Podcasts about extenders

Despite advances in epilepsy management, disparities and lack of inclusion of many people with epilepsy are associated with increased morbidity and mortality. Improving awareness and promoting diversity in research participation can advance treatment for underserved populations and improve trust. In this episode, Teshamae Monteith, MD, PhD, FAAN speaks Dave F. Clarke, MBBS, FAES, author of the article “Diversity and Underserved Patient Populations in Epilepsy,” in the Continuum® February 2025 Epilepsy issue. Dr. Monteith is a Continuum® Audio interviewer and an associate editor of Continuum® Audio and an associate professor of clinical neurology at the University of Miami Miller School of Medicine in Miami, Florida. Dr. Clarke is the Kozmetsky Family Foundation Endowed Chair of Pediatric Epilepsy and Chief or Comprehensive Pediatric Epilepsy Center, Dell Medical School at the University of Texas at Austin in Austin, Texas. Additional Resources Read the article: Diversity and Underserved Patient Populations in Epilepsy Subscribe to Continuum: shop.lww.com/Continuum Earn CME (available only to AAN members): continpub.com/AudioCME Continuum® Aloud (verbatim audio-book style recordings of articles available only to Continuum® subscribers): continpub.com/Aloud More about the American Academy of Neurology: aan.com Social Media facebook.com/continuumcme @ContinuumAAN Host: @HeadacheMD Full episode transcript available here Dr Jones: This is Dr Lyell Jones, Editor-in-Chief of Continuum, the premier topic-based neurology clinical review and CME journal from the American Academy of Neurology. Thank you for joining us on Continuum Audio, which features conversations with Continuum's guest editors and authors who are the leading experts in their fields. Subscribers to the Continuum Journal can read the full article or listen to verbatim recordings of the article and have access to exclusive interviews not featured on the podcast. Please visit the link in the episode notes for more information on the article, subscribing to the journal, and how to get CME. Dr Monteith: This is Dr Teshamae Monteith. Today I'm interviewing Dr Dave Clarke about his article on diversity and underserved patient populations in epilepsy, which appears in the February 2025 Continuum issue on epilepsy. So why don't you introduce yourself to our audience? Dr Clarke: Sure. My name is Dr Dave Clarke, as alluded to. I'm presently at the University of Texas in Austin, originating from much farther south. I'm from Antigua, but have been here for quite a while working within the field in epilepsy surgery, but more and more getting involved in outreach, access to care, and equity of healthcare in epilepsy. Dr Monteith: And how did you get involved in this kind of work? Dr Clarke: That's an amazing question. You know, I did it in a bit of a inside out fashion. I initially started working in the field and trying to get access to persons in the Caribbean that didn't have any neurological care or investigative studies, but very quickly realized that persons around the corner here in Texas and wherever I've worked have had the exact same problems, getting access via fiscal or otherwise epilepsy care, or geographically getting access, with so few having neurologists close at hand. Therefore, I started working both on a regional, national, and it transcended to a global scale. Dr Monteith: Wow, so you're just everywhere. Dr Clarke: Well, building bridges. I've found building bridges and helping with knowledge and garnering knowledge, you can expand your reach without actually moving, which is quite helpful. Dr Monteith: Yeah. So why don't you tell us why you think this work is so important in issues of diversity, underserved populations, and of course, access to epilepsy care? Dr Clarke: Sure, not a problem. And I think every vested person in this can give you a different spiel as to why they think it's important. So, I'll add in a few facts pertaining to access, but also tell you about why I think personally that it's not only important, but it will improve care for all and improve what you believe you could do for a patient. Because the sad thing is to have a good outcome in the United States presently, we have over three hundred epilepsy centers, but they have about eight or nine states that don't have any epilepsy centers at all. And even within states themselves, people have to travel up to eight hours, i.e., in Texas, to get adequate epilepsy care. So that's one layer. Even if you have a epilepsy center around the corner, independent of just long wait times, if you have a particular race or ethnicity, we've found out that wait may be even longer or you may be referred to a general practitioner moreso than being referred to an epilepsy center. Then you add in layers of insurance or lack thereof, which is a big concern regardless of who you are; poverty, which is a big concern; and the layers just keep adding more. Culture, etcetera, etcetera. If you could just break down some of those barriers, it has been shown quite a few years ago that once you get to an epilepsy center, you can negate some of those factors. You can actually reduce time to access and you can improve care. So, that's why I'm so passionate about this, because something could potentially be done about it. Dr Monteith: That's cool. So, it sounds like you have some strategies, some strategies for us. Dr Clarke: Indeed. And you know, this is a growth and this is a learning curve for me and will be for others. But I think on a very local, one-to-one scale, the initial strategy I would suggest is you have to be a good listener. Because we don't know how, when, where or why people are coming to us for their concerns. And in order to judge someone, if they may not have had a follow-up visit or they may not have gotten to us after five medications, the onus may not have been on that person. In other words, as we learned when we were in medical school, history is extremely important, but social history, cultural history, that's also just as important when we're trying to create bridges. The second major thing that we have to learn is we can't do this alone. So, without others collaborating with us outside of even our fields, the social worker who will engage, the community worker who will discuss the translator for language; unless you treat those persons with respect and engage with those persons to help you to mitigate problems, you'll not get very far. And then we'll talk about more, but the last thing I'll say now is they have so many organizations out there, the Institute of Medicine or the International League Against Epilepsy or members of the American Epilepsy Society, that have ways, ideas, papers, and articles that can help guide you as to how better mitigate many of these problems. Dr Monteith: Great. So, you already mentioned a lot of things. What are some things that you feel absolutely the reader should take away in reading your article? You mentioned already listening skills, the importance of interdisciplinary work, including social work, and that there are strategies that we can use to help reduce some of this access issues. But give me some of the essential points and then we'll dive in. Dr Clarke: OK. I think first and foremost we have to lay the foundation in my mind and realize what exactly is happening. If you are Native American, of African descent, Hispanic, Latinx, geographically not in a region where care can be delivered, choosing one time to epilepsy surgery may be delayed twice, three, four times that of someone of white descent. If you are within certain regions in the US where they may have eight, nine, ten, fourteen epilepsy centers, you may get to that center within two to three years. But if you're in an area where they have no centers at all, or you live in the Dakotas, it may be very difficult to get to an individual that could provide that care for you. That's very, very basic. But a few things have happened a few years ago and even more recently that can help. COVID created this groundswell of ambulatory engagement and ambulatory care. I think that can help to mitigate time to get into that person and improving access. In saying that, there are many obstacles to that, but that's what we have to work towards: that virtual engagement and virtual care. That would suggest in some instances to some persons that it will take away the one-to-one care that you may get with persons coming to you. But I guarantee that you will not lose patients because of this, because there's too big a vacuum. Only 22% of persons that should actually get to epilepsy centers actually get to epilepsy centers. So, I think we can start with that foundation, and you can go to the article and learn a lot more about what the problems are. Because if you don't know what the problems are, you can't come up with solutions. Dr Monteith: Just give us a few of the most persistent inequities and epilepsy care? Dr Clarke: Time to seeing a patient, very persistent. And that's both a disparity, a deficiency, and an inequity. And if you allow me, I'll just explain the slight but subtle difference. So, we know that time to surgery in epilepsy in persons that need epilepsy surgery can be as long as seventeen years. That's for everyone, so that's a deficiency in care. I just mentioned that some sociodemographic populations may not get the same care as someone else, and that's a disparity between one versus the other. Health equity, whether it be from NIH or any other definition, suggests that you should get equitable care between one person and the other. And that brings in not only medical, medicolegal or potential bias, that we may have one person versus the other. So, there's a breakdown as to those different layers that may occur. And in that I'm telling you what some of the potential differences are. Dr Monteith: And so, you mentioned, it comes up, race and ethnicity being a major issue as well as some of the geographic factors. How does that impact diagnosis and really trying to care for our patients? Dr Clarke: So again, I'm going to this article or going to, even. prior articles. It has been shown by many, and most recently in New Jersey, that if you're black, Hispanic, Latin- Latinx, it takes you greater than two times the time to surgery. Reduced time to surgery significantly increases morbidity. It potentially increases mortality, as has been shown by a colleague of mine presently in Calgary. And independent of that, we don't look at the other things, the other socially related things. Driving, inability to work, inability to be adequately educated, the stigma related to that in various cultures, various countries. So, that deficit not only increased the probability of having seizures, but we have to look at the umbrella as to what it does. It significantly impacts quality of life of that individual and, actually, the individuals around them. Dr Monteith: So, what are some of these drivers, and how can we address them, or at least identify them, in our clinic? Dr Clarke: That's a question that's rather difficult to answer. And not because there aren't ideas about it, but there's actually mitigating those ideas or changing those ideas we're just presently trying to do. Although outlines have been given. So, in about 2013, the federal government suggested outlines to improve access and to reduce these inequities. And I'll just give you a few of them. One of those suggestions was related to language and having more improved and readily available translators. Something simple, and that could actually foster discussions and time to better management. Another suggestion was try to train more persons from underserved populations, persons of color. Reason being, it has been shown in the social sciences and it is known in the medical sciences that, if you speak to a person of similar culture, you tend to have a better rapport, you tend to be more compliant, and that track would move forward, and it reduces bias. Now we don't have that presently, and I'm not sure if we'll have that in the near future, although we're trying. So then, within your centers, if you have trainings on cultural sensitivity, or if you have engagements and lectures about how you can engage persons from different populations, those are just some very simple pearls that can improve care. This has been updated several times with the then-Institute of Medicine in 2012, 2013, they came out with, in my mind, a pretty amazing article---but I'm very biased---in which they outline a number of strategic initiatives that could be taken to improve research, improve clinical care, improve health equity through health services research, to move the field forward, and to improve overall care. They updated this in 2020, and it's a part of the 2030 federal initiative not only for epilepsy, but to improve overarching care. All of this is written in bits and pieces and referenced in the article. To add icing on top, the World Health Organization, through advocacy of neurological groups as well as the International League Against Epilepsy and the AES, came out with the Intersectoral Action Plan on Epilepsy and Other Neurological Diseases, which advocates for parallel improvement in overall global care. And the United States have signed on to it, and that have lit a fire to our member organizations like the American Epilepsy Society, American Academy of Neurology, and others, trying to create initiatives to address this here. I started off by saying this was difficult because, you know, we have debated epilepsy care through 1909 when the International League against Epilepsy was founded, and we have continually come up with ways to try and advance care. But this have been the most difficult and critical because there's social dynamics and social history and societal concerns that have negated us moving forward in this direction. But fortunately, I think we're moving in that direction presently. That's my hope. And the main thing we have to do is try to sustain that. Dr Monteith: So, you talked about the importance of these global initiatives, which is huge, and other sectors outside of neurology. Like for example, technology, you spoke about telemedicine. I think you were referring to telemedicine with COVID. What other technologies that are more specific to the field of epilepsy, some of these monitorings that maybe can be done? Dr Clarke: I was just going to just going to jump on that. Thank you so much for asking. Dr Monteith: I have no disclosures in this field. I think it's important and exciting to think how can we increase access and even access to monitoring some of these technologies. That might be expensive, which is another issue, but…. Dr Clarke: So, the main things in epilepsy diagnosis and management: you want to hear from the patient history, you want to see what the seizures look like, and then you want to find ways in which to monitor those seizures. Hearing from the patient, they have these questionnaires that have been out there, and this is local, regional, global, many of them standardized in English and Spanish. Our colleagues in Boston actually created quite a neat one in English and Spanish that some people are using. Ecuador has one. We have created someone- something analogous. And those questionnaires can be sent out virtually and you can retrieve them. But sometimes seeing is believing. So, video uploads of seizures, especially the cell phone, I think has been management-changing for the field of epilepsy. The thing you have to do however, is do that in a HIPAA-compliant way. And several studies are ongoing. In my mind, one of the better studies here was done on the East Coast, but another similar study, to be unnamed, but again, written out in the articles. When you go into these apps, you can actually type in a history and upload a video, but the feed is not only going to you, it may be going to the primary care physician. So, it not only helps in one way in you educating the patient, but you educate that primary care physician and they become extenders and providers. I must add here my colleagues, because we can't do without them. Arguably in some instances, some of the most important persons to refer patients, that's the APPs, the PAs and the nurse practitioners out there, that help to refer patients and share patients with us. So, that's the video uploads they're seeing. But then the other really cool part that we're doing now is the ambulatory world of EEGs. Ceribell, Zeto, to name of few, in which you could potentially put the EEG leads on persons with or without the EEG technologist wirelessly and utilize the clouds to review the EEGs. It's not perfect just yet, but that person that has to travel eight hours away from me, if I could do that and negate that travel when they don't have money to pay for travel or they have some potential legal issues or insurance-related issues and I could read the EEG, discuss with them via telemedicine their care, it actually improves access significantly. I'm going to throw in one small twist that, again, it's not perfect. We're now trying to monitor via autonomic features, heart rate movement and others, for seizures and alert family members, parents, because although about 100,000 people may be affected with epilepsy, we're talking about 500,000 people who are also affected that are caregivers, affiliates, husbands, wives, etcetera. Just picture it: you have a child, let's say three, four years old and every time they have a seizure- or not every time, but 80% of times when they have a seizure, it alerts you via your watch or it alerts you in your room. It actually gives that child a sense of a bit more freedom. It empowers you to do something about it because you can understand here. It potentially negates significant morbidity. I won't stretch it to say SUDEP, but hopefully the time will come when actually it can prevent not only morbidity, but may prevent death. And I think that's the direction we are going in, to use technology to our benefit, but in a HIPAA-compliant way and in a judicious way in order to make sure that we not only don't overtreat, but at the end of the day, we have the patient as number one, meaning everything is vested towards that patient and do no harm. Dr Monteith: Great. One thing you had mentioned earlier was that there are even some simple approaches, efficiency approaches that we can use to try and optimize care for all in our clinics. Give me what I need to know, or do. Give me what I need to do. Dr Clarke: Yeah, I'll get personal as to what we're trying to do here, if you don't mind. The initial thing we did, we actually audited care and time to care delivery. And then we tried to figure out what we could do to improve that access and time to care, triaging, etcetera. A very, very simple thing that can be done, but you have to look at costs, is to have somebody that actually coordinates getting persons in and out of your center. If you are a neurologist that works in private practice, that could potentially be a nurse being associated directly one-and-one with one of the major centers, a third- or fourth-level center. That coordination is key. Educate your nurses about epilepsy care and what the urgent situations are because it will take away a lot of your headache and your midnight calls because they'll be able to know what to do during the day. Video uploads, as I suggested, regardless of the EMR that you have, figure out a way that a family could potentially send a video to you, because that has significantly helped in reducing investigative studies. Triaging appropriately for us to know what patients we can and cannot see. Extenders has helped me significantly, and that's where I'll end. So, as stated, they had many neurologists and epileptologists, and utilizing appropriately trained nurse practitioners or residents, engaging with them equally, and/or social workers and coordinators, are very helpful. So hopefully that's just some low-hanging fruit that can be done to improve that care. Dr Monteith: So why don't you give us some of your major takeaways to how we can improve epilepsy care for all people? Dr Clarke: I've alluded to some already, but I like counts of threes and fives. So, I think one major thing, which in my mind is a major takeaway, is cultural sensitivity. I don't think that can go too far in improving care of persons with epilepsy. The second thing is, if you see a patient that have tried to adequately use medications and they're still having seizures, please triage them. Please send them to a third- or fourth-level epilepsy center and demand that that third- or fourth-level epilepsy center communicate with you, because that patient will eventually come back and see you. The third thing---I said three---: listen to your patients. Because those patients will actually help and tell you what is needed. And I'm not only talking about listening to them medication-wise. I know we have time constraints, but if you can somehow address some of those social needs of the patients, that will also not only improve care, but negate the multiple calls that you may get from a patient. Dr Monteith: You mentioned a lot already. This is really wonderful. But what I really want to know is what you're most hopeful about. Dr Clarke: I have grandiose hopes, I'll tell you. I'll tell you that from the beginning. My hope is when we look at this in ten years and studies are done to look at equitable care, at least when it comes to race, ethnicity, insurance, we'll be able to minimize, if not end, inequitable care. Very similar to the intersectoral action plan in epilepsy by 2030. I'll tell you something that suggests, and I think it's global and definitely regional, the plan suggests that 90% of persons with epilepsy should know about their epilepsy, 80% of persons with epilepsy should be able to receive appropriate care, and 70% of persons with epilepsy should have adequately controlled epilepsy. 90, 80, 70. If we can get close to that, that would be a significant achievement in my mind. So, when I'm chilling out in my home country on a fishing boat, reading EEGs in ten years, if I can read that, that would have been an achievement that not necessarily I would have achieved, but at least hopefully I would have played a very small part in helping to achieve. That's what I think. Dr Monteith: Awesome. Dr Clarke: I appreciate you asking me that, because I've never said it like that before. In my own mind, it actually helped with clarity. Dr Monteith: I ask great questions. Dr Clarke: There you go. Dr Monteith: Thank you so much. I really- I really appreciate your passion for this area. And the work that you do it's really important, as you mentioned, on a regional, national, and certainly on a global level, important to our patients and even some very simple concepts that we may not always think about on a day-to-day basis. Dr Clarke: Oh, I appreciate it. And you know, I'm always open to ideas. So, if others, including listeners, have ideas, please don't hesitate in reaching out. Dr Monteith: I'm sure you're going to get some messages now. Dr Clarke: Awesome. Thank you so much. Dr Monteith: Thank you. I've been interviewing Dr Dave Clarke about his article on diversity and underserved patient populations in epilepsy, which appears in the most recent issue of Continuum on epilepsy. Be sure to check out Continuum Audio episodes from this and other issues. And thank you to our listeners for joining today. Dr Monteith: This is Dr Teshamae Monteith, Associate Editor of Continuum Audio. If you've enjoyed this episode, you'll love the journal, which is full of in-depth and clinically relevant information important for neurology practitioners. Use this link in the episode notes to learn more and subscribe. AAN members, you can get CME for listening to this interview by completing the evaluation at continpub.com/audioCME. Thank you for listening to Continuum Audio.

CJ delves into various aspects of men's health, particularly focusing on sexual performance and the importance of mindset. He discusses the role of epigenetics in achieving health goals, the effectiveness of modern extenders for increasing length, and the significance of recovery techniques and supplements. Throughout the conversation, he emphasizes the need for comfort and tracking progress, while also addressing the psychological aspects of pursuing personal enhancement goals.Chapters00:00 Introduction to Men's Health and Epigenetics01:27 Exploring Extenders for Length Enhancement05:46 Optimal Usage of Extenders and Recovery Techniques10:39 The Role of Supplements in Performance Enhancement16:47 Mindset and Expectations in Performance GoalsPaypal Donations: https://paypal.me/conradgr88?country.x=CA&locale.x=en_USEMAIL CJ: mhs.pcasts@gmail.comSupport the Show Click a Link BelowBelow

In this episode, we discuss what Becky and Dave are doing to prepare for their upcoming cruise!  We will review what Fish Extenders and Pixe Dust are on a cruise.  You may not expect sewing and 3D printing to be involved in preparation for a cruise, but it does for us!?  Don't feel pressure, it can look different for each person!   — Email us at: mousearsinparadise@gmail.com Website: https://www.mouseearsinparadise.com — ( 0:00 ) Intro ( 0:24 ) Preparing for our Disney Cruise - 3D printing pixie dust, sewing Fish Extenders, and more ( 22:05 ) Magical Moments

While on the campaign trail, President-elect Trump didn't just promise to extend the tax cuts he passed with the Tax Cuts and Jobs Act (TCJA) in 2017, he promised additional tax breaks for Americans. Ranging from the removal of taxes on tips and overtime for workers to reductions in corporate rates for businesses, tax legislation in the next administration will have wide-reaching effects. Our tax policy team breaks down these proposals and discusses their likelihood of inclusion in reconciliation legislation.

Summary In this conversation, CJ Rodriguez discusses his personal journey with penis enhancement, focusing on the evolution of penis extenders and their effectiveness. He shares his initial experiences with older models and contrasts them with the modern extenders available in 2025, emphasizing their comfort and engineering. Rodriguez provides recommendations for those looking to gain length, highlighting the importance of comfort and consistency in achieving results. Support the Show Click a Link BelowBelow

In this episode, Dr. Bravo and Dr. Rogu speak with Dr. Molly O'Shea, a pediatrician and owner of a holistic family practice in Michigan. They discuss the emerging field of personalized medicine in Michigan and Dr. O'Shea's journey into pediatrics. Dr. O'Shea shares her experiences, detailing her innovative practice model, including home visits and a holistic approach. She also delves into the significance of genetic screening in early childhood and her work with rare diseases. The conversation covers pediatric care's challenges and potential future, touching on the importance of mental health, the microbiome, and the evolving role of primary care in pediatrics.This episode is sponsored by our friends at Freed.ai. Without their generous contribution, the show would not be possible. Dr. Rougu uses this product daily, and as he says, "It has changed my life. I don't work anymore."   Please visit their website and support our sponsors. 00:00 Introduction and Setting the Scene00:09 Meet Dr. Molly O'Shea01:02 Dr. Molly's Journey to Pediatrics04:42 Family Influence and Childhood Challenges06:26 Resilience and Overcoming Adversity13:20 Innovative Pediatric Practice24:48 Personalized Medicine and Rare Diseases34:00 Advocacy and Future Projects37:29 The Illusion of Deleting Social Media Data38:10 Understanding Genetic Conditions: Monogenic vs Polygenic44:25 Penetrance and Its Role in Genetic Conditions51:47 Challenges in Pediatric Genetic Screening56:06 Future of Pediatrics: Personalized Medicine and Microbiome01:00:20 The Financial Struggles in Pediatric Care01:06:57 The Role of Extenders in Pediatric Practice01:12:49 Concluding Thoughts and Future MeetingsSupport the show

Marty and Eric speak about two kinds of monitor extenders they use for that second monitor while traveling. Marty's Single monitor - KYY Laptop extender - CIDETTY Eric's Single monitor - Viewsonic Laptop extender - Kefeya

Join Erik and Tage this week as they are joined by Kate and Bethany as they discuss what they would like to see on a Disney cruise, what makes Disney cruises worth their price, theire favorite excursions, and unique Fish Extender gifts. Support the podcast by going to https://www.thehubcrawl.com/support. Question 1: What would you like to see on a Disney Cruise Line ship? This could be a venue, show, character, etc. Question 2: Disney cruises have a reputation for being more expensive than other cruise lines. What is something about a Disney Cruise that you think makes it worth spending a little more?  Question 3: What kinds of excursions do you like to do on a cruise? Or do you just stay on board the whole time? Question 4: Fish Extenders: What's a unique gift you would give or have received? Bonus Question: What is your dream itinerary on a Disney Cruise?

My light is shining!!

My light is shining!!

My light is shining!!

My light is shining!!

Welcome to the 80th episode… eight zero… of the Lessons from the Cockpit show! I am your host Mark Hasara and for over 60 years my passion has been all things aviation. This is episode two with the Flight Operations Director Jamie McCarthy of Port City Air on what used to be Pease Air Force Base in Portsmouth, New Hampshire. In this episode he's going to talk about FBO planning and execution lessons learned when you have everything from big airplanes like a C-5M Galaxy to Executive Jets like Gulfstream G550 needing services at Port City Air. Every once in a while things don't go the way they're planned and Jamie tells a great story about how they obtained a massive C-5 tow bar when a Galaxy had a bleed duct failure and how to handle a fuel truck hitting a G550 winglet. The Lessons from the Cockpit show is financially supported by Wall Pilot, custom aviation art for the walls of your home, office, or hangar; these are incredibly detailed aircraft profiles printed on vinyl in four, six, and eight foot lengths you can peel off and stick on any flat surface. There are 144 ready to print aircraft profiles on the Wall Pilot homepage. Wall Pilot can also draw your favorite airplane with your name, unit, squadron, and your favorite weapons load. Just go to wallpilot.com and fill out the custom survey for your airplane. We also do unit patches, which we've found out all of our stuff is waterproof! Jamie speaks about several A-10 Warthog aircraft that come through Port City Air FBO for servicing during Large Force Exercises in Europe. This A-10 Warthog is from the Indiana Air National Guard Black Snakes squadron, the Hawg as it is called is the ground grunts best friend! While he and I were walking around the airfield several KC-135s were operating from the Pease ramp. This KC-135 is the airplane that had my name on it in the 90s while stationed with the 909th Air Refueling Squadron, Kadena Air Base in Okinawa Japan. When aircraft are deploying to Europe or the Middle East, chances are good that KC-10 Extenders are dragging them across the pond. This KC-10 is from the 60th Air Mobility Wing based at Travis Air Force Base near San Francisco California. The F-15 Eagle has always been one of my favorite airplanes! this is an F-15E from The 391st Fighter Squadron "Bold Tigers" based at Mountain Home Air Force Base, Idaho. It is carrying a Close Air Support and Battlefield Air Interdiction weapons load of GPS and laser-guided bombs with air-to-air missiles. Thanks for downloading and listening to this episode of the Lessons from the Cockpit show. We are almost at 27,000 downloads now. This and previous episodes of the Lessons from the Cockpit show can now be found on my YouTube channel @MarkHasara. I'm now posting the audio and video on my YouTube channel! I also do some pretty fantastic short videos on aviation and military subjects on my YouTube channel. You can also find all episodes of the lessons from the cockpit show on my website at www.markhasara.com Next week we'll hear from the highest scoring MiG Ace of the Vietnam War and talk to him about chasing and shooting down MiGs but also being a Fast Forward Air Controller doing Road Reconnaissance at night along the Ho Chi Minh trail. Thanks for tuning in and we'll talk to you next week on the Lessons from the Cockpit show.  

LADIES HAVE YOU EVER SCISSORED WITH A MAN? YEA I SAID A MAN!!! WAS THE WOOD SO SMALL HE SHOWED YOU A DIFFERENT SIDE TO YOUR #sexuality OR DID YOU #walk AWAY?

Welcome to the 80th episode… eight zero… of the Lessons from the Cockpit show! I am your host Mark Hasara and for over 60 years my passion has been all things aviation. This is episode two with the Flight Operations Director Jamie McCarthy of Port City Air on what used to be Pease Air Force Base in Portsmouth, New Hampshire. In this episode he's going to talk about FBO planning and execution lessons learned when you have everything from big airplanes like a C-5M Galaxy to Executive Jets like Gulfstream G550 needing services at Port City Air. Every once in a while things don't go the way they're planned and Jamie tells a great story about how they obtained a massive C-5 tow bar when a Galaxy had a bleed duct failure and how to handle a fuel truck hitting a G550 winglet. The Lessons from the Cockpit show is financially supported by Wall Pilot, custom aviation art for the walls of your home, office, or hangar; these are incredibly detailed aircraft profiles printed on vinyl in four, six, and eight foot lengths you can peel off and stick on any flat surface. There are 144 ready to print aircraft profiles on the Wall Pilot homepage. Wall Pilot can also draw your favorite airplane with your name, unit, squadron, and your favorite weapons load. Just go to wallpilot.com and fill out the custom survey for your airplane. We also do unit patches, which we've found out all of our stuff is waterproof! Jamie speaks about several A-10 Warthog aircraft that come through Port City Air FBO for servicing during Large Force Exercises in Europe. This A-10 Warthog is from the Indiana Air National Guard Black Snakes squadron, the Hawg as it is called is the ground grunts best friend! While he and I were walking around the airfield several KC-135s were operating from the Pease ramp. This KC-135 is the airplane that had my name on it in the 90s while stationed with the 909th Air Refueling Squadron, Kadena Air Base in Okinawa Japan. When aircraft are deploying to Europe or the Middle East, chances are good that KC-10 Extenders are dragging them across the pond. This KC-10 is from the 60th Air Mobility Wing based at Travis Air Force Base near San Francisco California. The F-15 Eagle has always been one of my favorite airplanes! this is an F-15E from The 391st Fighter Squadron "Bold Tigers" based at Mountain Home Air Force Base, Idaho. It is carrying a Close Air Support and Battlefield Air Interdiction weapons load of GPS and laser-guided bombs with air-to-air missiles. Thanks for downloading and listening to this episode of the Lessons from the Cockpit show. We are almost at 27,000 downloads now. This and previous episodes of the Lessons from the Cockpit show can now be found on my YouTube channel @MarkHasara. I'm now posting the audio and video on my YouTube channel! I also do some pretty fantastic short videos on aviation and military subjects on my YouTube channel. You can also find all episodes of the lessons from the cockpit show on my website at www.markhasara.com Next week we'll hear from the highest scoring MiG Ace of the Vietnam War and talk to him about chasing and shooting down MiGs but also being a Fast Forward Air Controller doing Road Reconnaissance at night along the Ho Chi Minh trail. Thanks for tuning in and we'll talk to you next week on the Lessons from the Cockpit show.  

The pros and cons of using lens extenders.   Transcript available here:  https://newyorkcityphotosafari.com

My light is shining!!

The utilization of physician extenders in the UK healthcare system has been quite controversial recently, with topics like training and validation requirements, impact on training and staffing, all bubbling to the surface. In addition, the lack of funding for physicians and residency slots has contrasted with the increasing spending on physician assistants. Dr. Ramey Assaf, resident and leader within Anesthetists United and Dr. Richard Marks, former Vice President for the Royal College of Anesthetists speak with Dr. Ludwig Lin on this topic.  

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What do a politician and a regretful camgirl have in common? Quite a lot in this day and age, where they can be one and the same. If I decided to join Chaturbate as anything other than one of the infamous "grays" who never tip, I'd definitely scratch "politician" off my list of life goals. Same goes for hosting a sex podcast, probably. I wonder, what percentage of camgirls decide later that maybe they regret the career choice. Does their feeling change depending on how successful they've been monetarily? Maybe fame makes a difference? We revisit the age-old question of whether a penis extender is a good or bad idea for a man's self esteem. We investigate yet another couple's free use arrangement. And, does wanting to have sex with a sleeping partner imply something more? We get a lot of our questions from Reddit, so for our listeners' enjoyment, here are links to some of the questions we discussed this week: https://ymmv.me/135/somnophilia https://ymmv.me/135/extender https://ymmv.me/135/free-use Twitter: @ymmvpod Facebook: ymmvpod Email: ymmvpod@gmail.com

Pastor Inho shares what it means to extend God's grace to others, which we first freely received.

Pastor Inho shares what it means to extend God's grace to others, which we first freely received.

 Krystie Lennox PA - industry trailblazer, founder of Lennox Aesthetics, and co-founder of the Aesthetic Extender Symposium - appears as this week's guest to dive into her M.O. behind developing one of the industry's most successful medical conferences tailored specifically for advancing aesthetic extenders' clinical skill sets & business acumen. Krystie also shares her start-up journey since opening the doors to her South Florida-based practice, Lennox Aesthetics, back in April 2023. Tune in to hear Krystie's journey, how she identified her niche, developing a "fresh approach to aesthetic medicine," how she retains patients, and so much more.

Twitter's rebrand is the next stage in Elon Musk's vision for the company. With Starlink, Elon Musk's satellite dominance is raising global alarms. NASA+ is the space agency's very own streaming platform. Uber's fatal self-driving car crash saga ends with the operator avoiding prison. The NSA is lobbying Congress to save a phone surveillance 'loophole'. What iPad should I upgrade to from the 6th generation iPad? How can I write a computer script to do a specific task within it? Mikah got his hands on the Bitzee toy after Dick DeBartolo showed it off in episode 1984. What's wrong with my printer? Can I isolate the iPad screen as its own video output to my streaming software? What is a good Linux OS for newer users to install on Chromebooks? Is there a way to have a backup cell provider if the power goes out in my area? What are some recommendations for a Wi-Fi extender? Is there an alternative solution to using a Wi-Fi extender? Is there an iPhone app to track my car maintenance over time? Are there external hard drives very close to Apple's internal SSD speeds that I can use without paying for more storage in a new Mac? Why should I update the firmware on my TV if I don't connect it to the internet? A caller calls in with a suggestion for the caller back in episode 1982 on re-sizing their photos in large batches using Adobe Lightroom. Hosts: Leo Laporte and Mikah Sargent Get episodes ad-free with Club TWiT at https://twit.tv/clubtwit Show notes and links for this episode are available at: https://twit.tv/shows/ask-the-tech-guys/episodes/1985 Download or subscribe to this show at: https://twit.tv/shows/ask-the-tech-guys Sponsor: cachefly.com

Twitter's rebrand is the next stage in Elon Musk's vision for the company. With Starlink, Elon Musk's satellite dominance is raising global alarms. NASA+ is the space agency's very own streaming platform. Uber's fatal self-driving car crash saga ends with the operator avoiding prison. The NSA is lobbying Congress to save a phone surveillance 'loophole'. What iPad should I upgrade to from the 6th generation iPad? How can I write a computer script to do a specific task within it? Mikah got his hands on the Bitzee toy after Dick DeBartolo showed it off in episode 1984. What's wrong with my printer? Can I isolate the iPad screen as its own video output to my streaming software? What is a good Linux OS for newer users to install on Chromebooks? Is there a way to have a backup cell provider if the power goes out in my area? What are some recommendations for a Wi-Fi extender? Is there an alternative solution to using a Wi-Fi extender? Is there an iPhone app to track my car maintenance over time? Are there external hard drives very close to Apple's internal SSD speeds that I can use without paying for more storage in a new Mac? Why should I update the firmware on my TV if I don't connect it to the internet? A caller calls in with a suggestion for the caller back in episode 1982 on re-sizing their photos in large batches using Adobe Lightroom. Hosts: Leo Laporte and Mikah Sargent Get episodes ad-free with Club TWiT at https://twit.tv/clubtwit Show notes and links for this episode are available at: https://twit.tv/shows/ask-the-tech-guys/episodes/1985 Download or subscribe to this show at: https://twit.tv/shows/ask-the-tech-guys Sponsor: cachefly.com

Discussing the House Ways and Means extenders bill-will expired business items, including R and E expensing, interest deductibility, and bonus depreciation, be extended?

In this episode of the Award-winning PRS Journal Club Podcast, 2023 Resident Ambassadors to the PRS Editorial Board – Rami Kantar, Yoshi Toyoda, and Ronnie Shammas- and special guest Kevin C. Chung, MD, MS, discuss the following articles from the May 2023 issue: “Impact of Physician Extenders and Midlevels in Plastic Surgery” by Seyidova and Lin. Read the article for FREE: https://bit.ly/PhysicianExtendersinPS Special guest Kevin C. Chung, MD, MS, who is the current Editor-in-Chief of Plastic and Reconstructive Surgery. He is a renowned hand surgeon who completed his plastic surgeon residency at the University of Michigan and hand surgery fellowship at the Curtis National Hand Center. Dr. Chung has a numerous amount of accomplishments, most notably, he is the current Chief of Hand Surgery for the University of Michigan, past President for the Plastic Surgery Foundation and the American Society for Surgery of the Hand. He has published over 730 peer-reviewed manuscripts and has maintained continuous NIH funding for over 20 years involving multiple multicentered studies evaluating outcomes in hand surgery. His work and extensive achievements in Plastic Surgery and Hand Surgery have been both recognized internationally and nationally. READ the articles discussed in this podcast as well as free related content from the archives: https://bit.ly/JCMay23Collection

In this episode of the Award-winning PRS Journal Club Podcast, 2023 Resident Ambassadors to the PRS Editorial Board – Rami Kantar, Yoshi Toyoda, and Ronnie Shammas- and special guest Kevin C. Chung, MD, MS, discuss the following articles from the May 2023 issue:   “A Systematic Review and Meta-Analysis of Nerve Gap Repair: Comparative Effectiveness of Allografts, Autografts, and Conduits” by Lans, Eberlin, Evans, et al.   “First-in-Human Free Flap Tissue Reconstruction Using a Dedicated Microsurgical Robotic Platform” by Innocenti, Malzone, and Menichini.   “Impact of Physician Extenders and Midlevels in Plastic Surgery” by Seyidova and Lin.   Special guest Kevin C. Chung, MD, MS, who is the current Editor-in-Chief of Plastic and Reconstructive Surgery. He is a renowned hand surgeon who completed his plastic surgeon residency at the University of Michigan and hand surgery fellowship at the Curtis National Hand Center. Dr. Chung has a numerous amount of accomplishments, most notably, he is the current Chief of Hand Surgery for the University of Michigan, past President for the Plastic Surgery Foundation and the American Society for Surgery of the Hand. He has published over 730 peer-reviewed manuscripts and has maintained continuous NIH funding for over 20 years involving multiple multicentered studies evaluating outcomes in hand surgery. His work and extensive achievements in Plastic Surgery and Hand Surgery have been both recognized internationally and nationally.   READ the articles discussed in this podcast as well as free related content from the archives: https://bit.ly/JCMay23Collection   #PRSJournalClub

Catching Up - Southwest Airlines/Blair Erskine - Lake Superior University Banished Words for 2023 - Things Are Going From Bad to Shit at Twitter. Thanks, Charmin!!

  Congress delivered the ambulance industry an early 2022 Christmas present when they passed an Omnibus package to extend the Extenders and put the brakes on PAYGO.  Download this important breaking news event right now!  Presenters:  Chuck Humphrey    

We are continuing our series about all things Disney Cruise Line. This week, we will be talking about all of the fun things you can do to make your cruise EXTRA- we're talking Facebook Groups, fish extenders, pixie dust, cruising ducks, beer exchanges, ornament exchanges, trick or treating and so much more. So grab your cocktail and let's get to it! MousekeMoms Podcast is sponsored by our friends at Kingdom and Cruise Travel.  They can plan your perfect luxury family getaway and are experts in Disney Destinations. Best of all, their services are 100% FREE!  Visit us on social media on Instagram at @mousekemoms_podcast or in our Facebook Group at @mousekemompodcast.  MousekeMoms Podcast is featured on the Top 100 Disney Podcasts https://blog.feedspot.com/disney_podcasts/ For a transcript of today's show, visit https://mousekemomsblog.com/

WiFi woes at home? Trouble sleeping? Our tech expert Andy O'Donoughue has you covered, as he joins Matt to discuss Wi-Fi extenders and technology for a better night's sleep. Catch the full chat by pressing the 'Play' button on this page.

This podcast episode of Nature Calls: Conversations from the Hudson Valley is perfect for the autumnal season. Extending the growing season, mums, asters, sedums and annual vines are all topics of conversation during the fall in New York. The Veggie Patch with Teresa Golden covers a wide range of options to help extend the gardening season, including cloches, row covers and hoop houses. These tips and tools may allow your garden to keep producing for a few weeks longer than if left to Mother Nature's own devices. The Cover Up with Jean Thomas and Tim Kennelty is also quite timely. Morning Glories are the featured annual vines, but this category extends to gourd and mini-pumpkin vines, scarlet running beans, and more. Sedums and Hens and Chicks are featured ground covers (and succulents) in this episode. These herbaceous perennials, commonly known as stonecrops, are great options for rock gardens and other areas that are drought prone.  Both of these vines and ground covers are low maintenance and relatively easy to grow. Linda Levitt returns with Flower Power. She discusses how to grow popular fall flowers that include Mums, Asters and Montauk Daisies. Including these beautiful plants in your flower gardens will bring lots of fall color to your landscape. Hosts: Tim Kennelty and Jean Thomas Guests: Teresa Golden and Linda Levitt Photo By: Tim Kennelty Production Support: Linda Aydlett and Teresa Golden Resources

As we look to the results of the midterm election, it appears that we will have a divided government in 2023-2024 and we will need to carefully consider the impact on our clients.  Year-end planning could include tax loss harvesting for crypto, new energy provisions and investments, Roth conversions and filling up the 22% and 24% tax bracket.  We will also need to give careful consideration to the preparation for the sunset of the Tax Cuts and Jobs Act of 2017 regarding the federal gift and estate tax exclusion.  As you approach this with your clients, conversations and plans will need to be developed in preparation for the changes happening in 2026.  In this PFP Section podcast, Bob Keebler, CPA/PFS also addresses the following: What is going to happen to SECURE 2.0? Will the EARN Act pass? Will there be an Extenders package? Will there be an update to the 10% penalty connected to a corrective distribution? Will there be a change in the required beginning date (RBD)? Will there be changes to Substantially Equal Periodic Payment (SEPP) rules? Will there be changes to the grantor trust regulations? Will the Corporate Transparency Act be passed? Access resources related to this podcast: Note: If you're using a podcast app that does not hyperlink to the resources, visit http://pfplanning.libsyn.com/ to access show notes with direct links.  Learn more about this and other year-end planning strategies at Bob Keebler's webcast on November 17th and 28th (free with CPE for PFP Section members). Find Bob's decision charts in the Proactive Planning Toolkit, exclusive to AICPA PFP Section members. This episode is brought to you by the AICPA's Personal Financial Planning Section, the premier provider of information, tools, advocacy and guidance for professionals who specialize in providing tax, estate, retirement, risk management and investment planning advice. Also, by the CPA/PFS credential program, which allows CPAs to demonstrate competence and confidence in providing these services to their clients. Visit us online at www.aicpa.org/pfp to join our community, gain access to valuable member-only benefits or learn about our PFP certificate program. Subscribe to the PFP Podcast channel at Libsyn to find all the latest episodes or search “AICPA Personal Financial Planning” on your favorite podcast app.

Discussing whether the lame-duck session will include a tax extenders bill and how party priorities may affect what's in the bill

Kyle and Dave discuss the debated existence of alternative electrified powertrains. Are PHEVs that good? What happened to range extenders? Will we see more? Questions to demystify!Find us on all of these places:YouTube: https://www.youtube.com/outofspecpodcastApple Podcasts: https://podcasts.apple.com/us/podcast/out-of-spec-podcast/id1576636119Spotify: https://open.spotify.com/show/0tKIQfKL9oaHc1DLOTWvbdAmazon: https://music.amazon.com/podcasts/473692b9-05b9-41f9-9b38-9f86fbdabee7/OUT-OF-SPEC-PODCASTFor further inquiries please email info@outofspecstudios.com Hosted on Acast. See acast.com/privacy for more information.

  ALERT- Extend the Extenders!  Once again the ambulance industry has to beg to retain important Medicare dollars.  We talk about this and sound a call to action in this latest edition of the QMC EMS Board and Collar podcast.  Download this important episode right now!!    Presenters:  Chuck Humphrey    

As the growing season winds down, there are some plants, known in the trade as season extenders, that bridge the gap between fall and winter in gardens.

Five years ago today we released our very first episode of the “Simply Tax” podcast, Talking Tax Reform with Ed Karl. Host Damien Martin takes a look at a range of current tax topics as special guest Ed Karl—VP of taxation at the American Institute of CPAs (AICPA)—returns to the podcast to cut through the static of the headlines swirling in the tax world. Here's what they discuss: A look back at five years and 150 episodes [0:00] The budget reconciliation roller coaster [05:48] Additional IRS funding and inaccurate information [10:27] IRS backlog and penalty relief [14:26] Extenders and the legislative outlook [25:07] The outlook for much needed guidance [37:46] What else Ed thinks you should watch for [39:40] New Schedules K-2 and K-3 Form 1040 virtual currency checkbox question Taxability of student loan forgiveness Aggressive Employee Retention Credit companies Tax practitioner resiliency Statement of Standards for Tax Services exposure draft Simply Thanks! @50:47 Learn more about Ed and get additional resources with the show notes to this episode comming soon  here! GET MORE SIMPLY TAX We're excited to also provide video content to strengthen your tax mind! Check it out on our YouTube channel. A complete archive of our episodes is available on our website and YouTube playlist. We'd love to hear from you! Email feedback and questions to SimplyTax@FORVIS.com.

Bryan joins Chris and Christy to cover one of our most requested episodes, that we have never done, everything you wanted to know about Fish Extenders. They cover the history behind Fish Extenders, what they are, how you can connect with a group to participate in the fun on your next cruise, favorite gifts they've … Continue reading "289 DCL 101: Fish Extenders"

Bryan joins Chris and Christy to cover one of our most requested episodes, that we have never done, everything you wanted to know about Fish Extenders. They cover the history behind Fish Extenders, what they are, how you can connect with a group to participate in the fun on your next cruise, favorite gifts they've … Continue reading "289 DCL 101: Fish Extenders"

Bryan joins Chris and Christy to cover one of our most requested episodes, that we have never done, everything you…

Experts recommend 1,000 mg of polyphenols daily! Polyphenols are the Next Most Important Nutrient Group after a Daily Multiple.

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The TopDAT hosts sit down to have a fun conversation with a great group of athletic trainers from Medstar Health and learn about the roles, responsibilities, pros, and cons of working as physician extenders. Our guests share what a typical day at work in a doctor's office is like and how it differs from our more traditional settings of the sidelines and athletic training rooms. #TopDATPodcast #AthleticTraining #ProvidingCareEverywhere #OwnYourImpact #GetDattedUp #TheStJames #d3athletictrainers #MedStarHealth #Blackpodcasts #TheUnApologeticAT #TheUpLiftAT --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

This is why there are things called seat belt EXTENDERS...   Check the links down below and join the SwoleFam today! Join The SwoleFam Download The 7 Pillars Ebook Watch The Daily Swole APPAREL - Use code "DAILYSWOLE" for 10% off Try A Swolega Class From Inside Swolenormous X Get Your Free $10 In Bitcoin   Questions? Email Us: Support@Swolenormous.com

Newspaper weed control, Peas, Season Extenders, Walls o' Water, Plant Zones, Lilacs, Peonies, Tulips, Broccoli, Remay, Hoop Tents, Starting Seeds, Heat Mats, Peppers, Gobsmacked, Marigolds, Basil, Tomatoes, Hot Peppers, Bad Plant Parenting, Egg Cartons, Eucalyptus, Helen Dillon, Buying Seeds For Other Zones, Trays, Forrest, Seeding Lettuce, Transplanting Seedlings, Long Winters, Agricultural Lime, Ash, Soil Test Kit, Manure, Roses, Epson Salt, Overwhelm, Magic, Dinner, Bacon.gardeningelated.com

This week we're gossin' 'bout the adventure of going to the furniture store, celebrity body part insurance policies, Holden's dark trumpet secrets, mailman hands, the When We Were Young Festival and its rip RWARin lineup, Daniel Radcliffe prepping to play Weird Al, Nicole Kidman responds to the feedback from her AMC ad, the rightful backflash regarding Melanie Lynskey's treatment on the set of Yellowjackets, the massive amount of tears shed to the newest season of Queer Eye, and in celeb conspiracy corner; Is the CW hiding a secretly taped gay episode of the cult show Supernatural?! Also, Jackie insures your interest with a wild list, the blinds and SHOUTZ! Want even more Page 7? Support us on Patreon! Patreon.com/Page7Podcast

This episode was made in regards to a question I received on which one is "better" I myself do not necessarily see one as superior than the other. Instead I see them as different tools which can be used for different intents/purposes depending on the situation. The brilliant thing about these devices is that now many of them now double down as both ADS and Extenders like the Phallosan/Plus, PeniMaster Pro or the TotalManShop everything kit, links are included below. ************************************************************************************************* For any inquiries, questions or for more content discussed here hit up masculinehealthsolutions.com follow MHS on Instagram @masculine.health.solutions.pe How to Make Your Penis Bigger EBOOK Check out meCOACH for 1 on 1 penis enhancement training with a plan tailored to your needs designed by PE legend Aj "Big AL" Alfaro! Looking to get started in PE check out TotalManShop hanging rig or their complete starter pack as you have all the tools you'll need and more. Use the promo code MHS2020 to get 12% off! Another great sponsor of the show is the NaturalHealthStore with products ranging from Test boosters, to Semen Increasers to my favorite the Men's Daily Pack Looking for a device that's so comfortable you can sleep in it? Then check out the PhallosanForte it aint cheap for this state of the art device at $380 USD but its well worth and has the research to back it up! Also if you are looking to get started in PE check out jelq2gain.com to learn in a class setting, and if you want to get yourself hanging be sure to use the promo code MHS10 for a sweet discount!