Podcasts about HGB

Stand Your Ground in the Raging Inferno Presenter: J. Basha, CCP, Open to Audience Participation  After two packed days, we tie it together in a fiery roundtable led by J. Basha, CCP. This isn't a sit-back session—it's a gloves-off discussion of PerfWeb 100's topics, and you're in the ring. Basha will steer us through RAPP, Hgb thresholds, ultrafiltration, and fluid balance, but your questions and challenges fuel the fire. I'll toss in tales from 40 years, like when I stood firm against a crystalloid-happy surgeon. We'll debate: Is there a perfect Hgb cutoff? When is ultrafiltration too much? It's a chance to learn from peers, experts, and your grit. Students and pros alike will sharpen their edge here. Jump into the inferno—let's forge stronger practices together.

RAPP (Retrograde Autologous Prime) Presenter: Samir Patel, MD, Graduate Perfusionist Time: 14:00–15:00 Back when I started in perfusion, priming the cardiopulmonary bypass circuit meant dumping in crystalloid and hoping the patient wouldn't drown in fluid overload. Then RAPP—Retrograde Autologous Prime—came along and flipped the script. In this session, Dr. Samir Patel, a skilled graduate perfusionist, dives into this game-changing technique that uses the patient's own blood to prime the circuit, slashing hemodilution and preserving hematocrit. Dr. Patel will walk you through the nuts and bolts: draining venous blood, displacing crystalloid, and reinfusing—all while keeping the patient stable. I'll share a standout case where RAPP saved the day for a Jehovah's Witness patient who refused transfusions—proof of its worth. You'll master cannula placement, pressure control, and timing, plus learn how RAPP cuts transfusion rates and post-op complications. Whether you're a newbie or a veteran, this lecture will sharpen your skills and show why RAPP's a must-have in my toolkit Hgb Thresholds Presenter: Samir Patel, MD, Graduate Perfusionist Time: 15:00–16:00 Hemoglobin thresholds have sparked debates for decades. Early in my career, an Hgb below 10 meant grabbing a blood bag—no questions asked. Today, we're wiser, and the evidence is richer. Dr. Samir Patel tackles this in a session that's all about balancing oxygen delivery with transfusion risks. He'll unpack the science of Hgb levels and tissue perfusion, diving into trials and guidelines that shape when we pull the transfusion trigger. I'll throw in a story of a mid-case Hgb drop to 7, where split-second decisions tested our team. We'll cover special cases—kids, the elderly, complex patients—and the risks of over- or under-transfusing. This is vital for perfusionists, surgeons, and ICU crews who live these choices daily. Walk away with a sharper eye for Hgb management, backed by Dr. Patel's expertise and my decades of real-time lessons.

In Episode 212 spricht Andy Scholz mit Wiebke Loeper, die 1990 mit 18 zu ihrer eigenen Verwunderung einen der wenigen Studienplätze für Fotografie an der Hochschule für Grafik und Buchkunst (HGB) in Leipzig bekam. Heute unterrichtet Sie Fotografie an der Fachhochschule Potsdam unter anderem mit dem Schwerpunkt Fotobuch. Wiebke Loeper wurde 1972 in Ostberlin geboren, studierte Fotografie in Leipzig an der HGB und ist Meisterschülerin von Joachim Brohm. Seit 2008 ist sie Professorin für Fotografie an der Fachhochschule in Potsdam. Sie lebt in Berlin. https://www.wiebkeloeper.de https://www.instagram.com/wiebkeloeper ​- - - Episoden-Cover-Gestaltung: Andy Scholz Episoden-Cover-Foto/Grafik: privat - - - Link zu unserem Newsletter: https://deutscherfotobuchpreis.de/newsletter/ - - - Idee, Produktion, Redaktion, Moderation, Schnitt, Ton, Musik: Andy Scholz Der Podcast ist eine Produktion von STUDIO ANDY SCHOLZ 2020-2025. Andy Scholz wurde 1971 in Varel geboren. Er studierte Philosophie und Medienwissenschaften an der Universität Düsseldorf, Kunst und Design an der HBK Braunschweig und Fotografie/Fototheorie an der Folkwang Universität der Künste in Essen. Er ist freier Künstler, Autor und Dozent. Seit 2012 unterrichtet er an verschiedenen Instituten, u.a.: Universität Regensburg, Fachhochschule Würzburg, North Dakota State University in Fargo (USA), Philipps-Universität Marburg, Ruhr Universität Bochum, Pädagogische Hochschule Ludwigsburg. 2016 wurde er berufenes Mitglied in der Deutschen Gesellschaft für Photographie (DGPh). Seit 2016 ist er künstlerischer Leiter und Kurator vom INTERNATIONALEN FESTIVAL FOTOGRAFISCHER BILDER, das er gemeinsam mit Martin Rosner gründete. Im ersten Lockdown im Juni 2020 begann er mit dem Podcast und seit 2022 ist er Organisationsleiter vom Deutschen Fotobuchpreis, der ins INTERNATIONALE FESTIVAL FOTOGRAFISCHER BILDER in Regensburg integriert wurde. Er lebt und arbeitet in Essen (Ruhrgebiet). http://fotografieneudenken.de/ https://www.instagram.com/fotografieneudenken/ https://festival-fotografischer-bilder.de/ https://www.instagram.com/festivalfotografischerbilder/ https://deutscherfotobuchpreis.de/ https://www.instagram.com/deutscher_fotobuchpreis/ http://andyscholz.com/ https://www.instagram.com/scholzandy/

Folgt uns auch bei Instagram, Threads, Mastodon und Facebook! Wir sind @heldenstadt ! Wer macht denn sowas? Der Diebstahl von Kunstwerken beim letzten HGB-Rundgang sorgt für Kopfschütteln - und Gesprächsstoff! Eure Hosts Daniel Heinze und Guido Corleone sind zurück mit einer neuen Folge von HELDENSTADT, dem Leipziger Wohnzimmerpodcast der LVZ. Wir haben wieder jede Menge interessante Geschichten aus Leipzig für Euch: Bald könnt ihr in der alten Hauptpost am Augustusplatz Kostüme kaufen. Die Stadt wird radfreundlicher, mit vielen neuen Radwegen. Zwei "Medfluencer" machen gerade mit ihren Geschichten aus dem Rettungsdienst auf Instagram und TikTok von sich reden. Wir klären, warum der Nachfolge-Club des "Instituts für Zukunft" so heißt, wie er heißt. Und dank Reddit überlegen wir, wie man die verschiedenen Stadtteile in Leipzig am besten beschreiben kann. Es ist viel los in der Stadt: Freut euch auf die Leipziger Buchmesse, die Nacht der Bibliotheken und die Konzerte von Mackefisch, Gwen Dolyn, Ghost Funk Orchestra und Rap-Legende Dendemann! Mehr Leipzig passt nicht in einer eine gute Hör-Halbestunde - viel Spaß mit dem Sondervermögen unter den Leipzig-Podcasts: „HELDENSTADT. Der LVZ-Podcast aus Leipzig mit Daniel Heinze und Guido Corleone“, Episode vom 10. März 2025.

Wenn Sie innerhalb von 3 Jahren nach der Anschaffung Ihrer Wohnimmobilie, die Wohnung renovieren, müssen Sie die 15-%-Grenze im Blick haben. Denn überschreiten die Kosten die 15 % der Anschaffungskosten des Gebäudes, können sie nicht mehr direkt abgezogen werden. Stattdessen werden sie wie das Gebäude über schlimmstenfalls 50 Jahre abgeschrieben. Wie genau funktioniert die 15-%-Grenze und welche Ausnahmen gibt es? Das erfahren Sie in dieser Folge.Hier finden Sie die gesetzlichen Grundlagen zum Nachlesen:§ 6 Abs. 1 Nr. 1a EStGBFH-Beschluss vom 28. April 2020, IX B 121/19§ 255 Abs. 2 HGB§ 82b EStDVSteuerberater gesucht? Von der Lohn- und Finanzbuchhaltung, über den Jahresabschluss und die Steuererklärungen bis hin zur Steuerberatung: Bei uns werden ausschließlich Steuerberater*innen tätig. Lernen Sie uns kennen und machen Sie künftig keine Kompromisse mehr: https://kanzlei-pfalz.de/index.html

Join the Behind the Knife Bariatric Surgery Team as they kick off 2025 with a crucial discussion on pediatric and adolescent bariatric surgery. Drs. Matt Martin, Adrian Dan and Katherine Cironi delve into the latest ASMBS guidelines, comparing long-term outcomes of gastric bypass and sleeve gastrectomy in adolescents versus adults. They explore key comorbidities, including type 2 diabetes, hypertension, and orthopedic issues, and emphasize the importance of early intervention. This episode also tackles the complex ethical considerations surrounding surgery in this vulnerable population, including consent, multidisciplinary care, and the evolving role of medical therapies like GLP-1 agonists. Show Hosts: - Matthew Martin - Adrian Dan - Katherine Cironi Learning Objectives:  ·  Identify the current ASMBS guidelines for pediatric and adolescent bariatric surgery, including BMI thresholds and associated comorbidities.  ·  Describe common comorbidities seen in the pediatric population eligible for bariatric surgery, such as type 2 diabetes, hypertension, and orthopedic issues.  ·  Compare and contrast long-term outcomes of bariatric surgery (gastric bypass and sleeve gastrectomy) in adolescents and adults, including remission rates of comorbidities and reoperation rates.  ·  Discuss the importance of a multidisciplinary approach, including psychological and ethical considerations, when evaluating adolescent patients for bariatric surgery.  ·  Explain the ethical framework used in evaluating adolescents for bariatric surgery, including consent/assent, parental involvement, and addressing potential coercion.  ·  Recognize the evolving role of medical management (e.g., GLP-1 agonists) in conjunction with or as an alternative to bariatric surgery in adolescents. Article #1: Inge 2019 – Five-year outcomes of gastric bypass in adolescents as compared with adults https://pubmed.ncbi.nlm.nih.gov/31461610/ - The cumulative effect of sustained severe obesity (BMI >35) from adolescence into adulthood increases the likelihood of diabetes, hypertension, respiratory conditions, kidney dysfunction, walking limitations, and venous edema in legs/feet (when compared to adults that did not report severe obesity in adolescence) - American Society for Metabolic and Bariatric Surgery (ASMBS) guidelines for adolescents who should be considered for bariatric surgery: BMI is ≥35 with a co-morbidity or if they have a BMI ≥40 (class 3 obesity, 140% of the 95th percentile) - This article utilizes the Teen-Longitudinal Assessment of Bariatric Surgery (TEENS LAB) and LABS (adults) databases to evaluate the outcomes of adolescents vs. adults who underwent bariatric surgery Roux-en-Y gastric bypass (2006-2009) - 161 adolescents (13-19 at the time of surgery) with severe obesity (BMI>35) vs 396 adults (25-50 years old at the time of surgery) who have remained obese (BMI>30) since adolescence  - Both groups had the gastric bypass procedure as their primary bariatric operation  - Both groups had unadjusted similar demographics, however, BMI was higher in adolescence (54) when compared to adults (51)  - Results were analyzed using linear mixed and Poisson mixed models to analyze weight and coexisting conditions - After surgery, adolescents were significantly more likely than adults to have remission of type 2 diabetes and hypertension - Increased likelihood of remission of diabetes due to the shorter duration of diabetes, lower baseline glycated Hgb, less use of medications, and increased baseline C-peptide levels  - Increased vascular stiffness in adults along with a longer duration of hypertension make the cessation of hypertension less responsive with surgery in adults  - No significant difference in percent weight changes between adolescents and adults 5 years after surgery  - Both adults and adolescent groups had decreased rates of hypertriglyceridemia and low HDL levels, albeit not significantly different when comparing the two groups  - Of note, the rate of abdominal reoperations was significantly higher among adolescents (20%) than among adults (16%) with cholecystectomy representing nearly half the procedures in both groups - Limitations - At baseline, adults had a high prevalence of both diabetes and hypertension - only 14% of adolescents had diabetes vs 31% of adults  - Only 30% of adolescents had hypertension vs 61% of adults  Article #2: Ryder 2024 – Ten-year outcomes after bariatric surgery in adolescents  https://pubmed.ncbi.nlm.nih.gov/39476348/ - The goal is to discuss the long-term durability of weight loss and remission of coexisting conditions in adolescents after bariatric surgery  - This article utilizes the Teen-Longitudinal Assessment of Bariatric Surgery (TEENS LABS) database to evaluate the 10-year outcomes in adolescents who underwent gastric bypass or sleeve gastrectomy  - 260 adolescents with an average age of 17 years old at the time of surgery (ages ranged from 13-19 years old) - 161 adolescents underwent gastric bypass, 99 adolescents underwent sleeve gastrectomy  - Results were analyzed using propensity score-adjusted linear and generalized mixed models  - At 10 years, the average BMI had decreased significantly with both groups experiencing about a 20% change in BMI on average - To assess comorbidities, both groups were analyzed together -  55% of patients who had DM2 at baseline, were in remission at 10 years - 57% of patients who had HTN at baseline, were in remission at 10 years -  54% of patients who had dyslipidemia at baseline, were in remission at 10 years - Limitations  - Neither of these studies compare surgery to medical management. GLP-1s have shown promise for weight loss management but we need more data in terms of long-term outcomes in co-morbidities like diabetes, hypertension, dyslipidemia  - Highlighted Outcomes  - Metabolic bariatric surgery is quite effective in the adolescent population  - Adolescents tend to have weight loss that is similar to that of adults and improved resolution of comorbid conditions (DM2, HTN, dyslipidemia) Article #3: Moore 2020 – Development and application of an ethical framework for pediatric metabolic and bariatric surgery evaluation https://pubmed.ncbi.nlm.nih.gov/33191162/ - The purpose of this paper is to describe the ethical framework that supports the use of metabolic & bariatric surgery (MBS) on the principle of justice, and how providers can conduct a thorough evaluation of patients presenting for these surgeries - Highlights adolescents with intellectual and developmental disabilities (IDD) and preadolescent children who pose more ethical questions before considering surgery  - This article utilizes the bariatric surgery center at one children's hospital and the institution's ethics consult service to develop an ethical framework to evaluate pediatric patients seeking bariatric surgery – using the national ASMBS guidelines  - This ethical framework utilized 4 central ethical questions 1.     Should any patients be automatically excluded from evaluation for MBS? 2.     How should it be determined that the benefits of MBS outweigh the risks? 3.     How do we ensure the patient fully understands and is capable of cooperating with the surgery and follow-up care? 4.     How do we make sure the decision to have surgery is truly voluntary, and not coerced by family or others? - Results: this ethical framework was discussed in depth in two case studies  - Overview of framework: an ethical question would arise from the bariatric team they would review & apply the ethical framework. The question is either resolved by the bariatric team OR ethics consult, continue pre-operative workup vs no surgery - Case 1: 17M (BMI 42) with a history of autism spectrum disorder, pre-DM, depression with behavior challenges, HTN, dyslipidemia. Testing at school demonstrates intellectual functioning at a fourth-grade level. Pt lives with mom and 11-year-old sister. Mom endorses food insecurity (on supplemental nutrition assistance benefits) and struggles with her son's large intake of food.  1.     Co-morbidities should not be exclusionary, but pt should undergo a comprehensive psychosocial evaluation with attention to family dynamics and support and the patient's decision-making capacity  2.     Discuss benefits vs risks. Benefits – decreased progression of DM2, HTN, hyperlipidemia, cardiometabolic dx. Risks – gastric leak, infection, bleeding, dumping syndrome, etc.  3.     Can assess decision-making capacity with the surgical team or if need be other teams. In this case, the pt had limited decision-making capacity  - His level of understanding remained stable during the pre-op visits, and he gave assent to surgery - The mom identified a second source of support (extended family) - The team talked to both the patient and mother alone and then, together, found that the patient developed an independent desire for surgery, and thus moved forward.  - Case 2: 8F (BMI 50) with a history of mod OSA, L slipped capital femoral epiphysis s/p surgical stabilization (6 mos prior). The patient is neurotypical & excels in school, and lives with mom & dad. Referred by mom & dad (mom with a recent history of sleeve gastrectomy).  1.     An 8-year-old should not be discriminated against based solely on age, but the patient should be offered more conservative/less invasive options before OR.  a.     In this case, the family had not yet been offered these nonsurgical approaches (structured weight management program, physical support, dietician) 2.     Discuss benefits vs risks. Benefits – preventing progression of hip disease, improvement of OSA, decreased risk of cardiometabolic dx. Risks – anatomic/infectious/nutrition risks  3.     Decision-making capacity was assessed. Found that the parents were more advocating for the surgery saying she has a poor quality of life physically and socially. When the patient was separated from her parents, she said she could lose weight if she had healthier foods at home and someone to exercise with. The patient had decision-making capacity & did not assent to surgery.  4.     When the ethics team interviewed the patient and parents, the parents had a strong preference toward surgery vs patient was scared of surgery and wanted to try other approaches first  a.      Decided that the child's dissent outweighed the medical necessity for surgery and that there were conservative treatment options still available to try  - Highlighted Outcomes  - ASMBS guidelines give us good direction on who qualifies for surgery and emphasize an interdisciplinary approach to decision-making. The decision to pursue surgery should always weigh the benefits and risks and should be made collaboratively with the patient, family, and care team ***SPECIALTY TEAM APPLICATION LINK: https://docs.google.com/forms/d/e/1FAIpQLSdX2a_zsiyaz-NwxKuUUa5cUFolWhOw3945ZRFoRcJR1wjZ4w/viewform?usp=sharing Please visit https://behindtheknife.org to access other high-yield surgical education podcasts, videos and more.

Unterstützt uns durch Sternchen, Likes, Glocken und Weitersagen! Ihre findet uns auch bei Instagram, Threads, Facebook und Mastodon. Wir sind @heldenstadt . . . . . . . Leipzig voll im Wahlkampfmodus: Plakate an jeder Straßenlaterne - und im Büro klicken sich alle durch den Wahl-O-Mat. Klar, dass die anstehende Bundestagswahl auch im HELDENSTADT-Podcast ein großes Thema ist. Wir, Eure Hosts Daniel Heinze und Guido Corleone, sprechen über die Demos gegen die CDU nach der Migrationsdebatte im Bundestag und die kontroversen Enthüllungen um den sächsischen BSW-Spitzenkandidaten. Ihr erfahrt, was sich dieses Mal bei der Briefwahl im Neuen Rathaus verändert hat. Und wir stellen Euch den Real-O-Mat vor, der die tatsächlichen Leistungen der Parteien analysiert statt nur Wahlversprechen! Außerdem: Aufatmen in der "Langen Lene"! Der Feuerteufel, der seit November für Ärger im Probstheidaer XXL-Wohnblock gesorgt hat, ist wohl gefasst. Ihr hört, worauf ihr beim nächsten Ostseeurlaub achten solltet (Vorsicht, giftiger Schaum!). Und wir feiern die abenteuerliche Geburt der kleinen Lola in einem Leipziger Cityflitzer. Feinste Konzert- und Ausgehtipps kriegt Ihr auch - viel Spaß beim Rundgang in der HGB und den Shows von Ankathie Koi im Naumanns und CARY im Werk II. Und damit wir in diesen aufgeregten Zeiten die gute Laune nicht verlieren, bewerfen wir Euch immer mal wieder mit flauschig-schönen Leipzig-Alltagsstorys, die wir in letzter Zeit erlebt haben. Gerade in diesen Zeiten echt wichtig. Eine informative Folge, die man sich nicht entgehen lassen sollte! So viel Leipzig passt in eine gute Hör-Halbestunde - viel Spaß mit dem TV-Duell unter den Leipzig-Podcasts: „HELDENSTADT. Der LVZ-Podcast aus Leipzig mit Daniel Heinze und Guido Corleone“, Episode vom 10. Februar 2025. Werbung: Diese Folge wird präsentiert von Augenoptik Findeisen.

Keberadaan pagar bambu di laut sekitar laut kabupaten Tangerang semakin mengundang misteri. Belum juga terungkap siapa pemiliknya dan apa motivasi pemasangan pagar, kini terungkap fakta mengejutkan lain. Wilayah laut di sekitar pagar bambu rupanya sudah dikavling-kavling dan dilengkapi dengan dokumen Hak Guna Bangunan alias HGB. Padahal aturan hukum melarang laut dikuasai dan dikavling-kavling. Bagaimana HGB bisa dikeluarkan di wilayah berupa lautan? Siapa sebenarnya pemilik puluhan kilometer pagar bambu di laut Tangerang?

Wenn es für Anna Lena von Helldorff so etwas wie ein Motto gäbe, stammte es vielleicht vom französischen Philosophen Jaques Rancière (*1940), der in seinem Buch „Der unwissende Lehrmeister“ (1987) schrieb: „Was siehst du? Was denkst du? Was machst du damit? (Und derart unendlich weiter).“ Anna Lena ist zwar 1977 in München geboren, lebt und arbeitet aber, mit Unterbrechungen, schon mehr als 20 Jahre in Leipzig. 1997 begann sie das Studium der Visuellen Kommunikation an der HdK Berlin, wechselte jedoch schon ein Jahr darauf nach Leipzig an die Hochschule für Grafik und Buchkunst (HGB); 2004 schloss sie ihr Studium in der Fachklasse Systemdesign bei Ruedi Baur ab. 2006 initiierte sie die Bürogemeinschaft buero total & kollegen, 2014 gehörte sie zu den Gründer:innen des KV – Verein für Zeitgenössische Kunst Leipzig e. V., der bereits 2019 mit dem Art Cologne Preis ausgezeichnet wurde. Seit dem Wintersemester 2023/24 arbeitet sie – back to the roots – als Professorin für Typografie an der HGB. In unserer neuen Folge sprechen wir mit Anna Lena darüber, wie es sich anfühlt, als Designerin in die Fußstapfen eines berühmten Vaters zu treten, über die Labor-Situation im Leipzig der Nullerjahre, kollaboratives Arbeiten und darüber, welche Rolle das Buch in ihrer gestalterischen Praxis spielt. Mit dabei: Die in Leipzig lebende Schriftstellerin Heike Geißler, die in diversen Projekten mit Anna Lena von Helldorff zusammengearbeitet hat. Dicker Dank wie immer an Conny Wolter (Voice), Steffen Brosig (Schnitt) und Gert Mothes (Fotos).

Folgt uns auch bei Instagram, Threads, Facebook und Mastodons! Wir sind @heldenstadt ! Das muss man sich erstmal trauen: Wochenlang hat ein Fake-Doktor in Leipzig ahnungslose Patientinnen und Patienten behandelt, und das auch noch mit der Unterstützung von Papa und Stiefmama. Aber keine Sorge, wir, eure Hosts Daniel Heinze und Guido Corleone, sind nicht auf diesen Quacksalber reingefallen und können Euch von dem Skandal erzählen - in der neuen Folge von HELDENSTADT, dem Leipziger Wohnzimmerpodcast der LVZ! Wir gehen wieder den wirklich wichtigen Fragen in Leipzig auf den Grund: Was passiert eigentlich mit den Fischen im Schwanenteich an der Oper, während die da alles sanieren? Und was kann der neue Hubschrauber von der sächsischen Polizei? Ach ja, und wo finde ich einen Miet-Weihnachtsmann für Heiligabend? Nebenbei erzählt Guido von seinen Erfahrungen als Weihnachtsmann-Darsteller und Daniel hat ein paar Kindheits-Traumata in Bezug auf Santa. Auch die Arbeit des Stadtrats ist Thema: Bleiben jetzt wirklich vier Autospuren an der Prager Straße zwischen Tabaksmühle und Friedhofsgärtnerei? Was machen die neuen Mehrheitsverhältnisse mit der Leipziger Kommunalpolitik? Und natürlich haben wir auch jede Menge Veranstaltungstipps für euch! Es ist richtig viel los: Lichtspiele des Westens auf der Karl-Heine-Straße! Wintermarkt der Hochschule für Grafik und Buchkunst! Vegan Winter Festival in den Pittlerwerken! Post-Metal von Sólstafir im Täubchenthal! Indie-Pop von Paul Weber in der Kulturlounge! Und danach wird's dank Reddit auch noch gruselig – was tun, wenn nachts das Klingeln an der Tür für Gänsehaut sorgt? Eine gute halbe Stunde Premium-Leipzig-Content zum Hören für den Weg zur Arbeit, zur Uni oder auf den Weihnachtsmarkt. Viel Spaß mit der Dampfnudel unter den Leipzig-Podcasts: „HELDENSTADT. Der LVZ-Podcast aus Leipzig mit Daniel Heinze und Guido Corleone“, Episode vom 2. Dezember 2024.

Das Vierte Bürokratieentlastungsgesetz (BEG IV), das am 26. September 2024 vom Bundestag verabschiedet wurde, bringt umfangreiche Änderungen zur Reduzierung bürokratischer Lasten in verschiedenen Bereichen des Steuer-, Handels- und Zivilrechts. Im Steuer- und Handelsrecht wurde die Aufbewahrungsfrist für Buchungsbelege von 10 auf 8 Jahre verkürzt (§ 147 Abs. 3 AO, § 257 Abs. 4 HGB). Dies gilt rückwirkend für alle Unterlagen, deren Frist bei Verkündung des Gesetzes noch nicht abgelaufen ist. Auch die umsatzsteuerliche Aufbewahrungsfrist für Rechnungen in § 14b Abs. 1 Satz 1 UStG wurde angepasst. Von der Bürgerbewegung Finanzwende wurde die Verkürzung der Aufbewahrungsfristen scharf kritisiert. Insbesondere bei komplexen Steuerdelikten wie Cum-Ex- und Cum-Cum-Geschäften könnten Beweismittel verloren gehen. Daraufhin wurde eine Sonderregelung eingeführt, um die Verkürzung der Aufbewahrungsfristen für Unternehmen, die der BaFin-Aufsicht unterliegen, um ein Jahr zu verzögern. Bemerkenswert ist hier auch, dass die strafrechtlichen Verjährungsfristen unberührt bleiben und somit ggf. nach 10 Jahren ein Strafverfahren eröffnet werden könnte, auch wenn die Aufbewahrungsfrist für die Unterlagen schon abgelaufen ist. Im Bereich der Bekanntgabe von Steuerbescheiden bringt § 122a Abs. 1 AO eine wichtige Neuerung. Ab dem 1. Januar 2026 ist keine ausdrückliche Einwilligung des Empfängers für die elektronische Bereitstellung von Verwaltungsakten mehr erforderlich. Stattdessen wird eine Widerspruchslösung eingeführt. Ein Verwaltungsakt gilt dann am vierten Tag nach Bereitstellung als zugestellt, auch wenn er auf dem elektronischen Weg übermittelt wurde. Im Umsatzsteuerrecht wurden die Schwellenwerte für die Pflicht zur monatlichen Umsatzsteuer-Voranmeldung von 7.500 EUR auf 9.000 EUR Umsatz angehoben (§ 18 Abs. 2 UStG). Zudem wurde die Bagatellgrenze bei der Differenzbesteuerung nach § 25a Abs. 4 UStG von 500 EUR auf 750 EUR erhöht, um Wiederverkäufer zu entlasten. Auch in anderen Gesetzen wurden mehrere Änderungen vorgenommen. Die Aufhebung des Schriftformerfordernisses in bestimmten Fällen erlaubt es, Gewerberaum-Mietverträge und Arbeitsverträge künftig in Textform (z.B. per E-Mail) abzuschließen. Ausnahmen bestehen weiterhin in Branchen, die besonders von Schwarzarbeit und illegaler Beschäftigung betroffen sind, wo der Nachweis in Papierform erforderlich bleibt. Weitere Erleichterungen umfassen die Möglichkeit, öffentliche Versteigerungen künftig online oder in hybrider Form durchzuführen. Zudem entfällt die Meldepflicht bei touristischen Übernachtungen.

 A 60 year old man presents with a chief complaint of a 6 month history of increasing fatigue despite adequate rest and sleep. He denies chest pain or difficulty breathing, and reports he is a non smoker. Concurrent history includes a 25 year history of alcohol used disorder, with daily intake of 5-7, occasionally more, 1.5 oz shots of whiskey, and chronic poor nutrition, reporting, “I eat chips and crackers a lot, I do not have the time to make a meal and I cannot afford to eat out. He is currently employed as a warehouse working, and states, “I get to work every day. The booze is really not  problem.”  On physical exam, mild pharyngeal redness without exudate, conjunctival pallor, and epigastric tenderness are present. The following lab results are noted.Hgb = 9 g/dL (normal 14 to 16 g/dL)Hct = 28.5% (normal 42% to 48%)RBC = 3.4 million mm3 (normal 4.7 to 6.1 million mm3)MCV = 108 fL (normal 81 to 96 fL)MCHC = 33.2 g/dL (normal 31 to 37 g/dL)RDW = 18.4% (normal 11-15%) These findings are most likely caused by:A. iron deficiency anemiaB. Vitamin B12 deficiency anemiaC. Folic acid deficiency anemiaD. Anemia of chronic disease.Visit fhea.com to learn more!

Die Themen im heutigen Versicherungsfunk Update sind: Frauen glauben, dass sie vom Gender Pension Gap betroffen sein werden 95 Prozent der Frauen in Deutschland gehen davon aus, dass sie vom Gender Pension Gap betroffen sein werden. Laut der Allianz Studie glaubt die Hälfte der Frauen nicht, dass ihre Altersvorsorge ausreichen wird. Die Unsicherheit bei dem Thema ist groß, auch weil ein Drittel der Befragten gar keine Vorstellung vom eigenen Einkommen im Alter hat. DFV steigert Konzernergebnis deutlich Die DFV Deutsche Familienversicherung AG ist gut in das Jahr 2024 gestartet. Das Konzernergebnis vor Steuern beträgt im ersten Quartal 2024 etwa 1,5 Millionen Euro. Ebenso erreicht das Unternehmen das Wachstumsziel und steigert die gebuchten Bruttobeiträge (HGB) um vier Prozent auf 49,7 Millionen Euro. Das operative Ergebnis erhöhte sich im Verhältnis zum Vorjahresvergleichszeitraum um 9,1 Prozent auf 1,6 Millionen Euro. Das Konzernergebnis vor Steuern konnte im Vergleich zum Vorjahresvergleichszeitraum um 19 Prozent auf 1,3 Millionen Euro gesteigert werden. BVK: Einstimmige Wiederwahl Der bisherige Präsident des Bundesverbandes Deutscher Versicherungskaufleute (BVK) Michael H. Heinz und der BVK-Vizepräsident Andreas Vollmer wurden von den Delegierten am 23. Mai 2024 in Berlin einstimmig für eine weitere vierjährige Amtszeit wiedergewählt. Die beiden BVK-Vizepräsidenten Gerald Archangeli und Marco Seuffert standen in diesem Jahr nicht zur Wahl. Provinzial wächst 2023 stärker als der Markt Der Provinzial Konzern ist 2023 stärker als der Markt gewachsen. Die Gesamtbeitragseinnahmen des Konzerns stiegen um 1,3 % (Marktwachstum 1,0 %) auf 6,6 Mrd. Euro. Die Beitragseinnahmen im selbst abgeschlossenen Schaden- und Unfallversicherungsgeschäft stiegen bei den Regionalversicherern des Konzerns um 8,5 % auf 4,1 (3,8) Mrd. Euro. Damit lag das Wachstum deutlich über dem vom Gesamtverband der Deutschen Versicherungswirtschaft ermittelten Marktwachstum in Höhe von 6,8 %. R+V: Rund 20 Millionen Euro durch Hochwasser-Schäden Eine Woche nach dem Unwetter zeichnet sich das Ausmaß der Schäden im Saarland, in Teilen von Baden-Württemberg und von Rheinland-Pfalz ab. Die R+V schätzt die Höhe der Schäden bei ihren Versicherten auf rund 20 Millionen Euro. Volkswohl Bund unterstützt Nachhaltigkeitsinitiative Die Volkswohl Bund Versicherungen haben die Principles for Sustainable Insurance (PSI) – Grundsätze für nachhaltiges Versichern – der Finanzinitiative des Umweltprogramms der Vereinten Nationen unterzeichnet. Mit der Unterschrift verpflichtet sich der Versicherer unter anderem, bei sämtlichen Entscheidungen Kriterien der Umwelt, der gesellschaftlichen Verantwortung und der Unternehmensführung zu berücksichtigen – und das in allen Unternehmensbereichen: von der Produktentwicklung über die Kapitalanlage bis zum Personalmanagement.

Die Themen im heutigen Versicherungsfunk Update sind: Renten steigen zum 1. Juli erneut deutlich Zum 1. Juli erhöhen sich die Renten um 4,57 Prozent. Die Bundesregierung hat dazu eine entsprechende Verordnung beschlossen. Damit profitieren Rentner im dritten Jahr in Folge von der guten Entwicklung der Löhne und Gehälter. DFV feiert bestes Geschäftsjahr der Firmengeschichte Die DFV Deutsche Familienversicherung AG hat im Jahr 2023 den Versicherungsumsatz um 7,9 Prozent auf 119,5 Millionen Euro steigern können. Das operative Ergebnis erhöhte sich um 9,0 Prozent auf 8,8 Millionen Euro. Das Konzernergebnis vor Steuern hat 5,6 Millionen Euro (IFRS) betragen. In der Konzernmutter konnte 2023 nach HGB ein Gewinn vor Steuern von 7,8 Millionen Euro erzielt werden. Damit habe der Versicherer die geplanten Ziele übertroffen. „2023 ist das beste Geschäftsjahr unserer Firmengeschichte.“, sagte DFV-Chef Stefan Knoll. BCA AG mit neuem Kundenselektions- und Kampagnentool Die BCA AG baut ihre Maklerserviceplattform DIVA weiter aus. In Verbindung mit der Endkunden-App „Ihr FinanzCockpit“ ermöglicht man eine effiziente Kundenberatung und -betreuung mit synchronisiertem Datenbestand. Durch die Kombination eines detaillierten Kundenselektionstools mit einem vertriebsorientierten Kampagnentool können Makler nun zielgerichtet Marketingkampagnen oder Kundengruppenansprachen erstellen und durchführen. Katrin Gruber übernimmt neues Ressort für das Direktversicherungsgeschäft der Generali Deutschland Mit Wirkung zum 1. Mai 2024 bündelt die Generali Deutschland AG die Verantwortung für das Direktversicherungsgeschäft in dem neu geschaffenen Vorstandsressort des Chief Business Officer Direct (CBOD). Katrin Gruber übernimmt die Funktion des CBOD im Vorstand der Generali Deutschland AG und wird CEO der Cosmos Versicherungen. Die 55-Jährige folgt auf Uli Rothaufe und Roland Stoffels. Nicole Heidemeyer soll neue Chief Operating Officer werden. Die neu geschaffene Vorstandsfunktion Chief Sales and Marketing Officer soll Petar Dobric ausfüllen. Alterseinkünfte von Frauen deutlich niedriger als bei Männern Frauen sind hinsichtlich ihrer durchschnittlichen Alterseinkünfte schlechter gestellt als Männer. Demnach bezogen über 65-jährige Frauen in Deutschland im Schnitt 18.663 Euro brutto im Jahr. Bei Männern der gleichen Altersgruppe waren es durchschnittlich 25.599 Euro brutto. Wie das Statistische Bundesamt (Destatis) mitteilt, lag damit das geschlechtsspezifische Gefälle bei den Alterseinkünften, auch Gender Pension Gap genannt, bei 27,1 Prozent. Die Alterseinkünfte von Frauen waren demnach durchschnittlich mehr als ein Viertel niedriger als die von Männern. InsurTech Hub Munich bekommt neue Geschäftsführerin Miriam Hook übernimmt zum 1. Mai 2024 die Geschäftsführung des InsurTech Hub Munich (ITHM) e.V.. Die Juristin folgt als Geschäftsführerin auf Christian Gnam, der die Leitung des Innovations- und Gründerzentrum Biotechnologie (IZB) übernommen hat. Überdies wird ein Führungsteam des ITHM etabliert. Esther Prax übernimmt neben ihren Aufgaben als Programmdirektorin die Rolle der stellvertretenden Geschäftsführerin. Finanzleiter Jens Schindler führt zusammen mit Miriam Hook die ITHM Innovation GmbH, in der das Dienstleistungsangebot des ITHM gebündelt ist.

Die Themen im heutigen Versicherungsfunk Update sind: Sparer änderten Geldanlage in der Inflation Jüngere und mittlere Altersgruppen haben sich während der stark gestiegenen Inflation in den Jahren 2022 und 2023 verstärkt Gedanken über ihre Geldanlage gemacht. Eine Änderung der Geldanlageform war die zweithäufigste Reaktion auf die Inflation in Finanzbelangen. Von allen Befragten hatten 32 Prozent dies schon umgesetzt oder planten einen solchen Schritt. Knapp die Hälfte von ihnen erklärte, nun langfristiger zu sparen. Allerdings nur ein gutes Drittel legt nun auch sicherer als bisher an. Das ergab die jüngste Studie des Deutschen Instituts für Altersvorsorge (DIA) mit dem Titel „Wenn der Euro an Wert verliert“. DFV erreicht Profitabilitätsziel Die DFV Deutsche Familienversicherung AG hat im Geschäftsjahr 2023 den Versicherungsumsatz um sieben Prozent auf 118 Millionen Euro gesteigert. Das Neu- und Mehrgeschäft in der Erstversicherung habe 19 Millionen Euro betragen und liege damit um fast 30 Prozent über Plan. Die gebuchten Bruttobeiträge wachsen um 4,8 Prozent auf 192 Millionen Euro, einschließlich des in 2021 aufgenommenen Rückversicherungsgeschäfts, das aber nicht gewachsen ist. Dadurch sei ein Konzernergebnis vor Steuern von fünf Millionen Euro erwirtschaftet worden. In der Konzernmutter konnte nach HGB ein Gewinn vor Steuern von 7,8 Millionen Euro erzielt werden. blau direkt bringt Aktivitäten-Feed ins MVP Das Maklerverwaltungsprogramm Ameise bekommt einen Aktivitäten Feed. Makler sollen in Echtzeit alle wichtigen Ereignisse zu ihren Vorgängen innerhalb des MVP in einer übersichtlichen Darstellung einzusehen können. Ein zentraler Bestandteil ist hierbei die Anzeige aller verarbeiteten Dokumente, die über die BiPRO-Schnittstellen von den Gesellschaften bereitgestellt werden. So können künftig beispielsweise Kunden-Aktivitäten innerhalb der Endkunden-App angezeigt werden. Auch Aktualisierungen bei der Meldung eines Schadenfalls sollen künftig integriert sein. Inter kooperiert mit Kliniknachsorge Vollversicherte der Inter mit psychischen Erkrankungen haben ab sofort die Möglichkeit, die Nachsorgeprogramme von mentalis für 12 Monate kostenfrei zu nutzen. Durch die Teilnahme soll der Behandlungserfolg aus (teil-)stationären Aufenthalten langfristig sichergestellt werden. Dabei wird eine therapeutische App mit psychologischen Telefongesprächen kombiniert – und das sofort zugänglich und ohne Wartezeit für die Patienten. Rating Risikolebensversicherung 2024 Auf der Suche nach den besten Risiko-Lebensversicherungen 2024 hat Franke und Bornberg 112 Tarife von 60 Gesellschaften nach 38 Kriterien analysiert. 26 Tarife und Tarifvarianten und damit fast ein Viertel der Angebote qualifizieren sich für die Bestnote FFF+ „hervorragend“. Die zweithöchste Bewertung FFF „sehr gut“ erreichen nur zehn Tarife. Ungefähr die Hälfte aller Produkte werden mit FF „gut“ bewertet. Die Gruppe der Minderleister (F+, F und F-) ist mit 4,46 % gegenüber dem Erstrating deutlich geschrumpft. LKH bietet Telemedizin an Durch eine Kooperation mit MD Medicus können Versicherte der LKH Landeskrankenhilfe V.V.a.G. in der Krankenvollversicherung und in einer Beihilferestkostenversicherung telemedizinische Leistungen in Anspruch nehmen. Die telemedizinische Beratung erfolgt für die Versicherten ohne weitere Kosten. Kunden in der betrieblichen Krankenversicherung (bKV) können Telemedizin ebenfalls beanspruchen – ohne Anrechnung auf das Budget.

Bienvenidxs a un nuevo episodio especial de Hospitalidad Emprendedora. Hoy te compartimos el segundo de los episodios especiales que grabamos desde el stand de @Bookine durante la pasada feria de FITUR. En esta ocasión hablamos acerca de innovación e IA con Jorge Álvarez, director del Hotel Gran Bilbao para aprender desde su perspectiva y de cómo lo están haciendo en HGB. ¿Quieres conectar con Jorge? Visita su Linkedin: https://www.linkedin.com/in/jorge%C3%A1lvarezdi%C3%A9guez/ ¿Quieres saber más acerca de sus proyectos? Visita: HGB-> https://www.hotelgranbilbao.com/es/ ¿Quieres saber más acerca de Bookline? Escríbenos y te contamos como puedes beneficiarte de la IA conversacional. ------------------------------------------------------------------------------------------------------------ ¿Quieres ser unx Hospitality Punk? Estamos preparando algo muy innovador que revolucionará el sector. Sé de lxs primeros en enterarte y asegurarte el acceso a una comunidad de referencia en innovación turística: https://www.hospitalidademprendedora.xyz/hospitality-punks/ ------------------------------------------------------------------------------------------------------- ️ Suscríbete a nuestra newsletter semanal gratuita con lo mejor en innovación turística: https://www.hospitalidademprendedora.xyz/suscripcion-newsletter/ -------------------------------------------------------------------------------------------------------- Web: https://www.hospitalidademprendedora.xyz/ Discord: https://discord.gg/ePkHdBmW Instagram: https://bit.ly/2FoU9TG LinkedIn: https://bit.ly/2ZuwZC8 Twitter: https://bit.ly/3mleIAY Email: hola@cursoweb3turismo.com ️Fountain.fm (la App de podcasts que te paga por escucharnos) https://www.fountain.fm/show/UO8m8gJpSPJxDULVQaoy ️Spotify: https://spoti.fi/2C5Xrcz ️Ivoox: https://bit.ly/3e6TIth ️iTunes: https://apple.co/3e5Z9bN YouTube: https://bit.ly/2N0Mifa Sigue a Albert: LinkedIn: https://www.linkedin.com/in/albertperezllanos/ Twitter: https://twitter.com/albertperezll Sigue a Gian Franco: Web: www.gianfrancomercado.com LinkedIn: https://www.linkedin.com/in/gian-franco-mercado-emprendimiento/ Instagram: https://www.instagram.com/gf_merc/ ¡Comparte esta transmisión y contagia la #ActitudEmprendedora! ------------------------------------------------------------------------------------------------------- ️ Suscríbete a nuestra newsletter semanal gratuita con lo mejor en innovación turística: https://www.hospitalidademprendedora.xyz/suscripcion-newsletter/

Olga Vostretsova ist im Museum der bildenden Künste Leipzig als Agentin für Diversität im Programm 360° der Kulturstiftung des Bundes tätig. Julia Hemmerling spricht mit ihr über ihre Ideen und Pläne.

Bitte ein Bitcoin! Sachsens Polizei stellt knapp 50.000 Bitcoins sicher - im Wert von zwei Milliarden Euro. Wir zwei _Heldenstadt_-Podcaster sind beeindruckt und fragen uns, warum wir eigentlich noch nie "was mit Krypto" gemacht haben ... Nicht nur virtuelle, auch ganz reale Probleme beschäftigen uns in der neuen Folge des Leipziger Wohnzimmerpodcasts: die Ecke Floßplatz etwa, für Radfahrerinnen und Radfahrer ein echter Gefahren-Hotspot. Dann wurde im Bundeshaushalt das Geld für klimafreundliche Angebote reduziert (Verkehrswende, anyone?). Und die Straßenzeitung "Kippe" gibt's jetzt auch digital und bargeldlos. Außerdem: ein grünes Dach fürs Gewandhaus, ein historisches Graffiti in der Ritterstraße und ein wenig UKW-Nostalgie ("Jugendradioooooo!"). Wir empfehlen den Rundgang an der Hochschule für Grafik und Buchkunst, die Deutschen Leichtathletik-Hallenmeisterschaften in der Arena und das Knallbrause-Festival im Neuen Schauspiel inklusive einem Konzert von Baby Of The Bunch. Mehr Leipzig-Real-Talk passt nicht in eine knappe halbe Stunde - gönnt Euch den Super Bowl unter den Leipzig-Podcasts: „Heldenstadt. Der LVZ-Podcast aus Leipzig mit Daniel Heinze und Guido Corleone“, Folge vom 12. Februar 2024.

OutlineChapter 14- Hypovolemic States- Etiology - True volume depletion occurs when fluid is lost from from the extracellular fluid at a rate exceeding intake - Can come the GI tract - Lungs - Urine - Sequestration in the body in a “third space” that is not in equilibrium with the extracellular fluid. - When losses occur two responses ameliorate them - Our intake of Na and fluid is way above basal needs - This is not the case with anorexia or vomiting - The kidney responds by minimizing further urinary losses - This adaptive response is why diuretics do not cause progressive volume depletion - Initial volume loss stimulates RAAS, and possibly other compensatory mechanisms, resulting increased proximal and collecting tubule Na reabsorption. - This balances the diuretic effect resulting in a new steady state in 1-2weeks - New steady state means Na in = Na out - GI Losses - Stomach, pancreas, GB, and intestines secretes 3-6 liters a day. - Almost all is reabsorbed with only loss of 100-200 ml in stool a day - Volume depletion can result from surgical drainage or failure of reabsorption - Acid base disturbances with GI losses - Stomach losses cause metabolic alkalosis - Intestinal, pancreatic and biliary secretions are alkalotic so losing them causes metabolic acidosis - Fistulas, laxative abuse, diarrhea, ostomies, tube drainage - High content of potassium so associated with hypokalemia - [This is a mistake for stomach losses] - Bleeding from the GI tract can also cause volume depletion - No electrolyte disorders from this unless lactic acidosis - Renal losses - 130-180 liters filtered every day - 98-99% reabsorbed - Urine output of 1-2 liters - A small 1-2% decrease in reabsorption can lead to 2-4 liter increase in Na and Water excretion - 4 liters of urine output is the goal of therapeutic diuresis which means a reduction of fluid reabsorption of only 2% - Diuretics - Osmotic diuretics - Severe hyperglycemia can contribute to a fluid deficit of 8-10 Iiters - CKD with GFR < 25 are poor Na conservers - Obligate sodium losses of 10 to 40 mEq/day - Normal people can reduce obligate Na losses down to 5 mEq/day - Usually not a problem because most people eat way more than 10-40 mEq of Na a day. - Salt wasting nephropathies - Water losses of 2 liters a day - 100 mEq of Na a day - Tubular and interstitial diseases - Medullary cystic kidney - Mechanism - Increased urea can be an osmotic diuretic - Damage to tubular epithelium can make it aldo resistant - Inability to shut off natriuretic hormone (ANP?) - The decreased nephro number means they need to be able to decrease sodium reabsorption per nephron. This may not be able to be shut down acutely. - Experiment, salt wasters can stay in balance if sodium intake is slowly decreased. (Think weeks) - Talks about post obstruction diuresis - Says it is usually appropriate rather than inappropriate physiology. - Usually catch up solute and water clearance after releasing obstruction - Recommends 50-75/hr of half normal saline - Talks briefly about DI - Skin and respiratory losses - 700-1000 ml of water lost daily by evaporation, insensible losses (not sweat) - Can rise to 1-2 liters per hour in dry hot climate - 30-50 mEq/L Na - Thirst is primary compensation for this - Sweat sodium losses can result in hypovolemia - Burns and exudative skin losses changes the nature of fluid losses resulting in fluid losses more similar to plasma with a variable amount of protein - Bronchorrhea - Sequestration into a third space - Volume Deficiency produced by the loss of interstitial and intravascular fluid into a third space that is not in equilibrium with the extracellular fluid. - Hip fracture 1500-2000 into tissues adjacent to fxr - Intestinal obstruction, severe pancreatitis, crush injury, bleeding, peritonitis, obstruction of a major venous system - Difference between 3rd space and cirrhosis ascities - Rate of accumulation, if the rate is slow enough there is time for renal sodium and water compensation to maintain balance. - So cirrhotics get edema from salt retension and do not act as hypovolemia - Hemodynamic response to volume depletion - Initial volume deficit reduced venous return to heart - Detected by cardiopulmonary receptors in atria and pulmonary veins leading to sympathetic vasoconstriction in skin and skeletal muscle. - More marked depletion will result in decreased cardiac output and decrease in BP - This drop in BP is now detected by carotid and aortic arch baroreceptors resulting in splanchnic and renal circulation vasoconstriction - This maintains cardiac and cerebral circulation - Returns BP toward normal - Increase in BP due to increased venous return - Increased cardiac contractility and heart rate - Increased vascular resistance - Sympathetic tone - Renin leading to Ang2 - These can compensate for 500 ml of blood loss (10%) - Unless there is autonomic dysfunction - With 16-25% loss this will not compensate for BP when patient upright - Postural dizziness - Symptoms - Three sets of symptoms can occur in hypovolemic patients - Those related to the manner in which the fluid loss occurs - Vomiting - Diarrhea - Polyuria - Those due to volume depletion - Those due to the electrode and acid base disorders that can accompany volume depletion - The symptoms of volume depletion are primarily related to the decrease in tissue perfusion - Early symptoms - Lassitude - Fatiguability - Thirst - Muscle cramps - Postural dizziness - As it gets more severe - Abdominal pain - Chest pain - Lethargy - Confusion - Symptomatic hypovolemia is most common with isosmotic Na and water depletion - In contrast pure water loss, causes hypernatremia, which results in movement of water from the intracellular compartment to the extracellular compartment, so that 2/3s of volume loss comes from the intracellular compartment, which minimizes the decrease in perfusion - Electrolyte disorders and symptoms - Muscle weakness from hypokalemia - Polyuria/poly dips is from hyperglycemia and hypokalemia - Lethargy, confusion, Seizures, coma from hyponatremia, hypernatremia, hyperglycemia - Extreme salt craving is unique to adrenal insufficiency - Eating salt off hands ref 18 - Evaluation of the hypovolemic patient - Know that if the losses are insensible then the sodium should rise - Volume depletion refers to extracellular volume depletion of any cause, while dehydration refers to the presence of hypernatremia due to pure water loss. Such patients are also hypovolemic. - Physical exam is insensitive and nonspecific - Finding most sensitive and specific finding for bleeding is postural changes in blood pressure - I don't find this very specific at all! - Recommends laboratory confirmation regardless of physical exam - Skin and mucous membranes - Should return too shape quickly - Elastic property is called Turgur - Not reliable is patients older than 55 to 60 - Dry axilla - Dry mucus membranes - Dark skin in Addison's disease Frim increased ACTH - Arterial BP - As volume goes down so does arterial BP - Marked fluid loss leads to quiet korotkoff signs - Interpret BP in terms of the patients “normal BP” - Venous pressure - Best done by looking at the JVP - Right atrial and left atrial pressure - LV EDP is RAP + 5 mmHg - Be careful if valvular disease, right heart failure, cor pulmonare, - Figure 14-2 - Shock - 30% blood loss - Lab Data - Urine Na concentration - Should be less than 25 mmol/L, can go as low as 1 mmol/L - Metabolic alkalosis can throw this off - Look to the urine chloride - Figure 14-3 - Renal artery stenosis can throw this off - FENa - Mentions that it doesn't work so well at high GFR - Urine osmolality - Indicates ADH - Volume depletion often associated with urine osm > 450 - Impaired by - Renal disease - Osmotic diuretic - Diuretics - DI - Mentions that severe volume depletion and hypokalemia impairs urea retension in renal medulla - Points out that isotonic urine does not rule out hypovolemia - Mentions specific gravity - BUN and Cr concentration - Normal ratio is 10:1 - Volume depletion this goes to 20:1 - Serum Na - Talks about diarrhea - Difference between secretory diarrhea which is isotonic and just causes hypovolemia - And osmotic which results in a lower electrolyte content and development of hypernatremia - Talks about hyperglycemia - Also can cause the sodium to rise from the low electrolyte content of the urine - But the pseudohyponatraemia can protect against this - Plasma potassium - Treatment - Both oral and IV treatment can be used for volume replacement - The goal of therapy are to restore normovolemia - And to correct associated acid-base and electrolyte disorders - Oral Therapy - Usually can be accomplished with increased water and dietary sodium - May use salt tablets - Glucose often added to resuscitation fluids - Provides calories - Promotes intestinal Na reabsorption since there is coupled Na and Glucose similar to that seen in the proximal tubule - Rice based solutions provide more calories and amino acids which also promote sodium reabsorption - 80g/L of glucose with rice vs 20 g/L with glucose alone - IV therapy - Dextrose solutions - Physiologically equivalent to water - For correcting hypernatremia - For covering insensible losses - Watch for hyperglycemia - Footnote warns against giving sterile water - Saline solutions - Most hypovolemic patients have a water and a sodium deficit - Isotonic saline has a Na concentration of 154, similar to that of plasma see page 000 - Half-isotonic saline is equivalent to 550 ml of isotonic saline and 500 of free water. Is that a typo? - 3% is a liter of hypertonic saline and 359 extra mEq of Na - Dextrose in saline solutions - Give a small amount of calories, otherwise useless - Alkalinizing solutions - 7.5% NaHCO3 in 50 ml ampules 44 mEq of Na and 44 mEq of HCO3 - Treat metabolic acidosis or hyperkalemia - Why 44 mEq and not 50? - Do not give with calcium will form insoluble CaCO3 - Polyionic solutions - Ringers contains physiologic K and Ca - Lactated Ringers adds 28 mEq of lactate - Spreads myth of LR in lactic acidosis - Potassium chloride - Available as 2 mEq/mL - Do not give as a bolus as it can cause fatal hyperkalemia - Plasma volume expanders - Albumin, polygelastins, hetastarch are restricted to vascular space - 25% albumin can pull fluid into the vascular space - 25% albumin is an albumin concentration of 25 g/dL compare to physiologic 4 g/dL - Says it pulls in several times its own volume - 5% albumin is like giving plasma - Blood - Which fluid? - Look at osmolality, give hypotonic fluids to people with high osmolality - Must include all electrolytes - Example of adding 77 mEw of K to 0.45 NS and making it isotonic - DI can be replaced with dextrose solutions, pure water deficit - Case 14-3 - Diarrhea with metabolic acidosis - He chooses 0.25 NS with 44 mEq of NaCl and 44 NaHCO3 - Talks about blood and trauma - Some studies advocate delaying saline until penetrating trauma is corrected APR about to. Keep BP low to prevent bleeding. Worry about diluting coagulation factors - Only do this if the OR is quickly available - Volume deficit - Provides formula for water deficit and sodium deficit - Do not work for isotonic losses - Provides a table to adjust fluid loss based on changes in Hgb or HCTZ - Says difficult to estimate it from lab findings and calculations - Follow serial exams - Serial urine Na - Rate of replacement - Goal is not to give fluid but to induce a positive balance - Suggests 50-100 ml/hr over what is coming out of the body - Urine - Insensibles 30-50 - Diarrhea - Tubes - Hypovolemic shock - Due to bleeding - Sequesting in third space - Why shock? - Progressive volume depletion leads to - Increased sympathetic NS - Increased Ang 2 - Initially this maintains BP, cerebral and coronary circulation - But this can decrease splanchnic, renal and mucocutaneous perfusion - This leads to lactic acicosis - This can result in intracellular contents moving into circulation or translocation of gut bacteria - Early therapy to prevent irreversible shock - In dogs need to treat with in 2 hours - In humans may need more than 4 hours - Irreversible shock associated with pooling of blood in capillaries - Vasomotor paralysis - Hyperpolarization of vascular smooth muscle as depletion of ATP allows K to flowing out from K channels opening. Ca flows out too leading to vasodilation - Glyburide is an K-ATP channel inhibitor (?) caused increased vasoconstriction and BP - Pluggin of capillaries by neutrophils - Cerebral ischemia - Increased NO generation - Which Fluids? - Think of what is lost and replace that. - Bleeding think blood - Raise the hct but not above 35 - Acellular blood substitutes, looked bad at the time of this writing - Di aspirin cross linked hemoglobin had increased 2 and 28 day mortality vs saline - Colloids sound great but they fail in RCTs - SAFE - FEAST - Points out that saline replaces the interstitial losses why do we think those losses are unimportant - Pulmonary circulation issue - Pulmonary circulation is more leaky so oncotic pressure less effective there - Talks about the lungs be naturally protected from pulmonary edema - Rate of fluid - 1-2 liters in first hour - Suggests CVP or capillary wedge pressure during resuscitation - No refs in the rate of fluid administration section - Lactic acidosis - Points out that HCO can impair lactate utilization - Also states that arterial pH does not point out what is happening at the tissue level. Suggests mixed-venous sample.ReferencesJCI - Phenotypic and pharmacogenetic evaluation of patients with thiazide-induced hyponatremia and a nice review of this topic: Altered Prostaglandin Signaling as a Cause of Thiazide-Induced HyponatremiaThe electrolyte concentration of human gastric secretion. https://physoc.onlinelibrary.wiley.com/doi/10.1113/expphysiol.1960.sp001428A classic by Danovitch and Bricker: Reversibility of the “Salt-Losing” Tendency of Chronic Renal Failure | NEJMOsmotic Diuresis Due to Retained Urea after Release of Obstructive Uropathy | NEJMIs This Patient Hypovolemic? | Cardiology | JAMAAnd by the same author, a textbook: Steven McGee. 5th edition. Evidence-Based Physical Diagnosis Elsevier Philadelphia 2022. ISBN-13: 978-0323754835The clinical course and pathophysiological investigation of adolescent gestational diabetes insipidus: a case report | BMC Endocrine DisordersSensitivity and specificity of clinical signs for assessment of dehydration in endurance athletes | British Journal of Sports MedicineDiagnostic performance of serum blood urea nitrogen to creatinine ratio for distinguishing prerenal from intrinsic acute kidney injury in the emergency department | BMC NephrologyThe meaning of the blood urea nitrogen/creatinine ratio in acute kidney injury - PMCLanguage guiding therapy: the case for dehydration vs volume depletion https://www.acpjournals.org/doi/10.7326/0003-4819-127-9-199711010-00020?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%20%200pubmedValidation of a noninvasive monitor to continuously trend individual responses to hypovolemiaReferences for Anna's voice of God on Third Spacing : Shires Paper from 1964 (The ‘third space' – fact or fiction? )References for melanie's VOG:1. Appraising the Preclinical Evidence of the Role of the Renin-Angiotensin-Aldosterone System in Antenatal Programming of Maternal and Offspring Cardiovascular Health Across the Life Course: Moving the Field Forward: A Scientific Statement From the American Heart Association2. excellent review of RAAS in pregnancy: The enigma of continual plasma volume expansion in pregnancy: critical role of the renin-angiotensin-aldosterone systemhttps://journals-physiology-org.ezp-prod1.hul.harvard.edu/doi/full/10.1152/ajprenal.00129.20163. 10.1172/JCI107462- classic study in JCI of AngII responsiveness during pregnancy4. William's Obstetrics 26th edition!5. Feto-maternal osmotic balance at term. A prospective observational study

Ruedi Baur, Designer, Frankreich und Schweiz, geboren 1956 in Paris. Ausbildung als Grafikdesigner bei Michael Baviera und an der Hochschule der Künste (ZHdK) Zürich. 1984 gründete er das Atelier Baur, Baviera, Vetter Lyon / Milano / Zürich, und 1989 in Paris, das transdisziplinäre Design Netzwerk Integral Concept. Bis 2023 leitete er die interdisziplinäre Design Studios Integral Ruedi Baur später Integral Designers in Paris oder Zürich. In 2011 gründet er mit Vera Baur das Institut Civic City, und 2019 das Design-Laboratorium Ruedi & Vera Baur, dix-milliards-humains. Baurs wissenschaftliche Expertise manifestiert sich in seiner breiten internationalen Lehr-, Vortrags- und Forschungspraxis seit 1987. Neben einer Professur für Grafikdesign war er von 1995 bis 2004 Rektor der Hochschule für Grafik und Buchkunst in Leipzig. Anschließend gründete und leitete er das Forschungsinstitut design2context an der Zürcher Hochschule der Künste, das er 2012 in das Institut für kritische Designforschung Civic City in Genf und Paris umwandelte. Seit 2013 ist er Professor in der Abteilung für Grafikdesign an der École des Arts Décoratifs, Paris und der Hochschule für Kunst und Design, Genf (Head). Im Jahr 2000 erhielt er den Dr. h.c. der Universität Laval in Quebec sowie von der Universität Sheng Jang. In 2016 wurde ihm der Dr.-Titel von der Universität Strasburg verliehen. Seine Lehre und Forschung, sein Schreiben sowie viele Projekte, die er mit seinen Teams entwickelt, zeigen seinen disziplinenübergreifenden Ansatz, seine Sensibilität für den Raum als Zeichen, sein Engagement für ein sozialeres Design im Dienste des öffentlichen Raums. Er steht für ein Design, das auf dem Kontext reagiert, ein Design der Relationen. Sein Ansatz verbindet Fragen der Orientierung, der Bildsprache, mit Fragen der Identität von Orten und Institutionen, urbaner Inszenierung und schließlich bürgerlicher Information. Durch die Verknüpfung der funktionalen Dimension mit dem Sinnlichen gelingt es Ruedi Baur, komplexen Infrastrukturen wie Flughäfen, Universitäten oder Krankenhäusern symbolische und kontextuelle Dimensionen zu verleihen. Einige Lebensstufen und frühen Projekte in Deutschland: 1987, Preisträger der Kieler Woche.1988 organisiert in seiner Galerie in Lyon-Villeurbanne eine Ausstellung unter dem Titel „Deutsch Design – Dieter Rams, Anton Stankowski, Otl Aicher". 1991wurde eine Ausstellung der Arbeiten von Ruedi Baur und Pippo Lionni am Institut für neue Technische Form in Darmstadt präsentiert. 1993 Gastprofessor der Klasse Corporate Design der Hochschule für Gestaltung Offenbach. 1994, graphische Installation in der Kunsthalle Schirn im Rahmen des Festivals „Design Horizonte. 1995 Professur für Systemdesign an der Hochschule für Grafik und Buchkunst Leipzig. Er leitete bis 2004 die Klasse für Systemdesign und fungierte von 1999-2002 als Rektor der HGB. 1995 wurde seine Arbeit im Museum für Kunst und Gewerbe, Hamburg unter dem Titel „Meine Augen schmerzen“ präsentiert. 1996, Erscheinungsbild der Institut Français in Deutschland. – Szenographie der Ausstellungen „Zeit und Ewigkeit“, „Längster Schnitt“, „1x100“ „Sächsische Nacht“ im Archäologischen Museum Dresden. Szenographie und Erscheinungsbild des Museums Kalkriese. 2000 berät und gestaltet er an der Zollverein School of Management und Design. 2002 gewinnt den Wettbewerb für das Erscheinungsbild des Flughafens Köln-Bonn.

Das Leben und die Kunst treiben Oliver Kossack an. Auch als Künstler bedeute es ihm aufgrund seiner langjährigen Verbundenheit mit Sachsen sehr viel, die Dresdner Kunsthochschule als Rektor weiter zu entfalten.

In Folge 14 Eures zivilrechtlichen Examensspezials dreht sich alles um das Gewährleistungsrecht, insbesondere den Ausschluss von Gewährleistungsrechten. Wann kann ein Gewährleistungsausschluss erfolgen? Welches Verhältnis herrscht zum Verbrauchsgüterkauf? Was muss ich zum Examensklassiker - dem notariell beurkundeten Grundstückskaufvertrag - wissen? Wie wirkt sich eine Erklärung ins Blaue bzw. § 377 HGB aus? Antworten auf diese Fragen sowie einen Gesamtüberblick zum Thema gibt's in dieser Folge - wie immer von Prof. Dauner-Lieb. Viel Spaß!

Die Themen im heutigen Versicherungsfunk Update sind: Vermittler mehrheitlich ohne Berührung mit KI 16 Prozent der Vermittler verwenden bereits mindestens eine Anwendung mit Künstlichen Intelligenz (KI) im Rahmen ihrer Arbeit. 15 Prozent antworteten mit „noch nicht“, haben dies also vor. Zwei Drittel (66 Prozent) haben im Rahmen ihrer Vermittlertätigkeit keine Berührung mit KI. Diese Erkenntnis ist eines der Ergebnisse des 16. AfW-Vermittlerbarometers, für das mehr als 1.000 Vermittlerinnen und Vermittler Auskunft im Rahmen einer umfassenden Online-Umfrage erteilten. P&R-Pleite: Dritte Abschlagsverteilung soll noch vor Weihnachten kommen Noch vor Weihnachten sollen die insgesamt mehr als 54.000 Gläubiger in den Insolvenzverfahren der vier deutschen P&R-Containerverwaltungsgesellschaften weitere rund 200 Millionen Euro erhalten. Die Gläubigerausschüsse haben der nunmehr bereits dritten Abschlagsverteilung zugestimmt, sodass die Zahlungen nach Niederlegung der Verteilungsverzeichnisse beim zuständigen Insolvenzgericht München und Ablauf der gesetzlich vorgesehenen Fristen erfolgen können. Damit erhöht sich die Gesamtsumme der auf die über 86.000 festgestellten Einzelforderungen bislang gezahlten Verteilungen auf über eine halbe Milliarde, genau rund 544 Millionen Euro. Das teilte der zuständige Insolvenzverwalter, Dr. Michael Jaffé, mit. W&W mit herben Einbußen beim Jahresüberschuss Die Wüstenrot & Württembergische-Gruppe (W&W) hat im dritten Quartal, wie in den ersten neun Monaten dieses Jahres, weiteres Wachstum im Neugeschäft erzielt. Der Konzern-Jahresüberschuss lag nach neun Monaten bei 101,1 Millionen Euro und damit deutlich unter dem Wert aus dem Vorjahr von 179,7 Millionen Euro. Das Unternehmen hatte im Oktober seine IFRS-Ergebniserwartung für das Gesamtjahr 2023 angepasst. Für den Einzelabschluss der W&W AG nach HGB wurde die Erwartung eines Jahresüberschusses von rund 120 Millionen Euro bestätigt. Zugleich strebt das Unternehmen Dividendenkontinuität an. Talanx schließt Zukauf von Liberty Seguros ab Der Geschäftsbereich Privat- und Firmenversicherung International der Talanx Gruppe hat den Erwerb des Geschäfts mit Privatkunden und kleinen sowie mittleren Unternehmen von Liberty Seguros in Brasilien erfolgreich zum 22. November 2023 abgeschlossen. HDI stärkt damit seine Marktposition in Brasilien und rückt auf Rang zwei im Schaden- und Unfallversicherungsgeschäft vor. Auf Basis der Ergebnisse für das Gesamtjahr 2022 erwartet HDI eine Steigerung der gebuchten Bruttoprämien in Brasilien um mindestens 1,1 Milliarden Euro. Straßenverkehrsunfälle im September 2023: 8 % mehr Verletzte Im September 2023 sind in Deutschland rund 36.700 Menschen bei Straßenverkehrsunfällen verletzt worden. Wie das Statistische Bundesamt (Destatis) nach vorläufigen Ergebnissen mitteilt, waren das 8 % oder 2.600 Verletzte mehr als im Vorjahresmonat. Die Zahl der Verkehrstoten stieg um 48 auf 297 Personen. Insgesamt registrierte die Polizei im September 2023 rund 210.700 Straßenverkehrsunfälle, das waren in etwa so viele wie im Vorjahresmonat.

Christopher & Jobst sprechen mit Jess. Wir reden über einen schwarzen Panther, die kultige Madonna, mit Cro-Mags im Cassiopeia, die ganze Band in Schlappen rumkommandieren, Anti-Swifty, dämliche Kommentare, deutsche Casting-Bands, Ausflug in den Müller und eine Live-Doppel-CD von Billy Talent, Carnifex & Whitechapel, For All This Bloodshed im Café Wagner, arbeitstechnisch auf See, verrückte Geschenke aus der ganzen Welt, Mobbing in der Schule, Muttis Tanzschule, sonntags ins Tanzcafé, Hotel Books, Nazis in Jena, Schwierigkeiten sich auf Demos zurechtzufinden, Nu Pagadi in Dauerschleife, aktiv Hip Hop tanzen, Girls United mit Kirsten Dunst, Schwerter und Nahkampf-Dolch, mal wieder Eisberg, Ophelias Great Day aus Jena, Metal Gulasch aus Erfurt, Empty Handed, super random in Darmstadt wohnen, hessische Getränke, Berufsschule als gestaltungstechnische Assistentin, Gedanken über eine Bewerbung bei der HGB, Töpfe interessant aussehen lassen, Finger weg von Start-Ups, Wii verkaufen um sich Tattoos zu machen, Funkenmariechen-Karnevals-CanCan-Gedöns, der elitäre deutsche Hardcore, die zufällige Gründung von Swoon, plötzlich Göttingen, die Unterschiede zwischen Tanz & Hardcore, nicht mögen im Mittelpunkt zu stehen, immer mit Cap spielen, Oathbreaker & Converge, Candy haben Hardcore durchgespielt, Return To Strength-Festival in Querfurt, Macker in der Hardcore-Szene, sehr viel OKF bei Speed, solange keiner den Schweiß an mir abreibt bin ich glücklich, Support aber auch Konkurrenz in der Szene, FLINTA-Personen supporten, Swoon geht in sich, der Freund von Jess, Einstieg ins Tattoo-Business, Tattoo-Trends, Gedanken zur Altersvorsorge, 2-Euro-große Tattoos all over the body, keine Witze ausm Stegreif, immer all in gehen, Reue über Bekanntschaften, Sehnsuchtsort Island, uvm. Songs über die wir reden: Siouxsie & The Banshees: Spellbound Blondie: Detroit 442 X-Ray Spex: Oh Bondage Up Yours Abwärts: Neon Kind Bluttat: Weisse Haut und schwarzes Leder Hans-A-Plast: Sex Sex Sex Avengers: We Are The One Bags: We Will Bury You

We recently had a patient in our OB high-risk community clinic whose maternal carrier screen result was either late or lost. Thinking the test may be lost, another resident ordered hemoglobin electrophoresis. The electrophoresis was NEGATIVE (that is, no abnormal hemoglobin was found at detectable levels)…by the way, good for that resident! After calling the lab for the genetic screen and not getting a clear answer from that location, they had the self- initiative in ordering a back-up test. AND TURNS OUT: this was a GREAT educational opportunity as the results from these two tests were discordant: the maternal carrier screening panel returned the day after and was POSITIVE for alpha thalassemia trait. So, which is better? Hgb electrophoresis (once considered the clinical gold standard over CBC with indices) or molecular testing? Let's explore the data in this episode.

Overview Hemoglobin Normal Value Range Pathophysiology Special considerations Elevated hemoglobin Decreased hemoglobin Nursing Points General Normal value range Males – 13.5-16.5 g/dL Females – 12.0 – 15.0 g/dL Pathophysiology Protein attached to red blood cell Iron based protein 4 groups 2 alpha 2 beta Has a high affinity (attraction) for oxygen Oxyhemoglobin Has oxygen attached Deoxyhemoglobin Oxygen has been released Oxyhemoglobin Dissociation Curve Oxygen saturation Shift to the right Partial pressure is higher HGB attraction to oxygen is lower Oxygen becomes less “sticky” and wants to be released Causes ↓pH ↑pCO2 ↑Temperature Shift to the left Partial pressure is lower HGB attraction is higher Oxygen wants to stay “stuck” to HGB Causes ↑pH ↓pCO2 ↓Temperature Special considerations Submit in lavender top tube Be cautious with phlebotomy technique Reduce hemolysis with proper tubing and syringes Elevated HGB values Polycythemia vera Treatments Blood letting Increased water intake Some medications Dehydration Lung disease Pulmonary fibrosis COPD Certain medical therapies EPO supplementation Decreased HGB values Thalassemia Blood loss Sickle Cell anemia Aplastic anemia Cancers Assessment Assess for signs of anemia Tachycardia Fatigue Shortness of breath Decreased SaO2 Pallor Therapeutic Management Blood transfusions as necessary Treat primary cause of anemia Nursing Concepts Lab Values Oxygenation

Overview Hematocrit Normal Value Range Pathophysiology Special considerations Elevations in lab results Decreased HCT levels Nursing Points General Normal value range HCT measured in percentage Males – 41-50% Females – 36-44% Pathophysiology Measurement of total pRBCs compared to rest of blood volume Helps to indicate anemia Often measured with HGB (hemoglobin) Special considerations Lavender top tube (EDTA) Be cautious with technique Do not force sample into tube Can cause hemolysis Alters results Causes of HCT elevation Dehydration Change in % compared to total blood volume Respiratory disease COPD Pulmonary fibrosis Increased need for oxygen -> increased need for RBC production Polycythemia vera RBC overproduction due to bone marrow cancer Treatment includes bloodletting and increasing water consumption (also some medications) Causes of decreased HCT Blood loss Trauma Hemorrhage Treatment Stop bleeding Transfuse blood Anemia Kidney disease Decrease in EPO production Treatment Supplement with EPO Pregnancy Relative to increase total blood volume Leukemia Decreased bone marrow production causes ↓ RBC Treat leukemia via oncology pathways Chemotherapy Radiation Bone marrow transplant Assessment Assess for signs of anemia Tachycardia Fatigue Shortness of breath Decreased SaO2 Pallor Therapeutic Management Blood transfusions as necessary Treat primary cause of anemia Use oncologic methods to treat leukemia Bloodletting (phlebotomy) for polycythemia patients Nursing Concepts Lab Values Oxygenation

Herzlich willkommen zu Folge 159 von "Irgendwas mit Recht" und zu Folge 3 unserer Spezialreihe "Irgendwas mit Examen" mit Prof. Dauner-Lieb. Wir steigen materiellrechtlich voll ein: Warum ist das BGB AT für deine Examensvorbereitung von so großer Bedeutung? Was genau ist ein Vertrag? Wo liegen die Grenzen der Vertragsfreiheit nach §§ 134,138 BGB? Warum sind Verträge als soziales Konstrukt so wichtig? Wann kann Schweigen tatsächlich als Willenserklärung gedeutet werden? Neben Antworten auf diese Fragen werfen wir einen Blick auf das kaufmännische Bestätigungsschreiben und seine Verknüpfung mit § 15 HGB. Schließlich besprechen wir Klassiker der höchstrichterlichen Rechtsprechung (siehe Links in den Shownotes) und prüfen Dein Wissen zur arglistigen Täuschung nach § 123 BGB - kennst du die Details? Antworten auf all diese Fragen sowie wertvolle Tipps für deine eigene Karriere findest du in dieser aufschlussreichen Podcastfolge. Viel Spaß beim Zuhören!

Wir hören heute Ivana de Vivanco zu. Ivana wurde 1989 in Lissabon geboren, wuchs aber in Chile, Peru und Ecuador auf. Sie studierte Kunst in Santiago und an der HGB in Leipzig. In ihren rätselhaft figürlichen, bisweilen psychedelisch bunten Bildern setzt Ivana sich mit ihrer südamerikanischen Heimat auseinander, mit Geschlecht, Sexualität, Familie und der christlichen Bildtradition. Es ist nahezu unmöglich, von ihrer surrealen symbolhaften Malerei nicht in den Bann gezogen zu werden. Ivana lebt und arbeitet in Berlin. Produktion & Schnitt: Sebastian Späth Foto: privat Musik: Nikita Heumann https://www.ivanadevivanco.com/

Attention all....its a Hot Ghoul Bummer. Its been awhile since we collaborated for a HGB but here we are! This time we are talking all about Lizzie Borden and the very well known murder of her father and stepmother, as well as the hauntings at the Borden House and Maplecroft. Follow us to keep up with new episodes and announcements:Insta: @hotghoulpodcastTwitter: @hot_ghoul_podSend us an email with your stories on any topic we've covered, or any suggestions you might have for future episodes! hotghoulpodcast@gmail.comIntro Music: Funeral Fashion by Forget Your Friends

HGU bagi Investor 180 Tahun, Sepenting Itukah Ibu Kota Baru? Oleh. Yana Sofia (Tim Penulis Inti NarasiPost.Com) Voice over talent: Dewi Nasjag NarasiPost.Com-Gaes, kontroversi proyek IKN enggak ada habis-habisnya, ya. Baik karena berpotensi merusak lingkungan, menyerap APBN, penuh unsur klenik, proyek bagi-bagi kavling, dan yang terbaru masalah HGU dan HGB yang diubah masing-masing menjadi 180 dan 160 tahun. Dikutip dari cnn.indonesia.com Jumat (2/12/2022), Menteri Investasi/Kepala BKPM, Bahlil Lahadalia, menyampaikan alasan terkait rencana pemerintah memberikan hak pengelolaan lahan di kawasan Ibu Kota Negara (IKN) sampai dengan 180 tahun ke investor. Ia mengatakan, "Ini bukan soal ngemis atau tidak ngemis." Menurutnya rencana ini adalah pemanis (sweetener) agar investor mau masuk ke IKN. Pun terkait HGB nih, Gaes! Negara juga mengatur regulasi HGB mencapai 160 tahun. Sebagaimana yang disampaikan Menteri Agraria dan Tata Ruang /Badan Pertahanan Negara, Hadi Tjahjanto bahwa Hak Guna Bangunan (HGB) berlaku 80 sampai 160 tahun, "HGB 80 tahun itu, apabila masih dimanfaatkan dengan baik dan untuk kepentingan masyarakat, kita masih bisa diperpanjang sampai 80 tahun lagi, sehingga 160," ungkapnya. Dikutip tempo.co, Senin (10/10/2022) Tentunya kita bertanya-tanya, Gaes! Mengingat problem utama rakyat saat ini, yakni kemiskinan sangat membutuhkan solusi mendesak. Kenapa proyek IKN ini lebih diprioritaskan? Lantas kenapa negara tidak mengerjakan proyeknya secara mandiri, tanpa berharap kepada investor asing? Naskah selengkapnya: https://narasipost.com/2022/12/14/hgu-bagi-investor-180-tahun-sepenting-itukah-ibu-kota-baru/ Terimakasih buat kalian yang sudah mendengarkan podcast ini, Follow us on: instagram: http://instagram.com/narasipost Facebook: https://www.facebook.com/narasi.post.9 Fanpage: Https://www.facebook.com/pg/narasipostmedia/posts/ Twitter: Http://twitter.com/narasipost --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Paranormal Conversations are random, off-the-cuff discussions on all things paranormal. On this eighth episode, we are joined by Dr. Kristy Sumner, founder of Soul Sisters Paranormal and owner of History, Highways and Haunts, LLC. We discuss the various techniques and experiments the group has conducted while investigating places like the Lizzie Borden House, Ma Barker House, Villisca Axe Murder House, Malvern Manor, Exchange Hotel and much more! Kristy also runs tours and ghost hunts out of the Historic Scott County Jail, which we will cover in a regular episode of HGB. The EVPs and Spirit Box sessions they have captured are amazing! Be sure to check out the YouTube video as well! You can find out more at https://soulsistersparanormal.com and https://historicscottcojail.com. Check out our website: http://historygoesbump.com  Become an Executive Producer: http://patreon.com/historygoesbump Music used in this episode:  Main Theme: Magic in the Air by Purple Planet Music https://purple-planet.com

Auf welchen Zeitpunkt kommt es beim Sachmangel an? Welche Sonderregeln gelten beim Verbrauchsgüterkauf? Und unter welchen Umständen sind Gewährleistungsansprüche generell ausgeschlossen? (02:12) Rückblick auf die vorangehende Einheit (Sachmängel und Rechtsmängel) (26:30) Gefahrübergang (38:20) Versendungskauf (45:06) Versendungskauf im Verbrauchsgüterkaufrecht (50:16) Beweislastumkehr (1:11:53) Rügeobliegenheit im Handelskauf nach § 377 HGB (1:23:02) Garantie (1:28:36) Haftungsausschluss

Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists. I am Pradip Kamat. I am Rahul Damania, a current 3rd year pediatric critical care fellow. I am Kate Phelps- a second year pediatric critical care medicine. We come to you from Children's Healthcare of Atlanta Emory University School of Medicine. We are delighted to be joined by guest expert Dr Stephanie Jernigan Assistant Professor of Pediatric-Pediatric nephrology, Medical Director of the Pediatric Dialysis Program at Children's Healthcare of Atlanta. She is the Chief of Medicine and Campus Medical Director at Children's Healthcare of Atlanta, Egleston Campus. Her research interests include chronic kidney disease, and dialysis. She is on twitter @stephaniejern13 I will turn it over to Rahul to start with our patient case... A 3 year old previously healthy male presents with periorbital edema. Patient was initially seen by a pediatrician who prescribed anti-histamines for allergy. After no improvement in the eye swelling after a two week anti-histamine course, the patient was given a short course of steroids, which also did not improve his periorbital edema. The patient progressed to having abdominal distention and was prescribed miralax for constipation. Grandparents subsequently noticed worsening edema in his face, eyes, and feet. The patient subsequently had low urine output, low appetite and lack of energy patient was subsequently brought to an ED and labs were obtained. Grandparents denied any illness prior to presentation, fever, congestion, sore throat, cough, nausea, vomiting, gross hematuria, or diarrhea. In ED patient was noted to be hypertensive (Average systolic 135-highest 159mm HG), tachycardic (HR 130s-140s), breathing ~20-30 times per minute on RA with SpO2 92%. Admission weight was recorded at 16.5Kg. Physical exam showed periorbital edema, edema of ankles, there was mild abdominal distention (no tenderness and no hepatosplenomegaly), heart and lung exams were normal. There were no rashes on extremities. Labs at the time of transfer to the PICU: WBC 10 (62% neutrophils, 26% lymphocytes) Hgb 7.2, Hct 21, Platelets 276. BMP: Na 142/K 8.4/Cl 102/HCO3 19/BUN 173/creatinine 5.8. Serum phosphorus was 10.5, Total Ca 6.4 (ionized Ca= 3.4), Mag 2.0, albumin 2.6, AST/ALT were normal. An urine analysis showed: 1015, ph 7.5, urine protein 300 and rest negative. Chest radiograph revealed small bilateral pleural effusions. After initial stabilization of his hyperkalemia-patient was admitted to the PICU. PTH intact 295 (range 8.5-22pg/mL). Respiratory viral panel including for SARS-COV-2 was negative. C3 and C4 were normal. A nephrotic syndrome/FSGS genetic panel was sent. A renal US showed: bilateral echogenic kidneys and ascites (small volume). Pradip: Dr Phelps what are the salient features of the above case presented? Kate Phelps: This patient has a subacute illness characterized by edema, anemia, and proteinuria. His labs show that he has severe acute kidney injury with significantly elevated BUN and Creatinine, hyperkalemia, hyperphosphatemia, and hypocalemia. Rahul: Dr Jernigan welcome to PICU Doc on Call Podcast. Thanks Kate, Rahul and Pradip for inviting me to your podcast. This is a such a great way to provide education and it is my pleasure to come today to speak about one of my favorite topics, pediatric dialysis. I have no financial disclosures or conflicts of interest and am ready to get started. Rahul: Dr Jernigan as you get that call from the ED and then subsequently from the PCCM docs, as a nephrologists whats going on in your mind ? When I get the call from the outside hospital my first job is to make sure the patient is safe and stable for transfer to a tertiary care center. This includes concern about airway, breathing and level of alertness. From a renal standpoint, I am worried about elevated blood pressure, electrolyte abnormalities, in this case primarily the hyperkalemia, and fluid...

https://amzn.to/3w2DMlV Douglas Murray is the author of the new book, “The War on the West” (Broadside Books), out now.Will God answer your prayer if you don't end with, "In Jesus' name, Amen?" Learn what praying in the name of Jesus really means. I taught this week on the call of Abraham and the development of God's missionary call through the nation of Israel as they were responsible to communicate the truth of God to the cultures around them. They were given that great commission. The great commission didn't start in Matthew 28. It started with Abraham in Genesis 12 —the first three verses there —Abraham, chosen by God to raise up a nation who would then be God's priests to the world so that they would be a blessing to all of the nations. They had a unique role in the great monotheistic religion. The Jews were supposed to reflect morality to the world. Israel was to witness to the name of God. When they talked about the name of God and witnessing to God's name, that does not mean that they were to let everybody know what they called God, "Yahweh." Their goal wasn't to cover the countryside with evangelists who just let everybody know what the right word for God was. It meant something different. ☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆ https://linktr.ee/jacksonlibon --------------------------------------------------- #realtalk #face #instagram #SDF #SYNDICAT #DESPUTES #amour #take #couple #dance #dancers #vogue #voguedqnce #garden #tiktok #psychology #beyou #near #love #foryou #money #ForYouPizza #fyp #irobot #theend #pups #TikToker #couplegoals #famille #relation #doudou #youtube #twitter #tiktokers #love #reeĺs #shorts #instagood #follow #like #ouy #oyu #babyshark #lilnasx #girl #happybirthday #movie #nbayoungboy #deviance #autotrader #trading #khan #academy #carter #carguru #ancestry #accords #abc #news #bts #cbs #huru #bluebook #socialmedia #whatsapp #music #google #photography #memes #marketing #india #followforfollowback #likeforlikes #a #insta #fashion #k #trending #digitalmarketing #covid #o #snapchat #socialmediamarketing

Will God answer your prayer if you don't end with, "In Jesus' name, Amen?" Learn what praying in the name of Jesus really means. I taught this week on the call of Abraham and the development of God's missionary call through the nation of Israel as they were responsible to communicate the truth of God to the cultures around them. They were given that great commission. The great commission didn't start in Matthew 28. It started with Abraham in Genesis 12 —the first three verses there —Abraham, chosen by God to raise up a nation who would then be God's priests to the world so that they would be a blessing to all of the nations. They had a unique role in the great monotheistic religion. The Jews were supposed to reflect morality to the world. Israel was to witness to the name of God. When they talked about the name of God and witnessing to God's name, that does not mean that they were to let everybody know what they called God, "Yahweh." Their goal wasn't to cover the countryside with evangelists who just let everybody know what the right word for God was. It meant something different. ☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆ ☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆☆ https://linktr.ee/jacksonlibon -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- #realtalk #face #instagram #amour #take #couple #dance #dancers #vogue #voguedqnce #garden #tiktok #psychology #beyou #near #love #foryou #money #ForYouPizza #fyp #irobot #theend #pups #TikToker #couplegoals #famille #relation #doudou #youtube #twitter #tiktokers #love #reeĺs #shorts #instagood #follow #like #ouy #oyu #babyshark #lilnasx #girl #happybirthday #movie #nbayoungboy #deviance #autotrader #trading #khan #academy #carter #carguru #ancestry #accords #abc #news #bts #cbs #huru #bluebook #socialmedia #whatsapp #music #google #photography #memes #marketing #india #followforfollowback #likeforlikes #a #insta #fashion #k #trending #digitalmarketing #covid #o #snapchat #socialmediamarketing

Die Haut vor, während und nach einer Bestrahlung richtig pflegen. Birte Schlinkmeier ist Selbsthilfebeauftragte der Rehaklinik Bad Oexen, Breast Care Nurse, MammaCare® Trainerin und Skin Coach für onkologisch betroffene PatientInnen. Seit vielen Jahren begleitet sie Patientinnen und Patienten auf dem Weg der Heilung nach einer Krebstherapie. Ihr Erfahrungsschatz ist riesig und sie teilt ihr Wissen gerne mit uns. In dieser Folge gibt sie wertvolle Tipps, was Du tun kannst, wenn Du in Folge einer Krebstherapie bestrahlt wirst. Wir weisen darauf hin, dass LebensHeldin! e.V. und Birte Schlinkmeier KEIN Geld oder andere Vergütung für die Nennung der Produkte bekommen. Die Empfehlungen beruhen ausschliesslich auf Birte Schlinkmeiers Erfahrung mit PatientInnen. Genannte Produkte und Tipps: Präventiv: schon Wochen vor der Bestrahlung mit Lipikar AP+M von La Roche Posay dünn auf die zu bestrahlende Stelle auftragen Während der Bestrahlung: den Anweisungen der Ärzte unbedingt folgen! Nach der Bestrahlung: Lipikar AP+M von La Roche Posay dünn auf die bestrahlte Stelle auftragen Bei wunder Haut: Cicaplast Baume abends dünn auftragen, morgens Lipikar AP+M, beides von La Roche Posay Thermalspray von La Roche Posay kühlt und spendet Feuchtigkeit BHs: falls der BH kratzt ein kleines Seidentüchlein zwischen BH und Haut legen Bei Bläschen und Entzündungen unbedingt sofort den Arzt aufsuchen! Birte bietet in eigener Sache Produkte für PatientInnen auf ihrer Homepage an: https://www.onko-goodies.de Disclaimer: Es wird ausdrücklich darauf hingewiesen, dass jegliche Art von Hinweisen und Tipps, die in diesem Podcast gegeben werden, keine wie auch immer geartete medizinische Dienstleistungen im Sinne von BGB und HGB darstellen.

Hitzewallungen reichen von leichten Schwitzanfällen bis hin zu schlaflosen Nächten. Wenn frau 5 mal das Nachthemd wechseln muss, weil es durchgeschwitzt ist, dann ist es höchste Zeit etwas zu tun. Im Volksmund manchmal ein wenig ins Lächerliche gezogen, leiden Betroffene oft still darunter und hoffen, dass die Hitzewallungen irgendwann von selber gehen. Es gibt vieles, was Du tun kannst, damit die Wallungen erträglicher werden oder ganz verschwinden: Birte Schlinkmeier ist Selbsthilfebeauftragte der Rehaklinik Bad Oexen, Breast Care Nurse, MammaCare® Trainerin und Skin Coach für onkologisch betroffene PatientInnen. Seit vielen Jahren begleitet sie Patientinnen und Patienten auf dem Weg der Heilung nach einer Krebstherapie. Ihr Erfahrungsschatz ist riesig und sie teilt ihr Wissen gerne mit uns. In dieser Folge gibt sie wertvolle Tipps, was Du tun kannst, wenn Du unter Hitzewallungen in Folge einer Krebstherapie leidest. Wir weisen darauf hin, dass LebensHeldin! e.V. und Birte Schlinkmeier KEIN Geld oder andere Vergütung für die Nennung der Produkte bekommen. Die Empfehlungen beruhen ausschliesslich auf Birte Schlinkmeiers Erfahrung mit PatientInnen. Genannte Produkte und Tipps: Salvysat 3x1 Tablette am Tag und viel trinken (1 Tablette abends mehr, wenn Du nachts stark schwitzt) Sport und Bewegung (mind. 1 x am Tag straff spazieren gehen) Akupunktur am Ohr nach Nadaprotokoll Primavera Hitzewallungsspray: 2 Hübe vor die Brust, wenn die Wallung kommt, in sich gehen und den Duft wahrnehmen Kleidung: Baumwolle oder funktionelle Mikrofaser Ernährung: nicht so spät zu Abend essen und nichts Schweres Birte bietet in eigener Sache Produkte für PatientInnen auf ihrer Homepage an: https://www.onko-goodies.de Disclaimer: Es wird ausdrücklich darauf hingewiesen, dass jegliche Art von Hinweisen und Tipps, die in diesem Podcast gegeben werden, keine wie auch immer geartete medizinische Dienstleistungen im Sinne von BGB und HGB darstellen.

Scheidentrockenheit ist oft Folge einer Krebstherapie und leider ein Tabuthema in unserer Gesellschaft. Daher greifen betroffene Frauen oft zu Mitteln, die gar nicht wirken oder alles nur schlimmer machen. Birte Schlinkmeier ist Selbsthilfebeauftragte der Rehaklinik Bad Oexen, Breast Care Nurse, MammaCare® Trainerin und Skin Coach für onkologisch betroffene PatientInnen. Seit vielen Jahren begleitet sie Patientinnen und Patienten auf dem Weg der Heilung nach einer Krebstherapie. Ihr Erfahrungsschatz ist riesig und sie teilt ihr Wissen gerne mit uns. In dieser Folge gibt sie wertvolle Tipps, was Du tun kannst, wenn Du unter Scheidentrockenheit leidest. Wir weisen darauf hin, dass LebensHeldin! e.V. und Birte Schlinkmeier KEIN Geld oder andere Vergütung für die Nennung der Produkte bekommen. Die Empfehlungen beruhen ausschliesslich auf Birte Schlinkmeiers Erfahrung mit PatientInnen. Genannte Produkte: Pur Gleitgel Premium Vulniphan von Dr. Pfleger für die innere Anwendung Dolmavan und Femisanit als Creme für die äußere Anwendung Birte bietet in eigener Sache Produkte für PatientInnen auf ihrer Homepage an: https://www.onko-goodies.de Disclaimer: Es wird ausdrücklich darauf hingewiesen, dass jegliche Art von Hinweisen und Tipps, die in diesem Podcast gegeben werden, keine wie auch immer geartete medizinische Dienstleistungen im Sinne von BGB und HGB darstellen.

In this podcast,Dr. Greg Giese, an internal medicine physician with Ridgeview talks about diabetic ketoacidosis (DKA). More specifically Dr. Giese will discuss the pathophysiology, initial assessment findings and diagnosis of DKA, along with addressing the differences between diabetic ketoacidosis (DKA) and hypersmolar hyperglycemic state (HHS), and treatment options for DKA patients. Enjoy the podcast! Objectives:   Upon completion of this podcast, participants should be able to: Define diabetic ketoacidosis. State the differences between diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS). Summarize how to diagnose and treat diabetic ketoacidosis. CME credit is only offered to Ridgeview Providers & Allied Health Staff for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within approximately 2 weeks. You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. To receive continuing education credit for this activity - click the link below, to complete the activity's evaluation. CME Evaluation (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  DISCLOSURE ANNOUNCEMENT  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition; and are property/rights of Ridgeview Medical Center & Clinics.  Any re-reproduction of any of the materials presented would be infringement of copyright laws.  It is Ridgeview's intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker's outside interest may reflect a possible bias, either the exposition or the conclusions presented. Ridgeview's CME planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. Thank-you for listening to the podcast. SHOW NOTES: *See the attachment for additional show information.  DKA: Deficit of insulin- Typical scenario     - Insulin deficienty + counterregulatory hormones     - Catabolic state     - Gluconeogensis     - Glycogenolysis     - Elevated blood sugar causes concomitant osmotic       diuresis DKA: 3 Parts- Ketones (ketonemia) - Hyperglycemia (lack of insulin) - Acidosis (Anion gap Metabolic Acidosis) Presentation- Critically ill individual on set in 24-48 hours - Kussmaul respirations - Other causes (infections, UTI, pneumonia, skin    infections, MI, drugs,) - Altered mental status - HHS: Hyperosmolar hyperglycemic state Work-up- Basics CBC with differential; metabolic panel, serum ketones, blood gas, urine analysis, plasma osmolality - Evaluation: Elevated WBC;  elevated anion gap;  electrolyte abnormalities;  Chest x-ray Results- Potassium (hold insulin if K was 3.4 or below) - Hyponatremia - Bicarb - Anion gap - Normal to elevated calcium - BUN greater than creatinine ration - Elevated creatinine - Elevated WBC due to catecholamines and stress response - Hgb/platelets - Urine Treatment- Fluids - Potassium - Insulin Transition to baseline- Discontinue insulin when anion gap metabolic acidosis closed and able to take oral nutrition- Bridge, start subcutaneous long acting insulin, stop insulin drip 1-2 hours later. Thanks for listening.

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat and I'm Rahul Damania. We are coming to you from Children's Healthcare of Atlanta - Emory University School of Medicine. Welcome to our Episode a 2-year-old with severe pallor and O2 desaturation. Here's the case presented by Rahul: A two-year-old presents to the PICU with severe pallor + O2 requirement. The patient went for a routine check with her primary care who noted the patient appeared severely pale. He sent the patient to the ED. An initial Hgb check revealed a Hgb of 1.5gm/dL. Per mother, she is otherwise healthy but a very picky eater. She also reports the patient drinks milk as a soothing adjunct at night, consuming between 12 - 36oz a day. No family h/o of anemia or any other blood disorders. No h/o recent illness. Mother had a normal spontaneous full-term delivery. The patient is up to date on her immunizations. Per mother, developmental milestones are normal. The mother also denies any history of decreased activity in the child. Given the low Hgb, the patient was admitted to the PICU. Let's transition into some history and physical exam components of this case? What are key history features in this child? Severe pallor in a 2-year-old H/o being a picky eater H/o excessive milk consumption Pertinent negatives include: No obvious blood loss, No petechia, bruising, or jaundice What did the physical exam show? The patient was hypertensive, tachycardic to the 140s, and 10th% weight for growth percentiles On physical exam, the patient was in no acute distress. Her lips, gums, and conjunctiva were pale. She had a systolic ejection murmur. As a pertinent negative, she had no hepatosplenomegaly. She also has no rash, bruising, or petechiae. The lack of hepatosplenomegaly may indicate that the patient has no signs of extramedullary hematopoiesis. Patients with hemolytic processes resulting in anemia may present with signs of scleral icterus, jaundice, and hepatosplenomegaly resulting from increased red cell destruction. In fact, in an emergency department setting, the clinical detection of jaundice was found to have sensitivity and specificity of only approximately 70 percent. To continue with our case, then what were the patient's labs consistent with: Initial CBC showed: WBC 8.5K, RBC 1.14 (L), Hgb 1.5gm/dL; Hct 6.1, MCV 53.5, and an elevated RDW 37.7. Initial platelet count was 50K, reticulocyte count 1.1% Peripheral smear revealed no blasts, thrombocytopenia - with occasional medium-sized platelets - ghost cells and anisocytosis/poikilocytosis- which appears most consistent with iron deficiency. It was interesting that the patient had thrombocytopenia Absolutely, typically with Iron deficiency, there is thrombocytosis (erythropoietin is increased which closely mimics thrombopoietin stimulates platelets). In fact, both act via the non-TK, JAK-STAT pathway. OK, to summarize, we have: Two year old with severe anemia most likely secondary to iron deficiency. As you think about our case, what would be your differential? For any patient with acute severe anemia presenting to the PICU- One has to think in terms of blood loss, decreased or impaired production (i.e bone marrow failure), or peripheral blood destruction (i.e hemolysis). Here would be the organizations: Blood loss Decreased or impaired production Increased destruction Let's go into detail for each: Blood loss can be internal or external (due to trauma, excessive blood draws, due to surgery)-typically gives rise to normochromic normocytic anemia. Decreased or impaired production: Deficiency of substances needed for Hgb & RBC production such as iron Vit B12 etc. Depression of BM due to infection (parvo B), chemicals, pharmacologic agents or immune mechanisms. Bone marrow aplasia can be idiopathic with or without congenital anomalies. Infiltration of BM due to malignancies such as leukemia, Hodgkin disease,...

It's almost time for the big reveal! This week Rooster joins us to talk about the newest faction in Heavy Gear Blitz, Eden. We'll be talking about every unit being added to the army, including all of their profiles and artwork. If you're a HGB fan, or just HGB-curious, you won't want to miss this episode! Eldon Cowgur: http://www.astray3.com/ http://www.astray3.bigcartel.com/ Tarosan (Kayuna): https://www.patreon.com/game_mini_garage Samuli: http://hgbtools.infohell.net/ Nick's RPG Session: https://www.youtube.com/watch?v=3Ur8B57tcWA Description Support The Dice Abide LIVE on Patreon: https://www.patreon.com/thediceabide Support Our Sponsors: Mythic Games, online and in Santa Cruz http://moe-games.com/ Board and Brew https://www.boardandbrew.games/ Corvus Belli https://corvusbelli.com/ Dream Pod 9 https://store.dp9.com/ Contact Us: Facebook: https://www.facebook.com/thediceabide Email: Adam @ thediceabide.com, Wisekensai @ bromadacademy.com Twitch: https://www.twitch.tv/thediceabide YouTube: https://www.youtube.com/c/thediceabidelive Instagram: @TheDiceAbide, @WiseKensai Twitter: @TheDiceAbide @WiseKensai Our Blogs: https://www.thediceabide.com/ https://www.mercrecon.net/ https://www.bromadacademy.com/ Our Patreon Supporters: D6 Tier: Alexander Arsenty D10 Tier: Adam Swift, Alfredo Ramirez, Eric Heymann-Heidelberger, Frank Washburn, Gregg Barlow, Nathaniel Beach-Hart, Obadiah Hampton, Pete Setchell, Steve D D20 Tier: Adriel Colon-Casiano, Dexter Esmaya, Jacob Ridley, Leif Hendricksen, Audio Attribution: https://www.bensound.com/royalty-free-music http://www.nihilore.com/license Kevin MacLeod (https://incompetech.com/) "Apero Hour" - Licensed under Creative Commons: By Attribution 3.0 Local Forecast - Slower by Kevin MacLeod Link: https://incompetech.filmmusic.io/song/3988-local-forecast---slower License: https://filmmusic.io/standard-license Applause by Halleck: https://freesound.org/s/18665/ https://soundsilk.com http://www.orangefreesounds.com/

Anett Stuth. Künstlerin, Berlin. Zitate aus dem Podcast: »Jeder Begriff löst ein Bild in uns aus.« »Oft sind es die Bilder anderer, die wir dann aufrufen und verarbeiten.« »Ich finde es immer ärgerlich, wenn ich von der Technik beherrscht werde, und ich nicht die Technik beherrsche.« »Es nützt nichts, wenn man eine gute Idee hat, sie aber nicht transportiert werden kann.« »Fotografie Neu Denken heißt für mich Grenzen überschreiten und mit Tabus brechen.« »Der Diversität der fotografischen Arbeiten verdankt die Fotografie ihren festen Platz im Bereich der Kunst.« »Ein gutes Bild muss mich sehr lange beschäftigen.« »Wenn man keine klaren, gesunden Entscheidungen treffen kann, dann ist die digitale Technik eher Fluch und Segen zugleich.« »Es wäre sehr hilfreich, wenn Politik Bildung endlich im ausreichenden Maß unterstützen würde.« Anett Stuth wurde 1965 in Leipzig geboren und zog 1983 nach Berlin. 1989 begann sie an der Hochschule für Grafik und Buchkunst Leipzig (HGB) im Grundstudium des Fachbereiches Fotografie bei ihrer Mentorin Evelyn Richter zu studieren. Kurze Zeit später fiel die Mauer und sie nutzte die Gelegenheit für einen längeren Studienaufenthalt in New York. Nach ihrer Rückkehr studierte sie weiter an der HGB bei Arno Fischer. Nach 1993 verließen erst Arno Fischer und dann Evelyn Richter die HGB. Sie studierte dann bis 1996 weiter bei Timm Rautert und wurde seine Meisterschülerin. Seit 1999 arbeitet sie als freie Fotokünstlerin in Berlin, wird von verschiedenen Galerien vertreten und ihre Arbeiten sind in nationalen & internationalen Ausstellungen und Sammlungen zu sehen. 2017 gründete sie gemeinsam mit der Kunsthistorikerin Julia Rosenbaum den Salon für Kunst und Kultur »special rooms« in Berlin-Mitte. Dieser Kunstsalon ist aktuell coronabedingt geschlossen, wird jedoch voraussichtlich in diesem Jahr wieder eröffnet. Sie lebt mit ihrer Familie in Berlin. http://anettstuth.de/ https://www.galeriekleindienst.de/ https://de.wikipedia.org/wiki/Anett_Stuth Episoden-Cover-Gestaltung: Andy Scholz Episoden-Cover-Foto: Kerstin Flake (Smartphone-Foto in der Ausstellungsinstallation von Peter Miller in seiner Ausstellung: »Dear Photography«, im c/o Berlin 2021, nach einer Fotografie von Lee Friedländer) Idee, Produktion, Redaktion, Moderation: Andy Scholz http://fotografieneudenken.de/ https://www.instagram.com/fotografieneudenken/ Der Podcast ist eine Produktion von STUDIO ANDY SCHOLZ 2022. Andy Scholz wurde 1971 in Varel am Jadebusen geboren. Er studierte Philosophie und Medienwissenschaften in Düsseldorf, Kunst und Design an der HBK Braunschweig und Fotografie/Fototheorie in Essen an der Folkwang Universität der Künste. Seit 2005 ist er freier Künstler, Autor sowie künstlerischer Leiter und Kurator vom FESTIVAL FOTOGRAFISCHER BILDER, das er gemeinsam mit Martin Rosner 2016 in Regensburg gründete. Seit 2012 unterrichtet er an verschiedenen Instituten, u.a. Universität Regensburg, Fachhochschule Würzburg, North Dakota State University in Fargo (USA), Philipps-Universität Marburg, Ruhr Universität Bochum. Im ersten Lockdown, im Juni 2020, begann er mit dem Podcast. Er lebt und arbeitet in Essen. http://fotografieneudenken.de/ https://www.instagram.com/fotografieneudenken/ https://festival-fotografischer-bilder.de/ https://www.instagram.com/festivalfotografischerbilder/ http://andyscholz.com/ https://www.instagram.com/scholzandy/

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamat and I'm Rahul Damania, and we are coming to you from Children's Healthcare of Atlanta - Emory University School of Medicine. Welcome to our Episode a 24-month-old girl with increased seizure frequency. Here's the case: A 24-month old girl presents to the ED with h/o shaking/jerking episodes in her sleep. The patient was in the care of her aunt when this acute episode occurred. When the father arrived from work, he saw his daughter having episodes of her body shaking alternating with heavy breathing. The patient would not wake up in between episodes. There was pertinently no history of trauma. 911 was called and when EMS arrived, she was starting to arouse and respond to stimuli. The patient was transported to the ED. In the ambulance, the patient continued to have similar shaking and jerking episodes and was given rectal diazepam. On arrival to ED, the patient had a fever of 38.5 Centigrade. Due to ongoing seizures, the patient was loaded with Fosphenytoin, after having been given a total of two doses of IV Lorazepam. The patient was subsequently intubated for airway protection and respiratory failure. A respiratory viral panel was negative for SARS-COV-2 but positive for Rhino-enterovirus. The patient was admitted to the PICU with cEEG monitoring and placed on mechanical ventilation with fentanyl + dexmedetomidine infusions with as needed Midazolam administrations Her physical examination on arrival to the PICU was unremarkable. She wasn't interactive as she had just received sedation after intubation. On her neuro-examination, Pupils are equal and punctiform. The face is symmetric.  The tongue is midline. Normal bulk and tone. No spontaneous movements were noted. No withdrawal to painful stimuli. Tendon reflexes were equal throughout. No clonus is noted. Rahul, to summarize key elements from this case, this patient has: Fever Viral infection with Rhinoentero virus Generalized Tonic clonic seizure lasting > 5minutes Acute respiratory failure All of which brings up a concern for status epilepticus Absolutely, we will get to this later on in the episode; however, remember that Status epilepticus is historically defined as single epileptic seizure of >30 minutes duration or a series of epileptic seizures during which function is not regained between ictal events in a 30-minute period Let's transition into some history and physical exam components of this case? What are key history features in this child who presents with status epilepticus? Prolonged Seizures Fever with viral symptomatology which may act as a trigger A pertinent negative is that this patient had no history of trauma or co-morbid conditions such as a genetic syndrome. The patient also had no presumed ingestions as well. Are there some red-flag symptoms or physical exam components which you could highlight? Important to look for rash (darkening of the skin = adrenoleukodystrophy), genetic facies, evidence of trauma —-all of which are absent in this girl To continue with our case, the patients labs were consistent with: Initial Labs: WBC 27K, with neutrophilic predominance, Hgb and platelets were normal. Initial CMP was normal except for a glucose of 233. Gas prior to intubation in the ED was 6.9/102/85/-9. (repeat after intubation 7.19/49/40/-9). Ionized ca 4.9mg/dl. A urine analysis was unremarkable. Head CT negative OK to summarize, we have: 24-month-old girl who presented with prolonged seizures and acute respiratory failure All of which brings up the concern for status epilepticus the topic of our discussion today. Let's start with a short multiple-choice question: A 14-year-old girl is brought to the PICU from the floor with new-onset status epilepticus. She was admitted to the floor on her second day after a posterior spinal fusion surgery and is still receiving intravenous fluids. Her seizure is described as...

Welcome to PICU Doc On Call, A Podcast Dedicated to Current and Aspiring Intensivists. I'm Pradip Kamatand I'm Rahul Damania. We are coming to you from Children's Healthcare  of Atlanta - Emory University School of Medicine. Welcome to our Episode of a 19 month old female with bloody stool, petechiae and no urine output Here's the case presented by Rahul: A 19 month old previously healthy female was brought to the pediatric emergency department for blood in her stool. Patient was at daycare the previous day where she developed a low grade fever, congestion and URI symptoms along with non-bloody-non-bilious vomiting and diarrhea. Patient had a rapid COVID test which was negative and was sent home with instructions for oral hydration. That evening, patient began having vomiting/diarrhea which worsened. She was unable to retain anything by mouth and her parents also noted blood in her stool. Due to this, she was rushed to the Emergency Department. In the ED here, she was hypertensive for age BP of 124/103 mm Hg, febrile, and ill. Specks of blood were noted on the diarrheal stool in the diaper. On her physical exam she was noted to be pale with petechiae on neck and chest. Her abdomen was soft, ND, with some hyperactive bowel sounds, and no hepatosplenomegaly. The rest of her physical examination was normal. In the ED, initial labs were significant for WBC 19, Hgb 8.8, and Platelets 34. CMP was significant for BUN of 74mg/dL and Cr of 3.5mg/dL, Na 131 mmol/L, and K of 5.5mmol/L, Ca 8.3mg/dL (corrected for albumin of 2.2g/dL), Phosphorous 8.5 AST 413, and ALT of 227, LDH > 4000. BNP was 142 and troponin negative. She was given 1 dose of CTX 50mg/kg and a 20cc/kg NS bolus. Stool PCR was sent. She was given labetalol for her hypertension, started on maintenance IV fluids and transferred to the PICU for further management. Rahul to summarize key elements from this case, this patient has: We have a 19-month old child with Diarrhea and emesis X 2 days No urine output for over 24 hours Bloody stool Petechiae on the neck and chest Anemia and thrombocytopenia All of which bring up a concern for hemolytic uremic syndrome the topic of our discussion today Let's transition into some history and physical exam components of this case. What are the key historical features in this child who presents with above? Bloody stool which alludes to an invasive diarrhea No urine output and an ill appearing state which points to a systemic inflammatory condition and end organ dysfunction. Are there some red-flag symptoms or physical exam components which you could highlight? Presence of petechiae which are physical exam features of thrombocytopenia Her pallor which is a physical exam sign of anemia Hypertension which is related to her renal dysfunction To continue with our case, the patient's labs were consistent with: Anemia Thrombocytopenia Elevated BUN and creatinine Elevated serum LDH The patient did not have hyperkalemia, or acidosis on initial presentation OK to summarize, we have a 19 month old girl with: Anemia, thrombocytopenia, and renal failure. This brings up the concern for Hemolytic uremic syndrome → Rahul Let's start with a short multiple choice question: A 2-year old boy is admitted to the PICU with acute respiratory failure secondary to pneumococcal pneumonia. On day # 3 of admission, the nurse reports the patient appears pale and has petechiae on his chest. The patient also has not had urine output for > 12 hours and appears to be fluid overloaded. Of the following the lab findings would be most consistent with the above clinical findings in the patient? A) Elevation of serum haptoglobin B) Low serum lactate dehydrogenase (LDH) C) Negative Direct Coombs test D) Peripheral smear showing schistocytes The correct answer is D-Peripheral smear showing schistocytes. Patient in the above case most likely has streptococcus pneumoniae associated hemolytic uremic syndrome commonly called as...

Welcome to PICU Doc On Call, a podcast dedicated to current and aspiring intensivists. My name is Pradip Kamat My name is Rahul Damania, a current 2nd year pediatric critical care fellow. We come to you from Emory University,School of Medicine, Children's Healthcare of Atlanta, Atlanta, GA. Today's episode is dedicated to O2 delivery in the PICU. We would like to highlight in this episode Stanford University School of Medicine Pediatric Critical Care's LearnPICU website. Thehttp://learnpicu.com ( LearnPICU.com) website Is dedicated to reviewing clinical topics related to pediatric critical care, and is an open access resources which Is widely accessed worldwide. The website has over 10,000 visits each month, and is managed by Dr. Kevin Kuo - Clinical associate professor of pediatrics pediatric critical care at Stanford University. Dr. Kuo has Been featured on our prior episode entitled seven habits of highly effective Picu fellows, and we are very excited to collaborate with his educational resources to provide you the listener a comprehensive educational experience. Rahul, let's go ahead and get into today's case. A 17-year old boy is admitted after he was struck by a car at slow speed while crossing the street. He is has SPO2 of 98%, HR 98 bpm with a normal capillary refill and perfusion. His blood gas at admission to the PICU reveals a ph of 7.3/PCO2 35/PaO2 196 mm Hg on 50% NRB with 100% O2 flowing at 12LPM. His admission hgb is 10.5 gm%. 4 hours post admission, the nurses noticed that the patient is tachycardic to 150s, with a drop in his BP, delayed capillary refill, with cool extremities and increased output from the chest tube. His SpO2 has decreased to 86% and PaO2 on his blood gas is now 65mm HG. He is found to have a POC Hgb of 6.8 mg/dL. Let's take this case and highlight key components of O2 delivery and O2 consumption. Lets focus on O2 delivery first. Rahul What are the components of O2 delivery ?  Pradip, O2 delivery is made of O2 content X Cardiac output Simply put, O2 content is the amount of blood present in 100ml of arterial or venous blood. Its is denoted by CaO2 or CvO2 and its unit is mL O2 / dL blood or mL O2 per 100 mL of blood. Before we introduce the complicated formula, let's just appreciate the variables within the equation. Oxygen content is going to be a function of three variables: This is going to be Hgb, Saturations on the hemoglobin also known as SaO2, and the amount of oxygen that is dissolved within the blood also known as your PaO2. Pradip, Can you elucidate further about O2 content? O2 content is given by the formula: CaO2 = (1.34X Hgb gm/dl X SaO2) + (0.003X PaO2) Important points to remember about above formula is that the constant 1.34 (or 1.36 as given by some textbooks) is the amount of O2 in mL bound by one gm of Hgb and is called as the O2 carrying capacity of Hgb. In a healthy person say with 15gm% of Hgb, the O2 carrying capacity is about 15X1.34 = 20gm%. Now many times amount of O2 bound to Hgb may not always reflect 100% saturation So we need to factor the % oxygen saturation into the oxygen carrying capacity of the Hgb. The final element is to understand that some oxygen is dissolved in the plasma and is calculated using a constant 0.003 X PaO2. Typically 100ml of arterial blood with a saturation of 100 will contain 100 X 0.003 = 0.30ml of dissolved oxygen. Rahul can you calculate the pre-decompensation oxygen content in the above case? The above patients hgb pre-decompensation = 10.5gm%. His room air saturation 98% and his PaO2 is 196. CaO2 = (1.34X10.5X0.98) + 0.003 X 196 = 13.7 + 0.58 = 14.2ml O2/dL blood. Great - what is the post decompensation CaO2.? The post decompensation CaO2 can be estimated using same formula as above: CaO2 = (1.34 X 6.8 X0.86) + (0.003 X 65) = 7.8 + 0.195 = 7.9 O2/dL blood. Exactly So if you see the pre and post bleed O2 content just with a drop in Hgb from 10.5 to 7.5gm/dL: There is almost a 38% decrease in...

Jakob Kirch, geboren 1980 in Dresden, ist der ältere der beiden. Er hat bei Günter Karl Bose an der HGB studiert, parallel bereits freiberuflich gearbeitet, unter anderem mit Florian Lamm, Jahrgang 1984, der aus Hannover an die Leipziger Hochschule kam. 2012 gründeten die beiden ihr Label, dessen Name so klingt, als könnte es sich auch um eine jahrhundertealte Bamberger Bierbrauer-Dynastie handeln. Die beiden arbeiten jedoch vor allem mit und für Kunden aus dem deutschsprachigen Kulturbereich; ziemlich erfolgreich, wie die gewonnenen Preise nahelegen – zuletzt gab es 2021 ein Ehrendiplom bei den Schönsten Büchern aus aller Welt. Die Digitalisierung erlaubte schon vor Corona räumlich getrennte Schreibtische in Leipzig (Jakob) und Berlin (Flo), was nicht ohne Folgen für den Charakter der Arbeit und die Produktion bleibt. Wir sprechen – unter anderem – über Hermann Glöckner, Kurt Wolff, Berliner Graffiti, gemeinsame Jobs, Brötchenverdienen und Forscherdrang, Pingpong & Feedbackschlaufen, Restpapiere & Sonderfarben, Luxus & Nachhaltigkeit, abgesagte Plakate und Kultur in Zeiten von Corona. Ebenfalls mit dabei: Der Wunderhorn-Verleger Manfred Metzner, Gründungs-Vorsitzender der Kurt-Wolff- Stiftung, und der Grafikdesigner, Typograf und UdK-Professor Fons Hickmann, Präsident von 100 beste Plakate e.V. Mit dickem Dank an Steffen Brosig (Schnitt).

El secreto del éxito de Jorge y del HGB está dentro, en su alma. En su persona, en su actitud, en su autenticidad al afrontar su día a día. Descubre su secreto En este podcast te vas a llevar actitud, paciencia, autenticidad, constancia y humor. Jorge nos cuenta: Cómo personas felices hacen empresas rentables Que activa su motivación con música “de buen rollo” Qué es la PAREPIA y cómo aplicarla La importancia de relativizar lo que nos sucede en el día a día Cómo liberarse de los frenos y miedos que nos impiden perseguir nuestros sueños La importancia de cuidarse y cuidar a quienes te rodean Gracias a David Alonso y su pregunta nos enseña cómo compaginar la vida personal y profesional Guiños a Gaby Salaberria de Lasttour y la artesana Elsa de Otrora. No aparece directamente pero están ahí siempre presentes compañeros del HGB como Miguel Angel, Raul, Iñaki, Carla, Eshter, Tomás,, Santi, Mikel, Charo, Pedro, Juli, Ana NOS VEMOS EN LAS REDES LinkedIn - https://www.linkedin.com/in/sergiodemiguel Instagram - https://www.instagram.com/elequilibrista_ Telegram GRUPO LA VIDA ES PERFECTA- https://t.me/joinchat/k5-Gogo_Bf43NDg0

Chapter Three: How the proximal tubule is like Elizabeth Warren and other truths my friends from Boston taught me References for Chapter 3: Faisy C, Meziani F, PLanquette B et al. Effect of Acetazolamide vs. Placebo on Duration of Invasive Mechanical Ventilation among patients with chronic obstructive pulmonary disease: a randomized clinical trial. JAMA 2016 https://pubmed.ncbi.nlm.nih.gov/26836730/This randomized controlled double blinded multi-center study of acetazolamide to shorten the duration of mechanical ventilation (known as DIABLO) there was no statistically significant difference (though it may have been underpowered to do so).Salazar H, Swanson J, Mozo K, White AC, Cabda MM Acute Mountain sickness impact among travelers to Cusco, Peru J Travel Med 2012 https://pubmed.ncbi.nlm.nih.gov/22776382/ Investigators found that altitude sickness is common and alters travel plans for 1 in 5 travelers but was prescribed infrequently.Buzas GM and Supuran CT. Journal of enzyme inhibition and medicinal chemistry 2015 https://www.tandfonline.com/doi/full/10.3109/14756366.2015.1051042This review describes the use of acetazolamide to treat peptic ulcers and how it was later learned that H. pylori have carbonic anhydrase NORDIC idiopathic intracranial Hypertension Study Writing Committee. The effect of acetazolamide on visual function in patients with idiopathic intracranial hypertension and mild visual loss: the idiopathic intracranial hypertension treatment trial. JAMA 2014 https://pubmed.ncbi.nlm.nih.gov/24756514/In this multi-centered trial, acetazolamide and low sodium weight reduction diet improved mild visual loss more than diet alone. Mullens W et al. Rationale and design of the ADVOR (acetazolamide in decompensated heart failure with volume overload trial) Eur J Heart Failure 2018 https://pubmed.ncbi.nlm.nih.gov/30238574/This reference explains the rationale for this ongoing trial.Gordon CE, Vantzelfde S and Francis JM. Acetazolamide in Lithium-induced nephrogenic diabetes insipidus NEJM 2016 https://www.nejm.org/doi/full/10.1056/NEJMc1609483A case report of efficacy of acetazolamide in a patient with severe polyuria.Zehnder D et al. Expression of 25-hydroxyvitamin D-1alpha hydroxylase in the human kidney. JASN 1999 This report explores the activity in the enzyme in nephron segments and suggests that the distal nephron may play an important part in the formation of 1,25 vitamin D https://jasn.asnjournals.org/content/10/12/2465Outline: Chapter 3 - This is chapter three, kind of the first real chapter of the book- Proximal Tubule- Reabsorbs 55-60% of the filtrate - Active sodium resorption - 65% of the sodium - 55% of the chloride - 90% of HCO3 - 100% glucose and amino acids - Passive water resorption - Water resorption is isosmotic - Secretion of - Hydrogen - Organic anions - Organic cations - Anatomy - S1, S2, S3 can be differentiated by peptidases - S1 more sodium resorption and hydrogen secretion, high capacity - S2 more organic ion secretion - Cell model - Basolateral membrane - Na-K-ATPase powers all the resorption - Luminal membrane - 100 liters a day crosses the proximal tubule cells - Microvilli to increase surface area - Microvilli has brush border which has carrier proteins as well as carbonic anhydrase - Water permeable, so sodium resorption leads to water resorption - Aquaporin-1 (sounds like this transporter is unique to the proximal tubule and RBC) - HCO3 is reabsorbed early, along with Na, resulting in increased chloride concentration which passively reabsorbed via paracellular route. - Tight junction has only one strand (on freeze fracture) as opposed to 8 in distal nephron - The Na-K-ATPase - Lower activity than in the LOH and distal nephron - Maintained intracellular Na at effective concentration of 30 mmol/L - Interior of the cell is negative due to 3 sodium out and 2 K in, then K leaks back out. - 3 Na out for 2 K in - An ATP sensitive K outflow channel on the basolateral membrane - Increased ATP slows potassium eflux - The idea is if Na-K slows, ATP will accumulate and this will slow K leaving, because there is less potassium entering. - K channel is ATP sensitive, ATP antagonizes K leak. - Highly favorable ELECTROCHEMICAL gradient for sodium to flow into the cell through the luminal membrane - Must be via a channel or carrier - Cotransporters - Amino acids - Phosphate - Glucose - Called secondary active transport - Countertransporters - Only example is H excretion - Basolateral membrane - Na-3HCO3 transporter - Powered by the negative charge in the cell- Chloride resorption - Formate chloride exchanger - Formate combines with hydrogen in the lumen, becomes neutral formic acid, and is reabsorbed where the higher pH causes it to dissociate and recycle again. - Dependent on continued H+ secretion - Chloride moves across basolateral membrane thanks to Cl and KCl transporters, taking advantage of negative intracellular charge- Passive mechanisms of proximal tubule transport - Accounts for one third of fluid resorption - Mechanism - Early proximal tubule resorts most of the bicarb and less of the chloride - Tubular fluid gets a high chloride concentration - Chloride flows through the tight junction down its concentration gradient - Sodium and water follow passively behind - Water moves osmotically into intercellular space from tubular fluid even though the osmolalities are equal since chloride is an ineffective osmole, so tonicity is not the same. ****** - Argues that bicarb is primarily important solute for passive resorbtion - Acetazolamide blocks Na and chloride resorption - Similar thing happens with metabolic acidosis where less bicarb is available to drive passive resorbtion of Na and Cl - Summary - Other than Na-K-ATPase Na-H antiporter main determinant of proximal Na and water resorption - 1. Direct bicarb resorption - Preferential bicarb resorbtion proximally drives passive chloride resorption - Drives active the formate exchanger for chloride resorption- Neurohormonal influence - AT2 drives a lot of Na resorption, primarily in S1 segment - Does not have a net effect on H-CO3 movement - Dopamine antagonizes sodium resorption - Blocks both Na-K-ATPase and - Na H antiporter- Capillary uptake - Starlings. Again - Low hydraulic pressure due to glomerular arteriole - High plasma on oncotic pressure from loss of the filtrate - The two together promote resorption - There maybe movement from interstitial back into tubular fluid (back diffusion) conflicting data- Glomerular tubular balance - The fractional tubular reabsorption remains constant despite changes in GFR (tubular load) - It is essential the GFR is matched by resorption - The rise in capillary osmotic pressure with increased GFR via increased filtration fraction is one mechanism of GT balance - Glomerular tubular balance os one of three mechanisms that prevents fluid delivery from exceeding the resorptive capacity of the tubules - GT balance - TG feedback - Autoregulation - GT balance can be altered if patients are volume overloaded or depleted - Closes this section with a story of a kid born without a brush border - Primacy of sodium in proximal tubule activity - Discusses bicarb resorbtion - There is no Tm for Bicarb as long as volume overload is prevented, in rats can rise over 60! - If you give NaHCO3 you get volume overload and the Tm I about 60 - Glucose - S1 and S2 have high capacity, low affinity glucose resorption - S3 has high affinity 2 Na fo every glucose - Tm glucose is 375 mg/min - For a GFR of 125t that comes out to 300mg/dL - 125 ml/min * 3mg/ml (300 mg/dL) = 375 mg/min - Functionally this is 200 mg/dL due to splay - Urea - Only 50-60 of filtered urea is excreted - Calcium Loop and distal tubule - Phosphate - 3Na-Phosphate high affinity transporters late in proximal tubule - three types of Na-Phos transporters, type 2 are the most important - regulated by PTH and plasma phosphate - PTH suppresses Phos resorption -Metabolic acidosis also reduces phosphate resorption (good to have phosphate in the tubule to soak up H+ - Decreased tubular pH converts HPO42- to H2PO4- which has lower affinity for phosphate binding site - Mg Loop and distal tubule - Uric AcidWhy do I love acetazolamide?- I love the proximal tubule- Many uses- Often forgottenMOA- Inhibit carbonic anhydraseMain effects- Renal: less bicarb reabsorption (ie less H secretion) à more distal Na/bicarb delivery à hypokalemic metabolic acidosis- Brain: reduce CSF production, reduce ICP/IOP, aqueous humor- Pulm: COPDNotes- Tolerance develops in 2-3 days- Sulfonamide derivative- Highly protein bound, eliminated by kidneys Source: Buzas and upuran, JEIMC, 2016S Data:1968 - High altitudeHigh altitude usually results in respiratory alkalosisAcetazolamide – lessens symptoms of altitude sickness (insomnia, headache) which occur because of periodic breathing/apnea1979- NEJM study took 9 mountaineers asleep at 5360 meters à improvement in sleep, improved SaO2 from 72 to 78.7 mmHg, reduce periodic breathing, increased alveolar ventilation (pCO2 change from 37 mmHg to 30.8mm Hg)1950s - Seizures/migrainesCAI reduces pH (more H intracellularly), K movement extracellularly à hyperpolarization and increase in seizure thresholdWeak CAI (Topamax, zonisamide) but not though to be important mechanism of antiseizure effect (topamax enhances inhibitory effect of GABA, block voltage dependent Na and Ca channels)Pulmonary/COPDThought to help with the metabolic alkalosis and as a respiratory stimulant to increase RR, TV, reduce ventilator timeIn 2001 Cochrane review – no difference in clinical outcomes, but did reduce pH and bicarb minimallyDIABLO study (RCT) on ventilated COPD patients – no difference in median duration of mechanical ventilation despite correction of metabolic alkalosisHigh altitude erythropoiesis (Monge disease)First described in 1925 via Dr. Carlos Monge Medrano (Peruvian doctor), seen in people living > 2500-3000 meters (more common in South America than other high altitude areas)Usually chronic altitude sickness with HgB > 21 g/dL + chronic hypoxemia, pHTNAcetazolamide – reduces polycythemia because induces a met acidosis à increases ventilation and arterial PPO2 and SaO2 à blunts erythropoiesis and reduces HCT and improves pulmonary vascular resistanceGI ulcersWhen H2 and PPI available, less useHistory: 1932 – observed alkaline tide, presumed existence of gastric CA (demonstrated in 1939)Acetazolamide was used to inhibit acid secretion in 1960s, ulcer symptoms, with reversible metabolic acidosis, BUT lots of SE (electrolyte losses, used Na/K/Mg salts to help, renal colic, headache, fatigue, etc)Later found H. Pylori encodes for two different CasHelps to acclimatize to acidic environmentBasically, the Ca changes CO2 into H+ and HCO3They also have a urease which produces NH3The NH3 binds with H+, leaving an alkaline environment for them to live inInhibition of CA with acetazolamide is lethal for pathogen in vitro1940sFound there was CA in pancreasThought acetazolamide to reduce volume of secretions from NGT (output from exocrine pancreas) Source: Human Anatomy at Colby Blog Diuretic resistanceIf develop hyperchloremic metabolic alkalosis, short course of acetazolamide + spironolactone (b/c need distal Na blockage) à can helpMay help with urine alkalization (ie uric acid stone) but increases risk of calcium phosphate stonesADVOR trial acetazolamide in HF exacerbation in Belgiumuse may help to prevent new episode, lower total diuretic doseCSF reduction (pseudotumor cerebri)Reduces CSF by as much as 48% when > 99.5% of CA in choroid plexus is inhibitedNORDIC trial (acetazolamide v. placebo) – improvement in visual symptoms especially if advanced papilledema, and reduced opening pressure)Side note also used off label to help with increased ICP and CSF leaks, as alternative to VP shunts, repeat LPs, etc Source: Eftekari et al, Fluid Barriers CNS, 2019.

Erster Mai, Feiertag, Zeit für eine neue Fußnote. Mit Klimaschutz, Sorgfaltspflichtengesetz und spannender juristischer Lektüre. (00:00) Herzlich willkommen! (00:18) Klimaschutzbeschluss des BVerfG v. 24. März 2021, 1 BvR 2656/18 u.a., Volltext (03:26) Aktuelle Gesetzgebung: Regierungsentwurf für ein Sorgfaltspflichtengesetz alias Lieferkettengesetz, pdf (15:50) Aktuelle Literatur: Daniel Löwer: Click and Collect – Besonderheiten beim Widerrufsrecht, MMR-Aktuell 2021, 436258 Nadine Klass: Der Kampf ums Urheberrecht, ZRP 2021, 74-77 Andreas Piekenbrock: Das frühe Schrifttum zum BGB, JURA 2021, 475-481 Maximilian Steinbeis: Eigentümliches Eigentum, online auf verfassungsblog.de (26:05) Aktuelle Rechtsprechung: Schutz einer 40 Jahre alten Schwarzkiefer: BGH v. 11. Juni 2021, V ZR 234/19, Volltext § 56 HGB im Autohaus: OLG Karlsruhe v. 16. Oktober 2020, 10 U 3/20, Volltext Dinklager Goldschatz: OLG Oldenburg v. 7. Oktober 2020, 1 W 17/20, juris

Heavy Gear 3.0 is here! To help you all get started with the new edition, Jon and I welcome Frank back to the studio, to talk about list building in the new edition. If you're new to the game, or curious about starting, this will be a great episode to watch. HGB 3.0 Blitz Rules Support The Dice Abide LIVE on Patreon: https://www.patreon.com/thediceabide Support Our Sponsors: Mythic Games, online and in Santa Cruz http://moe-games.com/ Brutal Cities, fine purveyors of MDF terrain! https://brutalcities.com/ Contact Us: Facebook: https://www.facebook.com/thediceabide Email: Adam @ thediceabide.com, Wisekensai @ bromadacademy.com Twitch: https://www.twitch.tv/thediceabide YouTube: https://www.youtube.com/c/thediceabide Instagram: @TheDiceAbide, @WiseKensai Twitter: @TheDiceAbide @WiseKensai Our Blogs: https://www.thediceabide.com/ https://www.mercrecon.net/ https://www.bromadacademy.com/ Our Patreon Supporters: D6 Tier: Alexander Arsenty D10 Tier: Adam Swift, Alfredo Ramirez, Eric Heymann-Heidelberger, Frank Washburn, Gregg Barlow, Nathaniel Beach-Hart, Obadiah Hampton, Pete Setchell, Steve D D20 Tier: Adriel Colon-Casiano, Dexter Esmaya, Jacob Ridley, Leif Hendricksen, Audio Attribution: https://www.bensound.com/royalty-free-music http://www.nihilore.com/license Kevin MacLeod (https://incompetech.com/) "Apero Hour" - Licensed under Creative Commons: By Attribution 3.0 Applause by Halleck: https://freesound.org/s/18665/ https://soundsilk.com http://www.orangefreesounds.com/

Anemia Anemia means low RBC or Hgb count. A patient could be bleeding out and have a low Hgb or they could have a dietary deficiency. Anemia is a starting place. As we get more detailed and more specific we can get a more clear diagnosis and treatment plan. One of the easiest places to […] The post S2 E075 Microcytic Anemia and a Better Way to Remember appeared first on Physician Assistant Exam Review.

Sertifikat Hak Guna Bangunan (HGB) adalah jenis sertifikat yang menyebutkan bahwa pemegang sertifikat memiliki hak untuk memiliki dan mendirikan bangunan di atas tanah yang bukan kepunyaan pemilik bangunan. Tanah tersebut dapat berupa tanah yang dikuasai langsung oleh negara, atau tanah yang dikuasai oleh perorangan atau badan hukum. Berdasarkan Undang-Undang No. 5 Tahun 1960 tentang Peraturan Dasar Pokok-Pokok Agraria, jangka waktu maksimal HGB berakhir adalah 30 tahun dan dapat diperpanjang dengan jangka waktu maksimal 20 tahun. Masa berlaku HGB bisa berbeda-beda, tergantung dari keputusan pihak Badan Pertanahan Nasional (BPN) ke pengembang. Lalu, bagaimana ketentuan baru dalam UUCK mengenai HGB? Apakah dalam ketentuan tersebut HGB bisa langsung diberikan 80 tahun? Yuk yang penasaran, coba kita dengerin di episode terbaru kita, dan langsung dengerin aja pembahasan tersebut di Podcast Ngopi Hukum by IDLC.ID. Podcast Ngopi Hukum selain bisa didengarkan melalui Spotify, juga bisa didengarkan dari berbagai platform podcast lainnya, yaitu: Anchor FM, Apple Podcast, Google Podcast, Breaker, Radio Public, dan Pocket Cast. Dan jangan lupa juga untuk follow medsos kami di Instagram: @idlc.id Twitter: @idlc_id, YouTube: IDLC ID dan Fanpage: idlc.id serta web idlc.id Happy Listening!

Practice Bulletin #95 - Published July 2008 (Reaffirmed 2017) 1. Normal physiologic changes in pregnancy that are relevant in anemia include increased blood volume, increased red blood cell mass, and increased iron stores. 2. Low serum ferritin is the most sensitive and specific single lab finding in iron deficiency anemia. 3. The CDC recommends universal screening for iron deficiency anemia in pregnancy along with universal supplementation. 4. B12 deficiency and folic acid deficiency are common causes of macrocytic anemia; folic acid deficiency much more likely than B12. 5. Blood transfusions are almost never indicated in pregnancy, apart from the rare case of a large, concealed placental abruption (Hgb non-reassuring fetal heart rate patterns, reduced amniotic fluid volume, fetal cerebral vasodilation, and fetal death) Show Notes **Visit our friends at The Labor of Love Co. to send a pregnant person in your life a curated maternity or postpartum care package!** Wine pairing: 2018 Red Blend from Horse Heaven Hills Wine Growers Theme music by Evan Handyside Logo design by JD Dotson (jddotson1@gmail.com)

Klausurbesprechung Bilanzbuchhalter H 2020, Klausur 3, Körperschaftsteuerteil. Im Umlaufvermögen, genauer gesagt bei den Rohstoffen, gab es eine Wertminderung, die als dauernd angegeben war. Nun muss man die Vorgehensweise beim strengen Niederstwertprinzip kennen, und zwar handels- als auch steuerrechtlich. Im Handelsrecht ist es egal, ob die Wertminderung dauernd oder nur vorübergehend ist, § 253 IV 1 HGB. Im Steuerrecht hingegen muss die Wertminderung zunächst dauernd sein (§ 6 I Nr. 2 S. 2 EStG), damit eine Teilwertabschreibung durchgeführt werden darf (!). Was "dauernd" heißt, bestimmt das (überaus wichtige) BMF-Schreiben vom 2.9.2016 zur Teilwertabschreibung (LAMBERT-TIPP: unbedingt vorher schon besorgen und durchlesen!). Hier geht es zu meinem Onlinekurs zur Körperschaftsteuer.  Zu meinen Videos für Steuern und Bilanzen auf YouTube geht es hier. Zu meinen Blogposts, Onlinekursen und Webinaren zu Steuern und Bilanzen geht es hier: www.daniel-lambert.de.

Klausurbesprechung Bilanzbuchhalter H 2020. Es ging in der Körperschaftsteueraufgabe um den derivativen Geschäfts- oder Firmenwert (= derivativer Goodwill = derivativer Firmenwert). Warum ist dieser eigentlich handelsrechtlich kein Vermögensgegenstand? Wofür gibt es speziell den § 246 I 4 HGB? Und über wieviele Jahre wird er eigentlich handelsrechtlich stets (planmäßig) abgeschrieben? Zehn Jahre? Oder fünf? Oder vielleicht 15 Jahre? Alles falsch - die richtige Antwort verrate ich in diesem Podcast. Diese Episode ist Teil meines Onlinekurses zur Körperschaftsteuer. Mehr zu meinen Blogposts, Videos, Audios, Webinaren und Onlinekursen unter www.daniel-lambert.de

Was ist eine dauernde Wertminderung? Um welchen Wert geht es überhaupt? Ist es im HGB oder EStG geregelt? Was ist denn eine Wertaufholung? Muss ich das oder kann ich das berücksichtigen?

In diesem Podcast rede ich über die Klausur 1, 2019 für Bilanzbuchhalter, Aufgabe 1. Es geht um Währungsumrechnung. Ich erzähle, wie man den § 256a HGB verstehen muss im Zusammenspiel zwischen Realisations- und Höchstwertprinzip, Umrechnung zum  Bilanzstichtag und kurz- und langfristigen Geschäften. Mehr über mein Angebot zur Klausurvorbereitung für Bilanzbuchhalter und Steuerfachwirte auf www.daniel-lambert.de. Wenn Dir dieser Beitrag gefällt, freue ich mich über ein Abonnement, damit Du keine weiteren Episoden verpasst. #lambertssteuerblog #hgb #bilanzbuchhalter #steuerfachwirte #klausurloesung #klausurvorbereitung #daniellambert

CardioNerds (Amit Goyal & Daniel Ambinder) join UCSF cardiology fellows (Emily Cedarbaum, Matt Durstenfeld, and Ben Kelemen) for some fun in San Francisco! They discuss a informative case of ST-segment elevation (STEMI) due to coronary vasospasm. Dr. Binh An Phan provides the E-CPR and program director Dr. Atif Qasim provides a message for applicants. Episode notes were developed by Johns Hopkins internal medicine resident Evelyn Song with mentorship from University of Maryland cardiology fellow Karan Desai. Jump to: Patient summary - Case media - Case teaching - References Episode graphic by Dr. Carine Hamo The CardioNerds Cardiology Case Reports series shines light on the hidden curriculum of medical storytelling. We learn together while discussing fascinating cases in this fun, engaging, and educational format. Each episode ends with an “Expert CardioNerd Perspectives & Review” (E-CPR) for a nuanced teaching from a content expert. We truly believe that hearing about a patient is the singular theme that unifies everyone at every level, from the student to the professor emeritus. We are teaming up with the ACC FIT Section to use the #CNCR episodes to showcase CV education across the country in the era of virtual recruitment. As part of the recruitment series, each episode features fellows from a given program discussing and teaching about an interesting case as well as sharing what makes their hearts flutter about their fellowship training. The case discussion is followed by both an E-CPR segment and a message from the program director. CardioNerds Case Reports PageCardioNerds Episode PageCardioNerds AcademySubscribe to our newsletter- The HeartbeatSupport our educational mission by becoming a Patron!Cardiology Programs Twitter Group created by Dr. Nosheen Reza Patient Summary A man in his mid-50s with alcohol use disorder, cirrhosis, atrial fibrillation, and alpha thalassemia complicated by iron overload presented with hematemesis. He was tachycardic and hypotensive. Labs were notable for Hgb 8.1 (baseline of 10.2), INR 1.3, lactate 4.2, and ferritin 4660. He was started on IV PPI and octreotide. Course was complicated initially by Afib with RVR with hypotension. Subsequently, the patient developed unstable VT requiring CPR. Post-code EKG showed inferolateral ST elevations. Troponin-I rose from 19 to 225 and his pressor requirement continued to increase despite resolution of his GIB. TTE showed LVEF 42% with new inferolateral wall motion abnormalities, normal RV systolic function, severe mitral regurgitation, and small pericardial effusion. After treatment of his GIB by IR and GI, he underwent an urgent LHC which showed 30% stenosis in proximal LAD, 70% in LADD2, and 95% in distal RCA. Coronary spasm was noted in all vessels. Intracoronary nitroglycerin and nicardipine were administered with significant improvement in spasm and resolution of STE on EKG. Vasopressors were quickly weaned off after. He was eventually stabilized, extubated, and started on an oral nitrate and calcium channel blocker. Repeat TTE showed normalized systolic function without any wall motion abnormalities.   Case Media ABClick to Enlarge A. Baseline ECG - atrial fibrillationB. ECG with inferior STEMI CORS - left system CORS- RCA pre-vasodilator CORS- RCA post-vasodilator Episode Schematics & Teaching Coming soon! The CardioNerds 5! – 5 major takeaways from the #CNCR case What are the cardiac manifestations of hemochromatosis? Cardiac hemochromatosis encompasses cardiac dysfunction from either primary or secondary hemochromatosis. Initially, hemochromatosis leads to diastolic dysfunction and arrhythmias. In later stages, it can lead to dilated cardiomyopathy.  Diagnosis of iron overload is established by elevated transferrin saturation (>55%) and elevated serum ferritin (>300 ng/mL).

Welche Gewährleistungsrechte bestehen im Kaufrecht? Was muss man zur Nacherfüllung wissen? Wie berechnet man eine Minderung? Und nach welchen Vorschriften können Verkäufer in Regress gehen? (1:49) Wiederholung von Folge 2 (Sachmängel und Rechtsmängel) (17:02) Einstieg in die Prüfung von Mängelgewährleistungsrechten (19:54) Mängelgewährleistung vs. Allgemeines Leistungsstörungsrecht (23:29) Mängelgewährleistung vs. Anfechtung (29:27) Verjährung von Mängelgewährleistungsrechten (39:00) Besondere Regeln für Rücktritt und Schadensersatz (49:46) Nacherfüllung (1:08:07) Minderung (1:20:02) Rügeobliegenheit nach § 377 HGB (1:26:55) Haftungsausschluss (1:31:07) Garantie (1:33:10) Regress

We've covered quite a few music related topics on the podcast. HGB has featured Ernestine and Hazel's Juke Joint, Bobby Mackey's Music World and the Cincinnati Music Hall and we've talked about the life and afterlife of Patsy Cline, John Lennon and Elvis Presley. Bonus episodes have featured haunted instruments, Gram Parsons and the Devil's Chord. We thought it would be interesting to do an episode on haunted music as a whole. This obviously won't be exhaustive, but we are going to delve into haunted radio stations, recording studios, buses and jukeboxes. We'll also look at the elements of music that lead to hauntings and curses. And wow, does music have some curses! The Moment in Oddity was suggested by Darren Koch and features Paris' open-air urinals helping to defeat the Nazis and This Month in History features the birth of Chris Cornell. Check out the website: http://historygoesbump.com Show notes can be found here: http://historygoesbump.blogspot.com/2020/07/hgb-ep-344-haunted-music.html Become an Executive Producer: http://patreon.com/historygoesbump The following music is from https://incompetech.filmmusic.io/: "Vanishing" by Kevin MacLeod (Moment in Oddity) "In Your Arms" by Kevin MacLeod (This Month in History) License: CC BY (http://creativecommons.org/licenses/by/4.0/) All other music licensing: PODCASTMUSIC.COM License Synchronization, Mechanical, Master Use and Performance Direct License for a Single Podcast Series under current monthly subscription. Going Mad by Strike Audio Twisted Lifestyle by Strike Audio Theremin Comedy by Comedy Express Horns Dissonant Tones Gallows Gate (Danse Macbre) by 5 Alarm Music Prowl Full by Chris Neeser and Pat Kelly

My guest today is Chef Jon Thompson. Jon has an amazing resume, and recently he was head chef at Mediterranean restaurant Zaytinya in Frisco, the second Zaytinya location for Michelin-starred chef José Andrés. After Zaytinya closed down last year, Jon set out to open the Yarbird Southern Table & Bar at the new Dallas location. However, COVID-19 pandemic has affected his plans, so we caught up to chat about what he is up to now. Chefs are the leaders in the kitchen, they are like captains of the ships. They too are suffering in this situation, and have to pivot and use different strategies to make amazing food for us. Here is how Jon handles being a chef at home, and what he thinks about how restaurant businesses will come out from this crisis. Time Stamps: 00:31 – Who our guest is and what we are going to talk about. 03:45 – Restaurant bubble burst that happened with COVID-19 quarantining. 06:44 – The lack of institutional funding that small restaurants left particularly vulnerable to the crisis. 09:28 – What would Jon do if he had a small restaurant and had to get his business back. 15:13 – Why this time looks like what normal life should be. 17:55 – What Jon eats at home at this time. 21:18 – How the pandemic stopped the grand opening of Jon's restaurant in Dallas. 25:20 – How people will respond to the reopening of the restaurants and the new rules. 31:30 – What Jon thinks about ghost kitchens. 35:00 – Why delivery companies' business model doesn't really work. 43:00 – Offering groceries or farm boxes in restaurants, and how it affects the dining space. 49:31 – How grocery stores are functioning right now and why HGB's rationing works well. 51:20 – Why this pandemic is the best thing that happened to local farmers. 58:00 – Why we admire Joel Salatin. Resources: Yardbird Southern Table & Bar Favor Delivery Runner City H-E-B Polyface Farms Joe Rogan Experience #1478 – Joel Salatin Connect with Chef Jon Thompson: Facebook Connect with Patrick Scott Armstrong: Instagram Facebook Email More From The Lone Star Plate Podcast: Should You Support Grubhub And Other Delivery Services Cultivate: Grow Your Own Food In a Box What is Regenerative Agriculture Rebuilding Local Farms with Jordan Green Sam Lash: How Farm to Table Works During the Pandemic

In this podcast, Dr. Nicholas Schneeman, a family medicine physician specializing in geriatrics, and chief medical officer for LifeSprk, presented at Ridgeview Medical Center's Live Friday CME Series - Annual Dr. Lehmann Lecture Series, on February 14, 2020.  At this annual event, Dr. Schneeman talked about value based care for the elderly, as well as moving away from the confusing, unfruitful and sometimes dangerous fee for service model we are currently practicing. Enjoy the podcast! OBJECTIVES:    Upon completion of this podcast, participants should be able to: Describe current demographic trends in U.S. Medicare populations. Identify financial drivers under Medicare in clinics, hospitals, and skilled nursing facilities. Recognize patient profiles at risk for low value care. Describe past and current attempts to solve for low value care. CLICK ON THE FOLLOWING LINK FOR YOUR CME CREDIT: CME Evaluation: "2020 Lehmann Lecture Series: Geriatrics & Medicare - A Frail Tale of Low Value Care" Note: CME credit is only offered to Ridgeview Providers for this podcast activity. Complete and submit the online evaluation form, after viewing the activity.  Upon successful completion of the evaluation, you will be e-mailed a certificate of completion within 2 weeks.  You may contact the accredited provider with questions regarding this program at  rmccredentialing@ridgeviewmedical.org. (**If you are listening to the podcasts through iTunes on your laptop or desktop, it is not possible to link directly with the CME Evaluation for unclear reasons. We are trying to remedy this. You can, however, link to the survey through the Podcasts app on your Apple and other smart devices, as well as through Spotify, Stitcher and other podcast directory apps and on your computer browser at these websites. We apologize for the inconvenience.)  The information provided through this and all Ridgeview podcasts as well as any and all accompanying files, images, videos and documents is/are for CME/CE and other institutional learning and communication purposes only and is/are not meant to substitute for the independent medical judgment of a physician, healthcare provider or other healthcare personnel relative to diagnostic and treatment options of a specific patient's medical condition.   FACULTY DISCLOSURE ANNOUNCEMENT  It is our intent that any potential conflict should be identified openly so that the listeners may form their own judgments about the presentation with the full disclosure of the facts. It is not assumed any potential conflicts will have an adverse impact on these presentations. It remains for the audience to determine whether the speaker’s outside interest may reflect a possible bias, either the exposition or the conclusions presented. Planning committee members and presenter(s) have disclosed they have no significant financial relationship with a pharmaceutical company and have disclosed that no conflict of interest exists with the presentation/educational event. SHOW NOTES: INTRODUCTION: Dr. Nick Schneeman is a family medicine physician who specializes in geriatric medicine, and has a keen interest and expertise in value based care for the elderly, as well as moving away from the confusing, unfruitful and sometimes dangerous fee for service model we are currently practicing in.  Dr. Schneeman is currently the chief medical officer of LIfesprk, and had over 30 years of clinical experience caring for this very special patient population. He joined us on February 14, 2020, for the annual Dr. Jim Lehmann lecture covering a variety of geriatric topics. Dr. Lehmann served his patients for many decades. Joining him and others in the audience today was the Spanus Family who helped fund this endeavor. Do sit back and enjoy the program. It is sure to make you think about how you fit into this complicated dilemma, but more importantly, how you can be part of the solution. PART 1: The way in which to fix the geriatrics dilemma is to understand the quality and cost factors on a very deep level. We will have 1 billion elderly patients in the world in the next several years. In the 1930s, only 3 to 5 % of the population was seniors, now we are at 20+%. To further complicate this statistic, senior citizens age 85 and older have a significant cognitive impairment rate of 50%. In the U.S., Medicare is the single payer system for our senior citizens. There are segments inside of Medicare where the costs are exorbitant, including the last 2-years of life where they go up 6-to-7 times what they were up to that point. Put another way, half of an individual's Medicare budget is spent in the last 6 months of life. Much of these costs unfortunately are very wasteful. Medicare is not sustainable in its current form; and it is going to continue to threaten our national economy. PART 2: Edith is 86 years old and lives in her own home by herself. She has a doctor who she loves. Mild ailments have ensued and she no longer drives. Her son and daughter check in periodically and neighbors lend a hand at times. Dr. John Goodparent and his partner Dr. Rachel Cakeandeatit are partner physicians who take care of Edith. They are a different kind of physician than the physicians of old, though, mostly working for large health systems with maximally loaded schedules. In addition, they are working either in the clinic or hospital, and no longer both. Lately, Edith's daughter, Connie, has concerns and has been calling Dr. Goodparent. So, he sees her in the clinic and determines she has had some chronic cerebral ischemic changes, so refers her to a neurologist who performs a battery of tests with no resolution. Sinemet is tried for what is felt to be some Parkinson's issues. Connie comes to the house and finds her in a bit of disarray. She takes her to see Dr. Cakeandeatit who determines she's depressed, so givers her a sample of an SSRI. Her UA is dirty although no symptoms of UTI, but antibiotics are started nonetheless. Connie takes time with her at home. Edith improves a bit. Up until now, her care has been paid for my Medicare financial driver domain clinic. Physician incentives are pretty bad in this model. No value in the extra phone calls, etc., and you can't crank this kind of patient through the clinic in a 10-minute appointment slot. Not to mention having to juggle and address all the calls from Connie and other concerned parties. Connie leaves town for a bit, and about a week later, Edith's son visits and sees her in a disheveled state. Now she's brought to the ER and meets Dr. Saverlife. Weakness and low grade fever are noted. Parkinson's history is acknowledged, with Lexapro and Sinemet on board, as well as a bunch of other new medications in the past several weeks to months. Final ER diagnosis is recurrent UTI and mild CHF. So a little more diuretic and now a fluoroquinolone are added. Well, a short while later when a neighbor finds that she now has stacked newspapers on her front porch and Edith is found to be stool-stained and stuck between the wall and her toilet. 10-days in the hospital ensue, with a new diagnosis of C diff colitis. She is in A-fib with RVR. Multiple consultations happen. Abd CT and colonoscopy are performed due to a Hgb drop. SNF is recommended but the patient and family refuse. So its back to home again; her medications are tweaked to now include a PPR and Seroquel. This current care is driven by domain hospital, and the hospital is paid a value-driven lump sum of money called a DRG. Administratively, we are pushed to get patients through the hospital and turn beds over. As providers, we are incentivized by part B, which is volume driven. See more patients and get paid more. Quality is not as rewarded. Edith now falls down at home, has a hip fracture. Ativan is given, and more Seroquel due to increased delirium. IV fluids are given throughout her care. She's discharged now to a SNF. The 10-day old H and P is noted and her d/c orders, but there is no d/c summary yet from this hospitalization. Due to the hyperregulated state of SNFs, a lot of documentation must take place, orders, Q/A parameters, etc. The nurse calls the on-call doctor who has no prior knowledge of this patient. This care is paid under Medicare nursing home domain, which is a split system. The SNF gets a daily rate based on how much therapy the patient needs. Just recently this has transitioned to payment based on the patient's diagnoses. While we should be incentivized to help manage the patient under this system, we ae still driven by fee for service and volume on Medicare part B, meaning uncompensated calls and no resource management incentives either. Edith doesn't really participate in rehab, demonstrates increased confusion and another urine is checked off the foley. Because it looks infected, she is restarted on Levaquin and an increase in Seroquel is also ordered. Big surprise here she continues to deteriorate, leading her down any number of etiology pathways for her further decompensated state. Edith is now back in the ED. And has entered the revolving door of rescue, rehab and relapse. Unfortunately, quality of care in this paradigm is suspect as best. It becomes a bit of a crap shoot, and there's little respect for consideration of patient autonomy. We've all experienced this, right? How do you have a meaningful "goals of care" conversation with patients and family when they're figuratively "stuck in the mud" of dilapidated care. There's obviously significant difficulty in obtaining informed consent. Drug cascading is highly prevalent. And as Dr. Schneeman eloquently illustrates for us, this is a complex issue made more complex by polypharmacy, limited time with our patients who are elderly with multiple comorbidities and multiple silos of care weighing in to crate a low quality, hyper expensive healthcare delivery model. PART 3: How has the healthcare industry responded? We've done a lot of work-arounds. Care coordination being one big "fix"! This notion started in the 1990s. CMS has funded a number of trials looking at the topic of Care Coordination. Many different strategies exist, but nothing has worked. In 2011, there was an initiative from private industry to fi healthcare for example. Dr. Jeff Brenner attempted to find a way in which we can use date to coordinate care for the 3-to-5% of hyper expensive patients within the Camden Coalition. But unfortunately this endeavor yielded no results. They couldn't fix things, per a recent follow-up article in the NEJM. There was a further attempt to tease out what could be of value in the 15 studies looking at care coordination. 1. Comprehensive d/c planning; 2. Timely communication of information; 3. medication reconciliation; 4. patient caregiver education with teachback; 5. open communication b/w providers; 6. prompt f/u visits with a provider. As Dr. Schneeman points out, medication reconciliation does not really improve risk benefit discussion and the truth is many of the drugs our senior patients take are in fact problematic and dangerous most of the time as well. It does not teach us how to unwind the drug list. Big pharma has had a heavy hand in how these drugs have been used over the years, including off label use. The intermittent confusion our senior patients have is not due to asymptomatic bacteriuria. C-diff colitis in a fail old person is potentially life-threatening, not to mention the other adverse effects brought on by antibiotics given for this reason. Patient education with teach back doesn't really teach us anything. Open communication about cancer screening with limited life expectancy does not validate the notion of open communication. Prompt follow-up does not address the fact that blood pressure medications are not getting deescalated, nor the fact that the marginally functioning demented patients will still have an unavoidable and predictable decline regardless of what we do. Finally, per Dr. Schneeman, comprehensive discharge planning does not address the lack of science to help guide us in treating our patients with the comorbidity of progressive dementia. These very patients are in fact excluded from the trials that originally brought these drugs to market! So what's going on here? Well, we're part of the problem as clinicians, for one. Secondly, we're living in a country where being multimorbid and elderly is not a good thing when it comes to quality of health care. On a positive note, we have an opportunity to be part of the cure. In other words, we have the opportunity to begin thinking and acting on the real cost of the care we're providing, as though we are paying for every penny of it. The selling-off of primary care clinics has been an issue for physicians and has taken them out of the discussion of the bottom line. There is poor accountability for cost and quality, due to lack of peer review within our silos let alone across silos. Compensation is not equated to value, and unfortunately there are still some unscrupulous techniques from industry to try and inform our practice. We're also taught in a way that doesn't fit with the Edith's of the world nowadays. The "chief complaint" from Edith is a syndrome and not a single complaint. We can all relate to this. Medicare Advantage is a platform that allows physicians to get paid based on quality of care. Dual eligible programs are also out there. As well as new payment options on the horizon, such as the Independence at Home demonstration project. Basically compensation for providing complex, in-home care. Medication delivery devices, sensors and other tech that is out there to help us provide more care is proliferating. New brick an mortars are also popping up and are attaching Medicare Advantage to the underserved elderly communities. And then of course, there are more and more Dr. Schneemann's out there who want to provide complex, in-home care. So what can we do? 1. Accept that we participate in low value care; 2. Subspecialty care needs to be just that, and no longer the primary care providers for these elderly patients. Ultimately the core solution is team base, flat hierarchy and a cultural shift to one of accountability across silos, thus creating a safety net for our patients. The physicians are the ones who need to take this bull by the horn, and not rely on guidelines solely. We are in the trenches and must be negotiating the trajectory of care. Getting involved in a value based care and compensation model is imperative. It can be a double-edged sword though. We need to provide the appropriate care when it's warranted, but also not withhold care to save or make more money. The onus falls on us to e the experts and to rebuild the current construct. Let's stop merely ordering a bunch of stuff and begin to have those conversations with patients and families to understand and clarify goals and realistic outcomes before committing to multiple diagnostic tests and polypharmacy. This is made difficult in patients with cognative impairment, but it can be done! PART 4: Well,  it's a happy ending after all. Edith survives her last hospitalization. And as it turns out there is a geriatric specialist working for a geriatric center of excellence, who takes over her care. She is able to access her care and chart 24/7. Medications are deescalated, and the fog is lifting. Edith is now participating in therapy. While a moderate fall risk exists, she is more independent and now using a walker, and she gets Meals-On-Wheels. Edith is now teed up to move into an assisted living facility. In addition, she has advanced care planning with a team trained to do this. A POLST form is completed and while Edith and her family can consider 911/ER visits, she is DNR/DNI with a tilt toward hospice care in the setting of a major health complication or event. Home based care is the new focus and guess what...people working for Edith actually love their jobs. Geriatric centers of excellence can be virtual; and they are made up of compassionate people providing personalize care that is also profitable. That's a lot of "P's". Questions from the audience were addressed by Dr. Schneeman as follows: How do we help patient and families make those decisions and changes in care plans. Well, its never easy to make that kind of decision during an emergency. But it is made easier by having a long-term patient relationship in this desirable model, something that spans over months to years, where the home based care team is at the forefront of the patient's care experience. They will help patients and families make realistic decisions and will obviate the option of "let's give it one more try!", suggested by the well meaning son who's visiting from California and hasn't been home in a couple years. In regards to "how do we fix this?", the new payment and reimbursement programs can and will.  Essentially making geriatric care a subspecialty level compensation model. New practitioners and nurses are hungry for vocation and meaning in their work. Bottom line though is that fee for service for this demographic is not sustainable. Are there local geriatric centers of excellence presently? Not yet, but the pendulum is swinging. Recruiting and employing physicians, nurses, APPs, and others who want longitudinal relationships with patients, and who have the personality and passion for this vocation will help to create such centers. It will be both exciting and game changing. Thanks so much to Dr. Schneeman for his time and expertise on this topic, and to all who care for this special population of patients in our community.

„Die jungen KünstlerInnen haben heute einen Kunstmarkt und eine Konkurrenzsituation, die wir in der DDR mitnichten kannten. Der unbarmherzige Konkurrenzgedanke ist bereits im Studium zuhause und fährt die Ellbogen aus.“ Annette Schröter - Malerin, Papierschnittkünstlerin und Professorin für Malerei und Grafik an der HGB - spricht in der aktuellen Folge von MdbK [talk] über die Herausforderungen der jungen KünstlerInnen in der heutigen Zeit, über ihre Ausreise von Leipzig nach Hamburg in den 1980er Jahren und die Gründe für den „späten“ Wechsel von der Malerei zum Papierschnitt. Im Sommer und Herbst 2019 widmet sich MdbK [talk] ganz der Ausstellung "POINT OF NO RETURN. Wende und Umbruch in der ostdeutschen Kunst", die bis November 2019 im MdbK läuft.

Diese 6. Episode ist eine Aufzeichnung einer Informationsveranstaltung vom 6. November 2019 an der Hochschule Hof. Es wurden verschiedene Schwerpunkte im WR Studium vorgestellt. Heute hören Sie die Vorstellung des Schwerpunktes Steuern und Rechnungslegung durch meinen geschätzten Kollegen Professor Dr. Ulrich Entrup. Dies ist ein wirtschaftlich geprägter Schwerpunkt. Dabei geht es u.a. um die beiden verschiedenen Arten der Rechnungslegung für Unternehmen, einmal nach dem HGB und einmal nach internationalen Regelwerken. Darüber hinaus wird die Wirtschaftsprüfung vorgestellt, die in der Praxis eine große Rolle spielt. Abgerundet wird dieser Schwerpunkt durch die Vermittlung der wesentlichen Steuern wie z.B. Körperschafts- und Gewerbesteuer, Besteuerungsregelungen für Personengesellschaften, Umsatz- und Bilanzsteuer und schließlich noch mit den Besonderheiten im Bereich von International Tax and Accounting. Dieser Schwerpunkt bereitet alle, die sich in der Praxis später mit Controlling, Finanzbuchführung, Steuerberatung und Wirtschaftsprüfung beschäftigen wollen, perfekt auf die entsprechenden Berufsfelder vor.

A 21 yo F presents c/o of increasing fatigue and occasional SOB. Her sx have been gradual in onset over the past few weeks. She denies: chest pain, cough, fever & leg edema. Vital signs are normal. No other complaints or Past Medical History. You obtain some labs that show you what you believe to be the answer. Hgb - 7.8 3 months ago: Hgb - 12.5 Whats the next step? What's the cause? How do you manage this? This week on the Medgeeks podcasts we discuss.. ANEMIA!   Do you have a question you'd like for us to answer? Submit your question here (it's free) and we'll answer on our next podcast episode: https://www.askmedgeeks.com - Stay up to date with our monthly audio program In the Know: https://medgeeks.samcart.com/products/in-the-know - Follow us on Instagram here: https://www.instagram.com/medgeeksinc - Check out our free resources here: https://medgeeks.co/start-here - This podcast should not be used in any legal capacity whatsoever, including but not limited to establishing standard of care in a legal sense or as a basis for expert witness testimony. No guarantee is given regarding the accuracy of any statements or opinions made on the podcast, video, or blog.

Pembahasan tentang SE No.2/SE-HT.2.01/VI/2019 tentang Pemberian HGB Untuk CV. Di sini akan dibahas tentang kriteria pemberian HGB untuk persero komanditer dan persero aktif. Akibat hukumnya dan apa resiko yang mungkin timbul. Dan jangan lupa follow podcast ini juga semua medsos kami di Instagram: @idlc.id Twitter: @idlc_id, YouTube: IDLC ID dan facebook: Idlc ID Untuk memudahkan akses peraturan-peraturan dan artikel-artikel populer yang menarik dari web irmadevitacom, bapak/ibu bisa mendownload aplikasi kami . Untuk versi ios (iphone) bisa di download disini: https://apple.co/2PZd9Ji Sedangkan untuk andoid (samsung, oppo, dll) bisa di download disini: https://bit.ly/2HYROOO Semoga bermanfaat!

Aktivierungswahlrechte gibt es im nationalen Handelsrecht, also nach HGB, drei Stück, nämlich aktive latente Steuern, das Disagio und die immateriellen Vermögensgegenstände des Anlagevermögens, die unentgeltlich erworben wurden. Mehr Informationen zu weiteren Fragen der Bilanzierung auch in unserem Blog auf www.daniel-lambert.de/blog und in Lamberts YouTube-Channel.  Zu den MindMaps für Bilanzbuchhalter, Steuerfachwirte und Steuerfachangestellte, die das prüfungsrelevante Wissen gehirn-gerecht und merk-würdig aufbereiten, geht es unter www.daniel-lambert.de/shop.

Thank you for joining us for our 2nd Cabral HouseCall of the weekend! I’m looking forward to sharing with you some of our community’s questions that have come in over the past few weeks… Let’s get started! Shikha: Hi Dr. Cabral, I have listened to your podcast on seed cycling. I wanted to know if seed cycling helps for low estrogen levels? I did my hormonal test recently and my progesterone levels,estrogen, cortisol and androgen levels were either low or lower end of the range. Is there a natural way to balance this. I get regular menstural cycle. I have hasimotos with hypothyroidism and I am currently on levothyroxine. I also have parasites, Sibo, candida and heavy metals, therefore I have started your 21 days detox, after which I will do parasite protocol, CBO protocol and heavy metal detox. Majority of my diet includes organic plant based food. Any recommendation on hormonal balance will be helpful. Darrell: Hey! Good day Dr. Cabral. Hope all is well with you and your family. I am writing with regard to your response to my previous question on episode 1212 where I said I'm a regular voluntary blood donor but recently my blood count has been hovering around 13.5 which the nurse say is lower than normal for males. You believed it was the RDW (red cell distribution width) I was referring to when it was actually the hemoglobin (Hgb) level I was talking about. I am not sure if they're the same thing or not, nevertheless what can cause it to be at that rate in a an active 34 year old male weighing around 155, 5’6 height, vata pitta body type, fit, no known issues. Is there anything that can be causing the low count? Is it really a cause for concern? A random nurse recommended taking liquid chlorophyll. Do you agree with using it or any other product or lifestyle tip? Anyway, keep up great work as always. Brandy: Hello Doc- first if all thank you for all the information you share! I’m a 35 year old female, fairly overweight (can’t lose weight), had a terrible diet for most of my life, and have had a whole lot of symptoms that have brought me to the doctor the last couple years... I was otherwise healthy before having my too children. One problem I’m mostly concerned with is my diagnosis of Lichen Sclerosis. I want to find the root cause but do not know where to start. I do not have any other autoimmune conditions but I do have anxiety and lots and lots of random symptoms that are telling me my body isn’t happy. But medical doctors say I’m otherwise healthy. Would you have any knowledge on this condition? What would your advice be for me to get to the root? Niki: I have gallbladder pain for a month and they want me to get surgery any way to get sludge out naturally and not get the surgery? What are the risks of declining the surgery Julia: Hello! Dr. Cabral, you are amazing! I love your podcasts and use some of your supplements like candida and clean gut protocols. Why do you still use the fillers in your supplements, like magnesium stearate? Brands like Pure discontinued it a long time ago. Thanks! Jen: Hi Dr. Cabral,  I had written in a while back asking how to get rid of cellulite on the front/back of my legs and gluts and you said that it was a toxicity issue. I had since been working on eradicating this issue. I have done the 21 day detox twice and I just finished the candida cleanse. Ive also been working out a lot and eating right and I still cant see the difference. I feel so frustrated with trying to figure out what the toxins are that are causing this issue. I recently also bought your intestinal cleanse and have used that a few times. Is there anything I can do to figure this out? Thanks so much!  Jen Kayla: What are your thoughts on St. John’s wort? Catherine: Hi, I was looking at purchasing the prenatal vitamin that you have on your site. I noticed that it has Vitamin A. Is that safe during pregnancy? Thank you Catherine   Thank you for tuning into today's Cabral HouseCall and be sure to check back tomorrow where we answer more of our community’s questions!  - - - Show Notes & Resources: http://StephenCabral.com/1269 - - - Get Your Question Answered: http://StephenCabral.com/askcabral   - - - Dr. Cabral's New Book, The Rain Barrel Effect https://amzn.to/2H0W7Ge - - - Join the Community & Get Your Questions Answered: http://CabralSupportGroup.com - - -   Dr. Cabral’s Most Popular Supplements: > “The Dr. Cabral Daily Protocol” (This is what Dr. Cabral does every day!) - - - > Dr. Cabral Detox  (The fastest way to get well, lose weight, and feel great!) - - - > Daily Nutritional Support Shake  (#1 “All-in-One recommendation in my practice) - - - > Daily Fruit & Vegetables Blend  (22 organic fruit & vegetables “greens powder”) - - - > CBD Oil  (Full-spectrum, 3rd part-tested & organically grown) - - - > Candida/Bacterial Overgrowth, Leaky Gut, Parasite & Speciality Supplement Packages - - - > See All Supplements: https://equilibriumnutrition.com/collections/supplements  - - -   Dr. Cabral’s Most Popular At-Home Lab Tests: > Hair Tissue Mineral Analysis (Test for mineral imbalances & heavy metal toxicity) - - - > Organic Acids Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Thyroid + Adrenal + Hormone Test  (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Adrenal + Hormone Test (Run your adrenal & hormone levels) - - - > Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Omega-3 Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - > Stool Test (Use this test to uncover any bacterial, h. Pylori, or parasite overgrowth) - - - > Genetic Test (Use the #1 lab test to unlocking your DNA and what it means in terms of wellness, weight loss & anti-aging) - - - > Dr. Cabral’s “Big 5” Lab Tests (This package includes the 5 labs Dr. Cabral recommends all people run in his private practice) - - - > View all Functional Medicine lab tests (View all Functional Medicine lab tests you can do right at home for you and your family!)