Podcasts about Dressler

The Kenny & JT Show is underway, live from Rooster's at the corner of Fulton and Dressler for our NCAA Tournament tip off party. We set the scene there, talk more Louisville and Perry state championship hoops, and the suddenly slumping Cavs have dropped three straight.

On The Kenny & JT Show, Rooster's owner Shawn Wilson stops by with delicious food to preview our visit to Rooster's next week. The guys will be broadcasting there next Thursday to tip off the college basketball tournament. Rooster's is at the corner of Dressler and Fulton in Canton, and you can check them out at roosterswings.com.

SummaryIn this episode of the Inorganic Podcast, host Christian Hassold discusses the recent acquisition of ContentServ by Centric Software with their co-founder and former board member Armin Dressler. Their discussion spans the history of Contentserve, its journey from an on prem to SaaS solution, transition of leadership to the current CEO, Michael Kugler, and the details of the M&A process. This episode discusses the acquirer, their rationale and some of the inside baseball on the deal valuation. Chapters0:00 Introduction2:54 How Contentserv Built Its Market Position10:01 Key Learnings from how ContentServ evolved14:02 Insights on Leadership Changes19:49 Why It Was the Right Time to Sell23:37 The Sale Process and Participants26:23 Why Centric Software Made the Acquisition36:02 Implications for the PIM and Commerce Ecosystem40:46 ConclusionConnect with Christian & In/organic PodcastChristian's LinkedIn: https://www.linkedin.com/in/hassold/In/organic on LinkedIn: https://www.linkedin.com/company/inorganic-podcastIn/organic on YouTube: https://www.youtube.com/@InorganicPodcast/featuredConnect with E24 guest, Armin Dressler on LinkedInhttps://www.linkedin.com/in/armindressler/?originalSubdomain=chReferenceshttps://www.3ds.com/newsroom/press-releases/dassault-systemes-announces-centric-softwares-acquisition-ai-powered-pxm-solution-contentservhttps://www.investcorp.com/investcorp-agrees-to-sell-software-vendor-contentserv/ Hosted on Acast. See acast.com/privacy for more information.

LEIDER FEHLT DER ANFANG

"Let George Do It" was a compelling American radio drama series broadcast from 1946 to 1954. Created by Owen and Pauline Vinson, it starred Bob Bailey as private investigator George Valentine, later voiced by Olan Soule. The show transitioned from sitcom-style episodes to thrilling private eye stories, directed by Don Clark. George Valentine's services were advertised in the newspaper, and he worked with his secretary Claire Brooks (voiced by various actresses). The show featured recurring characters like Sonny, Caleb, and Lieutenant Riley. John Hiestand announced the episodes, and the music evolved from a full orchestra to an organ.

Hallo liebe Senfis zu einer weiteren Folge Volleyball mit Senf. Vielen Dank an alle die den Podcast bisher unterstützen. Gerne könnt ihr auch weiterhin Feedback zu den Folgen geben. Freuen würde ich mich auch, wenn ihr das direkt in Spotify in den Kommentaren macht. +++++Werde Premium-Senfi+++++ Wer möchte, kann mit nur 30 Euro pro Jahr Premium-Senfi werden. 4mal im Jahr werde ich eine Verlosung unter allen Premium-Senfis machen. Zu Gewinnen gibt es VolleyballmitSenf-Shirts, Espresso-Tassen oder Cappis. Außerdem werde ich alle Premium-Senfis im Podcast begrüßen und jedes mal, sobald eine oder einer dazukommt, wird der Vorname dieser Person im Podcast erwähnt. Dazu bitte den Namen als Betreff bei der Überweisung angeben., sofern er sich vom Bankkontoinhaber unterscheidet. Überweisung an: Peter Eglseer, AT83 2033 3000 0027 1585 Heute war Christoph Dressler zu Gast im Podcast. Christoph ist aus der Steiermark und erzählt in dieser Episode wie er sich vom kleinen Gosdorf in die große weite Welt hinaufgearbeitet hat. Er spricht über seine verschiedenen Partner, Gegensätze die sich anziehen und über sein zweites Standbein, die Wissenschaft. Er forscht neben seiner hauptberuflichen Tätigkeit dem Beachvolleyball, zum Thema Mentaltraining und berichtet darüber, wie er das theoretische Fachwissen in die Praxis umsetzt, bzw. praktische Anwendungen aufgrund des Studiums besser versteht. Wir sprechen außerdem über unser gemeinsames Abenteuer in Porto und über seine World-Tour-Siege bzw. Medaillen. Viel Spaß mit einer weiteren Folge, Volleyball mit Senf. https://www.instagram.com/dresslerchristoph/?hl=de

Who is crazy enough to own a restaurant? Today's guest, Jon Dressler along with his wife, Kim, are the Founders of Rare Roots Hospitality. Tune in to hear his incredible story. Now 57, Jon started at 16 years old working for Morton's Steakhouse. After 10 years at Morton's, attaining his bachelor's degree from Penn State and MBA from Univ. of Texas- Dallas, Jon and his wife opened their first restaurant Dressler's in 2003. Now in 2025 the Rare Roots Hospitality Portfolio includes 7 restaurants: Dressler's Chapter 6 Fin & Fino Joan's The Porter's House Dressler's Improv Kitchen at Middle C Jazz Club Dogwood: A Southern Table & Bar While each Rare Roots endeavor varies in concept and design, they are all deeply rooted in the desire to treat guests like they are family. Their attention to detail, their ability to remember a name, and their carefully crafted menus are all expressions of a genuine hospitality that is increasingly harder to find. It requires talent, but it also requires a mindset of service. Their people have both. They come together every day, for 20 years and counting, to practice the type of hospitality you will typically only find at home. ​ They take great pride in remembering the details that matter to you—what you like to drink, where you love to sit, what you want to eat. No matter how many times you've dined with us, they're working hard to make each experience better than the last.  Ready to visit a Rare Roots Hospitality establishment near you? Visit: https://www.rarerootshospitality.com/ Thank you for listening to another episode of the Perky Collar Radio Show! Warmest Regards, David M. Frankel Perky Collar Inventor, Founder of Perky, LLC & Perky Franchising, LLC, Perky Collar Radio Show Host, Commercial Real Estate Broker & Business Broker www.PerkyLLC.com Join my Entrepreneur Group: Facebook.com/Groups/CharlotteEntrepreneurThinkTank Feel free to connect with me on Linkedin: www.Linkedin.com/in/DavidMFrankel

En este episodio, resumimos varios artículos científicos sobre espasticidad, en cuanto a conceptualización, neurofisiología, evaluación y tratamiento. Es una forma de actualización anual sobre esta temática tan estudiada en neurociencia. Hablamos sobre nuevos estudios de neuroimagen sobre la espasticidad, consensos sobre evaluación y desarrollos emergentes de tratamientos médicos. Referencias del episodio: 1. Cho, M. J., Yeo, S. S., Lee, S. J., & Jang, S. H. (2023). Correlation between spasticity and corticospinal/corticoreticular tract status in stroke patients after early stage. Medicine, 102(17), e33604. https://doi.org/10.1097/MD.0000000000033604 (https://pubmed.ncbi.nlm.nih.gov/37115067/). 2. Gal, O., Baude, M., Deltombe, T., Esquenazi, A., Gracies, J. M., Hoskovcova, M., Rodriguez-Blazquez, C., Rosales, R., Satkunam, L., Wissel, J., Mestre, T., Sánchez-Ferro, Á., Skorvanek, M., Tosin, M. H. S., Jech, R., & members of the MDS Clinical Outcome Assessments Scientific Evaluation Committee and MDS Spasticity Study group (2024). Clinical Outcome Assessments for Spasticity: Review, Critique, and Recommendations. Movement disorders : official journal of the Movement Disorder Society, 10.1002/mds.30062. Advance online publication. https://doi.org/10.1002/mds.30062 (https://pubmed.ncbi.nlm.nih.gov/39629752/). 3. Gracies J. M. (2005). Pathophysiology of spastic paresis. I: Paresis and soft tissue changes. Muscle & nerve, 31(5), 535–551. https://doi.org/10.1002/mus.20284 (https://pubmed.ncbi.nlm.nih.gov/15714510/). 4. Gracies J. M. (2005). Pathophysiology of spastic paresis. II: Emergence of muscle overactivity. Muscle & nerve, 31(5), 552–571. https://doi.org/10.1002/mus.20285 (https://pubmed.ncbi.nlm.nih.gov/15714511/). 5. Gracies, J. M., Alter, K. E., Biering-Sørensen, B., Dewald, J. P. A., Dressler, D., Esquenazi, A., Franco, J. H., Jech, R., Kaji, R., Jin, L., Lim, E. C. H., Raghavan, P., Rosales, R., Shalash, A. S., Simpson, D. M., Suputtitada, A., Vecchio, M., Wissel, J., & Spasticity Study Group of the International Parkinson and Movement Disorders Society (2024). Spastic Paresis: A Treatable Movement Disorder. Movement disorders : official journal of the Movement Disorder Society, 10.1002/mds.30038. Advance online publication. https://doi.org/10.1002/mds.30038 (https://pubmed.ncbi.nlm.nih.gov/39548808/). 6. Guo, X., Wallace, R., Tan, Y., Oetomo, D., Klaic, M., & Crocher, V. (2022). Technology-assisted assessment of spasticity: a systematic review. Journal of neuroengineering and rehabilitation, 19(1), 138. https://doi.org/10.1186/s12984-022-01115-2 (https://pubmed.ncbi.nlm.nih.gov/36494721/). 7. He, J., Luo, A., Yu, J., Qian, C., Liu, D., Hou, M., & Ma, Y. (2023). Quantitative assessment of spasticity: a narrative review of novel approaches and technologies. Frontiers in neurology, 14, 1121323. https://doi.org/10.3389/fneur.2023.1121323 (https://pubmed.ncbi.nlm.nih.gov/37475737/). 8. Levin, M. F., Piscitelli, D., & Khayat, J. (2024). Tonic stretch reflex threshold as a measure of disordered motor control and spasticity - A critical review. Clinical neurophysiology : official journal of the International Federation of Clinical Neurophysiology, 165, 138–150. https://doi.org/10.1016/j.clinph.2024.06.019 (https://pubmed.ncbi.nlm.nih.gov/39029274/). 9. Li, S., Winston, P., & Mas, M. F. (2024). Spasticity Treatment Beyond Botulinum Toxins. Physical medicine and rehabilitation clinics of North America, 35(2), 399–418. https://doi.org/10.1016/j.pmr.2023.06.009 (https://pubmed.ncbi.nlm.nih.gov/38514226/). 10. Qin, Y., Qiu, S., Liu, X., Xu, S., Wang, X., Guo, X., Tang, Y., & Li, H. (2022). Lesions causing post-stroke spasticity localize to a common brain network. Frontiers in aging neuroscience, 14, 1011812. https://doi.org/10.3389/fnagi.2022.1011812 (https://pubmed.ncbi.nlm.nih.gov/36389077/). 11. Suputtitada, A., Chatromyen, S., Chen, C. P. C., & Simpson, D. M. (2024). Best Practice Guidelines for the Management of Patients with Post-Stroke Spasticity: A Modified Scoping Review. Toxins, 16(2), 98. https://doi.org/10.3390/toxins16020098 (https://pubmed.ncbi.nlm.nih.gov/38393176/). 12. Winston, P., Mills, P. B., Reebye, R., & Vincent, D. (2019). Cryoneurotomy as a Percutaneous Mini-invasive Therapy for the Treatment of the Spastic Limb: Case Presentation, Review of the Literature, and Proposed Approach for Use. Archives of rehabilitation research and clinical translation, 1(3-4), 100030. https://doi.org/10.1016/j.arrct.2019.100030 (https://pubmed.ncbi.nlm.nih.gov/33543059/).

Entfessle die Kraft deiner Stimme – Diana Dressler zeigt, wie du sie als Erfolgs-Tool für Webinare, Bühnenauftritte und Social Media einsetzt.

In this conversation, Mark Burik and Christoph Dressler explore various aspects of beach volleyball coaching and competition. They discuss Christoph's journey in the sport, the pathways to becoming a professional player in Austria, and the importance of multi-sport participation for youth athletes. The conversation delves into coaching philosophies, tactical analysis, and the significance of repetition in skill development. They also highlight the qualities of effective coaches and the methodologies used in training and periodization for beach volleyball. In this conversation, Mark Burik discusses various aspects of training and coaching in beach volleyball, emphasizing the importance of recovery practices during the season, the qualities that make an effective coach, and the balance between fitness and skill training. He also highlights the significance of building trust and communication between athletes and coaches, understanding different learning styles, and the mental resilience required to overcome injuries. The discussion concludes with insights into the characteristics of a good defender in volleyball.

Clint and Heather are joined this week by Taylor Dressler! She is the owner of Fast Babes, a community-based initiative to empower women in motorcycling. Taylor shares her start in off-road riding that led to her various roles in the industry, including her role as a Marketing Specialist with Troy Lee Designs. Find Taylor on Instagram! @taylor_on2wheels Find Fast Babes on Instagram! @fastbabes_ MotoAmerica is the OFFICIAL Sponsor of Pit Pass Moto This episode is brought to you by MotoAmerica, home of AMA Superbike racing and North America's premier motorcycle road racing series. Revisit all the season's action with the Moto America Live+ video-on-demand streaming service. Or visit the Moto America YouTube Channel for race highlights and behind-the-scenes video content. Look for the 2024 race schedule over on the motoamerica.com website, and be sure to follow MotoAmerica on social media for real-time series updates and original content. Get your PPM swag at our Pit Pass Moto online store! Pit Pass Moto is a production of Evergreen Podcasts.

Host Molly Jacobson interviews Dr. Dani McVety, founder of Lap of Love, a nationwide veterinary hospice and in-home euthanasia service. In this long conversation, the veterinary hospice expert and the dog mom explore tough and important decisions dog lovers face in terrible, heart-wrenching moments. Dr. McVety offers compassionate guidance on what to expect during the euthanasia process. If you're wondering about the right time to make end-of-life decisions for your beloved dog, this episode offers comfort, understanding, and practical advice. Your Voice Matters! If you have a question for our team, or if you want to share your own hopeful dog cancer story, we want to hear from you! Go to https://www.dogcancer.com/ask to submit your question or story, or call our Listener Line at +1 808-868-3200 to leave a question. Related Videos:            The 26 signs a dog might be entering the dying process: https://www.youtube.com/watch?v=LW0DJHJGZmc Dr. Dressler's answer to when to euthanize: https://www.youtube.com/watch?v=7dj7ajAPhL0 A dog mom's perspective on euthanasia versus natural death: https://www.youtube.com/watch?v=YUXM_jMgkdI Related Links: Lap of Love Veterinary Hospice: https://www.lapoflove.com/ A great article on the signs your dog is near the end of life: https://www.dogcancer.com/articles/hospice-and-end-of-life/signs-your-dog-is-dying/ Wondering about hospice? Read this: https://www.dogcancer.com/articles/hospice-and-end-of-life/hospice-for-dogs/ Wondering about euthanasia? This article will help: https://www.dogcancer.com/articles/hospice-and-end-of-life/dog-euthanasia/ Chapters: 00:00 - Introduction 01:00 - The Birth of Lap of Love 03:30 - The Importance of Hospice for Pets 08:00 - Signs It's Time for Euthanasia 15:00 - The Role of Veterinary Hospice and Euthanasia 25:00 - Managing Emotional and Physical Burdens 35:00 - What Happens During Euthanasia 45:00 - Coping with Grief After Pet Loss 50:00 - Final Thoughts & Advice Get to know Dr. Dani McVety: https://www.dogcancer.com/people/dani-mcvety-dvm/ For more details, articles, podcast episodes, and quality education go to the episode page: https://www.dogcancer.com/podcast/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Über 15 Jahre hat Holm Dressler als Produzent und Ideengeber Thomas Gottschalk begleitet, angefangen von den Telespielen, über Na sowas!, Wetten das..? und seine RTL Plus Late Night. Kurz gefasst: Einer, der ihn wirklich kennt! Wie sieht Holm die Kontroversen, die Gottschalk erneut mit seinem Buch auslöst, seinen Auftritt im Kölner Treff und Thomas möglicher Zukunft im Streaming Geschäft?! Stefan Raab hat es vorgemacht. Das alles und noch viel mehr, aktuell und exklusiv - nur im Peckhams Talk!

Dr. Mary Gardner, co-founder of Lap of Love, explains the critical distinctions between geriatric, palliative, and hospice care for dogs. Key Topics: The difference between palliative care and hospice care. Recognizing when a dog has moved from senior to geriatric. How caregiver burden plays a role in a dog's end-of-life care. Signs of aging versus illness in dogs. The importance of managing mobility issues in older dogs. Understanding pain and how to manage it in aging and sick dogs. The role of anxiety as a form of pain in dogs. Tools and resources for tracking your dog's quality of life, including Dr. Gardner's Pet Hospice Journal and Grey Muzzle app. Resources Mentioned: Lap of Love: lapoflove.com Help 'Em Up Harness: helpemup.com Quality of Life Scales from Lap of Love: Search “Quality of Life Scale for Dogs” for various resources. Books by Dr. Mary Gardner: Never Long Enough - A book about cherishing your dog's final days. Nine Lives Are Never Enough - Coming soon, focusing on cats. The Pet Hospice Journal and Grey Muzzle App - Track your dog's symptoms, good and bad days, and mobility concerns to help monitor their quality of life. Dog Cancer Support Group: https://www.dogcancer.com/support Actionable Insights: Say "I love you" every day: Dr. Gardner reminds listeners to be present with their dogs daily, especially during their final days. Monitor your dog's quality of life: Use tools like the Pet Hospice Journal to track good and bad days, which helps with decision-making as your dog ages. Keep your dog moving: Adjust walking routines to maintain mobility, even for dogs with mobility issues. Don't skip pain medications: If your dog is prescribed pain or anti-nausea meds, be proactive in giving them, even on "good" days, to avoid pain escalation. Final Thought: Cherish every moment with your aging dog and seek veterinary care regularly, even later in life, to ensure they have the best quality of life possible. Your Voice Matters! If you have a question for our team, or if you want to share your own hopeful dog cancer story, we want to hear from you! Go to https://www.dogcancer.com/ask to submit your question or story, or call our Listener Line at +1 808-868-3200 to leave a question. Related Videos:            The 26 signs a dog is near the end of life: https://www.youtube.com/watch?v=LW0DJHJGZmc&t=9s A heartfelt discussion of choosing euthanasia versus natural death: https://www.youtube.com/watch?v=YUXM_jMgkdI Dr. Dressler's thoughts on the end of life and when we should help our dog's pass: https://www.youtube.com/watch?v=4jYoMulSRyQ Related Links: Our article about the signs a dog is dying: https://www.dogcancer.com/articles/hospice-and-end-of-life/signs-your-dog-is-dying/ Our article about hospice care: https://www.dogcancer.com/articles/hospice-and-end-of-life/hospice-for-dogs/ Get to know Dr. Mary Gardner: https://www.dogcancer.com/people/mary-gardner-dvm/   For more details, articles, podcast episodes, and quality education, go to the episode page: https://www.dogcancer.com/podcast/ Learn more about your ad choices. Visit megaphone.fm/adchoices

Football & Fahrrad, zwei Welten treffen aufeinander, oder gibt es etwa Gemeinsamkeiten? In der neusten Folge Querfeldein mit Dr. Robert Peschke, CEO Little John Bikes und Jörg Dressler, Geschäftsführer der Dresden Monarchs e.V., gehen die beiden darauf ein, was die zwei Sportarten gemeinsam haben und warum Fahrrad fahren für Footballspieler besonders gut geeignet ist.

The Green Zone with Jamie & Drew The Green Zone

Colby Dressler is a freelance writer, editor, and YouTuber. On this episode, Colby opens up about his family dynamic and relationship with his siblings. Colby explains what it was like having a brother on the autism spectrum who was mostly nonverbal and how they led him to have more compassion for others. Also, he talks about his love for sports and more specifically baseball. Colby mentions moving to Georgia for college and working towards studies in animation/art. Then, Colby discusses why he moved to Arizona during the pandemic and how he started putting more effort into YouTube. Colby shares some advice on trying to achieve success on YouTube. Join us in this authentic conversation on animation, art, and mental health. Colby's YT Channel: https://www.youtube.com/@Colby2D

I don’t care what you say, Gosling is still a liability in the defensive backfield. This week on the podcast, Brian and Darry review The Fall Guy, then talk about the new Mr. McMahon docuseries, Toxic House of the Dragon Changes, and Star Wars YouTube drama. Episode Index Intro: 0:07 Mr. McMahon: 7:47 Toxic Dragon Stuff: 12:15 Star Wars YouTube: 26:15 The Fall Guy: 46:17 News Bites Mr. McMahon Official Trailer on Netflix https://www.youtube.com/watch?v=fwKm7WM_P8E George R.R. Martin Calls Out ‘Toxic' Changes To ‘House Of The Dragon' https://www.forbes.com/sites/erikkain/2024/09/04/george-rr-martin-offers-a-grim-warning-about-house-of-the-dragon-and-toxic-changes-coming-to-seasons-3-and-4/ Star Wars YouTuber Civil War https://www.youtube.com/watch?v=UNRndtbnaek The Fall Guy (2024) Out of 10 Engaged Cores Darryl: 5.9/10 Brian: 5.88/10 Summary The Fall Guy (2024), starring Emily Blunt and Ryan Gosling, is a blend of action, comedy, and romance. The story follows Colt Seavers (Gosling), a former stuntman who has retired after a serious on-set accident that sidelined him for over a year. Emily Blunt plays Jody Moreno, Colt’s ex-girlfriend and a first-time film director. When a major actor, Tom Ryder (played by Aaron Taylor-Johnson), goes missing from Jody’s film set, Colt is brought in by producer Gail Meyer (Hannah Waddingham) to help find him. What starts as a reluctant mission for Colt evolves into a high-stakes adventure as he navigates both personal and professional challenges, including rekindling his relationship with Jody. The film, directed by David Leitch, is a tribute to stunt performers, with jaw-dropping stunts and a nostalgic nod to the 1980s TV series of the same name. It balances humor and heart with thrilling action sequences, making it a fun cinematic experience Cast Ryan Gosling as Colt Seavers, a seasoned action stuntman Emily Blunt as Jody Moreno, Colt’s ex-girlfriend and a first-time director Aaron Taylor-Johnson as Tom Ryder, a famous action film star Hannah Waddingham as Gail Meyer, the producer of Jody’s film Teresa Palmer as Iggy Starr, Tom’s girlfriend and co-star Stephanie Hsu as Alma Milan, Tom’s personal assistant Winston Duke as Dan Tucker, Colt’s long-time friend and stunt coordinator Adam Dunn as Nigel, a crew member on Jody’s film Zara Michales as Venti Kushner, the visual effects supervisor on Jody’s film Ben Knight as Dressler, Tom’s bodyguard Additionally, Lee Majors and Heather Thomas, who starred as Colt Seavers and Jody Banks respectively in the original television series, reprise their roles in a mid-credits scene with Majors credited as “The Fall Guy”, while Jason Momoa has an uncredited appearance as himself. Additionally, Justin Eaton, who is Ryan Gosling’s stunt double in real life, portrays Henry, the stunt double who is accidentally killed. Crew & Production Directed by David Leitch Written by Drew Pearce Based on The Fall Guy by Glen A. Larson Produced by Kelly McCormick David Leitch Guymon Casady Ryan Gosling Cinematography Jonathan Sela Edited by Elísabet Ronaldsdóttir Music by Dominic Lewis Production Companies 87North Productions Entertainment 360 Distributed by Universal Pictures Release dates May 3, 2024 (United States) Running time 126 minutes Country United States Budget $125 million Box office $180.5 million* * as of recording Infamous Shirts for Naked Bodies… You’ll feel “shirty” when you buy our gear from the Flying Pork Apparel Co. Contact Us The Infamous Podcast can be found wherever podcasts are found on the Interwebs, feel free to subscribe and follow along on social media. And don't be shy about helping out the show with a 5-star review on Apple Podcasts to help us move up in the ratings. @infamouspodcast facebook/infamouspodcast instagram/infamouspodcast stitcher Apple Podcasts Spotify Google Play iHeart Radio contact@infamouspodcast.com Our theme music is ‘Skate Beat’ provided by Michael Henry, with additional music provided by Michael Henry. Find more at MeetMichaelHenry.com. The Infamous Podcast is hosted by Brian Tudor and Darryl Jasper, is recorded in Cincinnati, Ohio. The show is produced and edited by Brian Tudor. Subscribe today!

Presented in partnership with Fertility and Sterility onsite at the 2024 ANZSREI meeting in Sydney, Australia.  The ANZSREI 2024 debate discussed whether patients with unexplained infertility should go straight to IVF. Experts on both sides weighed the effectiveness, cost, and psychological impact of IVF versus alternatives like IUI. The pro side emphasized IVF's high success rates and diagnostic value, while the con side argued for less invasive, cost-effective options. The debate highlighted the need for individualized care, with no clear consensus reached among the audience. View Fertility and Sterility at https://www.fertstert.org/ TRANSCRIPT: Welcome to Fertility and Sterility On Air, the podcast where you can stay current on the latest global research in the field of reproductive medicine. This podcast brings you an overview of this month's journal, in-depth discussion with authors, and other special features. F&S On Air is brought to you by Fertility and Sterility family of journals in conjunction with the American Society for Reproductive Medicine, and is hosted by Dr. Kurt Barnhart, Editor-in-Chief, Dr. Eve Feinberg, Editorial Editor, Dr. Micah Hill, Media Editor, and Dr. Pietro Bordoletto, Interactive Associate-in-Chief. I'd just like to say welcome to our third and final day of the ANZSREI conference. We've got our now traditional F&S podcast where we've got an expert panel, we've got our international speaker, Pietro, and we've got a wonderful debate ahead of us. This is all being recorded. You're welcome, and please think of questions to ask the panel at the end, because it's quite an interactive session, and we're going to get some of the best advice on some of the really controversial areas, like unexplained infertility. Hi, everyone. Welcome to the second annual Fertility and Sterility Journal Club Global, coming to you live from the Australia and New Zealand Society for Reproductive Endocrinology and Infertility meeting. I think I speak on behalf of everyone at F&S that we are so delighted to be here. Over the last two years, we've really made a concerted effort to take the podcast on the road, and this, I think, is a nice continuation of that. For the folks who are tuning in from home and listening to this podcast after the fact, the Australia and New Zealand Society for Reproductive Endocrinology is a group of over 100 certified reproductive endocrinologists across Australia and New Zealand, and this is their annual meeting live in Sydney, Australia. Today's debate is a topic that I think has vexed a lot of individuals, a lot of patients, a lot of professional groups. There's a fair amount of disagreement, and today we're going to try to unpack a little bit of unexplained infertility, and the question really is, should we be going straight to IVF? As always, we try to anchor to literature, and there are two wonderful documents in fertility and sterility that we'll be using as our guide for discussion today. The first one is a wonderful series that was published just a few months ago in the May issue, 2024, that is a views and reviews section, which means there's a series of three to five articles that kind of dig into this topic in depth. And the second article is our professional society guideline, the ASRM Committee Opinion, entitled Evidence-Based Treatments for Couples with Unexplained Infertility, a guideline. The format for today's discussion is debate style. We have a group of six experts, and I've asked them to randomly assign themselves to a pro and a con side. So I'll make the caveat here that the things that they may be saying, positions they may be trying to influence us on, are not necessarily things that they believe in their academic or clinical life, but for the purposes of a rich debate, they're going to have to be pretty deliberate in convincing us otherwise. I want to introduce my panel for today. We have on my immediate right, Dr. Raewyn Tierney. She's my co-moderator for tonight, and she's a practicing board-certified fertility specialist at IVF Australia. And on my immediate left, we have the con side. Going from left to right, Dr. Michelle Quick, practicing board-certified fertility specialist at IVF Australia. Dr. Robert LaHood, board-certified reproductive endocrinologist and clinical director of IVF Australia here in Sydney. And Dr. Clara Bothroyd, medical director at Care Fertility and the current president of the Asia Pacific Initiative in Reproduction. Welcome. On the pro side, going from right to left, I have Dr. Aurelia Liu. She is a practicing board-certified fertility specialist, medical director of Women's Health Melbourne, and clinical director at Life Fertility in Melbourne. Dr. Marcin Stankiewicz, a practicing board-certified fertility specialist and medical director at Family Fertility Centre in Adelaide. And finally, but certainly not least, the one who came with a tie this morning, Dr. Roger Hart, who is a professor of reproductive medicine at the University of Western Australia and the national medical director of City Fertility. Welcome, pro side. Thank you.  I feel naked without it. APPLAUSE I've asked both sides to prepare opening arguments. Think of this like a legal case. We want to hear from the defence, we want to hear from the plaintiffs, and I'm going to start with our pro side. I'd like to give them a few minutes to each kind of introduce their salient points for why we should be starting with IVF for patients with unexplained infertility. Thanks, Pietro. To provide a diagnosis of unexplained infertility, it's really a reflection of the degree investigation we've undertaken. I believe we all understand that unexplained infertility is diagnosed in the presence of adequate intercourse, normal semen parameters, an absence ovulatory disorder, patent fallopian tubes, and a normal detailed pelvic ultrasound examination. Now, the opposing team will try to convince you that I have not investigated the couple adequately. Personally, I'm affronted by that suggestion. But what possible causes of infertility have I not investigated? We cannot assess easily sperm fertilising capability, we cannot assess oocyte quality, oocyte fertilisation potential, embryonic development, euploidy rate, and implantation potential. Surely these causes of unexplained fertility will only become evident during an IVF cycle. As IVF is often diagnostic, it's also a therapeutic intervention. Now, I hear you cry, what about endometriosis? And I agree, what about endometriosis? Remember, we're discussing unexplained infertility here. Yes, there is very good evidence that laparoscopic treatment for symptomatic patients with endometriosis improves pelvic pain, but there is scant evidence that a diagnostic laparoscopy and treating any minor disease in the absence of pain symptoms will improve the chance of natural conception, or to that matter, improve the ultimate success of IVF. Indeed, in the absence of endometriomas, there is no negative impact on the serum AMH level in women with endometriosis who have not undergone surgery. Furthermore, there is no influence on the number of oocytes collected in an IVF cycle, the rate of embryonic aneuploidy, and the live birth rate after embryo transfer. So why put the woman through a painful, possibly expensive operation with its attendant risks as you're actually delaying her going straight to IVF? What do esteemed societies say about a diagnostic laparoscopy in the setting of unexplained infertility? The ESHRE guidelines state routine diagnostic laparoscopy is not recommended for the diagnosis of unexplained infertility. Indeed, our own ANZSREI consensus statement says that for a woman with a minimal and mild endometriosis, that the number of women needed to treat for one additional ongoing pregnancy is between 3 and 100 women with endometriosis. Is that reasonable to put an asymptomatic woman through a laparoscopy for that limited potential benefit? Now, regarding the guidelines for unexplained infertility, I agree the ASRM guidelines do not support IVF as a first-line therapy for unexplained infertility for women under 37 years of age. What they should say, and they don't, is that it is assumed that she is trying for her last child. There's no doubt if this is her last child, if it isn't her last child, sorry, she will be returning, seeking treatment, now over 37 years of age, where the guidelines do state there is good evidence that going straight to IVF may be associated with higher pregnancy rates, a shorter time to pregnancy, as opposed to other strategies. They then state it's important to note that many of these included studies were conducted in an area of low IVF success rates than those currently observed, which may alter this approach, suggesting they do not even endorse their own recommendations. The UK NICE guidelines, what do they say for unexplained infertility? Go straight to IVF. So while you're listening to my esteemed colleagues on my left speaking against the motion, I'd like to be thinking about other important factors that my colleagues on my right will discuss in more detail. Consider the superior efficacy of IVF versus IUI, the excellent safety profile of IVF and its cost-effectiveness. Further, other factors favouring a direct approach to IVF in the setting of unexplained infertility are what is the woman's desired family? We should not be focusing on her first child, we should be focusing on giving her the family that she desires and how we can minimise her inconvenience during treatment, as this has social, career and financial consequences for those impediments for her while we attempt to help her achieve her desired family. Thank you. APPLAUSE I think the young crowd would say that that was shots fired. LAUGHTER Con side? We're going to save the rebuttal for the time you've allocated to that, but first I want to put the case about unexplained infertility. Unexplained infertility in 2024 is very different to what it was 10 and 20 years ago when many of the randomised controlled trials that investigated unexplained infertility were performed. The armamentarium of investigative procedures and options that we have has changed, as indeed has our understanding of the mechanisms of infertility. So much so that that old definition of normal semen analysis, normal pelvis and ovulatory, which I think was in Roy Homburg's day, is now no longer fit for purpose as a definition of unexplained infertility. And I commend to you ICMART's very long definition of unexplained infertility, which really relies on a whole lot of things, which I'm going to now take you through what we need to do. It is said, or was said, that 30% of infertility was unexplained. I think it's way, way less than that if we actually look at our patients, both of them, carefully with history and examination and directed tests, and you will probably reduce that to about 3%. Let me take you through female age first. Now, in the old trials, some of the women recruited were as old as 42. That is not unexplained infertility. We know about oocyte aneuploidy and female ageing. 41, it's not unexplained. 40, it's not unexplained. 39, it's not unexplained. And I would put it to you that the cut-off where you start to see oocyte aneuploidy significantly constraining fertility is probably 35. So unexplained infertility has to, by definition, be a woman who is less than 35. I put that to you. Now, let's look at the male. Now, what do we know about the male, the effect of male age on fertility? We know that if the woman is over 35, and this is beautiful work that's really done many years ago in Europe, that if the woman is over 35 and the male is five years older than her, her chance of natural conception is reduced by a further 30%. So I put it to you that, therefore, the male age is relevant. And if she's 35 and has a partner who's 35 years older than her or more, it's not unexplained infertility. It's related to couple age. Now, we're going to... So that's age. Now, my colleagues are going to take you through a number of treatment interventions other than IVF, which we can do with good effect if we actually make the diagnosis and don't put them into the category of unexplained infertility. You will remember from the old trials that mild or moderate or mild or minimal endometriosis was often included, as was mild male factor or seminal fluid abnormalities. These were really multifactorial infertility, and I think that's the take-home message, that much of what we call unexplained is multifactorial. You have two minor components that act to reduce natural fecundability. So I now just want to take you through some of the diagnoses that contribute to infertility that we may not, in our routine laparoscopy and workup, we may not pick up and have previously been called unexplained infertility. For instance, we know that adenomyosis is probably one of the mechanisms by which endometriosis contributes to infertility. Chronic endometritis is now emerging as an operative factor in infertility, and that will not be diagnosed easily. Mild or minimal endometriosis, my colleagues will cover. The mid-cycle scan will lead you to the thin endometrium, which may be due to unexpected adhesive disease, but also a thin endometrium, which we know has a very adverse prognostic factor, may be due to long-term progestin contraception. We are starting to see this emerge. Secondary infertility after a caesarean section may be due to an isthma seal, and we won't recognise that unless we do mid-cycle scans. That's the female. Let's look at the male. We know now that seminal fluid analysis is not a good predictor of male fertility, and there is now evidence from Ranjith Ramasamy's work that we are missing clinical varicoceles because we failed to examine the male partner. My colleagues will talk more about that. We may miss DNA fragmentation, which again may contribute via the basic seminal fluid analysis. Now, most of these diagnoses can be made or sorted out or excluded within one or two months of your detailed assessment of both partners by history and examination. So it's not straight to IVF, ladies and gentlemen. It's just a little digression, a little lay-by, where you actually assess the patient thoroughly. She did not need a tie for that rebuttal. LAUGHTER Prasad. Thank you. Well, following from what Professor Hart has said, I'm going to show that IVF should be a go-to option because of its effectiveness, cost-effectiveness and safety. Now, let me first talk about the effectiveness, and as this is an interaction session, I would like to ask the audience, please, by show of hands, to show me how many of you would accept a medical treatment or buy a new incubator if it had a 94% chance of failure? Well, let the moderator please note that no hands have been raised. Thank you very much. Yet, the chance of live birth in Australian population following IUI is 6%, where, after IVF, the live birth is 40%. Almost seven times more. Now, why would we subject our patients to something we ourselves would not choose? Similarly, findings were reported from international studies that the hazard ratio of 1.25 favouring immediate IVF, and I will talk later about why it is important from a safety perspective. Cost-effectiveness. And I quote ESHRE guidelines. The costs, treatment options have not been subject to robust evaluations. Now, again, I would like to ask the audience, this time it's an easy question, how many of you would accept as standard an ongoing pregnancy rate of at least 38% for an average IVF cycle? Yeah, hands up. All right, I've got three-quarters of the room. OK. Well, I could really rest my case now, as we have good evidence that if a clinic has got an ongoing pregnancy rate of 38% or higher with IVF with single embryo transfer, then it is more effective, more cost-effective, and should be a treatment of choice. And that evidence comes from the authors that are sitting in this room. Again, what would the patients do? If the patients are paying for the treatment, would they do IUI? Most of them would actually go straight to IVF. And we also have very nice guidelines which advise against IUI based on cost-effectiveness. Another factor to mention briefly is the multiple births, which cost five to 20 times more than singleton. The neonatal cost of a twin birth costs about five times more than singletons, and pregnancy with delivery of triplets or more costs nearly 20 times. Now, the costs that I'm going to quote are in American dollars and from some time ago, from Fertility and Sterility. However, the total adjusted all healthcare costs for a single-dom delivery is about US$21,000, US$105,000 for twins, and US$400,000 for triplets and more. Then the very, very important is the psychological cost of the high risk of failure with IUI. Now, it is well established that infertility has a psychological impact on our patients. Studies have shown that prolonged time to conception extends stress, anxiety, and depression, and sexual functioning is significantly negatively impacted. Literature shows that 56% of women and 32% of men undergoing fertility treatment report significant symptoms of depression, and 76% of women and 61% of men report significant symptoms of anxiety. Shockingly, it is reported that 9.4% of women reported having suicidal thoughts or attempts. The longer the treatment takes, the more our patients display symptoms of distress, depression, and anxiety. Safety. Again, ESHRE guideline says the safety of treatment options have not been subjected to robust evaluation. But let me talk you through it. In our Australian expert hands, IVF is safe, with the risk of complications of ectopic being about 1 in 1,500 and other risks 1 in 3,000. However, let's think for a moment on impact of multiple births. A multiple pregnancy has significant psychological, physical, social, and financial consequences, which I can go further into details if required. I just want to mention that the stillbirth rate increases from under 1% for singleton pregnancies to 4.5% for twins and 8.3% for higher-order multiples, and that multiple pregnancies have potential long-term adverse health outcomes for the offspring, such as the increased risk of health issues through their life, increased learning difficulties, language delay, and attention and behavior problems. The lifelong disability is over 25% for babies weighing less than 1 kilogram at delivery. And please note that the quoted multiple pregnancy rates with IUI can reach up to 33%, although in expert hands it's usually around 15%, which is significantly higher than single embryo transfer. In conclusion, from the mother and child safety perspective, for the reason of medical efficacy and cost effectiveness, we have reasons to believe you should go straight to IVF. We're going to be doing these debates more often from Australia. This is a great panel. One side, please. Unexplained infertility. My colleagues were comparing IUI ovulation induction with IVF, but there are other ways of achieving pregnancies with unexplained fertility. I'm going to take the patient's perspective a little bit here. It's all about shared decision-making, so the patient needs to be involved in the decision-making. And it's quite clear from all the data that many patients with unexplained infertility will fall pregnant naturally by themselves even if you do nothing. So sometimes there's definitely a place in doing nothing, and the patient needs to be aware of that. So it's all about informed consent. How do we inform the patient? So we've got to make a proper diagnosis, as my colleague Dr. Boothright has already mentioned, and just to jump into IVF because it's cost-effective is not doing our patients a justice. The prognosis is really, really important, and even after 20 years of doing this, it's all about the duration of infertility, the age of the patient, and discussing that prognosis with the patient. We all know that patients who have been trying for longer and who are older do have a worse prognosis, and maybe they do need to look at treatment quicker, but there are many patients that we see that have a good prognosis, and just explaining that to them is all they need to achieve a pregnancy naturally. And then we're going to talk about other options. It's wrong not to offer those to patients, and my colleague Dr. Quick will talk about that in a moment. Look, we've all had patients that have been scarred by IVF who've spent a lot of money on IVF, did not fall pregnant, and I think the fact that they weren't informed properly, that the diagnosis wasn't made properly, is very frustrating to them. So to just jump into IVF again is not doing the patients a justice. And look, there are negatives to IVF. There's not just the cost to the patient, the cost to society. As taxpayers, we all pay for IVF. It's funded here, or sponsored to some degree, and it's also the family and everyone else that's involved in paying for this. So this is not a treatment that is without cost. There are some harms. We know that ovarian hyperstimulation syndrome still exists, even though it's much less than it used to be. There's a risk of infection and bleeding from the procedures. And we can look at the baby. The data still suggests that babies born from IVF are smaller and they're born earlier, and monozygotic twinning is more common with IVF, so these are high-risk pregnancies, and all this may have an impact on the long-term health of the babies somewhere down the track at the moment. That is important to still look out for. But I come back to the emotional toll. Our colleagues were saying that finishing infertility quicker helps to kind of reduce the emotional toll, but the procedure itself does have its own toll if it doesn't work, and so we've got to prepare patients, have them informed. But at the end of the day, it's all about patient choice. How can a patient make a choice if we don't make a proper diagnosis, give them a prognosis and offer them some other choices that exist? And running the anchor leg of the race for the pro side. IVF in couples with unexplained infertility is the best tool we have in our reproductive medicine toolkit for multiple reasons. Professor Hart has clarified the definition of unexplained infertility. As a reflection of the degree of investigation we've undertaken. He's explained that IVF is often importantly diagnostic as well as therapeutic, both demonstrating and overcoming barriers to natural conception. Dr Stankiewicz has convinced us that IVF is efficient, safe and cost-effective. My goal is to show you that IVF is the correct therapy to meet the immediate and big picture family planning goals for our patients with unexplained infertility. More than 80% of couples with defined unexplained infertility who attempt IVF treatment will have a baby. In Australia, ANZSREI data shows us that the average age of the female patients who present with primary unexplained infertility is over 35 years. And in fact the average is 38 years. We're all aware that the average age of first maternity in Australia has progressively become later over the past two decades. Currently it stands in the mothers and babies report at 32 years. If the average age of first maternity is 32 years, this means that at least 50% of women attempting their first pregnancy are over 32 years. Research I conducted in Melbourne University with my student Eugenie Pryor asking university students of their family planning intentions and aspirations demonstrated that most people, male and female, want to be parents and most want to have more than one child. However, in Australia, our most recent survey shows that births are at an all-time low, below replacement rate and falling, with an ever greater proportion of our population being unable to have the number of children they aspire to and an ever growing proportion seeking assisted reproductive care. Fertility declines with age. Factors include egg quality concerns, sperm quality concerns and the accumulation of pathologies over time. Adenomyosis, fibroids, endometriosis are concerns that no person is born with. They exist on a spectrum and progress over time and may be contributing factors for unexplained infertility. Our patients, when we meet them, are the best IVF candidates that they will ever be. They are the youngest they will ever be and they have the best ovarian reserve they will ever have. They will generate more euploid embryos now than they will in years to come. The sooner we get our patients pregnant, the sooner they will give birth. It takes nine months to have a baby, 12 months potentially to breastfeed and wean and of course most patients will need time to care for a young infant and recover prior to attempting another pregnancy. IVF and embryo banking may represent not only their best chance of conception with reduced time to pregnancy but also an opportunity for embryo banking to improve their cumulative live birth rate potential over time. By the time our 38-year-old patient returns to try to conceive for a second child, she will undoubtedly be aged over 40. Her chance of live birth per cycle initiated at IVF at this stage has reduced phenomenally. The ANZSREI dataset from our most recent report quotes that statistic to be 5%. Her chance of conception with an embryo frozen at 38 years, conversely, is one in three to one in four. There is no room for doubt that IVF gives couples with unexplained infertility not only the most effective treatment we have to help them have a baby, but their best opportunity to have a family. Last but certainly not least, Dr. Quick, to round out the con sides arguments before we open up for rebuttal. And I'll make a small plea that if you have questions that you'd like to pose directly to the panel, prepare them and we'll make sure we get to them from the audience shortly. Thank you. So, whilst we have heard that we may be bad doctors because we're delaying our patients' time to pregnancy, I would perhaps put it to you that unexplained infertility is a diagnosis which is made based on exclusion. So perhaps you are the bad doctors because you haven't looked hard enough for the cause of the unexplained infertility. So, in terms of the tests that we all would do, I think, we would all ensure that the woman has an ovarian reserve. We would all ensure that she has no structural anomaly inside the uterus. We would all ensure that her tubes are patent. We would all ensure that she has regular cycles. We would ensure that he has a normal semen analysis. I think these are tests that we would all do when trying to evaluate a couple for fertility who are struggling to conceive. And therefore, the chance of them getting pregnant naturally, it's never going to be zero. And one option therefore, instead of running straight to IVF, would be to say, OK, continue timed intercourse because the chance of you conceiving naturally is not actually zero and this would be the most natural way to conceive, the cheapest way to conceive, the least interventional way to conceive. And whether that be with cycle tracking to ensure appropriate timed intercourse, whether that be with cycle tracking to ensure adequate luteal phase support. When you clear the fallopian tubes, we know that there are studies showing an improvement in natural conception. Lipidol or oil-based tubal flushing techniques may also help couples to conceive naturally. And then you don't have this multiple pregnancy rate that IVF has. You don't have the cost that you incur with IVF, not just for the couple but to Australian society because IVF is subsidised in this country. You don't have the risks that the woman goes through to undergo IVF treatment. You don't have the risks that the baby takes on being conceived via IVF. And so conceiving naturally, because it's not going to be zero, is definitely an option for these couples. In terms of further tests or further investigations that you could do, some people would argue, yes, we haven't looked hard enough for the reason for infertility, therefore we know that ultrasound is notoriously bad at picking up superficial endometriosis. We know that ultrasound cannot pick up subtle changes in the endometrium, as Dr Boothroyd referred to chronic endometritis, for example. So these patients perhaps should undergo a hysteroscopy to see if there is an endometrial issue. Perhaps these patients should undergo a laparoscopy to see if there is superficial endometriosis. And there are meta-analyses showing that resecting or treating superficial endometriosis may actually help these couples conceive naturally down the track and then therefore they avoid having more interventional treatment in order to conceive. There is also intrauterine insemination with or without ovarian stimulation, which may improve their chances of conceiving naturally. And that again would be less invasive, less intervention and cheaper for the patient. And we know that therefore there are a lot of other treatment options available to help these couples to conceive. And if it's less invasive, it's more natural, it's cheaper, that ends up being better for the patient. Psychologically as well, which the other side have brought up, even with Dr Stankiewicz's 38% ongoing pregnancy rate, that also means that 62% of his patients are not going to be pregnant. The psychological impact of that cannot be underestimated because for a lot of patients, IVF is your last resort. And when you don't get pregnant with IVF, that creates an issue too for them. Embryo banking, which was also brought up, what happens when you create surplus embryos and what's the psychological impact of having to deal with embryos that you are then not going to use in the future? So therefore for those reasons we feel that IVF is not your first line treatment for couples who are diagnosed with unexplained infertility. There are many other ways to help these couples to conceive. We just have a multitude of things to unpack. And I want to start off by opening up an opportunity for rebuttal. I saw both sides of the panel here taking diligent notes. I think all of us have a full page worth of things that kind of stood out to us. Since the pro side had an opportunity to begin, I'm actually going to start with the con side and allow the con side to answer specific points made by the pro side and provide just a little bit more detail and clarity for why they think IVF is not the way forward. My learned first speaker, wearing his tie of course, indicated that it was all about laparoscopy and IUI, and it's way more than that. I just want to highlight to you the paper by Dressler in 2017 in the New England Journal of Medicine, a randomised controlled trial of what would be unexplained infertility according to the definition I put out, the less than 35 ovulatory normal semen analysis. And the intervention was an HSG with either oil-based contrast or water-based contrast. And over the six months, there was clear separation, and this is an effective treatment for unexplained infertility or mild or minimal endometriosis, however it might work. And there's probably separation out to three years. So as a single intervention, as an alternative to IVF, the use of oil-based contrast is an option. So it's not just about laparoscopy and IUI. I guess the other thing the second speaker did allude to, fairly abysmal success rates with IUI being 6%. That is a problem, and I would like to allude to a very good pragmatic trial conducted by Cindy Farquhar and Emily Lu and their co-workers in New Zealand that really swung the meta-analysis for the use of clomiphene and IUI to clinical efficacy. And they reported a 33% chance of live birth in their IUI and clomiphene arm. I'm going across to Auckland to see what the magic is in that city. What are they doing? The third speaker did allude to the problem of declining fertility, a global problem, and Australia is not alone. We have solved the problem to date, which we've had for 40 years, with immigration. But Georgina Chambers' work shows beautifully that IVF is not the answer to the falling fertility rates. It is a way more complex social problem and is probably outside the scope of today's discussion. So those are my three rebuttals to our wonderful team. Thank you very much. So... You can't bury them. We'll give them an opportunity. Thank you for the opportunity. So I'd like to address some of the points that my learned debaters on the opposition raised. The first speaker really suggested quite a few things that we probably omitted, like endometritis, failing to examine the male. I think things like that... I think, at a good history, that is essential what we do as part of our investigation. We're looking for a history of cesarean section, complications subsequent to that. We're doing a detailed scan, and that will exclude the fact that she's got a poor endometrium development, she's got a cesarean scar niche. A good history of a male will allude to the fact that he has some metabolic disorder, degree of hypogonadism. So we're not delaying anything by these appropriate investigations. Adenomyosis will be raised. I talked about a detailed gynaecological examination. So I honestly think that a very... As my opening line was, a detailed gynaecological scan, obviously with a very good history taken, is essential. We're not delaying her opportunity to go straight to IVF if we've addressed all these factors. The second speaker talked about shared decision-making, and we'd all completely agree with that. But we have to be honest and open about the success, which my second speaker talked about, the success of the treatment we're offering. And one thing we should sort of dwell on is it's all... It's a fundamental description of the success of treatment is probably all about prognostic models, and that who not model, that's the original model about the success of conception, is really... Everything flows on from that, which basically talks about a good prognosis patient. 30% chance of live birth after a year. That's what they talk about, a good prognosis patient. Perhaps the rest of the world is different to your average Australian patient, but if we talked about that being a good prognosis, you've got a one in three chance of being pregnant by a year. I think most of our patients would throttle us. So that is what all the models are sort of based on, that being a good prognosis patient. So I completely agree with the second speaker that we do have a shared decision. We have to be honest with our patients about the success. We have to be honest about giving them the prognosis of any treatment that we offer. But really, as my third speaker was talking about, it's about giving the patient the opportunity to have a family, minimal career disruption, minimal life disruption. We have to be honest and talk about the whole picture. They're focused on the first child because really they can't think beyond that. We're talking about giving them the family that they need. The third speaker spoke very eloquently about the risks associated with the treatment we offer. I believe we offer a very safe service with our IVF, particularly in Australia, with our 2% twin pregnancy rate. We talk about the higher risk of these pregnancies, but they perhaps don't relate to the treatment we're offering. Perhaps, unfortunately, is the patient, if she's got polycystic ovary syndrome, if she's more likely to have diabetes, premature delivery, preeclampsia. So I think often the risks associated with IVF and potentially the risks associated to the child born from IVF perhaps don't relate to the treatment of IVF per se. It may well be the woman and perhaps her partner, their underlying medical condition, which lead those risks. So I strongly would encourage you to believe that you take a very good history from your patient, you do a thorough investigation, as I've alluded to, looking for any signs of ovulatory disorder, any gynaecological disorder by a detailed scan, checking tubal patency and a detailed history and the similarities from the man, and then you'll find you're probably going straight to IVF. APPLAUSE I'd like to talk a bit about the embryo banking and having been in this field for a long time, as a word of caution, we're setting a lot of expectations. I remember going to an ASRM meeting probably 10 years ago where they had this headline, all your embryos in the freezer, your whole family in the freezer, basically expecting that if you get four or five embryos frozen that you'll end up with a family at the end. We all know that for the patient, they're not a percentage, it's either zero or 100%. And if all the embryos don't work, they don't have a family at the end, you know, it didn't work for them and their expectations haven't been met. And the way we talk about the percentages and that we can solve the patient's problems, that we can make families, it doesn't always happen. So the expectations our position is setting here, we're not always able to meet and so we're going to end up with very unhappy patients. So this is just a warning to everyone that we need to tell people that this doesn't always work and sometimes they'll end up with no success at all. And from that point of view, I think the way it's presented is way too simplistic and we've got to go back to looking at the other options and not promising things we can't always deliver. So just taking into account all our esteemed interlocutors have said, we don't necessarily disagree with the amount of investigations that they described because nowhere in our argument we said that as soon as the patient registers with the receptionist, they will direct it to an IVF lab. I think to imply so, we'd be very rich indeed. Maybe there are some clinics that are so efficient. I don't know how it works overseas, but certainly not in Australia. The other point that was made about the cost of IVF and our, again, esteemed interlocutors are very well aware from the studies done here in Australia that actually every baby that we have to conceive through IVF and create and lives is actually more than 10 to 100 times return on investment because we are creating future taxpayers. We are creating people that will repay the IVF treatment costs over and over and over again. So I'll put to you, Rob, that if you are saying that we can't do IVF because it costs money, you are robbing future treasurers of a huge amount of dollars. I hope the American audience is listening. In America, we call embryos unborn children in freezers in certain parts and here they're unborn taxpayers. Con side, final opportunity for rebuttal before some audience questions and one more word from the pro side. Well, actually, Dr Stankiewicz was very happy to hear that you're not going to send your patients straight to the IVF lab because we've managed to convince you that that's not the right thing to do. I clearly have forgotten how to debate because I did all my rebuttals at the end of my presentation but essentially I'll recap because when we're talking about IVF, as we're saying, the chance of pregnancy is not going to be 100% and so there is a psychological impact to IVF not working. There is a psychological impact to banking embryos and creating surplus embryos that eventually may not be used and they were my main rebuttal points in terms of why IVF was not the first-line treatment. Thank you. So we've heard from the opposition some very valid points of how our patients can be psychologically impacted when fertility treatment is unsuccessful. I will again remind you that IVF is the most successful fertility treatment we have in our treatment armoury. We are most likely to help our patients have a baby with IVF. The cumulative pregnancy rates for IVF have started back in the late 70s and early 80s in single-digit percentages. We now, with a best prognosis candidate, have at least a one-in-two chance of that patient having a baby per embryo transfer and in our patients with unexplained infertility, the vast majority of our patients will have success. We also heard from the negative team about the significant chance of pregnancy in patients with expectant management. You're right, there's not a 0% chance of natural conception in patients who have unexplained infertility, but there is a not very good chance. We know from data that we've had for a really long time, going back as far as the Hutterite data, to today's non-contradictory models, which tell us that a couple's chance of conception per month in best prognosis candidates is one in five. If they've been trying for six months, it's one in ten. If they've been trying for 12 months, it's only 5%, and if they've been trying for 24 months, it's less than 1%. So it may not be zero, but it isn't very good. In terms of our team reminding us of the extended ICMART definition of unexplained infertility, we don't argue. When we say someone has unexplained infertility, we make the assumption that they have been comprehensively diagnosed by a robust reproductive endocrinologist, as everyone in this room is. And I would say one closing rebuttal. IUI success rates have been the same for the last 50 years, whereas IVF success rates continue to improve. Why would you offer your patient a treatment from 50 years ago when you can offer them one from today? Thank you. APPLAUSE I'm going to take a personal privilege and ask the first question, in hoping that the microphone makes its way to the second question in the audience. My colleagues on the pro side have said IVF, IVF, IVF. Can you be a little bit more specific about what kind of IVF? Do you mean IVF with ICSI? Do you mean IVF, ICSI, and PGT? Be a little bit more deliberate for us and tell us exactly how the patient with unexplained infertility should receive IVF. As I said in my statement, I think it's a diagnostic evaluation. I think there is an argument to consider ICSI, but I think ICSI does have some negative consequences for children born. I think perhaps going straight to ICSI is too much. I think going straight to PGTA perhaps is too much, unless there is something in their history which should indicate that. But we're talking about unexplained infertility. So I believe a standard IVF cycle, looking at the opportunity to assess embryonic development, is the way to go. I do not think you should be going straight to ICSI. I think the principle of first do no harm is probably a safe approach. I don't know whether my colleagues have some other comments, but I think that would be the first approach rather than going all guns blazing. I can understand, though, in different settings in the world, there may have... We're very fortunate in Australia, we're very well supported from the government support for IVF, but I think the imperatives in different countries may be different. But I think that approach would be the right one first. We'll start with a question from the audience. And if you could introduce yourself and have the question allowed for our members in the audience who are not here. It's Louise Hull here from Adelaide. The question I would like to put to both the pro and con team is that Geeta Mishra from the University of Queensland showed that if you had diagnosed endometriosis before IVF, you were more likely to have a pregnancy and much less likely to have high-order IVF cycles. Given that we now have really good non-invasive diagnostics, we're actually... A lot of the time we can pick up superficial or stage 2 endometriosis if you get the right scan. We're going to do IVF better if we know about it. Can you comment on that impacting even the diagnosis of unexplained infertility? Thanks. I'd love to take that. Can I go first, Roger? LAUGHTER Please do. Look, I'd love to take that question. It's a really good question. And, of course, this is not unexplained infertility, so this is outside the scope here. And I think, really, what we're seeing now, in contrast to where we were at the time of the Markku study, which was all... And the Tulandy study on endometrioma excision, we now see that that is actually damaging to fertility, particularly where there is ovarian endometriosis, and that we compromise their ovarian reserve by doing this surgery before we preserve their fertility, be it oocyte cryopreservation or embryo cryopreservation. So I think it's a bit outside the scope of this talk, but I think the swing of the data now is that we should be doing fertility preservation before we do surgery for deeply infiltrated ovarian endometriosis. And that would fit with Gita's findings. A brief response. Thanks very much, Louise. Yeah, we're talking about unexplained infertility here, and my opening line was we need a history, but a detailed gynaecological ultrasound. I think it's important it's a really good ultrasound to exclude that, because the evidence around very minor endometriosis is not there. I agree with significant endometriosis, but that's not the subject of this discussion. But I do believe with very minimal endometriosis there is really no evidence for that. Janelle MacDonald from Sydney. I'm going to play devil's advocate here. So everyone is probably aware of the recent government inquiry about obstetric violence. I'm a little concerned that if we are perceived to be encouraging women to IVF first, are we guilty as a profession of performing fertility violence? That's just digressing a little bit, just thinking about how the consumers may perceive this. I think our patients want to have a baby, and that's why they come to see us, and that's what we help them to do through IVF. I'm not sure the microphone's working. And just introduce yourself. I'm from Sydney, Australia. Can I disagree with you, Roger, about that question about minimal and mild endometriosis? I'm 68, so I'm old enough to have read a whole lot of papers in the past that are probably seen as relics. But Mark Khoo published an unusual study, because it was actually an RCT. Well, sorry, not an RCT. It was a study whereby... Well, it was an RCT, and it was randomised really well. It was done in Canada, and there were about 350 subjects, and they were identified to have stage 1 or stage 2 endometriosis at laparoscopy. And the interesting thing is it was seen as an intervention which didn't greatly increase the chance of conception, but it doubled the monthly chance of conception. So there was clearly a difference between those patients who didn't have endometriosis and those that had stage 1 and stage 2 endometriosis. So the intervention did actually result in an improvement. One of the quotes was, well, I heard since then, well, it didn't make much difference. But when you realise that infertility is multifactorial, there were probably other factors involved as well. So any increase like that in stage 1 and stage 2 endometriosis sufferers was clearly beneficial for them. So I wouldn't disagree with you completely, but I do think you've got to take it on board that there is some evidence that surgical intervention can help. And certainly in those patients whereby the financial costs of IVF are still quite, even in Australia, astronomical. Many patients can get this through the public sector or the private sector treatment of their endometriosis laparoscopically very cheaply or at no cost. Thanks, Dr Persson. So you're right that there was also a counter-randomised controlled trial by the Grupo Italiano which was a counter to that. And actually did not show any benefit. But I believe the Marcu study demonstrated an excess of conception and with treatment of minima and endometriosis of about 4% per month for a few months. So absolutely, that shared decision-making. Personally, I wouldn't like a laparoscopy to give me an extra 4% chance of a natural conception for four months, which I think the data was. So basically, the basis to my statement that I said without going into great detail was a review article published by Samy Glarner recently in Reproductive Biology and Endocrinology. And their conclusions were what I basically said, that from looking at all the data, there is no real evidence of intervention for minor endometriosis. We're not talking about pain or significant diagnosed endometriosis on the outcomes of IVF, ovarian reserve, egg quality, embryo development, and euploidy rate. So that was the basis of my... I hate to disagree... I hate to agree with my opponents in a debate, but I'm going to... But there is actually a new network analysis by Rui Wang and some serious heavyweights in evidence-based medicine that pulls together the surgical studies. And the thing that made the most difference to this of mild and minimal endometriosis from a fertility point of view, not pain, is the use of oil-based uterine contrast. And I commend that paper to you, which fits with exactly what Roger is saying. Hi, my name's Lucy Prentice.  I work in Auckland. And I just wanted to point out the New Zealand perspective a little bit. Where we come from a country with very limited public funding for IVF. I'm currently running an RCT with Cindy Farquad directly looking at IVF versus IUI for unexplained infertility. And I'd just like to point out that both the ASRM and ESHRE guidelines, which are the most recent ones, both suggest that IUI should be a first-line treatment with oral ovarian stimulation. We have no evidence that IVF is superior based on an IPD meta-analysis published very recently and also a Cochrane review. And although we would love to be able to complete the family that our patients want from IVF and embryo banking, that option is really not available to a lot of people in New Zealand because of prohibitive costs. We know that IUI with ovarian stimulation is a very effective treatment for people with poor prognosis and unexplained infertility. And I also would just like to add that there's not a cost-effectiveness analysis that shows an improvement in cost-effectiveness for IVF. There's also never been a study looking at treatment tolerability between the two, so I don't think that you can say that IVF is a treatment that people prefer over IUI. So I may turn around and shoot myself in the foot based on our results that will be coming out next year, but I think at the moment I don't think you can say that IVF is better than IUI with ovarian stimulation for unexplained. We have time for two more questions from the audience, and we have two hands in the back. Now we can. It's the light green. OK. Hossam Zini from Melbourne. Thank you very much for the debate. It's very interesting. The problem is that all of the studies that have been done about comparing IUI to IVF, they are not head-to-head studies. The designs are different. They are having, like, algorithmic approach. For example, they compare three or four or five cycles of IUI to one cycle of IVF. But about 10 years ago, our group at the Royal Women's Hospital, we have done a study, a randomized control study, to compare IUI to IVF head-to-head, and we randomized the patients at the time of the trigger who only developed, so we did a low stimulation to get two to three follicles only, and that's why it was so hard to recruit lots of patients. So the criticism that was given to the study that it's a small sample size, but we end up with having IVF as a cost-effective treatment. Our IVF group had a live birth rate about 38%, and on the IUI, 12%. And with our cost calculations, we find out that the IVF is much more cost-effective than the IUI. But I believe that we all now believe in individualized kind of treatment, so patients probably who are younger than 34 years old probably wouldn't go straight to IVF. Maybe I'll do a laparoscopy and a histroscopy first, okay, and we may give them a chance to achieve a natural conception in the next three months or so. Patients who are older than 35, 37 years old probably will benefit straight from IVF. But again, in day-to-day life cases, we will not force the patient to go straight to IVF. I will talk to her and I'll tell her, these are your options, expectant treatment. This is the percentage that you would expect. IUI, this is what you expect. IUI with ovulation induction, this is what you expect. IVF, this is what you expect. And then she will discuss that with her partner and come back to me and tell me what she wants to do. Thanks. I saw a hand show up right next to you, so I'll add one more question given our time limitation. Thanks so much, Kate Stone-Mellon. I'd like to ask our panel to take themselves out of their role playing and put themselves in another role where they were the head of a very, very well-funded public service, and I'd like to ask the two sides what they really think about what they would do with a patient at the age of 35 with 12 months of unexplained infertility. Well, can I say that? Because that's my role in a different hat. LAUGHTER So, yeah, I run the state facility service in Western Australia. We looked at the data, because obviously that's what we're doing, IUI, IVF, and unfortunately we stopped doing IUI treatment. The success rate was so low. So we do go straight to IVF with unexplained infertility. Disappointing, as I'm sure you hear that, Kate, that we do. We looked at the data. Yeah, I think that I would still offer the patients the options, because some people don't want to do IVF. Even though it's completely free, they may not still want to do the injections and the procedure and take on the risks of the actual egg collection procedure. I don't know, religious issues with creating embryos. Yeah, I would still give patients the option. We have time for one more question in the back. We'll take the other ones offline afterwards. We'll get you a microphone just to make sure our listeners afterwards can listen. Following on from the New Zealand experience, which I've experienced... Hello? Yeah. From the New Zealand experience, and having worked here extensively and in New Zealand, you're not comparing apples with apples, Claire. That unexplained couple in New Zealand will wait five years to get funding and currently perhaps another two years to get any treatment. That's then an apples group compared to the pilot group who may, in fact, walk past the hospital and get treatment. The other thing about this, I think, that we need to forget, or don't forget, is the ethics of things here, two of which is that the whole understanding of unexplained infertility needs research and thinking. And if it wasn't for that understanding of what is the natural history of normal and then the understanding of pathology, we wouldn't do a lot of things in medicine. So if we have got a subgroup here that's unexplained, it's not just to the patient, we have a responsibility to future patients and ourselves to be honest and do research and learn about these factors. Now, it doesn't answer the debate, but it is something that's what drives the investigation and management of unexplained delay. And, for example, at the moment, there's quite a discussion about two issues of ethics, one about the involuntary childlessness of people that don't get to see us but don't have those children that they wanted to have because they didn't want to undergo treatment, or it was the involuntary childlessness of a second or subsequent child. And that's quite a big research issue in Europe, I realise, at the moment. And the final thing is about the information giving. The British case Montgomery 2015 has changed consent substantially, for those of you from England, that all information given to patients must include and document the discussion about expectant management versus all the different types of treatment, for and against and risks. And we're not currently doing that in IVF in this area, but if you read about what's happened in England, it's transformed consent in surgery. And I think a lot of our decision-making isn't in that way. So there are a couple of ethical principles to think about. Wonderful questions from the audience. Since we're coming up at the end of our time, we typically end the debate with closing remarks, but we'll forego that for this debate. And I'd actually like to just poll the audience. After hearing both the pro and the con side's arguments, by a show of hands, who in the audience believes that for the patient with unexplained infertility, as defined and detailed here broadly, should we be beginning with IVF? Should we be going straight to IVF? So by a show of hands. And I would say probably 50% of the room raised their hand. And those who think we should not be going straight to IVF? It feels like a little bit more. 40-60, now that I saw the other hands. Well, I'm going to call this a hung jury. I don't know that we have a definitive answer. Please join me in a round of applause for our panelists. In America, we would call that election interference. I wanted to thank our panelists, our live audience, and the listeners of the podcast. On behalf of Fertility and Sterility, thank you for the invitation to be here at your meeting and hosting this debate live from the Australian New Zealand Society for Reproductive Endocrinology meeting in Sydney, Australia. Thank you. This concludes our episode of Fertility and Sterility On Air, brought to you by the Fertility and Sterility family of journals in conjunction with the American Society for Reproductive Medicine. This podcast was developed by Fertility and Sterility and the American Society for Reproductive Medicine as an educational resource and service to its members and other practicing clinicians. While the podcast reflects the views of the authors and the hosts, it is not intended to be the only approved standard of living or to direct an exclusive course of treatment. The opinions expressed are those of the discussants and do not reflect Fertility and Sterility or the American Society for Reproductive Medicine.    

Kol 3, 1 – 4

Don't pass up on passing out! Stand up to syncope as Dr. Dan Dressler (Emory University) guides us to confidently manage cases! We review a framework for understanding different types of syncope, and strategies for determining which low-risk patients can be safely discharged, and appropriate next steps to work up those high-risk and in-between cases.  Claim CME for this episode at curbsiders.vcu health.org! Patreon | Episodes | Subscribe | Spotify | YouTube | Newsletter | Contact | Swag! | CME Show Segments Intro Picks of the Week Case 1: Tamara What is syncope? Categorizing Syncope Initial workup Risk scores Pulmonary embolism  Case 2: Travis Cardiac evaluation Take-home points Outro Credits Producer, Script and Show Notes: Emi Okamoto MD  Infographic and Cover Art: Caroline Coleman MD Hosts: Monee Amin MD and Meredith Trubitt MD Reviewer: Rahul Ganatra MD, MPH Showrunners: Matthew Watto MD, FACP; Paul Williams MD, FACP Technical Production: PodPaste Guest: Daniel D. Dressler, MD, MSc, MHM, FACP Sponsor: Freed You can try Freed for free right now by going to freed.ai. And listeners of Curbsiders can use code CURB50 for $50 off their first month. Sponsor: Pattern Request your disability insurance quotes with Pattern at patternlife.com/curbsiders. Sponsor: Pathway Download the Pathway app by visiting pathway.md

Dr. Alex Dressler, a professor of Classics at the University of Wisconsin - Madison, joins Lexie to discuss his favourite Roman poets and Sappho's legacy, queer theory and its relationship to Classics, and issues of politics, death, and Christianity in the ancient world. So tuck in your togas and hop aboard Trireme Transit for this week's exciting odyssey!  Don't forget to follow us on Twitter, Facebook & Instagram or visit our website www.theozymandiasproject.com! Learn more about Dr. Dressler: https://canes.wisc.edu/staff/alex-dressler/Check out his publications on Academia: https://wisc.academia.edu/AlexDressler Find his book Selections from the Poems of Paulinus of Nola: https://www.routledge.com/Selections-from-the-Poems-of-Paulinus-of-Nola-including-the-Correspondence-with-Ausonius-Introduction-Translation-and-Commentary/Dressler/p/book/9781138561359Support us on Patreon: https://www.patreon.com/TheOzymandiasProject Custom music by Brent Arehart of Arehart Sounds and edited by Dan Maday. Get exclusive bonus content (ad free episodes, early releases, and experimental content) on Patreon! Hosted on Acast. See acast.com/privacy for more information.

Henoc & Donnovan discuss all of the news coming out of training camp including what's going on in Hamilton with Bo Levi Mitchell? Now that he's retired, Henoc takes World Vision Canada's CFL ‘Team Picker' quiz to find out who he should be cheering for this season. And the guys catch up with honourary ‘Canadian Air Force' member, Weston Dressler to discuss his recent induction into the Canadian Football Hall of Fame with the Class of 2024.

We hear from one of the latest inductees into the CFL Hall of Fame, Rider Legend Weston Dressler!

Jon Dressler joins me for this episode to talk about the opening of the Fin and Fino restaurant concept at Birkdale Village. Jon was one of my first guests way back in episode 12 where we talked about his entrepreneurial journey. This episode is all about Fin and Fino, though, and I'm really excited to share our conversation with you.Fin & Fino - Birkdale Village8630 Lindholm Dr #1aHuntersville, NC 28078(704) 987-1779Special thanks to North American Properties and Birkdale VillagePhotography by: LKN Images by Kathleen MartinSupport the show

rWotD Episode 2499: Marie Dressler Welcome to random Wiki of the Day where we read the summary of a random Wikipedia page every day.The random article for Thursday, 7 March 2024 is Marie Dressler.Leila Marie Koerber (November 9, 1868 – July 28, 1934), known by her stage name Marie Dressler, was a Canadian stage and screen actress, comedian, and early silent film and Depression-era film star. After leaving home at the age of 14, Dressler built a career on stage in traveling theatre troupes, where she learned to appreciate her talent in making people laugh. In 1892, she started a career on Broadway that lasted into the 1920s, performing comedic roles that allowed her to improvise to get laughs. She soon transitioned into screen acting and made several shorts, but mostly worked in New York City on stage. During World War I, along with other celebrities, she helped sell Liberty bonds.In 1914, she played the title role in the first full-length screen comedy, Tillie's Punctured Romance (1914), opposite Charlie Chaplin and Mabel Normand. In 1919, she helped organize the first union for stage chorus players. Her career declined in the 1920s, and Dressler was reduced to living on her savings while sharing an apartment with a friend.In 1927, she returned to films at the age of 59 and experienced a remarkable string of successes. For her performance in the comedy film Min and Bill (1930), Dressler won the Academy Award for Best Actress. She died of cancer in 1934.This recording reflects the Wikipedia text as of 01:20 UTC on Thursday, 7 March 2024.For the full current version of the article, see Marie Dressler on Wikipedia.This podcast uses content from Wikipedia under the Creative Commons Attribution-ShareAlike License.Visit our archives at wikioftheday.com and subscribe to stay updated on new episodes.Follow us on Mastodon at @wikioftheday@masto.ai.Also check out Curmudgeon's Corner, a current events podcast.Until next time, I'm Brian Standard.

When Sheila Cooperman's husband said he wanted a dog, she said that was fine and good, but it would be HIS responsibility. Then she met Tucker, the Boykin Spaniel, and transformed into a full-fledged Dog Mom. When Tucker died suddenly of lymphoma last year, Sheila, a teacher with decades of experience and a literacy expert, turned to writing to help herself cope. Her “Friday posts” on social media are turning into books. Sheila's message that “writing is for everyone; you don't have to be a writer” is a refreshing one and much-needed for those who are going through a tough time. In fact, Sheila has realized recently that her grieving for Tucker has helped her to resolve her grief over losing her own mother to the same disease fifty years ago. This is truly a very special episode of Dog Cancer Answers! Join our Facebook support group at https://dogcancer.com/support Call +1 808-868-3200 to leave a question on our Listener Line for a future show! Related Videos:            Dr. Dressler's biggest signs that a dog is nearing the end of their life: https://www.youtube.com/watch?v=Ff4zmrzS0Mk Wendy Van de Poll on how to cope and prepare for your dog's death: https://www.youtube.com/watch?v=J5Bh1wIp5bY Related Links: A Tucker story reprinted with permission from Dr. Sheila Cooperman on DogCancer.com: https://www.dogcancer.com/perspectives/hospice-and-end-of-life/tucker-week-22/ Just one of the beautiful Tucker posts in our support group: https://www.facebook.com/groups/dogcancersupport/permalink/3538454839753356/ Everything-Lymphoma article on DogCancer.com: https://www.dogcancer.com/articles/types-of-dog-cancer/lymphoma-in-dogs/ A helpful perspective on how to know your dog is near the end of their life: https://www.dogcancer.com/perspectives/hospice-and-end-of-life/warning-signs-dog-is-dying/ The Dog Cancer Survival Guide: Full Spectrum Treatments to Optimize Your Dog's Life Quality & Longevity by Dr. Demian Dressler and Dr. Susan Ettinger, DVM, Dip. ACVIM (Oncology) is available everywhere books are sold and on https://dogcancerbook.com Chapters: 00:00 START 01:20 About Tucker 03:57 Discovering Tucker's Mutated B-Cell Lymphoma 07:07 Tucker's True Tail Cancer Journey 14:41 Finding the Facebook Support Group 17:25 Finding Writing After Tucker's Passing 22:25 Writing a Book 25:44 Writing as Catharsis for Everyone, Not Just “Writers” -- Get to know Sheila Cooperman, PhD: https://www.dogcancer.com/people/sheila-cooperman-phd/ For more details, articles, podcast episodes, and quality education, go to the episode page: https://www.dogcancer.com/podcast/ Learn more about your ad choices. Visit megaphone.fm/adchoices

John and Stacy discuss the aspects of writing for an animated show with Derek Dressler. Watch this episode on YouTube: https://youtu.be/YMosOY-O2o8  For more on showrunning, visit www.theshowrunnershow.com More about Derek: https://twitter.com/DeekiDeke https://www.instagram.com/deekideke/ https://www.linkedin.com/in/deekideke/ Derek Dressler, who writes under the name Deeki Deek. Deek has tons of experience working in animated TV and movies. Most recently, he was the head writer for a gorgeous Netflix series called “The Cuphead Show,” and he won a Primetime Emmy for season 1 of “Mickey Mouse” on Disney. Deek has also written for live TV and film, and we will for sure be asking him about his experience writing for the infamous indie film producers, Troma.

Discover how this cutting-edge platform is revolutionizing healthcare communication with simplified, secure, and HIPAA-compliant messaging. In this episode, Keith Dressler, the founder, chairman, director, and CEO of Rhinogram, shares insights about the cutting-edge communication platform designed to revolutionize healthcare communication and improve patient outcomes. Rhinogram's unique feature allows patients to initiate secure and convenient communication through SMS, MMS, or text, resulting in improved treatment outcomes and operational efficiencies. Throughout this conversation, Dr. Dressler emphasizes Rhinogram's use of artificial intelligence to streamline communication channels and alleviate staffing shortages and burnout. He also stresses the importance of placing patients at the center of healthcare and highlights Rhinogram's comprehensive features designed to improve patient outcomes and healthcare communication. Tune in to learn how Rhinogram puts patients at the center of healthcare by bridging communication gaps for seamless experiences between patients and providers!  Resources:  Connect with and follow Keith Dressler on LinkedIn.  Learn more about Rhinogram on their LinkedIn and website. Email Keith here.

Mit Peter Dressler, Vice President Logistics, von Infineon Technologies AG haben Andreas und Jens in der aktuellen Folge einen echten Logistikanwender zu Gast. Worum geht's in dieser Folge Irgendwas mit Logistik? - Wie funktioniert die Logistik für Halbleiter? - Wie konnte Infineon die Resilienz der Lieferkette erhöhen, um die Produktion- und Lieferfähigkeit in heraufordernden Zeiten aufrechtzuerhalten? - Hat sich der Stellenwert von Logistik in den vergangenen Jahren bei Infineon verändert? - Welche Fähigkeiten sollten Logistikmitarbeitende heutzutage mitbringen? - Welche Themen sollten Logistiker für die Zukunft auf dem Schirm haben? Hört einfach mal rein! Bezahlte Partnerschaft

Dec 10, 2023 #richcyr #reeltalk #theclawscornerOn this episode of The Claw's Corner Rich "The Claw" Cyr interviews author Mark L. Dressler. Mark is the author of the Detective Dan Shields series of mystery books and more! Purchase Mark's books online: MARK L DRESSLER | Barnes & Noble® (barnesandnoble.com) Amazon.comMark L. Dressler (facebook.com)Do not miss Rich's book, "Confessions of a Frenetic Mind" available now - https://www.amazon.com/Confessions-Frenetic-Mind-Blood-Curdling-Terror/dp/1946577103/ref=sr_1_1?keywords=Rich+Cyr&qid=1667737186&sr=8-1 Copyright 2023 The Claw's Corner - Produced by Rich Cyr https://www.facebook.com/richtheclawcyr/   Edited by Elmwood Productions - http://elmwoodproductions.com/index.html and subscribe to Elmwood Productions on YouTube: https://www.youtube.com/c/ElmwoodProductions/featuredShow some love for Elmwood!  It's your support that keeps content like this coming!  Visit our Ko-Fi Page and help keep us caffeinated! -  https://ko-fi.com/elmwoodproductions Enhanced and uploaded by Rob Bull.  For Music, Podcast, Graphic Design, and Video info Email Rob At: robbull61792@gmail.com  Also Follow and Message Him through FaceBook https://www.facebook.com/profile.php?id=100085244920212 Rob Bulls Music on youtube at https://www.youtube.com/@crackhouse2012Rob Bulls Soundcloud https://soundcloud.com/robertbullSearch Rob Bull on Spotify. 

Das Interview aus der aktuellen Folge mit: - Holm Dressler, TV-Produzent und Gottschalk-Intimus (u.a. „Wetten, dass..?“) Die reguläre Folge der "Wochentester" hören Sie ab sofort exklusiv vorab im "Wochentester-Club". Werden Sie Mitglied über Apple Podcasts, Spotify oder direkt hier über unseren Partner Steady: https://steadyhq.com/de/wochentester-club/about Fragen und Anregungen unter: - kontakt@diewochentester.de - https://facebook.com/diewochentester - http://www.diewochentester.de Informationen und Rabatte unserer Werbepartner finden Sie hier: - https://wonderl.ink/@diewochentester

Diese Themen „testen“ Wolfgang Bosbach und Christian Rach in dieser Woche: - Milliardenloch: Betreibt die Ampel organisierten Verfassungsbruch? - Gastronomie-Streik: Lässt die Regierung die Wirte im Stich? - DFB-Debakel: Fehlen der Fußballnationalelf deutsche Tugenden? Gäste: - Giovanni di Lorenzo, Journalist und Bestsellerautor „Vom Leben und anderen Zumutungen“ - Holm Dressler, TV-Produzent und Gottschalk-Intimus (u.a. „Wetten, dass..?“) Die reguläre Folge der „Wochentester“ hören Sie ab sofort exklusiv vorab im "Wochentester-Club". Werden Sie Mitglied über Apple Podcasts, Spotify oder direkt hier über unseren Partner Steady: https://steadyhq.com/de/wochentester-club/about Fragen und Anregungen unter: - kontakt@diewochentester.de - https://facebook.com/diewochentester - http://www.diewochentester.de Informationen und Rabatte unserer Werbepartner finden Sie hier: - https://wonderl.ink/@diewochentester

Die Kompakt-Ausgabe der aktuellen Folge mit: - Giovanni di Lorenzo, Journalist und Bestsellerautor „Vom Leben und anderen Zumutungen“ - Holm Dressler, TV-Produzent und Gottschalk-Intimus (u.a. „Wetten, dass..?“) Die reguläre Folge der „Wochentester“ hören Sie ab sofort exklusiv vorab im "Wochentester-Club". Werden Sie Mitglied über Apple Podcasts, Spotify oder direkt hier über unseren Partner Steady: https://steadyhq.com/de/wochentester-club/about Fragen und Anregungen unter: - kontakt@diewochentester.de - https://facebook.com/diewochentester - http://www.diewochentester.de Informationen und Rabatte unserer Werbepartner finden Sie hier: - https://wonderl.ink/@diewochentester

"Suspense" was a radio drama series that captivated audiences from 1940 through 1962 during the Golden Age of Radio. Often subtitled "radio's outstanding theater of thrills," this program was a shining example of suspense thriller entertainment. It specialized in delivering heart-pounding stories, typically featuring some of the leading Hollywood actors of its era. With an impressive total of approximately 945 episodes aired over its lengthy run, "Suspense" remains an enduring classic, with over 900 episodes still in existence. "Suspense" was a dynamic series that evolved through several significant phases, each marked by distinct hosts, sponsors, and director/producers. Despite these changes, the show maintained a core set of formulaic plot devices that kept its audience consistently engaged. The show's hallmark elements included: Ordinary Protagonists in Extraordinary Situations: The typical protagonist of a "Suspense" episode was an everyday person who found themselves abruptly thrust into a perilous, bizarre, or highly suspenseful situation. This relatable quality made it easy for listeners to connect with the characters. Withheld Solutions: The show was known for building tension by withholding the resolution of the story until the very last possible moment. This strategy ensured that listeners remained on the edge of their seats, eagerly anticipating the outcome. Moral Consequences: "Suspense" often featured stories where evildoers or wrongdoers faced justice in the end. This moral aspect added a layer of satisfaction for the audience, as justice was typically served. The combination of these elements, along with the skillful use of sound effects and music, made "Suspense" a thrilling and unforgettable radio program. It's not surprising that it continues to be celebrated for its contributions to the world of suspenseful storytelling in the audio medium. --- Support this podcast: https://podcasters.spotify.com/pod/show/dwight-allen0/support

Sometimes building a community is the best way to grow your brand. In this special episode of People Heroes Rising, William Tincup interviews Amberly Dressler VP, of Brand & Customer Marketing at isolved. They dig into the improvements of these roadshows over the years, and how isolved has been emphasizing building a strong community. They manage this with techniques like outreach activities, feedback from customers, and other improvement processes. Then, they dip into how isolved serves the role of an extension to a companies HR team, due to their efficient support and service teams. It's all about speaking the language of business to bridge the gap between HR and the C-Suite, it seems. isolved doesn't seem to stop growing, what could the future hold for an organization such as this? Listen in to learn more.Listen & Subscribe on your favorite platformApple | Spotify | Google | AmazonVisit us at RecruitingDaily for all of your recruiting, sourcing, and HR content.Follow on Twitter @RecruitingDaily Attend one of our #HRTX Events

„Fotos formen Erinnerung“, sagt Hauke Dressler. Das weiß der GEO-, Stern- und National Geographic-Fotograf aus eigener, ganz persönlicher Erfahrung. Im Gespräch mit Sabine Heinrich berichtet er von der letzten gemeinsamen Reise, die er mit seinem an Demenz erkrankten Vater unternommen hat. Es sei extrem anstrengend gewesen, aber zugleich die beste Entscheidung, die er treffen konnte. Die Tage unterwegs mit seinem kranken Vater, der einst selbst erfolgreicher Fotograf und Architekt war, hat Dressler mit der Kamera begleitet. Ursprünglich waren die Fotos nur für die Familie gedacht. Doch die Geschichte „Winterreise nach Finnland – Der Sohn ist Fotograf, der Vater dement. Das ist die Reise ihres Lebens“ wurde unter anderem im Stern veröffentlicht. Die Resonanz war überwältigend, Dressler war überrascht von dem großen Interesse: "Aber es zeigt die Wirkung der Fotografie.“ Im Podcast berichtet Dressler über seine ambivalenten Gedanken, die er beim Fotografieren hatte. Auch aus diesem Grund unterstützt er den Foto-Wettbewerb „Demenz neu sehen“. Wenn er sich seine Fotos anschaue, lasse das seinen Vater lebendig erscheinen. "Deswegen bin ich froh, auf den Auslöser gedrückt zu haben." Ein hörenswertes Gespräch mit einem Sohn, der seinen Vater verloren, aber auch viel gewonnen hat.

"Suspense" was a highly influential and acclaimed old-time radio show that aired from 1942 to 1962. It is often regarded as one of the greatest and most enduring radio drama series in the history of American radio. Created by its original director, William Spier, "Suspense" was known for its thrilling and suspenseful tales that kept listeners on the edge of their seats.Format and Content: "Suspense" primarily featured standalone episodes, each presenting a self-contained story with a focus on mystery, thriller, crime, horror, or the supernatural. The show's tagline, "Radio's Outstanding Theater of Thrills," aptly described its genre. The stories covered a wide range of themes and settings, from murder mysteries and psychological thrillers to tales of espionage and the occult.The series was known for its skilled use of tension-building techniques, dramatic music, and sound effects to create an immersive and suspenseful atmosphere. Each episode often began with a chilling introduction by the "Man in Black," played by various actors over the years, who set the stage for the upcoming story with a foreboding tone.Notable Episodes and Performers: "Suspense" featured a rotating cast of talented actors who delivered memorable performances. Many Hollywood stars appeared on the show, both in leading and supporting roles. Some notable episodes and performers include:"Sorry, Wrong Number" (1943) - Starring Agnes Moorehead, this episode is one of the most famous in the series, featuring a woman who overhears a murder plot while trying to make a phone call."The Hitch-Hiker" (1942) - Starring Orson Welles, this episode follows a man on a cross-country trip who becomes increasingly unnerved by the presence of a mysterious hitchhiker."The House in Cypress Canyon" (1946) - This episode is a chilling tale of a new homeowner who discovers a strange and horrifying secret in the walls of his house."Sorry, Wrong Number" (1943) - Starring Agnes Moorehead, this episode is one of the most famous in the series, featuring a woman who overhears a murder plot while trying to make a phone call."The House in Cypress Canyon" (1946) - This episode is a chilling tale of a new homeowner who discovers a strange and horrifying secret in the walls of his house.Legacy: "Suspense" was a groundbreaking series that set the standard for radio suspense and thriller dramas. It played a significant role in shaping the conventions of the genre and influenced subsequent generations of writers, filmmakers, and storytellers. Even today, its episodes are celebrated for their high-quality writing, acting, and production values.The show's success and enduring popularity are a testament to the enduring appeal of suspenseful storytelling in the medium of radio. It remains a classic and beloved example of the art of old-time radio drama.

Proper nutrition is a crucial part of helping pets in a shelter prepare for a better life when they are adopted. In this VetFolio Voice podcast episode, host Dr. Cassi chats with Dr. Cody Dressler about the importance of quality and consistency in foods for shelter pets, including resources for shelter feeding programs. Learn about the American Association of Shelter Veterinarians' guidelines for feeding shelter pets and hear about real-life examples that demonstrate the importance of feeding high-quality food consistently to shelter pets. Dr. Dressler and Dr. Cassi also delve into how to improve the appetite and manage the stress of animals in shelters.

Dr. Alan Dressler discusses the James Webb Space Telescope and its ability to see galaxies in the throes of birth 13 billion years ago. The telescope takes pictures of galaxies with extreme sensitivity to infrared light, allowing astronomers to explore the earliest moments of the universe. The team found that galaxies were born with explosive bursts of star formation, unlike anything seen before. New episodes of Looking Up release every other Friday!

00:00 intro 02:08 Apple VR 12:10 Watches 15:24 WSD After Barstool 24:55 Make-A-Wish 30:29 Buying a House 40:55 Aliens 50:00 NBA & NHL Finals 55:00 White Sox 01:09:16 Blackhawks Broadcast 01:21:35 Interview with Cooper Dressler 01:46:15 OutroYou can find every episode of this show on Apple Podcasts, Spotify or YouTube. Prime Members can listen ad-free on Amazon Music. For more, visit barstool.link/redlineradio

This week's host, John Arndt, is joined by Cooper Dressler to chat gearing up for the SailGP Season 3 Grand Final in San Francisco on May 6-7, 2023. Cooper is in his 2nd season on the U.S. SailGP Team. He's been sailing since he was a child and recently competed as a grinder with the 2021 America's Cup challenger, American Magic. Hear how to become a professional sailor, the aspects of sailing that got Cooper hooked from an early age, learning to sail on boats that go 50 knots, how much practice and preparation goes into training for SailGP, and how to succeed when you're racing against the clock. Learn more about the U.S. SailGP Team on social media @SailGPUSA and get tickets for the Season 3 Grand Final at https://sailgp.com/races/season-3/united-states-sail-grand-prix-san-francisco/overview/

laItay Dressler is the Co-Founder of TheGist; his previous roles include VP of Engineering at OpenWeb, as well as CTO & Co-Founder of Salaryo

In this episode, Jennifer Alleva takes on a different subject matter though no less important. She speaks with YPTC's own Jerilyn Dressler, Director of Strategic Partnerships, who co-produces this podcast and hosts the Ask the Controller segment. She recently wrote an article that was published with the National Council of Nonprofits called “A Storm is … Continue reading The Accountant Shortage Featuring Jerilyn Dressler →

Ashleyne sits down with Sydney Dressler, a transgender male and an advocate for the queer community, to talk about the obstacles that have come up as he navigates a binary world. From finding hormone treatment to buying shoes that fit, transitioning has brought up a slew of unexpected things for Sydney to deal with, and he graciously shares his story with Ashleyne. Sydney is a husband, foster parent, and School Coordinator for Indianapolis Public Schools. Sydney shares his personal journey and the obstacles he has faced coming out and openly transitioning in hopes of better educating the world around him to be a safer and more inclusive space for all.

Sierra Vista crossed the threshold into a new era of leadership last week when Clea McCaa was sworn in as the city's 21st mayor.Support the show: https://www.myheraldreview.com/site/forms/subscription_services/See omnystudio.com/listener for privacy information.

https://upmyinfluence.com/wp-content/uploads/2022/09/Dressler-Wide.png () 1325 - The Ten Year Plan with Quiet Advisory's David Dressler