ska få möjligheten att lyssna till Alfs klokskap och det vi pratade om, tillsammans med ett fint erbjudande från Semnos förlag som givit ut boken. Du kan köpa den till 20% rabatt med koden: PEACE för att du lyssnar till podden, passa på att bunkra upp presenter att ge vidare. >> Till Boken https://www.semnos.com/bocker/upptack-alla-dina-gavor/ Vill du komma i direkt kontakt med Alf kan du höra av dig till oss så skickar vi din förfrågan vidare. Lyssnar du på detta i samband med släppet så är det bara några få dagar kvar tills vårt event, anmälan har gått ut, men är det för dig så hör av dig så ser vi om vi kan göra plats åt dig. Du är så välkommen! >> Läs mer och säkra din plats https://www.theperfectpeace.se/courses/omstartevent Ta del av reflekterande och coachande frågor och fördjupning genom vårt Peppbrev som släpps i samband med poddavsnittet. >> Prenumerera på Peppbrevet https://www.theperfectpeace.se Missa inte 14 dagars live på instagram följ mig på: @emmeliahlander Hör du detta avsnitt senare. Finns det alltid resurser att ta del av på vår webbsida. Vill du sätta igång idag? Gå vår kostnadsfria minikurs i form av e-mail och video fylld med undervisning, praktisk övning samt coaching på området att få sin tid att räcka till. Något som vi alla kan kämpa med i den här tiden. >> Ta del av gratis minikurs: Stärk ditt inre & väx i ditt uppdrag https://www.theperfectpeace.se/fp/strala
In this episode of the Post Acute Care Saves The World Podcast, we cover three questions that regularly come across our desk: 1. Getting Non-Medical referrals from Medical referral sources. 2. In Hospice, why are some of my doctors referring patients with just a few days to live? 3. Since COVID, I haven't been able to get into any of our Assisted Living Facilities. Can you help? Be sure to connect with us at homecaresales.com/welcome Additionally, if you want to take advantage of our bonus gift and the Roadmap to Referrals, email mike@homecaresales.com with the subject line "podcast" and he'll reach out to you to set up a call. If you have any questions, feel free to email Jason Lewallen at jason@homecaresales.com and we'll be glad to connect.
In this episode I sit down and talk with Interview Gail Matillo and Jason Hand from the Florida Senior Living Association. We discuss the past legislative session. Also, the challenges facing ALFs and what lies ahead.
In this episode I sit down and talk with Luis Collazo Director of Palm Breeze Assisted Living Facility. We discuss the Challenges that Limited Mental Health facilities face as well as the challenges all ALFs have faced in the last two years. For the past 20 years, Luis has devoted his career to serving those most in need and currently serves as the Director of Palm Breeze Assisted Living Facility, an Assisted Living Facility specializing in providing assistance to clients with mental illness.
Abats Bernhards Nābers OSB ir palīdzējis ļoti daudziem: Katoļu Baznīcai Latvijā, skolām, privātpersonām, organizācijām. Par savu nesavtīgo palīdzību Latvijai mūsu valsts bijusī prezidente Vaira Vīķe – Freiberga 2000. gadā pasniedza abatam Bernhardam Nāberam Trīszvaigžņu zelta ordeni. Šodien, 2022. gada 27. janvārī ir abata Bernharda Nābera OSB nāves 4. gadadiena. Tādēļ, viņu pieminēdami dalījāmies atmiņu stāstos par viņa dzīvi, aicinājām arī klausītājus aktīvi dalīties atmiņās.
Discussion on the latest weeks episodes of Home and Away on Channel 5. This week includes Alfs unwelcome reaction to Keiran. Bella's exhibition is gate crashed by Nik and Ziggy does the unimaginable behind Tane's back.
Assisted living facilities are probably the first, and maybe only option that comes to mind when discussing what to do about your mother who is declining in health and cannot live alone any further. While Assisted Living Facilities, or ALFs are of the most common care options to consider, did you know that there is another option? Join us this week as we explore, compare, and contrast care alternatives, including in home care. Show Notes: Julie's Uplifting Story of the Week: https://abcnews.go.com/US/youngest-american-space-shares-surviving-cancer-helped-prepare/story?id=78930930 Inga's Uplifting Story of the Week: https://www.today.com/food/baltimore-chefs-drive-6-hours-customer-terminal-cancer-t212203 Read the Article: epagahomecare.com/alf-vs-in-home-care Watch the video: https://youtu.be/oPnVTO2Ges4 Follow Inga & Julie! Connect with Inga on LinkedIn: https://www.linkedin.com/in/inga-lake-4857301b8/ Connect with Julie on LinkedIn: https://www.linkedin.com/in/julie-brubaker-3a89b2114/ Follow Caregiven on Instagram: https://www.instagram.com/thecaregivenpodcast/ Follow Caregiven on TikTok: https://www.tiktok.com/@thecaregivenpodcast?lang=en Subscribe to the Caregiven YouTube Channel: https://www.youtube.com/channel/UChtq-gS4yCWGE5UFnrU8OAA Follow EPAGA Home Care on Facebook: https://www.facebook.com/EPAGAHomeCare Join the Care and Share Facebook Group: https://www.facebook.com/groups/715609402176814 Follow EPAGA Home Care on Instagram: https://www.instagram.com/epagahomecare/ Follow EPAGA Home Care on LinkedIn: https://www.linkedin.com/company/epaga-home-care Visit EPAGA's Website for more articles about home care: https://www.epagahomecare.com/articles
It's all part of God's plan this week when Aunt Wanda visits Pat and Mags and we tackle Alan Funt, the old badge, Lauderdale, Rumspringa break, giving them some sand to talk about, catching eels, Dick Magnets, and gut panties. TW: Rhoda, briefly Aunt Pat - Colleen Doyle Auntie Mags - Dana Quercioli Aunt Wanda - Katie Caussin Artwork - Jordan Stafford Mauntras - Carol Doyle Editor - Colleen Doyle Anchor: The easiest way to make a podcast. https://anchor.fm/app Support this podcast: https://anchor.fm/the-babymakers/support --- Support this podcast: https://anchor.fm/the-babymakers/support
André berichtet in der 97. Ausgabe des GlotzCast u.a. über sein geplantes ALF-Remake, verteidigt LISA Film und seine Leidenschaft für Roy "Kinderarzt Doktor Fröhlich" Black. Frank verurteilt den "kinderfreundlichen" Woody Allen und Kevin Spaceys Comeback mit Franco Nero in Italien. Außerdem: Wir sprechen zum 100sten Mal über Bruce Willis und Kevin Smith und erzählen sie bezüglich wahrscheinlich genau das gleiche wie in den GlotzCast-Ausgaben zuvor und die Top 10 der erfolgreichsten FIlme aus dem Jahr 1990 ;) Diese und weitere Audioproduktionen können über Patreon unterstützt werden: Alle Supporter erhalten Bonus-Inhalte sowie exklusive Vor- und Nachgespräche – www.patreon.com/isolierstation Titelsong von bengtrock – www.unpassend.de
Den här veckan är det alternativa investeringar som gäller - Vin! Vi har med oss Alf Tumble och Petter från podden Dela En Flaska som berättar hur dom tänker när dom letar och investerar till sin vinsamling.Petter och Alf går att följa på Instagram: - https://www.instagram.com/petteralexis/ - https://www.instagram.com/delaenflaska/ - https://www.instagram.com/alftumble/ - https://www.instagram.com/budbreakwine Petter och Alfs tips på vinimportörer att följa: - https://budbreak.se/ - https://skoogsvinhandel.se/ - https://franskavinlistan.com/ - https://www.vinunic.se/ - https://www.johanlidbyvinhandel.se/ - https://www.caviste.se/ - https://handpickedwines.se/ - https://www.provinum.se/ - https://vinnatur.se/ - https://winetrade.se/ - https://www.pompette.eu/ -----Stort tack till RareWineInvest. Är du intresserad av att investera i vin, spana då in: https://www.rarewineinvest.se/-----Kolla in Fidelity.se om du vill veta mer om Fidelity Internationals fonder, t.ex. med inriktning mot spännande tillväxtmarknader såsom Kina och Indien.-----Är du intresserad av att investera i Xpecunia så är teckningsperiod igång fram till 9e Juni. Det går att teckna digitalt med BankID via Aqurat Fondkommissions hemsida, www.aqurat.se/ eller via din internet bank.-----Tidsstämplar och eventuella länkar som nämndes i avsnittet: - 01:25 Avsnittet om Naked Wines: https://www.marketmakers.se/2021/168-vin-och-va%CC%88rde-pa%CC%8A-na%CC%88tet/ -----Twitter: https://twitter.com/marketmakerspod Kontakt: podcast@marketmakers.se Hemsida: https://www.marketmakers.se/ Niklas och Fabian finns förstås också på Twitter:https://twitter.com/alden_niklas https://twitter.com/franzen_fabian See acast.com/privacy for privacy and opt-out information.
Join us today as Senior Advocate Rhonda Thissen shares with us the differences between Assisted Living Facilities (ALFs) and Nursing Homes. dLCV does monitoring work at both types of facilities and Rhonda is here to shed light on the similarities and differences. You can learn more about ALFs here and Nursing Homes here. Find out more general information at www.dlcv.org. Full episode transcriptions available on our websites and you can follow us on Twitter and on Facebook.
Jan og Henrik snakker om Det støver stadig fra 1962. Kronologisk gennemgang af filmen. www.janoghenrik.dk/ www.henrikogjan.dk/ En ny dag gryer. Solvænget vågner op til en ny dag. Vicevært Alf Thomsens (Dirch Passer) talende vækkeur dikterer et hårdt dagsprogram for ham: Kl. 7. 30 oliefyret renses, kl. 8.15 fejning af fortovet, kl. 8. 45 besøg hos tandlægen. Mens han er godt i gang med fejningen, begynder opgangens mandlige beboere, at begi' sig på arbejde og den altfavnende Alf får tid til at præsentere beboerne: Tim Feddersen (Karl Stegger) 2. Sal tv. kommunal embedsmand: Spiser for meget, laver for lidt. 1. Sal tv.: Thorbjørn Hansen (Ove Sprogøe) postassistent: Kører på rød Scooter, gift med fru Rigmor (Bodil Udsen) - opgangens dominerende hersker. Parco Johansen (Henrik Wiehe) 2. Sal th: Skilt for nylig, bor hos sin mor. Han er brugtbilsforhandler, kører i sportsvogn, med for mange hestekræfter, prøver at nedlægge Mona Lisa Jacobsen (Hanne Borchsenius), som er journalist ved ugebladet "Alt for alle" Hun bor på kvisten. St tv.: Arne Henriksen (Søren Elung Jensen) salgschef. Hans kone Bodil (Helle Virkner) er tandlæge. Hun har optaget sit gamle erhverv og har for nyligt åbnet en klinik i ejendommen. st. th.: Viggo Svendsen. (Henning Palner). Her hersker der nervøsitet. Lene, hans kone (Beatrice Palner), skal snart føde. Samme aften afholdes den første generalforsamling i boligforeningen "Solvænget". Beboerne har, med kommunens støtte, købt ejendommen. Hertil har man inviteret viceborgmesteren (Olaf Ussing) for at takke for hans støtte. Thorbjørn og Feddersen har et skænderi om, hvem der skal byde ham velkommen. Alf demonstrerer en automatisk talerstol der indeholder mange indbyggede snurrige finesser for Mona Lisa. Den skal bruges for første gang på generalforsamlingen. Tidligere på dagen har Mona Lisa en samtale med sin redaktør og hun lover ham, (Asbjørn Andersen) at hun snart vil finde nyt stof til bladet, men hun er gået tom for ideer. Under samtalen fostres der en ide, og hun lover redaktøren, at han skal få 4 artikler inden søndag. De skal alle handle om "Hvor selvglade mænd er". Ved generalforsamlingen aflægger Feddersen, som formand, årets beretning, herunder regnskab om, hvordan de har skaffet midler til at købe ejendommen: Alf solgte sin store modeljernbane, Rigmor Hansen er blevet bestyrer af en Quickvask, Svendsens svigermor kautionerede for et banklån, og Parco's mor præsterede udbetalingen. Feddersen beretter, at overskuddet bl.a. er brugt til indkøb af et flot springvand og man ønsker viceborgmesteren skal indvie dette. Dagen oprinder. Alf's talerstol er på plads, men midt under indvielsen opstår der misforståelser, og vandet springer lystigt, og Alfs talerstol går totalt amok. Umiddelbart efter denne episode, indkaldes der til en storstilet hjemmeværnsøvelse, og her mødes gamle venner og fjender. Feddersen udsættes for den værste tortur, som tænkes kan: - Han holdes isoleret fra sin madpakke- . Thorbjørn og Alf må udklæde sig som brudepar for at slippe gennem fjendens linjer. På hjemmefronten tager fruerne deres egen raffinerede hævn over Parco, så han gør sig selv til grin.
Special Guest: Kimberly R. Smoak, MSH, QIDP Hosted by: Diane Sanders-Cepeda, DO, CMD Our learning objectives for this session were: 1. Review the progress we have made since the onset of this pandemic. 2. Discuss the challenges faced by our SNFs and ALFs and the steps taken to resolve those issues. 3. Describe the gains we have made with vaccinations in our facilities and the obstacles we still need to overcome. 4. Evaluate the future state for our facilities and the improvements we need to make to our PALTC infrastructure. Recorded: March 17, 2021 Click here to access the PowerPoint Slides Available Credit 0.25 CMD-Clinical
Dr. Amy Schiffman and Dr. Alex Mohseni do a deep dive interview with Jonathan Edenbaum, the owner of Eden Homes about the ALF industry. What is an Assisted Living What is a Group Home Small vs large assisted living Kosher assisted living Key triggers for transitioning from independent living to assisted living Standard ratios in assisted living days vs nights Incontinence as a trigger for assisted living What patients don't qualify for ALFs They don't do ALFs, ventilators, certain bed sores (III or IV) Assessments required for qualifying for ALF RN needs to reevaluate the resident every 45 days Some facilities charge more for level of care Romantic relationships between ALF seniors State and county unannounced random checks How to determine a low vs high quality ALF Do an unannounced visit to check quality Get family reference RPM in the ALFs Zoning requirements for ALFs HOA issues for ALFs Risks in an ALF Marketing ALF services When an ALF resident gets hospitalized Eden Homes of Potomac www.edenhomesofpotomac.com 301-299-0090 Jonathan recommends these finder services: CarePatrol FamilyTies Video version: https://youtu.be/pJgIa3EWxVA
We did it Adelaide, 128 Alfs, which means Alf is back in bed with Erin. All the action from the Garden of Unearthly Delights today as Operation Alf kicked off featuring Anne Edmonds and Sam Mac.Plus, Andy Lee told us his favourite childhood made up game. Learn more about your ad choices. Visit megaphone.fm/adchoicesSee omnystudio.com/listener for privacy information.
We did it Adelaide, 128 Alfs, which means Alf is back in bed with Erin. All the action from the Garden of Unearthly Delights today as Operation Alf kicked off featuring Anne Edmonds and Sam Mac. Plus, Andy Lee told us his favourite childhood made up game.
Herbalist and author Matthew Alfs joins Mary for a discussion of his new book, Edible and Medicinal Wild Plants of the Midwest, Third Edition (Minnesota Historical Society Press, 2020. We discuss plants Minnesota gardeners may be familiar with as weeds or garden plants and their edible and medicinal properties. Disclaimer: Ingestion of any wild plant requires care in identification, selection and processing. Some plants may be toxic. Please take all reasonable care and consult a physician or other health care provider before using wild plants medicinally. To Learn MoreMatthew's bookMatthew's virtual book talkWho was Euell Gibbons?Stalking the Wild AspargusMary's blogMary's bookFollow Grow it, Minnesota on InstagramFollow Mary on InstagramMore about stinging nettlesMore about anise hyssop
Boomer Living Tv - Podcast For Baby Boomers, Their Families & Professionals In Senior Living
Donika Schnell began her healthcare career in financing as a hospital consultant at KPMG and then in financial reporting with The University of Chicago Hospitals. She transitioned to lending to healthcare providers starting with working capital finance in lending operations and adding real estate and cash flow term loans soon after.Donika moved into business development for Heller Financial, GE Capital and then CapitalSource building pipelines and relationships to providers and capital providers along the entire continuum of healthcare primarily in the Western half of the country. With rounded lending and industry experience, Donika was tapped to build two national healthcare lending divisions for banks before her recent focus on real estate lending at Greystone solely eyeing seniors housing, skilled nursing and hospitals.Greystone is the number 1 HUD lender to the healthcare industry who also provides Fannie/Freddie and bridge term loan lending. Greystone additionally owns and operates about 4,000 seniors/skilled beds.Topics Discussed:Overview of the sources of capital available to providers:Equity – There is approximately $2T of pent up equity to deploy into the economy from the Private Equity sector. Healthcare is very attractive as it has proven to be recession proof and if supporting the right sectors and operators/managers, equity investments have been solid returns.Bank Debt – Community banks willing to work with smaller providers. Larger banks stalled with COVID first hit as they tried to assess existing portfolio risk and then what the pandemic meant overall to the industry. Took about 90 days or so but most banks are back to lending at usually lower advance rates and perhaps asking for increased credit enhancements. Pricing increased by 25 to 75 bps.Finance Companies – also stalled a bit when COVID first hit in March, but are back at lending at prior lending levels. Pricing increased by 50 to 100 bps.What does a lender look for in evaluating credit?Operator experience and track recordFinancial performance of the business historically. High emphasis on dealing with COVID in the business.For real estate such as skilled nursing, look to surveys and reports from CMS and especially Star Ratings and Special Focus Candidate lists.Occupancy trends.Projections/Proformas. Sources of revenue, thorough understanding of reimbursement, expenses especially any additional COVID costs such as increased staffing and PPE costs.Debt needs clearly defined.From a national lender’s perspective, how are the Seniors Housing and Skilled Nursing industries performing?Occupancy naturally down in ALFs and SNFs. With the drop in selective procedures, occupancy went down. Additionally, fewer discharges to SNFs after hospital stays affected occupancy. Independent living facilities have fared rather well with occupancy.Stimulus monies have helped ease the concern of working capital for providers so they can focus on caring for patients/residents and staff with needed safety measures.Have seen providers work closely with county and/or state health departments to provide for COVID only patients for care upon hospital discharge. Delicate balance to ask staff if they are committed to working in those buildings and wards – very collaborative efforts being made in communities.Future sees a high need for mental health services.Preventative services back to near pre-COVID levels such as with dentists, PCPs, ancillary services put on hold.Donika's Links:LinkedIn: https://www.linkedin.com/in/donikaschnell/Twitter: https://twitter.com/dschnell1968
Das vermeintliche Vertrauen in Corona-„Experten“ ist oft nur Vertrauen in die staatliche Autorität. Wer seine Mündigkeit nicht an Drostens Garderobe abgeben will, muss sich ein eigenes Urteil bilden. Der Text wurde veröffentlicht auf: https://www.novo-argumente.com/artikel/ich_vertraue_den_experten
How a dentist can improve your sleep, breathing, and more If you have perfect sleep, NEVER mouth breathe, and have excellent tongue posture, then you can skip this post. But if you are like the rest of us, no doubt you or your clients struggle in one or many of these areas. What if all of these issues were related to the structure of your mouth? That's why I interviewed Dr. Brian Hockel, a dentist who I work with personally, and a leading expert in the field of dentistry and airway orthodontics. [caption id="attachment_12956" align="aligncenter" width="600"] The legend![/caption] In this podcast, you'll learn: How facial structure can impact breathing and tongue position Why a CPAP doesn't really fix sleep apnea How a well-trained dentist can improve mouth position to enhance your sleep and breathing How occlusion, tooth contact, may not be the exact science that people make it out to be What you need to look for to find a dentist who can best help your sleep and breathing If the health of your airway is important to you and you want to get your sleep on fleek, then you need to check out this interview. You can watch the interview here. Learn more about Dr. Brian Hockel His website: Life Dental & Orthodontics His practice is located in Walnut Creek, CA 64598. Bio As a graduate of the University of California, San Francisco, School of Dentistry in 1989, Dr. Hockel is a general dentist in private practice with a focus on orthodontics that aims to prevent or treat airway problems like sleep apnea. He aims for more permanent solutions to Airway-Friendly Smiles, going beyond the dental oral appliance approach, often having to reverse previous orthodontic treatments. He has lectured nationally and internationally on topics of facial growth guidance, orthotropic, and airway orthodontics, and is an orthodontic instructor for the Academy of Airway and Gnathologic Orthopedics (AAGO). He is also co-founder of the Team Airway Study Club, a co-founder and board member of the North American Association of Facial Orthotropics, and a board member of the AAGO. Show notes Here are links to things mentioned in the interview: Joe Cicinelli - He is our mutual physical therapy colleague, and a dear friend. ALF - A lightwire appliance that is often used when there is cranial dysfunction present DNA - An appliance that aims to expand the palate in multiple directions. It's akin to the Invisalign of palatal expansion AGGA - An appliance that is used for sagittal palate expansion A Randomized Crossover Trial Evaluating Continuous Positive Airway Pressure Versus Mandibular Advancement Device on Health Outcomes in Veterans With Posttraumatic Stress Disorder - A neat study that positively affected PTSD symptoms by targeting sleep. Upper Airway Resistance Syndrome Patients Have Worse Sleep Quality Compared to Mild Obstructive Sleep Apnea - If you have never heard of UARS, then this is a must-read Bruxism: A Literature Review - An excellent in-depth article on all things bruxism, grinding, clenching, and more. Modified Transcripts The difference between conventional dentistry and airway dentistry Dr. Hockel: I think a lot of it has to do with the understanding of how we get to where we are and what the underlying causes are of some of the problems that we're dealing with. And then the connections to what we're doing in the orthodontic world, the orthopedic world. By that I mean if you understand that our growth really affects our function, especially of the airway but certainly of the jaw joints and of the bite, how those relate to each other? if someone says “we are the way we are because of our genes; we're just going to grow.” “This is a set shape to the skull, a set position for the jaws and it is what it is and make the teeth fit within that confine of the skeleton.” That's going to lead you to a very definite approach in orthodontics. As opposed to the belief that the way we posture our mouths and the way we use the muscles of our mouth and head and neck, that's going to affect how our face grows at a young age. Then as an adult, it's going to affect the function of the airway, again of the joints and that maybe if we look for the underlying causes and address them, we can have other successes beyond just getting the teeth to fit. So it's looking beyond how the teeth fit together and looking at the overall structure; jaws, airway. It turns out that the roof of the mouth is the floor of the nose. The nasal airways are our next-door neighbor that way going up and the oropharyngeal airway is right behind the tongue. We're always looking at the back of the throat but we don't recognize that that's where the air has to go to be able to breathe. So there are neighbors in the dental world and it turns out that the things we do affect them. Zac: It's a lot more than making a pretty smile in terms of the impact that you can have on someone's health and well-being. What kind of implications or negative things have you seen from people who don't respect that? We've spoken before having this conversation about some people who are just doing retractable orthodontics which maybe you can talk about. They're just pulling teeth so things can fit and the smile can look nice. What are some of the implications of not taking into consideration the structure of the face? Dr. Hockel: It might be an overstatement to say that most orthodontists are focused on just making the teeth pretty because obviously there's a lot of science that goes into how we try to make the teeth fit. Jaw joints and even airway are in the conversation, though the latter seems to be lip service. The best way to answer your question would be to use a term that was coined by Dr. Bill Hang in Southern California, he calls it ERRS (extraction retraction regret syndrome). He purposely called it errs because it's based on the answer to your question, what are the errors that we've been forced to live with? The first is kind of an aesthetic one where people don't like the way they look and with a lot of traditional orthodontics. There's a feeling like maybe the teeth are further back in the face than they should be or the lips seem sunken in or thin. There might be a feeling like the face has lengthened after orthodontic treatment has been done. Then there's the whole functional side and this includes, both the airway and the jaw joints and also includes the bite, of course, the way the teeth fit together can be affected by that. How we chew and how we breathe, they can go hand in hand. If you bring teeth too far back in the face, the tongue doesn't have enough room, the chewing motions of the jaws can be affected and of course, the dimensions of the oropharyngeal airway can be affected. People who live with this for a long time and have been told this or that thing is all in your head and you just need to learn to deal with that. [caption id="attachment_12855" align="alignnone" width="810"] How embarassing[/caption] We who work in the orthodontic profession may be saying your bite is fine, everything fits together, it meets every possible standard that or criteria that I could have treated it to. So whatever you're not happy with, it's not what I did and maybe I did treat to the best standard of care that's out there. But we're learning now that there are things beyond what we've been held to and by ourselves and others and what we try to achieve that have really profound and far-reaching effects that we weren't even aware of. Zac: I mean you just think of this area of the body, you have most of your sensory systems there. There's a lot of prime real estate that could potentially be influenced in one direction or the other. It's intriguing that you're saying the wide-ranging effects that can happen on this. I remember a study I read years ago about people who had PTSD. They put an appliance in the person's mouth as treatment in this randomized control trial and it had a profound impact on symptoms. We can have large substantial changes on someone's health and well-being by affecting this area of the body in the way that you're talking about. Now you weren't always into the airway side of things so in your career what led to you appreciating this side of dentistry more? Dr. Hockel: I think it was contact with doctors like Bill Hang and John Mew. John Mew is an orthodontist in the UK who for many years developed treatments that were based on what he called the tropic premise. That was the belief that the jaws are going to grow to the position that they most commonly adopt, so keep your jaws closed, pointed forward they're going to grow forward. Keep them apart, pointed away from each other they're going to grow away from each other. It turns out that the treatments he was doing to get the face to grow to what was a better proportion, more aesthetically pleasing result; it was also making a difference with the airway. Initially, he didn't really even realize this so he's one of these people that looked at the results of what he was doing and actually saw something really good. There were a lot of us that looked at the results of what we were doing with more traditional methods and saw that we weren't doing things that were good. Bill Hang, who I already mentioned, is probably the biggest influence on how I've been able to connect the dots between the airway and what we do in the orthodontic and orthopedic world. I thought I had every answer that I needed at one point and I suppose sometimes we get that state of pride in our careers. At first it can be unnerving to learn something new but then you can get to a point where you're kind of in a zone, you feel comfortable and I felt like I had a tool to treat pretty much every type of bite problem that I could come across. It was right then that Bill Hang dropped into my life and taught me to look at things in a very different way that included growth direction, growth guidance, developing more space for the tongue, looking at the oral posture. Especially looking at what was happening with the airway and how things affected that. Like most of the people who've heard Bill Hang, there was some of it that I readily accepted and other things I was skeptical about. I had to go home and think “I don't know if he's really right about what he says about the herbst appliance” for example. I'm going to go home and look at my cases a little more critically and I just shook my head as he was right. There were things going on that I didn't want to have going on right under my nose because I wasn't paying attention to it. So now my attitude is “just don't cause any harm, don't do anything that's going to make anything worse.” “And if you're doing something that has made other people worse and you're not sure if it's going to make this person in front of you worse, just don't do it,” it's the safest thing to do. Zac: Yeah and I imagine too if you're not taking into consideration things like oral posture airway and things like that just because of how important respiration is. You could have wide-ranging effects of doing harm that you didn't know you were doing. Dr. Hockel: Right or at least miss the opportunity to do good, to me that's just as bad; if I had an opportunity to do something a lot better for someone and I missed the chance, I don't like that. Zac: Was that hard for you to have that kind of paradigm shift? Dr. Hockel: Yeah my wife would tell you, I was in a very difficult mental state during those years. It was a big paradigm shift and very emotional and around that time we had a lot of little kids around the house. It's hard to realize your professional foundation isn't as solid as you thought it was. I knew however, that I needed to keep growing and learning; not being foolish to where I thought I knew it all. Zac: Yeah, that's when you know you need to retire or quit. What types of patients would benefit from airway orthodontics Dr. Hockel: I think the people that search me out know that there are important ramifications of the types of treatment we do in orthodontics and in growth guidance. And they don't want something bad to happen to their kids or they're an adult that has already seen something that happened to themselves. We talked about extraction retraction regret syndrome and there's either an emotional component or an aesthetic component, more often I see the functional component. People will come wanting to know what they can do to improve their situation as an adult and some of them might come very bitter about what was done with them in orthodontics. It's unfortunate because the person who treated them was only treating what the standard of care was at that time and they probably did a very good job. [caption id="attachment_13014" align="alignnone" width="500"] Making kids unhappy in more ways than one since 1960 (Photo credit: Orthodontist101)[/caption] I don't see too many people who were treated by an orthodontist who did a bad job; they were just doing it with a very different philosophy of how to treat and why to treat. So there are the moms with the kids that want them to grow right, that's a group of people who have young kids and they want to catch them as early as possible. The earlier we get to kids the better. I'd rather get kids at six days old and talk to the parents at that point. Make sure there's no tongue tie, make sure you're breastfeeding as long as you can, try to switch to solid food as early as you can, and the whole concept of baby-led weaning. Take away bottles, pacifiers, and sippy cups. So it's not classic orthodontics to talk to a parent about their child when they're that young. And yet, if they follow what advice I'm giving them, it can help minimize what I might have to do later on. I think the goal would be for us to really find as far upstream as we can go to find the causes that can be addressed so that we don't have to treat them at the stage where we are. Even at age four and five when I'm treating a child that young in a way, it'd be better if I could have got them earlier. Tongue ties Zac: It seems like even the concept of having your child have a tongue-tie release is very controversial. I read stuff on the internet all the time where it's like “oh, we don't need to do that” and it's unfortunate because it can definitely negatively impact things like breastfeeding and things of that nature. Let's say I have a kid and I say “Dr. Hockel, do unto this child what we can do to minimize any negative effects,” where would you start? Dr. Hockel: Well those things that I just tossed off a little bit of a list when they handed me that little scissors to cut the umbilical cord in the delivery room for my kids. I look back on it now and think I probably should have just looked around like lifted their tongue going “okay, I'll just do that first! Tongue ties can affect speech and growth. When they're really bad and a lactation consultant picks it up and says you're not able to breastfeed because of the tongue tie, they deal with it. Or if a speech pathologist says your child can't make those sounds because he's tongue-tied, they deal with it. But there's a wide range of restricted mobility of the tongue that can come before you ever have any of those kinds of troubles and it does affect the tongue posture. There's research that's being done now by Souresh Zaghi, but it's going to take time to build the evidence body. They showed at Stanford that when you have a tongue tie, there's a correlation with narrow palates, and it kind of makes sense, it's common sense. The tongue is the scaffold of the palate so if it isn't able to posture up against the palate, how is it going to grow wide and up and forward? It's going to tend to be narrow and down and back. While we cannot expect adults who get a tongue tie release to grow differently, we do know that the muscles of the head and neck can be in better balance with good oral posture. I'm not an expert in cranial osteopathy but I'm told that the cranial bone and the balance of how they fit together and move, you know cranial bones move right? [caption id="attachment_12694" align="aligncenter" width="329"] Now I got the loosest tongue in the game...wait....[/caption] Zac: Haha yes I do! Dr. Hockel: Some adults will report some wide-ranging improvements of symptoms and you got to be careful about that. Because they'll tell their story on the internet and somebody else thinks “oh if I go get my tongue-tie release, all my troubles are going to go away.” It is controversial probably because there's such a wide range of techniques in doing it. Back in the day, I got my laser in 1999 and I thought “oh, there's a tongue-tie, I'll just release that tongue-tie with my laser” and it's like getting a lightsaber on Star Wars. There's no bleeding and all of a sudden the tongue can just elevate really easily. Mainly, all I was treating was that flap of tissue on the outside not knowing that there were deeper fibers that of fascia or even the mylohyoid going deeper that needed to be dealt with. Then the scar tissue would come because I wasn't having them do exercises afterward and the scar tissue ends up restricting the tongue down even more than it was before. Doing it the wrong way is oftentimes going to make things worse and not any better at all so the data points that people have to compare to are very limited. The unfortunate thing is we currently lack a body of knowledge out there of training. It's changing slowly because people know improvement when they feel it. You can't put an idea in somebody's head that effectively after I do this all of a sudden you're just going to imagine that you have a tension release in your whole head and neck area. They're going to tell you stuff like that or you see a child who has a tongue tie and you get a certain growth direction improvement. Then don't treat the tongue tie and you see the growth direction tend to drop back, that's kind of the lost opportunity side of it. You want to get everything going in your favor for optimal mouth posture. Facial underdevelopment Zac: Now if you have someone who was breastfed, had a tongue tie release, did myofunctional therapy, addressed nasal patency, do you see a reduced need for orthodontic services down the line? Or do you think that our altered cranial shapes are generational? Dr. Hockel: If I had seen that happen here or there, that's such a small number of patients, it's really anecdotal and there's confirmation bias. I'm not sure how valuable that would be, I do know that I see patients who were breastfed very early on and their parents follow Westin Price. They feed them really well and try to avoid sugar and stuff, they avoid bottles and pacifiers, avoid milk, avoid wheat and they seem to be doing all the right things. Yet there are still issues there so there's so much that we don't understand about it. I feel like we're just at the tip of an iceberg and we're doing our best, we know certain things do affect it and we're trying to change those but we don't know everything. I can sympathize with the mother who says that “I've done all this, what else do I need to do?” Well, sell everything you own, give it to the poor and then maybe… I don't know. Zac: It's hard, especially in health and wellness. You want people to do everything right. They eat healthily, they're sleeping and they're doing all of this, but sometimes there are genetic factors, epigenetic factors, and exposomal factors outside of your control that are the rate-limiting steps. It's unfortunate. But life's not fair either so I get that. Airway orthodontics for children Dr. Hockel: Orthotropics can be used for kids in a particular age range. There's a narrow window because orthotropics is growth guidance, and if you're trying to guide growth you need growth to be able to guide. There are actually a couple of different windows where you can do it but for practical reasons, it tends to be a better fit somewhere in the 7-10 age range. In England, they'll say eight is too late, but in America, we tend to do it at nine or ten as well. The older you get, the less growth there is and the less cooperation there is to be able to do what's required for the treatment. So guiding growth and starting at that age; say seven or eight, you want to look at how the face is growing. You want to look at imaging to see how the airway might be restricted. Although you can't diagnose from imaging, it's a glimpse into what's going on in the nasal airway, the oropharyngeal airway, and tongue posture sometimes. Then you look at obviously orthodontic issues like how the teeth are fitting together, and how the jaws are fitting. If the jaws have not grown as far forward as they should and there's an oral posture issue, those are two things you can consider affecting at that age. Younger than that age, it's harder to make a change with how the jaws are growing with appliances and postural changes, and after age 11 or 12 it's very difficult, so during those middle years is prime time for treatment. I had two boys in my office yesterday morning. Both of their faces were tending to grow more downward and backward than they should, and I always say “welcome to our world.” That's all of us to one degree or another much more so than our ancestors a few hundred years ago. I looked at their imaging, teeth, questionnaires, and my notes from their exam and I thought I think they could really benefit from just simply widening out the dental arches. This would give their tongue and teeth more room. Then releasing the tongue tie could really help oral posture. Then I got their sleep studies. Both boys had overnight sleep studies and had sleep apnea at over 11 events an hour. For a child that's severe. For you and me it'd be 32, 35 or 40 times an hour (normal is less than 5 per hour). When I saw that, the scale was tipped WAY in favor of orthotropics. Meaning it'd be worth the cost, the time, and the hassle if the parents and the patients were candidates for it. Cooperation both by the child and by the family is so much a part of orthotropics. It's not like any other treatments that we do. Lack of family support, discipline, or money are all factors to consider. What I like to do is look at what are the problems; what are this family's capabilities and desires and then what's possible from a technical point of view. How can I put all that together in a way that's going to be a win-win and get a good result? [caption id="attachment_13015" align="alignnone" width="810"] Yeah, let's discuss airway later honey. (Image by Dimitris Vetsikas from Pixabay)[/caption] Had it been a family that came in where the kids were climbing up and down the chairs in the room, they weren't listening to me at all when I talked to them. The mom's on her phone trying to carry on a conversation at the same time talking to the dad who doesn't live with them and is trying to tell him “don't worry, I'll bring them over;” you know just a lot of other challenges in life for a situation like that. Even though I knew it would make a big difference for them, I wouldn't even mention the word orthotropics because it's going to be frustrating and in the end, not a fruitful endeavor. Airway Orthodontics for adults Dr. Hockel: Let's assume there's an airway problem, have sleep-disordered breathing, and don't want to be on a CPAP for the rest of their life. What are the options? Although everyone is different, there are a lot of commonalities. The three general approaches are: CPAP [caption id="attachment_13016" align="alignnone" width="800"] It saves lives, fam! (photo credit: myupchar)[/caption] Dr. Hockel: The first is to push harder on the air going into the airway. That's the CPAP option and usually, there's kind of an x through that option, but for a lot of people, it is a realistic option. If those boys from earlier had severe sleep apnea, I told them “you need to follow the doctor's recommendation.” CPAP is a viable first aid option. Whenever we do growth guidance, changes in the skeletal structure aren't going to have an effect overnight, so just get some good sleep and get healthy in the meantime. Oral appliances Dr. Hockel: Option two would be to open the airway temporarily at night time, and that's effectively what the dental appliances do. When you see dentists or orthodontists talking about how they treat sleep apnea, generally it's because they make appliances like this. There are over 200 different FDA approved designs for the appliances so there are lots of ways to try something and not be happy and then try something else and not be happy. Or you get a good fit, if somebody really knows what they're doing and making these appliances, they look at other things beyond just the appliance itself then they can be effective too. They have their place; everything has advantages and disadvantages and the big advantage of an oral appliance is you don't have to be married to this machine on the bedside table. You're not dependent on electricity, you could bring it with you when you travel a lot easier, it's less bulk in the mouth, it's not as unromantic as having this thing strapped around your head. It's got downsides too and that is it's not really fixing the underlying problem, it's not addressing the structural underlying problem for most people. The other downside is that it's anchoring a lot of force, pulling the lower jaw forward on the upper teeth. So there tends to be a reciprocal effect on the upper jaw of pulling it backward and over time that can allow for changes in the bite, how the teeth fit together or even on the jaws themselves. It may not be the end-all be-all for many years for everyone although there are people who've gone many years and have not had bite changes, but you just don't know if you're going to be that one. It helps with cardiovascular effects with sleep apnea which cpap does not. Zac: Why is that? Dr. Hockel: They don't know. Zac: It is so interesting. Dr. Hockel: It is. Zac: Because they say CPAP will save lives right, but if you're not getting the cardio protective effects... Dr. Hockel: When my dad heard that he said “what should I just give up on my CPAP?” I said, “no dad breathing is important, you need to be able to breathe and without that, you might stop breathing in your sleep.” “You will stop breathing and that's not a good thing,” but it's kind of artificial breathing, forcing the air in and out. And the parts of the brain that control your breathing are like “all, right don't need us anymore” and may become less responsive over time, but I don't understand the physiology of it completely. I know that it's better than not breathing and it does save lives when it works, but the compliance goes way down after six months or so and for a lot of different reasons. Feeling claustrophobic, drying out the airway if it's not humidifying it, restriction of movement in bed just the hassle of wearing it, the feel of it on the face, a lot of reasons why people might not want to wear it. For them, the dental appliance might be a good alternative and it's got the added bonus that it turns out it does help with the cardiovascular effect. Zac: Is it effective in severe sleep apnea? Dr. Hockel: It can be. Medical doctors will often tell you if you're over 30 on your AHI, the score of how severe the sleep apnea is, you should be on a CPAP. But if you're under 30, you can try an appliance. However, my friend Pat McBride has treated more people than I know using appliances like this, including a lot of people with very severe sleep apnea, and she's been very successful at it so I think a lot of it has to do with the skill of the person making the appliance and how they adjust it. It has to do with what else they do in addition to it: do they work on vitamin D levels? Nutrition? Overall body markers? Breathing mode? Are they lip taping? Is the nasal airway clear? There's a lot else that can go into it; the tongue-tie for some people can make a difference, so it can be a part of a good regimen for some people, but then there's that risk of the bite changing. Change the airway structure Dr. Hockel: Option three is to structurally open the airway; do something so that the airway is able to be more open by changing the structure around the airway. Ear nose and throat doctors do the same thing with different types of nasoseptal surgery or reduction of turbinates or any number of things there. But what we do in the dental world is either move teeth to a different position to allow more room for the tongue to come forward out of the way of the airway or work with an oral surgeon who's able to move the jaws themselves into a more optimal position. So in both of those cases, you're trying to change the underlying structure. They have the potential of being a more definitive change to the airway but they're also more involved. Going through orthodontics takes time and going through double jaw surgery, first of all, it has to be done right and a lot of times it isn't as effective as it should be, but even when it's done right it's still an expensive and invasive procedure. Everything has pros and cons. In our world, we ask what can we do to change the shape of the jaws? Either by moving teeth or by moving the bones of the jaws. Zac: I appreciate you listing out those options because I want people to know that if you do have some type of sleep issue. Like I had a guy reach out to me where he's like “I got my CPAP and my numbers are good according to my doctor, I don't need to do anything else,” it's like it depends right? If we're just looking at pure symptom management you're probably okay but if you want to fix the underlying structural issues maybe we do need to go down a different pathway. Using oral appliances and orthodontics to improve the airway Zac: So there are some people who would argue that they're creating bone growth with some appliances versus you're saying moving teeth. What is the underlying physiological way that an appliance like I have (Crozat) works and what is likely not happening? Dr. Hockel: It's a good question and it's a hard one that I don't have a fully comprehensive answer to, but I'll tell you what my thinking is on it today. Bill Hang calls it the alphabet soup appliances; we've got the AGGA, DNA, ALF, and all these different types of appliances that are out there. Zac: And they're all three or four letters, just like in our industry! Dr. Hockel: Right, yeah pretty much yeah so but like you say claims are being made about the growth of the jaws and I'm skeptical of that in the way they make it sound. When you move teeth, you don't just move teeth, you move the teeth and you move the bone around the teeth. Technically, that alveolar bone is part of the upper jaw and the lower jaw. So yes you're expanding the jaw by moving the teeth, but you're not really expanding the jaw when you think about the basal bone, the roof of the mouth, the hard palate. In a child, you can much more dramatically change the shapes of the jaws. You can apply to pull forward force with something that touches the chin and the forehead and rubber bands come forward out of the mouth and attach to that reverse pull headgear. Not like the old headgear that pulled things backward but a reverse pull headgear at the right age can bring the whole upper jaw forward; that's moving the base of the jaw. I think the bottom line is most of the time for adults; it's not a huge order of magnitude in terms of the growth changes. Now you're going the right direction if you keep your tongue on your palate, you push it up there and help your oral posture. Maybe you're going to slow the worsening of it. You're going the right direction if you expand both side to side and somewhat forward with any appliance; I mean to a certain degree if someone can get it done with an appliance that's different from the one I use then great. I think as practitioners we get better with specific appliances by using them a lot. We learn the idiosyncrasies of them and it probably makes sense for practitioners to stick with tools that they are proficient with. But on the other hand, I think there are some tools out there that don't accomplish the same thing even though a lot of times the people who use those appliances are talking about them accomplishing the same thing. For example, I'm asked a lot of the time what about the ALF appliance? Derrick Nordstrom developed this appliance from the Crozat, which was a lightwire appliance, just not as light of a wire as the ALF. He wanted to develop an appliance that was cranial compatible because he was looking at what was happening with the movement of the head bones. He found that with certain adjustments of the wires in the mouth, he could help the mouth posture and encourage the mouth posture to help develop the jaws themselves. It's a way of letting the body's healing potential come out on its own to help the body do the healing from within. As a pure mechanical tooth moving device, it's probably not as efficient. I know it's not as efficient as other appliances would be, but it's not really fair to compare the two. Because the objectives that a good ALF practitioner is going to have are cranial stability and health; likely working together with an osteopath. They're doing very different things than somebody like I am is doing. I'm trying to accomplish larger-scale changes in either lateral arch development or forward arch development by advancing front teeth. As for something like the anterior growth guidance appliance (AGGA), the claim is that it's stimulating the growth center of the premaxilla, that with that pressure behind the upper front of the jaw there that now the maxilla is going to grow further forward. I have yet to see either case, research or x-rays, where that kind of growth could be anything more than dental alveolar changes. A dental alveolar, meaning the teeth and the bone around them moving, and I think they're going in the right direction. I love to see the changes in advancing the front teeth with those kinds of appliances, but my question is what do you do after that? What about the side-to-side expansion? What about the lower jaw position? There's more to it than just bringing the upper front teeth forward. I think that's a good direction to go in. Do I think it's something that's happening with the epigenetic change now and activating the bone growth genes to grow? I don't know enough to say that it's not; I'll just say that I haven't seen the cases that have shown me the kind of bone growth that is making that kind of a claim. It's a very different order of magnitude of change compared to what you would do with orthognathic surgery, where you may be going forward 18 millimeters and able to change the whole plane of the occlusion at the same time. The ALF crowd would say, “but that's completely destroying the cranial mechanism,” now the bones are frozen and unable to move as they should. I'm not going to say that they're wrong about that. I don't know enough to say when they are and when they aren't, the osteopaths I know will say, “Yeah they shut down for a period of time, but they work their way back to normal. There's this inherent healing potential the body has and that it's worth it to be able to get the kinds of changes in the structural airway that you would get. However, picking the appliance you want to use for yourself is like telling your contractor he should use a Craftsman hammer. What do you know about the appliances? The consumer really is in a worse position than we are as professionals. We're going to lectures and hearing pro other experts talk about these things, it's confusing for us to try to piece together what's really going on. So for the consumer to be able to do that same thing and say, “well based on what this person said I want their results, so I want you to use this particular Craftsman hammer.” On the other hand, the consumer could say, “well to me the osteopathic angle is the highest priority and I want to work with an osteopath,” and so in the hands of that practitioner, the ALF appliance might be the best thing to achieve those goals. Zac: It's just funny because we have the same issue in the movement industry. You have these people who are in these different camps and systems, all three or four letters. But the tools themselves are irrelevant, it just depends on what you're objectively trying to achieve. I actually really like how you broke it up into different camps because this was one thing that I wanted to talk to you about a little bit. You have Alf, which is more cranial osteoporosis driven, you have the Crozat which I have in right now, which is more airway focused? Dr. Hockel: Well no, the Crozat started out as something that osteopaths like to do. In my dad's book, Orthopedic Gnathology, is the best textbook out there on the Crozat. The idea was that it was developing the potential that was there and the growth, both for the kids and for the adults and they knew there was an effect on the airway, not to the degree we know it now. There's a whole chapter in that book on cranial osteopathy and the pictures that are in that book are used in almost every cranial osteopathic lecture that I've gone to because they're well done. So the thinking by the osteopaths with Crozats was that they were also very cranial compatible. I'm not one to say how to compare Crozats versus the ALFS, but I know Derek Nordstrom's position as the very light biomimetic forces seem to be more cranial compatible. The Crozats to me having a larger body wire on them are more effective at getting transverse arch development, especially in the back in a more defined time period. An ALF practitioner will often go much longer periods of time than we would be comfortable in the orthodontic world wanting to have someone commit to. The objectives of the end of the treatment aren't what are focused on; it's more the journey along the way. Let's do the tweaking we need to do now, see if that's getting you going in the right direction and then nine years later maybe we're still doing the same tweaking and your bite is nowhere near fitting together. We've been looking at the symptoms and the cranial situation, it can go in a direction like that and maybe it's helping people, I'm not going to say it's not; it's just not what I do. I can't comment on it, except to say that I want to have a more defined period of time to accomplish certain objectives and in my world, I can do that. The Crozat is a common tool that I'll use, the sagittal designed by Bill Hang has been a very effective tool, as well as different kinds of other expansion screw appliances. They're different approaches depending on what you want to do and it's really hard to say, “I want this appliance.” The most important thing would be to say what it is you want as a result of your treatment? People say, “Well can you use the ALF appliance to do what you want to do with that particular appliance?” I'll say, “yeah I could use my kids watercolor brush to paint that whole wall over there too,” it's not the most efficient way to do it, give me a roller and I'll just go like that and there it's painted. I think certain things can be done in other people's hands if that's the way they choose to do it. How to seek better dental care Dr. Hockel: That's a really hard question because what job do they want to have done? What's their goal? I think if I could rephrase your question it might be “how could I help people know whether they're seeing a practitioner?” Who's going to do things that are not going in the wrong direction for the airway and sometimes for the jaw joint? Better yet, that they're going to be focused on ways that they can help improve the airway and there are other people around the country and around the world that focus on this and we all have our different approaches, but that's okay! I think asking questions like: “If you have a child and the front teeth seem to be a little bit ahead of the upper than they are on the lower, what would be your favorite way to try to correct that kind of a bite problem?” I can tell you that almost all the time the solution is going to be some type of mechanics that's going to end up pulling the uppers backward to a certain degree. We'll conceptualize in our mind that the appliance we're using is bringing the whole lower jaw forward, but that's a really hard thing to do. So dentists end up using things to pull teeth back. Back in the old days, it was headgear, now it might be the Herbst, the twin block, or the Carrier appliance, it could be the Invisalign with attachments on the side that brings the lower jaw forward. It could be class two elastics rubber bands going from the top to the bottom. There are all kinds of things: twin force bite correctors, jasper jumper. They've invented all these different things because it's the most common malocclusion, the class 2 malocclusion. [caption id="attachment_12200" align="alignnone" width="472"] #overrated (Photo credit: Rjmedink)[/caption] I won't say it's where the lower is too far back and I won't say where the upper is too far forward. I'll say where both jaws are too far back, but the lower is further too far back than the upper. So to do something that's going to pull it back even more is going further in the wrong direction, and it's not following the best principle which is do no harm. So if you found an orthodontist that had a way of leaving those upper front teeth where they were, not pulling them back and consciously trying to hold them where they are and do something to compensate for it with the lower, you have somebody who is really on the right track. For an adult when there's a big discrepancy between the upper and lower like that there really aren't a lot of things that they can do. I have a patient who went to a local department head of orthodontics in the local dental school because her dentist had told her before he did porcelain veneers that she really should just get her bite fixed, which was a class II malocclusion. They recommended that she take out two teeth on the upper and just pull the upper front teeth back to match the lower teeth, a very common way of fixing it that's been done for many years for many people around the world. It's considered the standard of care in many ways, but she felt that everything went downhill for after that: diabetes, hair falling out, she got atrial fib and more. She remembers having dreams while her front teeth were being pulled back of choking. So she thought that this is probably affecting my airway health, my sleep, and my breathing. This is all on her own, from her own research, and she told her doctor, “you need to do a sleep study for me,” it turned out she had sleep apnea. Then she was recommended to have laser surgery from the back of her tongue to reduce the size of her tongue. They recommended double jaw surgery to bring the jaws forward; of course, there was CPAP, which she wasn't able to tolerate. She attributes all of this to pulling the upper teeth backward. Reversing that for her opening up that space again and eliminated the sleep apnea! Her hair didn't grow back, but she felt overall so much better and people report little things that they notice along the way when you reverse that kind of extraction orthodontics. Our experience of patients reporting what negative things they went through, the extraction retraction, regret syndrome stuff, in her case it was functional, but it became emotional and aesthetic too. She didn't like how her face looked with those teeth further back. People generally look better when you bring the teeth forward. Their lips look fuller; they aren't sunken behind a line between their nose and their chin. She's a good example of an overjet problem. When people have this they have an overjet problem, but they call it overbite. Zac: Just so people have that definition and I know this is not correct. It's when the top part the top teeth appear to be further forward than the bottom teeth even though from a facial structure standpoint that's not the case, versus an underjet, commonly misnamed an underbite would be the reverse of that where the lower teeth appear further forward than the upper teeth even though both are back. [caption id="attachment_13017" align="aligncenter" width="255"] Overjet is front to back, overbite is top down (chrome spinnin') (photo credit: Nielson2000)[/caption] Dr. Hockel: Yeah exactly, even though both are back that's the key, you see people with these really big chins, they're probably too far back. Zac: Like Jay Leno? Dr. Hockel: Like Jay Leno, his chin is actually not too far forward, if you put an outline on his face and make a comparison to the ideal. You'd see that it's really mainly the upper jaw that needs to be more forward and his lower if anything is slightly back. [caption id="attachment_13018" align="aligncenter" width="272"] HE HAS AN UNDERDEVELOPED JAW?!?!?!?! (photo credit: Wikimedia Commons)[/caption] Zac: Gosh could you imagine if he worked with you, he would have the most prominent chin. Dr. Hockel: No he'd have a balanced face because we get the whole midface further forward. He probably has sleep apnea as a result because his tongue must have nowhere to go. You see in his smile, it's a very narrow upper arch. Poor celebrities getting diagnosed by us dentists all the time on TV. Another thing to ask a practitioner is: Do they think that there are times when it's worth taking teeth out and pulling front teeth backward? Are there cases they think that can be helpful for? If they say yes, I would probably just go somewhere else because if it's okay for an exception it's probably okay as a general rule. I'll tell you, the last time I took a tooth out and pulled things back it was when somebody had five lower incisors. Zac: Normally there are four. Dr. Hockel: There are four, so taking one out and pulling them together now we're just right back to where a normal set of teeth would be. Although there's a case to be made for leaving that tooth in there, allowing the lower arch to be that much bigger and then just making the upper fit bigger over the top of it. That would be a question to ask you: How do they know if there's an airway problem? If your medical doctor has told you have sleep apnea then I know you have an airway problem and you might want to ask: Is sleep apnea the only kind of breathing disorder that you address? What are the ways that you address it? If they say yes, that's the main kind of disorder we treat and we treat it using appliances that bring your lower jaw forward. Well on the diagnostic side, if sleep apnea is the main thing that's being treated they might be missing something that's even more prevalent than sleep apnea and that's upper airway resistance. It's a whole side to sleep breathing disorders that get missed for kids, for thin, fit adults; people like you or women especially. It isn't always apneas, although the sleep medical doctor I was talking to yesterday was telling me if you score the sleep study the right way you'll see the apnea is there. It's just not things that would be traditionally called an apnea, so finding upper airway resistance as a potential confounding factor of these patients who have problems is important. I think for the dental practitioner either working with a medical doctor who knows what they're doing with this or maybe helping the patient get the sleep study yourself. Another important question to ask would be: If they are finding the upper airway resistance, then what are the ways that you try to treat it? Are they doing expansion arch development, getting the tongue more room, and working with a myofunctional therapist, in either their office or somewhere else to try to optimize the oral posture? If that's not a part of what they do to try to treat it then they're probably not as deep into this rabbit hole as they should be, because that's at the outer rim of the rabbit hole. That's the basics: create more room for the tongue however you're going to do it, don't close spaces generalized. You could ask them: If my child has a lot of gaps between his teeth, how would you tend to treat that? And whether you do it with Invisalign or braces or whatever to take spacing between teeth and close all that spacing up? You're talking about a friend who had a bunch of missing teeth, when people have missing teeth the jaws don't develop to the size they should. If you just close all the spacing where there were teeth missing the tongue is going to have much less room to fit into, it's going to go back toward the airway and there's going to be a risk for sleep apnea, so that's another combo. Zac: The big things are you want are: Moving teeth forward and outward Prioritizes expansion Appreciation of sleep disorders Focus on attaining palatal tongue posture and adequate lip posture Utilizes myofunctional therapy Dr. Hockel: Yeah it's the tongue posture and the lip posture: lips together at rest all the time breathing through the nose and the teeth either together or in near contact. so lips together, teeth together, and tongue to the roof of the mouth; those are the three things posturally that a good myofunctional therapist is going to work towards. Keeping Our Wisdom Teeth Zac: Now I want to talk a little bit about getting teeth pulled, the ones that I'm going to bring up of course are the ones that are old remnants from caveman days, wisdom teeth. I was recommended by a practitioner to get mine pulled out, I didn't get them pulled out when I was 18, I actually pulled them out in my late 20s. The reason why I got mine pulled out was because I had no lateral jaw movement. Are there instances in which you should have wisdom teeth pulled out? Dr. Hockel: In the ideal world we would not have to take wisdom teeth out. In the ideal world, our jaws would be further forward and we would all look way better than we look now. In the ideal world, our airways would be massively open, we'd be breathing through our nose, and our muscles would be much stronger to support that. We're not in an ideal world, so taking wisdom teeth out now it's not the best way to go, and our hope in developing more forward growth of the jaws is that there would be room for them, but sometimes there just isn't room for them. Sometimes they're at crazy angles and you really don't have much of a choice. I don't tend to focus too much on the wisdom tooth issue. As much as I'd like everyone to have 32 teeth in position with the way they should, once the growth is done (age 12-14), there's not as much that can be done to make a difference in how much room they have or whether they come in. In my family, my dad tended to have us just keep them in our mouth and he didn't want to take the wisdom teeth out. So I still have all four of mine, I've got all 32 teeth and occlusion, but it's still somewhat tight on space back there. I think it's the case that when you leave them in you tend to get more growth of the jaw. I can't prove this and I don't know if there's research to show this. I've had a lot of kids where they'll come in and maybe the general dentist has said take the wisdom teeth out I'm looking at them thinking, “you know what there might be room. You're only 18, go another seven years let's see how you grow.” I think that there's more and better jaw growth as a result of those wisdom teeth being there. We know that people like your friend with missing teeth get less jaw growth; why wouldn't having extra teeth back there help encourage more jaw growth? At the same time, as an adult, if you're wisdom teeth are sideways pointing forward, now it's a liability for the bone integrity around the back of that molar in front of it better not to take that chance. I know that there's a discussion of meridians attached to different teeth and I'm not an expert in that. People might tell you if you lose that tooth that's going to affect some other part of the body, that may be true, but I'm just not sure what the best compromise is. I'd rather not lose that second molar in front of it by having more bone loss there, and I'd rather just lose the wisdom tooth. Zac: Yeah because I think in my case, mine were pointing straight forward at least on the lowers. Dr. Hockel: There probably was nothing that could be done to try to straighten them yeah and even if you went and did heroic orthodontics to try to move them up then where are they going to go? There's no space back there. Occlusion Zac: When I was first getting exposed to this even being a thing because in PT school, we never talked about when you need to refer to sleep apnea or how teeth influence things or anything. My anatomy is still lackluster up here; what is occlusion? Is it from your perspective an important thing that we need to consider? I know that they make appliances to alter occlusion, if you could just give a little overview of that I think that would be amazing. Dr. Hockel: Sure, that's kind of where I started, I was a senior in high school and my dad said “I bet you could earn more making teeth than you could slicing salami at the deli where you're working, why don't you give it a try?” I was like sure, I don't know what it really involves but that was my start in dentistry. I was working as a dental technician doing full mouth reconstruction. We call it wax up where you create and wax how the teeth should fit together, upper and lower, and it's a very precise scheme of how the teeth should fit. Gnathology was where I came from and people who are in dentistry would know they're kind of different camps of different types of occlusions and gnathology is the one that really raised the bar for how teeth should fit together. There were certain principles you always tried to follow with it, and as a dental technician and as an early years in practice as a dentist, I focused a lot on the occlusion of my patients and trying to get the bite right. Gnathology means trying to get the bite right, but it turns out that some of the things we do to try to get the bite to fit right can work against the bigger picture. So I'm not against looking at how the occlusion fits and trying to be as precise with it as you can, but that's a tree. And if you don't see the forest, then you're way down a side path that's going to be very distracting. We'd always try to get the canines to touch each other to guide the jaw as it moves side to side. It's called canine guidance, and the thinking is that there's enough leverage this far forward in the jaw to separate the back teeth as the muscles are chewing side to side. It's got leverage against the muscles way back here if the molars right next to the muscles that are chewing are the ones that are mainly hitting when you go side to side, it's much stronger bite forces and it's a risk for wear or for the fracturing of the teeth. The idea was the front teeth protect the back teeth and the back teeth protect the front teeth; when you close, the back teeth should touch stopping the closing motion of the jaw. When you move side to side, the front teeth should touch so that you can bite through things and so that you separate the back teeth in those other positions. All this works great if you have jaws in a face that's in the right position so that now the joint is in a favorable condition and the airway is in a favorable condition. If you have jaws that are somewhat too far back, take the case of my patient who had the bicuspids extracted and the front teeth pulled back. They did that partly because it looks better but mostly because we're just taught that's how teeth should fit together; the front teeth should fit with overbite and overjet. Also close contact or maybe slightly away so that they can slide against each other to separate the back teeth during the chewing movements. The problem is her jaws were already too far back and by pulling front teeth backward to meet against the lowers for the sake of what we disclusion, the best functioning of the teeth against each other. It can be making things worse for the airway, it can also be making things worse for the jaw joint when front teeth are brought back so that you have that contact which in the gnathological occlusal philosophy you want to have. Then it can tend to cramp the style of the joint, the whole lower jaw can be held in a position that's too far back. That was one of the things in the early years of learning about the airway is how do I mix this with my occlusion...I won't say beliefs, but it's almost like beliefs. There's no research to show that this kind of occlusion is better than that kind of occlusion. Even class one, ever since Edward Angle the father of modern orthodontics came up with his ways of putting a bite together and one of them is the molars need to fit like this what we call class one. There's no research to show that that's any better functionally or any other way than any other kind of occlusion. So yeah I had to balance how do I mix gnathology with the airway, and I think that you always put the airway first. Michael Gelb has termed this ‘airway centric;' instead of having a centric relation which is what his dad and my dad and I would all be worried about. How do you make the teeth fit together when the jaws are in their center position? That would be the best connection of the two. The tooth home is the same as the bone home and they just work in coordination with each other. Well, maybe the bone home is pathologic, maybe there's something about that bone home that isn't right. Because maybe the lower jaw and maybe the upper jaw belongs further forward for the sake of the airway or for the sake of the function of the joint if the little disc gets displaced, then the lower jaw might need to be further forward. If we do things with the bite, the occlusion, that works against that, the results are never going to be what they should be. Another philosophy of occlusion might be to go to where the muscles in there are in their most relaxed or harmonious state and make the teeth fit there. Here again, in any philosophy of occlusion, if you're not looking at the airway function, you might be going down the wrong path. Zac: It's funny you mentioned Michael Gelb because that was the first appliance that I was exposed to. I wore it because we were trying to improve my jaw motion, and I definitely got some interesting changes within my body. Dr. Hockel: His dad Harold Gelb is the one who developed the appliance. It allows the bite to open and it allows you a lot of times to bring the lower jaw forward a little bit, which can decompress the joints. It can be good for a TMJ appliance and without knowing it, it was sometimes also helping the airway. Zac: Yeah, but it's also doing so without necessarily affecting the airway dimensions or the health of the airway, whereas it may be affecting other areas like you said the TMJ. Dr. Hockel: There are some people that when you put a thickness between the teeth, the lower jaw rotates as the lower jaw opens, it goes backward. There are some people that put a thickness between their teeth like that and it can make the airway worse, it'll make them grind their teeth even more so it isn't the same for everyone. Zac: Interesting, because they definitely said it would be bringing my jaw down and forward. An analogy in my domain is shoe orthotics. Sometimes, shoewear is something that we can use to influence someone's movement versus not. I've had people where we've put them in really supportive shoes and have a completely undesirable outcome from a movement perspective versus someone having those same shoes doing very well. It's just funny how you kind of have the same thing. Dr. Hockel: We call them the same thing; you call it an orthotic, we call it an orthotic. Dental pathology. Zac: There are a lot of other pathological processes that some people may be dealing with. Like people who have gum recession or crowns or veneers; I don't know much about this. Sometimes I'm sure that my clients and people are getting exposed to these things, how does that influence and play a role in the airway health? Tooth implants Dr. Hockel: Well you didn't mention implants. If somebody's thinking about getting an implant, but they also think they may have bite or jaw position or airway problems, they've got to be analyzed and diagnosed really completely first from the big picture before putting in an implant. Because once an implant's in, it's not going to move ever; it's just going to stay right where it is. I've had patients where I've had to do a lot of expansion of the arches and just leave the implant where it was. So in the end, the implants are like way over here toward the inside and sometimes you can work with it and just kind of warp a tooth out to where everything else is and leave it. But I've had other people where the implant has to be taken out and then put back in or another crazy way I've done it before is to have an oral surgeon just create corticotomies. Cut around the bone where the implant is and then I'll make an appliance so that after I've expanded everything else, he just cuts the bone around that section where the implant's sitting and then moves it out into the position where it belongs. Then we just let the bone heal there. Don't do an implant until you know where it's going to need to end up. I saw someone yesterday that's going to need one for an upper front tooth and their front teeth may need to be in a different position. I'd rather catch them now and say just don't do anything until it's in the right place. Gum recession Recession is the gums moving down the root of the tooth exposing some of the roots, and it's generally a function of some bone loss around the tooth as well. It's not a good thing, but you don't look at any gravestone and see recession as a cause of death, it's usually not even a cause of death of an individual tooth even when there's a lot of recession. It's the bone between the teeth that tends to hold the teeth in really well so it's not a crazy bad thing if somebody does have some recession. Having said that, you'd rather not have recession. So we look now at ways of expanding the upper jaw for example, that the base of the upper jaw will expand skeletally so that the teeth don't have to be moved in a way that might risk recession. Of course, there are procedures the periodontists can do to help minimize it or add bone back to those areas, different kinds of bone grafting procedures. It's sometimes a necessary evil. But it's often a sign that something's going wrong functionally with the tongue and the tongue space. You'll see people whose teeth don't even meet together in the front and they have recession. It's not from heavy bite forces or clenching or grinding on the teeth that caused it which is one cause of recession; it's like if you take a fence post and shakes it, the dirt kind of moves away and you're going to lose the support down where it's coming out of the ground. If the bite is putting forces on the teeth up where it comes out of the ground at the gum line, the bone may be getting lost and the gums may be receding. That would be like shaking the fence post but in the analogy another thing that happens you get a cow that comes up to the fence post and just leans against it all day long. That can also make it come loose and lose the support down below. That's the tongue on the inside without enough room putting constant force against teeth either forward toward the front teeth, sideways toward the back teeth and sometimes recession is the tongue's fault and the tongue just not having enough room. We've been talking about the airway and when you don't have enough room for the tongue, you often want to make more room for the tongue so that the airway can be healthy. But making more room for the tongue might be important to try to prevent further recession when there's already been recession. Zac: Have you ever seen a case where you improve tongue positioning and you give the tongue enough shape where you've had a positive change in gum recession? Because I think with Wolf's law you might be able to get some bony adaptation. Dr. Hockel: No I can't. What I have seen is sometimes if there's a little recession in the front and you bring front teeth forward, it just from the way that it's moving through the tissue, the recession seems to look a little bit better. Other times the recession just follows it along; I don't know if there's really a pattern to when you're going to keep it or see it get worse. For some people it will get a little worse, it's a risk of any orthodontics you could have some recession, but grafting is a possibility and trying to do things that avoid that. Moving slowly, lighter forces, and getting the tongue in balance too; get the tongue enough room so it's not going to be putting pressure on the teeth as well. Crowns and veneers Dr. Hockel: Those are the world of restorative dentistry and
We talk about whether or not nursing facilities or assisted livings will survive COVID themselves.
Amy and Alex interview Andy Diamond, the President of Diamond Medical Labs and Mobile Medical Imaging. In this amazing episode, Andy teaches us everything about how labs are done in nursing homes, rehabs, assisted livings and in patients' homes. In part 1 we discuss: How and why do lab companies have contracts with nursing homes and assisted living facilities? Part A and Part B billing for labs in the same facility Figuring out Same and Similar in the lab world Patient financial responsibility for labs drawn in a nursing home Lack of centralized database of lab data Integration with state health information exchange / CRISP What is a health information exchange? Why does CRISP charge the lab company to participate? Nursing home is paying for some lab tests directly Lab billing denials Revenue cycle management in the lab world What are the most common mistakes and issues when nursing homes and assisted livings order labs? What labs aren't allowed to tell ordering physicians? Alex thinks the rules for ordering labs are stupid Trends in lab testing Molecular testing - why is molecular testing becoming more popular? Who collects urine samples in nursing homes and homebound patients? What is the cost of molecular testing and is the denial rate different? What things to consider other than just the cost of a lab test? Workflow requirements for molecular testing PGX testing - what is it and why would you order it? Cost of PGX testing Are the results from PGX testing easy to interpret? Effect of PAMA on labs and lookback for lab payments Why doctors can't have their own labs
Vinerna hittas här: https://vinos.se/listor/146375/54.-support-your-local-dealer! Alfs låt: https://open.spotify.com/track/23PIMIlFx1FeiCmmIf1RgZ?si=GxafjKpXR2C8LhGoTY2G9A
Some happy news for a change: Gov. Ron DeSantis and the First Lady have a brand-new baby girl. But the Governor wasn’t in the delivery room because of coronavirus. Also, on today’s Sunrise: — The Florida Department of Education has extended school closures through May 1 (at least) due to the coronavirus pandemic. The expected news came during a conference call. Florida has now confirmed 5,704 cases of coronavirus, including 71 fatalities. — A minister in Hillsborough County is facing criminal charges for holding services where hundreds of people attended in person — violating common sense and health regulations during a pandemic. — A cruise ship loaded with sick passengers — and four dead bodies — is headed for Broward County; DeSantis wants to stop it. — The head of Florida’s emergency management agency says the hunt for N95 masks (to protect health care workers) is fraught with fraud and price gouging. He calls it’s a “Ponzi scheme.” — The head of the Florida branch of the AARP is asking state officials to explain why they won’t release the names of nursing homes and ALFs with confirmed cases of coronavirus. — DeSantis is still refusing to issue a statewide lockdown because of the virus, but he’s joining the Mayors of four South Florida counties for a new program called “Safer at Home.” It’s like a lockdown, but without the curfews. — And checking in with Florida Man, who does his best to spread fear and panic amid the pandemic.
Här kommer avsnitt 146, där vi åker hem till Monica Robertson i Frillesås och pratar om livet före, tillsammans med och efter Alf Robertson, den legendariske vis- och countryartisten som avled på självaste julafton 2008. Hur var det att bli änka med två små döttrar och efter ett tag börja föra vidare Alfs musikaliska arv? […]
Vinerna hittas här: https://vinos.se/listor/135976/48.-%22som-att-slicka-pa-sten%22 Alfs låt: https://open.spotify.com/track/5XXztOLO4kmLtjDPsifbdj?si=jWjuYJYdRAqEOon-MlP0cQ
Vinerna från avsnittet hittas här: https://vinos.se/listor/133549/47.-rockvin-and-panikskumpa Alfs sista minuten-tips med nyårsbubbel: https://vinos.se/listor/132931/nyarsbubbel-i-butik Musik från avsnittet: https://open.spotify.com/track/70Z9t1qhytWtG4cCmmi7mU?si=NLgdTPcBSUa3MWNZo3LRsA
Vinerna i avsnittet: https://vinos.se/listor/127797/45.-vinderby-pa-iberiska-halvon Alfs låt: https://open.spotify.com/track/4jp4Z02kzzg8gK0NmDGgml?si=_7kQT6k2QxSFS2jWo-4WaQ Petters låt: https://open.spotify.com/track/6af4M7OpCgFX4iiMaO7u2G?si=7dmQHPV1RSO5TvmM1X249Q
Alfs topp 10 från Australien: https://vinos.se/listor/122335/nya-australien-top-10
Vinerna i avsnittet hittar du här: https://vinos.se/listor/121629/42.-sa-mycket-battre-vin Alfs låt: https://open.spotify.com/track/4Cgedth1L3nBdVLU5Z42m1?si=F7bMDCbCQTW3Iv0LLotUog Petters låt: https://open.spotify.com/track/6HJasLoTKvxglAMQH8nPcD?si=SEuEzdnmQiyTOAxd6goq7g
Musik i avsnittet: Alfs låt: https://open.spotify.com/track/24HQTVa7OIBQvF67njCzTI?si=70N8poLuRju35MhWYI3hXQ Petters låt: https://open.spotify.com/track/3MISrN0By6rv1f9BUgv6Rv?si=S8APh2JLQ_Slx42N5dsXYw
Vin och musik i veckans avsnitt: Alfs vin https://www.systembolaget.se/dryck/roda-viner/rings-218301 Petters vin Olivier Riviere El Cadastro 2015 Spanien, Arlanza 259 kr (släpps 3 sept) Alfs låt https://open.spotify.com/track/2PMImUyrasvtoNvF1pRtt6?si=sGIWesYYRPijo3sGVd7WvA Petters låt https://open.spotify.com/track/2XOe8cUTomyWPjegbs1rRW?si=da1qqiV4TIOGrk14CiPk1Q
Vin och musik i detta fullspäckade avsnitt: Alfs vin https://www.systembolaget.se/dryck/roda-viner/deaetna-240001 Petters vin https://www.systembolaget.se/dryck/roda-viner/chateau-le-puy-7468901 Petters låt https://open.spotify.com/track/2cmGQ5bEL9vPxRHIC7TcvT?si=PtwRjaKvRK6Rkz3W6qHYzw
Vin och musik i avsnittet: Petters vin: Casanova di Neri Brunello di Montalcino 2004 https://www.systembolaget.se/dryck/roda-viner/brunello-di-montalcino-7923401 Alfs vin: Domnaine Sérol Cote Roannaise Les Blondins 2018 https://laculture.se/produkt/domaine-serol-cote-roannaise/ Petters låt: https://open.spotify.com/track/11Yk4i4EolLpZrOddHLugX?si=J4hKbWMtR0GsHcNwl6XVCA
Susan Alfs works in biotech in L.A. as a Process Validation Specialist at Atara Biotherapeutics, focused on setting up manufacturing of their first product. She's worked for 6 years doing QA, validation, and project management. Susan got her degree in Biological Sciences at Carnegie Mellon and then went on to earn her masters of Biosciences, in Medical Devices at Keck Graduate Institute.
Vin och musik i avsnittet: Petters vin: Coursodon Les Oliviers 2013 ca 250 kr (går ej att köpa nu) Petters låt: https://open.spotify.com/track/7tFT3NnNOzPlhRDGBoauZP?si=9YDQf_bhTDCG4ebYEEJ3RA Alfs vin: https://www.systembolaget.se/dryck/roda-viner/bramaterra-9233101 Alfs låt: https://open.spotify.com/track/2N3U8uTYhjX2KwGT0pf5x0?si=ZbGdshVYQAap6c9PAWU5pQ
Vin i avsnittet: Petters vin: https://www.systembolaget.se/dryck/mousserande-viner/bollinger-741801 Alfs vin: https://www.systembolaget.se/dryck/vita-viner/kamara-pure-9601701
We talk McNuggets, Paul Lynde, fat jokes, John’s shaved mustache, Hairy Harry, haircuts, sad commercials, Chris’ recent storytelling show, Spider-Man, and why we hope our kids never listen to this podcast - PLUS listener poems and voicemail!
Vin och musik i avsnittet: Alfs vin Jean-Michel Stephan Syrah 2014 (finns ej på SB), ca 180 kr Petters vin Chateau Larrivet Haut-Brion 2009, (409 kr årgång 2016 på SB) https://www.systembolaget.se/dryck/vita-viner/chateau-larrivet-haut-brion-9201201 Alfs låt https://open.spotify.com/track/3JtVYa2nFVX7ZiumlysZFq?si=RMJioLUPTm62rKTxslSrXw Petters låt https://open.spotify.com/track/3nyx2Ey0Zl2s5vnZEOzPOs?si=4FDnpH6ERfumjJ9UUHr-Kg
Vin och musik i avsnittet: Alfs vin: https://www.systembolaget.se/dryck/aperitif-dessert/bergskar-7069701 Alfs låt: https://open.spotify.com/track/6KvsOwZSycmnPYVI2IKi9G?si=iyR2YORmRWGaEJRB9XFk1w Petters vin: https://www.systembolaget.se/dryck/roda-viner/barolo-7540201 Petters låt: https://open.spotify.com/track/2yHFlRtC1sUcg2sGNH5YVi?si=EeFLMaQLR5GRQJz1r4_gXQ
Musik och vin i veckans avsnitt: Alfs vin https://www.systembolaget.se/dryck/vita-viner/pouilly-fume-222701 Petters vin Felton Road Pinot Noir Block 3 Alfs låt https://open.spotify.com/track/0ejDsacg1pMeEFPnZy9poy?si=35u1x6cTSmC6fR-4Gj6m_w Petters låt https://open.spotify.com/track/63anYuuPBLeU0CB52vZUAF?si=IIzAQzVGSReF7hcVPbq2uQ
Vinerna den här veckan finns inte på bolaget men är följande: Alfs vin: Genet Rosé Champagne Non Vintage, Frankrike Petters vin: Fram Chenin Blanc 2015, Sydafrika Petters låt: https://open.spotify.com/track/61hgZt5HEewtSjxibp01Vy?si=_RQtkux9QAWrJ-lr34Re-w
Alfs vin: Esporao Reserva 2017, ca €17 Petters vin: https://www.systembolaget.se/dryck/vita-viner/zilliken-9024801 Alfs låt: https://open.spotify.com/track/0GhBU1fuptdqNhFRlFaBLJ?si=K5Tc86CNSO6Mr8nRpI4mBg Petters låt: https://open.spotify.com/track/4g2zbjbLCJPkNEJMcUwGoJ?si=0ulqtRWYSKSLzwpIXcoqyg
Musik och vin i veckans avsnitt: Alfs vin: https://www.systembolaget.se/dryck/roda-viner/bodegas-emilio-moro-lada-7135009 Petters vin: https://www.systembolaget.se/dryck/roda-viner/le-cupole-9133301 Alfs låt: https://open.spotify.com/track/3XM3y8vqAWmkC1bZP3ewMS?si=yRcaiNn5T_e7HtgyFLJk0A Petters låt: https://open.spotify.com/track/5Vn92CtttS5jEMiHJ0BKV8?si=l0k2m6N7QNiL1mIZrOJdJQ
This week we talk with Garret of DixieMech! It's also worth noting that we finally are back to normal; meaning Chris has a home and Danny is back from vacation! Thanks for hanging with us during that doofy period, we promise we'll try to keep those episodes to a minimum! In this episode we tackle the Drop(.com) name change, STEAK TACOS, stealing PCB and Sticker designs (fake ALFs to PO Boxes and more), and learn about everything and anything DixieMech! Links you may want to check out: DixieMech Website Drop Website Mizu on DixieMech
Vin, te och musik i veckans avsnitt: Alfs vin: http://www.evercohol.com/en/products/domaine-ganevat-poulprix Petters te: Earl grey Alfs låt: https://open.spotify.com/track/1Y8R1CKdai0oycCf6K0sjh?si=AMRwZVPIRMaQAIvkDDyhOQ Petters låt: https://open.spotify.com/track/2UvBaqVAfLolthOYeXwPLn?si=VuJM5v69S0OmXxScN7tgDA
Musik och vin i veckans avsnitt: Alfs låt: https://open.spotify.com/track/5wj6aTBLslYtZu15TIkaRK?si=9AZqesacSoiR58t6P1CrLw Petters låt: https://open.spotify.com/track/5IqtW5o7NafEXqzc7pDBRz?si=tKuznQccQwSjOWnOuRJCKA Alfs vin: https://www.systembolaget.se/dryck/roda-viner/saumur-7967601 Petters vin: Elio Altare Langhe Nebbiolo
Musik och vin i veckans avsnitt! Alfs vin: https://www.systembolaget.se/dryck/vita-viner/saumur-7061401 Petters vin: Forlong Vino de la Tierra Cadiz (privatimport 239 kr ex moms) Petters låt: https://open.spotify.com/track/4oGTsvXCG4CgY2AgFCKAF9?si=00ujIZsxQaStEupQJ0wVnQ Alfs låt: https://open.spotify.com/track/4oGTsvXCG4CgY2AgFCKAF9?si=5R8ew_teTbCU1lowX0p-JA
Musik och vin i veckans avsnitt! Petters låt https://open.spotify.com/track/39xWBHPM4E9MwzEy5gbM7p?si=DlmdcbWFTKyHOdoU1ZiDuA Petters vin https://www.systembolaget.se/dryck/roda-viner/navaherreras-9203801 Alfs låt https://open.spotify.com/track/6Cog2WLr8HEpfTE08MeAl7?si=KxHW-YyXR4CvnQIqJJdYWQ Alfs vin https://www.systembolaget.se/dryck/roda-viner/naoussa-boutari-9539001 Missa inte Alfs tips om Systembolagets lanseringar på fredag! Sist i programmet.
En dag for over 3 år siden møter Alf tingrettsdommer Merete Svartveit i retten. Det endrer livet hans. Dette er Alfs historie.
Stjärnreportern Petter har varit ute på fältet och fått sig ett snack med Madeleine Stenwreth, Master of Wine. Vin och musik i avsnittet: Alfs vin https://www.systembolaget.se/dryck/mousserande-viner/palmer-co-786701 Petters vin https://www.systembolaget.se/dryck/roda-viner/brunello-di-montalcino-4230201 Alfs låt https://open.spotify.com/track/5rpb2KAl31B4ghYvOTOslu?si=a5wBpfewR0GAsxGVW7Jrag Petters låt https://open.spotify.com/track/5a39V8NZADQeq7yxRJ8H7l?si=kiy8ZaOfQLKt9fimxTy2ig
I veckans avsnitt: Janne Gradvall! Robotar i vingården! King James! Sommelier-VM! Veckans låt! Blindprovning på tåg! Alfs vin: https://www.systembolaget.se/dryck/roda-viner/brouilly-9532501 Alfs spellista: https://open.spotify.com/user/atumble/playlist/4qltoEyVhFzpuYmA8jtQhd?si=qSqLqR9kSWG566N9fX1dmA Petters vin: Vina Chilico Chardonnay Riserva 2011 (finns ej på bolaget) Petters låt: https://open.spotify.com/track/7F83IxwksIdCgxk30MUPXM?si=LMXeVBVkQra9ltV379XgDQ
I veckans avsnitt blir det: Barberatips! Det nya Tyskland! Vin på Twitter! Italienska skidskyttekockar! Friterat! Strage! Basketvin! Hamsterbeteende! Alfs vin: Juwel Nr 71699 Petters vin: Amalia Nr 77035
Alf är på vinturné i Spanien och Petter tar upp en lyssnarfråga om vinallergi. Dessutom en Julio Iglesias story och lite branschnyheter! Alfs vin: Dominio do Bebei "Lacima" 2013, 379 kr (kommer som tillfällig lansering snart) Alfs låt: Boxed In - Foot of the hill Petters vin: Alvarinho Contacto Nr:6707 Petters låt: Intro / Ludacris / The Red Light District
Petter har trillat från ett tak och kör rejält i diket. Alf fyller snart år och det blir därför en hel del snack om champagne. Dessutom: Söta viner, vin på burk, Alf tänka annorlunda och äppelmust. Alfs vin: Palmer & Co Nr: 7372 Alfs låt: Lack Of Afro - Missing Me Petters vin: Nivole Nr:7787 Petters låt: E- 40 Yup - Choices
Petter i Melodifestivalen? Håller vinet på att bli folkligt? Dessutom: Brunello! lyssnarfråga! Dryck till ägg! Hamstrande! Och mycket mer! Vin och musik i avsnittet: Alfs vin - Arbois Nr 76892 Petters vin - Bruno Giacoso Dolcetto d'Alba 2015 (finns inte just nu på bolaget, ca 180 kr) Sean Paul, Stefflon Don - Shot & Wine 1999 - Bedövad
Alf och Petter pratar bland annat om nyhetssläppet på Systembolaget imorgon, Txakoli, Grand Master Flash, Alfrobeats och Stefan Löfven. Vin och musik i avsnittet: Alfs vin https://www.systembolaget.se/dryck/vita-viner/marko-9901001 Alfs låt https://open.spotify.com/track/54MONNKu7yBK7w9LBVQ7vx?si=v6hAY-0_RpK3uaztZhV95A Petters vin 2016 Domaine de Marcoux Châteauneuf du Pape – 395 kr https://www.caviste.se/cav/cav0091-domaine-de-marcoux/ Petters låt https://open.spotify.com/track/4uQCXA6OhU36r0lnSsXKQ5?si=WIR3iPlWRcaT5ruEuKBlMw
Vin och musik i detta avsnitt: Alfs vin https://www.systembolaget.se/dryck/roda-viner/pizza-wine-7513001 Petters vin Montevertine Pian del Ciampola, Chianti ca pris 250 kr Alfs låt https://open.spotify.com/track/5k15mNOIeUSwODE52L1LAn?si=-LdD5pTsSDOuubqmRkp6DQ Petters låt https://open.spotify.com/track/0C2gBGykQ6acOpyHzacXLd?si=3T5gA-8AS-O2bHKcyDBdSQ
Vin och musik i avsnittet: Alfs vin https://www.systembolaget.se/dryck/vita-viner/jurtschitsch-293901 Petters vin https://www.systembolaget.se/dryck/roda-viner/cairanne-grande-reserve-7283201 Alfs låt https://open.spotify.com/track/2UxfXcmgmOIXQ5IqFxmZ1m?si=jlbD5y_6R56CJkQcnp87iw Petters låt https://open.spotify.com/track/2cVFmsMVt8aDsHGg70ilkl?si=RLKbA7xnS-C806Xhs6QMeg
Vin och musik i veckans avsnitt av Dela en flaska: Alfs vin https://www.systembolaget.se/dryck/roda-viner/ugo-lequio-242601 Petters vin https://www.systembolaget.se/dryck/roda-viner/sandro-fay-7483401
Vin och musik i veckans avsnitt: Alfs vin: https://www.systembolaget.se/dryck/roda-viner/the-butcher-7052101 Petters vin: https://www.systembolaget.se/dryck/roda-viner/boom-boom-671401 Alfs låt: https://open.spotify.com/track/24GjrpnpHXmuErfvmJu0jP?si=2HlhIyj1Rl-pLPYqJGcL7A Petters låt: https://open.spotify.com/track/76GUOMKAbAnVliU40wM534?si=6Qn73ofvQCqhAlsf8Xk43Q
Vin och musik i veckans avsnitt: Alfs vin: https://www.systembolaget.se/dryck/roda-viner/chateau-pineraie-285201 Petters vin: https://www.systembolaget.se/dryck/roda-viner/peter-lehmann-portrait-barossa-1638101 Alfs låt: https://open.spotify.com/track/1Bhm5HNO1cq8olDbBmokyL?si=HLg7zCD2QMq56HhHH7fvQA Petters låt: https://open.spotify.com/track/0BALcq0CFzQeWZ1hStZDsF?si=Ki16OOZmQemlWluLBkgzuA
Alfs vin: Sandro Fay Costa Bassa 2015 (229 kr), Italien, Valtellina (Beställningssortimentet nr. 71192) Petters vin: Raats MR De Compostella, (ca 400 kr) Privatimport
Här har ni vin och musik för veckans avsnitt: Alfs vin: Paolo Scavino Langhe Nebbiolo 2016, Nr 2368 Italien, Piemonte, Langhe, 99:- OBS! halvflaska https://www.systembolaget.se/dryck/roda-viner/langhe-nebbiolo-236802 Petters vin: Barolo Fontanafredda Nr 70227 Italien, Piemonte, Barolo 219:- OBS! Vi pratar om årgång 2010 i podden, 2013 finns på bolaget https://www.systembolaget.se/dryck/roda-viner/barolo-fontanafredda-7022701 Alfs låt: https://open.spotify.com/track/4mVLzFbc3gaCoWCEENLouc?si=arjDUBg7SZaU1aIC7dxX6Q Petters låt: https://open.spotify.com/track/236Mhem3oDvVU53UaMqRB2?si=kujFNHi8QluGEK6rrt0jmw
Vin och musik i veckans avsnitt: Alfs vin: Bermejos Malvasia Vocanica Seco 2017, Lanzarote, Spanien (nr 72049) 159 kr https://www.systembolaget.se/sok-dryck/?searchquery=72049 Alfs låt: https://open.spotify.com/track/3VEpRXloN4rbzNRPSQzZFW?si=Uf9mCKPXQieWWeiB-iN8Bg Petters vin: Timo Myer Bloody Hill Pinot Noir 2017, Yarra Valley, Australien (ej släppt på Systembolaget än, ca 400 kr) Petters låt: https://open.spotify.com/track/1a22CQ0sNg5iWh5jMfrdA1?si=7WBDe0EsTFWL7ygMj-J9vg
Vin och musik i dagens avsnitt: Petters vin: Pillot Bourgogne Pinot Noir 2017, 179 kr (Beställningssortimentet Nr 73444) https://www.systembolaget.se/dryck/roda-viner/bourgogne-7344401 Alfs vin: Calcaris Hellen 2017, 210 kr, Puglia, Italien. Privatimport (kommer även i vinlåda 5 december) Petters låt: https://open.spotify.com/track/16etD0jjMNdKsHByc48tOY?si=yazjTtJQSJu-XKyQrXialQ Alfs låt: https://open.spotify.com/track/1CDHzsQbTMMDJVIkqb8uDD?si=fmnbJeIjQ_2jPIVi8fFz8w
Går det att dricka svenskt vin? Och vem är Petters åttonde familjemedlem? Och vad har Annie Lööf för vinprofil? Om detta och mycket mer i veckans avsnitt. Och här kommer blindvinerna och låtarna: Petters vin https://www.systembolaget.se/dryck/roda-viner/brunello-di-montalcino-7542101 ...och låt https://open.spotify.com/album/0DmPSogcZSN5xRA8jeDdz5?si=3vnL6FWtRKeeSL5hTubzuQ Alfs vin https://www.systembolaget.se/dryck/aperitif-dessert/colombo-madeira-780302 ...och låt https://open.spotify.com/track/7eJljkiDRhO1qYa9dIDSDT?si=gZYtRsp7SIKX7SZ8yubzNQ
Today we talk about transitions in assisted living and hospitals. In assisted living facilities, transitions occur when moving from the traditions unit to the memory care unit. These transitions are not always as smooth and easy as many hope. It can take time to make the move from one unit to another and that can [...] The post Transitions in Assisted Living and Hosptials appeared first on Minute Women Home Care.
I MUSEUMs program "Carl Fredriksens Transport" er det med noen få klipp fra NRKs arkiv hvor grenselos Alf Pettersen forteller om hvordan den illegale flyktningeruten ble organisert. Klippene er fra et program NRK-journalist Olav Vesaas laget i 1982, hvor også flere av flyktningene, en svensk grenseoppsynsmann og Alfs kone Gerd var med. dette programmet ble sendt 27/12 1982. I denne ekstra podkasten har MUSEUMs programleder Øyvind Arntsen redigert ut og tilrettelagt de delene av det opprinnelige programmet hvor Alf Pettersen forteller, og som ikke ble brukt i MUSEUMs sending. Denne ekstra podkasten blir kun publisert på denne måten, og ikke sendt i radio på vanlig måte. Av innholdet kan nevnes at Alf Pettersen snakker om : - Det var vanlig å slå ned "hysteriske" flykninger før de ble tatt med på lasteplanet - Brann i en lastebil ved Kjeller flystasjon, og tyske soldater fra Luftwaffe hjelper til med å slokke - Våpen i bilene og hos hjelperne langs fluktruten - Varslingssystemer med kvister og steiner i veien i Indre Østfold
This week you’ll get to hear the presentation that Alvilldr has given at Trothmoot, the Mystic South Conference, and the Conference of Heathen Women. This presentation utilized voice recordings of women she interviewed for her book. For some of the recordings, however, voice actors were used due to some of the original recordings being of […]
Her i 2017 er vi ved at være lidt mættede med superhelte-film. I starten af 90erne fik vi film om flagermusemanden, mørkemanden og skyggen og alligevel var det "Beverly Hills 90210", som man snakkede om i skolen. 1994 var året, hvor Russell Mulcahys "The Shadow" havde premiere. Den havde Alec Baldwin i hovedrollen, musik af Jerry Goldsmith, banebrydende effekter og et manuskript af David "Toy Soldiers" Koepp. Det lød jo rigtig godt, men alligevel fik filmen ikke ret positive anmeldelser og havde lidt svært ved at finde et publikum. Vi ser nærmere på, hvad der var skidt og godt ved filmen, om John Lone var en cool skurk, om Baldwin er mere overbevisende som Trump end som The Shadow og ikke mindst: når man har Gandalf, Pennywise, Neelix, Lo Pan og Alfs far i en og samme film - går det så hen og bliver for meget for en ganske almindelig udødelig filmnørd? God fornøjelse.
Marika Westerberg är gäst i veckans BBpodd. Hon avslöjar givetvis pappa "Tränar-Alfs" största hemligheter, från Fläskpannkaka till Handbolls-beroende! Vi rankar våra "top-blåvitt moments" tillsammans med lyssnarna och går igenom "Dubai-gate". Dessutom "råkar" vi accidently bli världens största podcast om Gais... For information regarding your data privacy, visit acast.com/privacy
Interview with Alan G. Rosenbloom, President and CEO of Senior Care Pharmacy Coalition (SCPC) about the Avalere Health Study: Long Term Care (LTC) Pharmacy Sector Plays Key, Growing Role in U.S. Seniors' Care as New Payment, Delivery Models Gain Prevalence in the industry. More Transparent Drug Pricing Can Help LTC Pharmacies Sustain High Quality SNF, ALF Patient Care Washington, DC - A new Avalere Health study of the nation's growing long term care (LTC) pharmacy sector - the most detailed analysis since Medicare Part D was implemented in 2006 - finds LTC pharmacies playing a greater role in seniors' clinical care as new health payment and delivery models such as Accountable Care Organizations (ACOs), bundled payments and value-based purchasing proliferate amid a rapidly changing healthcare marketplace. The study, entitled " Long-Term Care Pharmacy: The Evolving Marketplace and Emerging Policy Issues ," was conducted for the Senior Care Pharmacy Coalition (SCPC), and also suggests that a more transparent, streamlined drug pricing and distribution process can help sustain the beneficial LTC pharmacy clinical services that advance high quality care and Medicare cost-savings."As the launch of the SCPC was an important milestone for our sector in 2014, our release of this benchmark report in 2015 demonstrates independent LTC pharmacies, our patients and our business partners will continue to benefit from a robust, sector-specific advocacy and educational effort in which facts, data and metrics demonstrate the significant added value of medication therapy management and unique, clinical services we provide," stated Michael Bronfein, Chairman of the SCPC, and co-founder of the Baltimore, MD-based NeighborCare and Remedi SeniorCare. "With this report, and another to soon be released related to Maximum Allowable Cost (MAC) pricing, we will continue to focus not just upon the challenges facing independent LTC pharmacies and our patients, but also putting forward the bipartisan policy solutions to address them," Bronfein continued. "Moreover, we believe it is time to finally initiate an objective, constructive, data-informed policy discussion on how best to meet the interests and health needs of elderly consumers in a volatile, excessively opaque drug pricing marketplace.” Observes the Avalere Health report on more transparent drug pricing: "To preserve choice, and to ensure that elderly SNF and ALF patients continue to receive the LTC pharmacy clinical services that help advance high-quality patient care and cost-savings objectives, policymakers should consider how to address the unique needs and roles of LTC pharmacies as they seek to streamline, standardize and make more transparent the drug pricing and distribution process." In addition to noting LTC pharmacies are distinctly different than retail pharmacies -- with significantly greater clinical, operational, legal and regulatory requirements resulting in higher costs to dispense -- the 32-page study also details how LTCPs play an essential, unique role in patient care teams; that the typical skilled nursing facility (SNF) patient receives 8 to 10 different medications each day; and that LTCPs serve a crucial role in the care continuum by ensuring seniors' pharmaceutical needs are met, consultative services are performed and patient-specific clinical intervention is carried-out as needed. Other key sections of the study include an Overview of LTC Pharmacies and their national footprint; Understanding the Differences Between LTC and Retail Pharmacies; State of the LTC Pharmacy Sector and the most common conditions for which LTC Pharmacies dispense prescriptions; LTC Pharmacy Sector Consolidation and their relationship with prescription drug plans (PDPs) and pharmacy benefit managers (PBMs); LTC Pharmacy Policy Issues and Challenges including MAC pricing, dispensing fees and short-cycle dispensing, FDA repackaging guidance and the shift to value-based payment and other delivery models. The conclusion details the issues policymakers should consider to improve the viability and strength of the LTC pharmacy sector as it assumes a larger role in the broader spectrum of care. Alan G. Rosenbloom, President and CEO of SCPC, concluded: "Independent LTC pharmacists provide a unique set of capabilities to serve an increasingly vulnerable patient population. As baby boomers age, the population over 85 will grow by nearly 90 percent over the next 20 years, and these seniors' need for medications and related consultative services will grow. Independent LTC pharmacies can be increasingly integral to optimizing care outcomes and boosting spending efficiencies -- and this new study will help us to continue making this case on Capitol Hill and with the broader national healthcare community." Rosenbloom said SCPC would release subsequent news releases over the next several months corresponding to the wide variety of issues and topics addressed in this LTC pharmacy sector report. The SCPC represents companies that own and operate independent long-term care pharmacies (LTCPs) in more than 40 states, serving over 400,000 residents in skilled nursing facilities (SNFs) and assisted living facilities (ALFs) daily. To learn more, visit seniorcarepharmacies.org or follow us on Twitter . See omnystudio.com/listener for privacy information.
The Real Estate Guys Radio Show - Real Estate Investing Education for Effective Action
Cash in on the silver tsunami as aging baby boomers turn their attention to caring for their aging parents...and ultimately helping their own children care for them. Our special guest Gene Guarino is an expert in turning single family homes into assisted living facilities. These properties cash flow at a very high rate and ALFs are a great way to acquire and pay for beautiful properties in nice areas that might not otherwise cash flow. Listen in and learn how you can earn healthy profits helping people solve one of the biggest challenges facing an aging population. The Real Estate Guys™ radio show provides real estate investing news, education, training and resources to help real estate investors succeed. Learn more and subscribe to the free newsletter! Visit www.realestateguysradio.com.
Från 2011. Med Håkan Lidbo. Om mat och vin och kryddat med musik. Köksradions sista avsnitt den här säsongen. Och vi slutar med stil och med temat lyx. Vi lagar mat som ska ätas inom en minut och mat som tar ett dygn att laga. Vi dricker den perfekta GTn och årgångsvin från Alfs vinkällare. Musik från världens dyraste skivor och från världens dyraste instrument. Men det lyxigaste är att allt är utvalt just för oss tre. För Lisa, Alf och Håkan. Det personliga och handgjorda är ju det allra lyxigaste.
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