Podcasts about lpa

Do our cholesterol numbers tell the full story? Cardiometabolic health encompasses more than just heart function—it includes metabolic processes, blood sugar control, lipid levels, and inflammation markers that affect your entire body's health. Fewer than 12% of Americans are metabolically healthy, making it crucial to look beyond standard cholesterol numbers to understand your complete cardiovascular risk profile.In today's episode, functional nutritionist Chris Newport explores hidden factors that could be quietly impacting your heart and metabolic health.You'll discover: • Why traditional cholesterol tests might miss critical warning signs • What the size of your LDL particles can reveal about your risk • The simple blood test that offers a clearer picture of heart disease risk • A genetic marker that could influence your heart health—whether your labs are "normal" or not • How your body's ability to shift between fuel sources impacts your long-term health • The surprising link between blood sugar, carbs, and cholesterol problems • A fresh look at heart health through the American Heart Association's updated roadmap • How your environment and lifestyle could silently shape your risk • Why tiny daily habits can lead to massive improvements over time

Mon, 28 Apr 2025 03:00:00 +0000 https://milieu-oder-mikrobe.podigee.io/95-neue-episode 684f7391fe262ea3fa5dd5c5e7054967 Cholesterin – Freund oder Feind unseres Herzens? In dieser Folge von 'Milieu oder Mikrobe' lüften wir den Schleier um diesen oft missverstandenen Stoff. Erfahre, was wirklich hinter den Cholesterinwerten steckt, welche Rolle Ernährung und Genetik spielen und wie du deine Herzgesundheit aktiv unterstützen kannst. Schluss mit Halbwissen – hier gibt's die Fakten, die zählen!" Alle Infos zu unserem Gast Dr. Volker Schmiedel, sind unter dem Link zu finden. Cholesterin - endlich Klartext!, das Buch von Dr. Volker Schmiedel zum Thema Cholesterin. Hier könnt ihr ganz einfach Euer Herzinfarktrisiko testen. Vorher die benötigten Werte beim Arzt einmal bestimmen lassen. Die erwähnte Framingham-Herz-Studie findet ihr hier. Eine wissenschaftliche Rückschau zu dieser Studie bekommt ihr hier. Die erwähnte Helsinki Heart Study Die erwähnte Studie aus Korea! Und hier noch die Single Case-Studie, die zeigt, dass man mit Änderung des Lebensstils auch sein LpA verbessern kann! full Cholesterin – Freund oder Feind unseres Herzens? no

Tuesday, April 15 -  Host Doug Stephan and Dr. Ken Kronhaus of Lake Cardiology (352-735-1400) cover a number of topics affecting our health. First up, Doug and Dr. Ken start with a recap of Doug's visit to Dr. Ken's practice in Mount Dora, FL. Next up, the biggest topics in the news of health and medicine, including how lowering bad cholesterol also lowers the risk of developing dementia, why you should learn what your cholesterol readings should be (because it's not one-size-fits-all), why you should talk to your doctor about your LPa numbers (and what that means), and a number of other therapies to help maintain your best cholesterol (good and bad) levels for optimum health. Then, Doug waves his HIPAA rights to share insight of how many of us forget to look at things in our lives affecting our health, like stress. Mental stress, poor sleep, and obesity are the three main culprits contributing to plaque buildup, high cholesterol, and poor overall health. The first step to better health is getting those three things under control. Website: GoodDayHealthShow.com Social Media: @GoodDayNetworks

This episode covers: Cardiology This Week: A concise summary of recent studies Relevance and management of ventricular ectopic beats  Lp(a) in cardiovascular risk management Mythbusters: A vegetarian diet lowers cardiovascular risk Host: Susanna Price Guests: Carlos Aguiar, Thomas Deneke, Kausik Ray Want to watch that episode? Go to: https://esc365.escardio.org/event/1802 Disclaimer: ESC TV Today is supported by Bristol Myers Squibb and Novartis. This scientific content and opinions expressed in the programme have not been influenced in any way by its sponsor. This programme is intended for health care professionals only and is to be used for educational purposes. The European Society of Cardiology (ESC) does not aim to promote medicinal products nor devices. Any views or opinions expressed are the presenters' own and do not reflect the views of the ESC. Declarations of interests: Stephan Achenbach, Thomas Deneke, Nicolle Kraenkel and Susanna Price have declared to have no potential conflicts of interest to report. Carlos Aguiar has declared to have potential conflicts of interest to report: personal fees for consultancy and/or speaker fees from Abbott, AbbVie, Alnylam, Amgen, AstraZeneca, Bayer, BiAL, Boehringer-Ingelheim, Daiichi-Sankyo, Ferrer, Gilead, GSK, Lilly, Novartis, Novo Nordisk, Pfizer, Sanofi, Servier, Takeda, Tecnimede. Davide Capodanno has declared to have potential conflicts of interest to report: Bristol Myers Squibb, Daiichi Sankyo, Sanofi Aventis, Novo Nordisk, Terumo. Steffen Petersen has declared to have potential conflicts of interest to report: consultancy for Circle Cardiovascular Imaging Inc. Calgary, Alberta, Canada. Kausik Ray declared to have potential conflicts of interest to report: research grants from Amarin, Amgen, Daiichi Sankyo, Merck Sharp & Dohme, Pfizer, Regeneron, and Sanofi, consultant for Abbott, Amarin, Amgen, AstraZeneca, Bayer, Biologix, Boehringer Ingelheim, Cargene Therapeutics, CRISPR, CSL Behring, Eli Lilly and Company, Esperion, Kowa Pharmaceuticals, NewAmsterdam Pharma, Novartis, Novo Nordisk, Pfizer, Regeneron, Resverlogix, Sanofi, Scribe Therapeutics, Silence Therapeutics, Vaxxinity, and Viatris, honoraria for lectures from Novartis, BI, AZ, Novo Nordisk, Viatris, Amarin, Biologix Pharma, Sanofi, Amgen, Esperion, Daiichi Sankyo, Macleod and stock options New Amsterdam Pharma, Pemi 31, SCRIBE Therapeutics. Emma Svennberg has declared to have potential conflicts of interest to report: Abbott, Astra Zeneca, Bayer, Bristol-Myers, Squibb-Pfizer, Johnson & Johnson.

Curious about lipids? Do you know what to do with LPa and ApoB?Listen in this week as host Karli Burridge speaks with Josh Wageman, author of the newly released book titled: "The Home Security System and the Lipid Neighborhood: Un-Complicating Cholesterol and Cardiovascular Disease"It sounds like the start of a bad joke…or perhaps a confusingly awesome dream. A Physical Therapist, ex-collegiate track athlete, Ivy league grad, Youth Pastor, and some dude with a PhD start having a conversation about cholesterol. And then you realize all those guys are THE SAME GUY, and that guy takes you on a whimsical pilgrimage that results in YOU having a framework for NOT having heart attacks, strokes, and dementia. Employing a smorgasbord of metaphors, pictures, and catchphrases, The Home Security System and the Lipid Neighborhood serves as a valuable reference for clinicians and non-clinicians alike, bringing refreshing relatability to complex biochemical topics. Through a lipid-lens, you'll learn, laugh, and love your way through its pages…and in the end, you'll undoubtedly add “life to your years!”Available at: https://www.amazon.com/dp/B0DR33FPZF?ref_=pe_93986420_775043100On X: https://x.com/joshjwagemanInstagram Tag is @wagemanjosh and you're welcome to find Josh on LinkedIn and FacebookSupport the showThe Gaining Health Podcast will release a new episode monthly, every second or third Wednesday of the month. Episodes including interviews with obesity experts as well as scientific updates and new guidelines for the management of obesity.If you're a clinician or organization looking to start or optimize an obesity management program, and you want additional support and resources, check out the Gaining Health website! We offer a Roadmap to starting an obesity program or practice, pre-recorded Master Classes, digital resources including patient education materials and office forms, and much more! Check out our resources on our Gaining Health Shop! If you are loving this podcast, please consider supporting us on Patreon

Justice delayed is justice denied - the court backlog in England and Wales has reached a record high and suspects being charged with new offences are regularly told they may not get a trial until 2027. Some courts are already booking court dates for 2028. The government has commissioned an independent review of criminal courts to work out how to cut waiting times. A victim of crime and a criminal defence solicitor tell Dr Joelle Grogan about the human cost of court delays. Also on the programme, the MP introducing a law to end the abuse of Lasting Powers of Attorney and what can someone do when their ex refuses to pay child maintenance?Presenter: Dr Joelle Grogan Producers: Ravi Naik and Louise Clarke Editor: Tara McDermott Contributors: Tracey Moloney, solicitor, Moloney Family Solicitors Stephen Davies, criminal defence solicitor at Edwards Duthie Shamash Solicitors Tom Franklin, CEO of the Magistrates Association Professor Carolyn Stephens, whose father was a victim of LPA abuse Fabian Hamilton, Labour MP for Leeds North East.

Calls for the introduction of lasting or enduring powers of attorney (LPA or EPA) into South African legislation from several quarters over many years have been falling on deaf ears. According to the Fiduciary Institute of Southern Africa this is an urgent matter. As things stand, the power of attorney extended to any other person lapses when the person who extended the power loses the legal capacity to act. This could be due to mental illness, advanced age, head injury or when the person enters a comatose condition. FISA says South Africans should be allowed to appoint someone who can look after their well-being and assets when they cannot do so themselves. To unpack this Bongiwe Zwane spoke to Louis van Vuren, CEO of the Fiduciary Institute of Southern Africa (Fisa)

What is a Lasting Power of Attorney (LPA) and why do all working adults need it ASAP? If both spouses die simultaneously without writing a will, whose parents will the assets be distributed to? Can money and inheritance really tear apart a “perfect”, loving family?In today's podcast, we take a deep dive into why you NEED an LPA as a working adult and why it is a key component of retirement planning, financial planning and estate planning. We also share our own take on a viewer's dilemma about who to appoint as the donee and executor of her LPA and will—her older child, who has different values when it comes to money, or her younger child, who tends to be more reliable but lacks financial knowledge. We discuss some of the key considerations, including the pressure it places on the donee to manage the inheritance prudently, the effects money could have on relationships between family members, and the option to distribute the LPA to both parties to minimise conflict.What would you do if you were the donor? Share your thoughts in the comments section below!

In this episode Zach and Tori touch on the broader implications for American politics and society. The discussion then shifts to more serious subjects, focusing on the context and controversies surrounding the use of the M-word and its historical and current implications within the Little People of America (LPA) community. They also analyze recent political events, addressing reactions within the LPA community towards statements made by public figures like Trump. Learn more about your ad choices. Visit megaphone.fm/adchoices

What if the sky truly is the limit? Join us for an inspiring conversation with Claudia, the president of the Latino Pilots Association (LPA), and Manny, the director of finance, as we explore what it means to break into the aviation industry, particularly for people of color and women. With heartfelt stories of personal and family journeys, they unravel the unique challenges faced by Latinos and Latinas in aviation and share how the LPA is paving the way for a more inclusive future. Whether you're dreaming of a career in aviation or simply curious about what it takes to soar, this episode promises insights and encouragement to chase those dreams.In a tapestry of personal narratives, we hear about the life-altering decisions that led individuals to the aviation field, from parents escaping war and hardship to children finding their wings. The stories of resilience and cultural identity paint a vivid picture of the struggles and triumphs of immigrant families, highlighting the power of perseverance and the unexpected paths life can chart. These tales serve as a testament to the belief that it's never too late to follow one's passion, even when faced with career transitions later in life.As our conversation continues, we spotlight the vibrant community fostered by the LPA and other organizations championing diversity in aviation. We celebrate the spirit of empowerment through mentorship, scholarships, and shared experiences, underscoring the importance of representation. From the exciting prospects for older career changers to the dream aircraft choices of our guests, this episode showcases the personal aspirations and collective mission to inspire the next generation of aviators. So tune in, and let your curiosity take flight as we explore the skies and the stories of those who navigate them.Want to work with me one on one? Head over to www.nicobarraza.comInterested in hiring Sonora Studios for your marketing, social media management, graphic design and or event work? Learn more and contact them at www.sonorastudios.coSupport the showWarmly,Nico Barraza@FeedTheSoulNBwww.nicobarraza.com

It's another Q&A show, and this week we cover managing finances under an LPA, Maternity pay, and what to do with a big windfall, plus lots more besides! Shownotes: https://meaningfulmoney.tv/QA4  00:58  Big fan of the show. Really appreciate your work. Dad is 92 with rapidly declining health (Dementia and mobility issues). He is still living at home with Mum (80) who is caring for him with family help. At the moment, it is about manageable. I am managing their finances. We have moved the majority of savings into my mum's accounts. I have used up mum's entire ISA allowance for this year. There is still around £38k of savings sitting in a no interest paying Barclays account. Due to their ages, I do not want to tie up the cash for too long, though at this point in time, they do not need to use this money as they are still able to live off my Dad's pension. Can you suggest how I might manage this chunk of cash? Possibly a simple savings account, but I am aware that the interest rates are not exactly brilliant, and I wonder about moving into a GIA instead (I have moderate experience buying/selling shares in my own SIPP and ISA, though I am personally high on the risk curve with investments heavily in MSTR and TSLA). Any advice would be appreciated. Cheers, Rich 05:08  Love the podcast (obviously!), it's genuinely very helpful and has really helped me get my stuff together!!! Not sure if this is something you'd know about but, do you think you would be able to explain to me in your very listenable way, how to work out maternity pay, as in how it's actually calculated and how to plan to make up the difference etc plus anything else that might be helpful that I don't even know that I don't know!! I can't really find what I'm looking for anywhere else so just thought I'd ask as I find your explanations of things easy to understand (and could listen to you chat about anything tbh)!! Thank you! Jess 12:16  Thanks so much for your brilliant podcasts. I love the idea of the question and answer ones! I have a fun question I have been meaning to ask for ages. I keep my contingency fund in premium bonds, and I periodically enjoy a thought experiment, around what I would do if I were to win the big prize of £1 million. (I fully realise this will never happen, but it is a helpful thought experiment to get me thinking about where my priorities lie in case I do receive a much smaller lump sum in the future). I have no bad debts, I have a contingency pot and I contribute to a pension and ISA. My hypothesis is that I would give some to charity (maybe 10%?), might retain 5% for fun – a nice holiday or an upgrade to my car, would max out my ISA and pension,  and then would split the rest between a world index tracker and one or two investment properties. I'm curious to hear your thoughts on this and how you would allocate. Thanks! Justyn 17:52  The mantra is that the most important time to take advice is when nearing retirement. That's certainly true for us now, and my other half sought some regulated advice recently in respect to tax free cash and pension recycling rules. The advice was provided (that it was not tax free cash recycling) & so we are continuing with the plan as discussed  / agreed with the regulated IFA that we contracted the discussion with (we checked the company and the individuals credentials out on the FSA website .. All good). The question is (call me paranoid, but quite a lot of money – for us, is involved) what happens if in due course HMRC come to us and effectively look to impose penalties for us acting in accordance with the regulated advice provided / paid for (ie, they dont agree with it / decide it has broken the recycling rules)? I have no (sane) reason to suggest this will happen, but paranoia is a terrible thing!! Keep up the good work (oh, and Roger as well) Regards, Kevin Milsom 23:02  With UK inflation now only 1.7% (from 16 Oct 24), are we in a very unusual phase were inflation is less than half of the rate you can easily get on savings? This leads onto thinking about investing versus savings – we all invest to try and beat inflation, but we can currently do this easily with no risks via savings accounts. It is a conversation my wife and I are having at the moment! She is  ‘saver' and I am an ‘investor'. Of course we have a good mix of both from all the guidance you have provided. Cheers. Dave Hicklin 27:40  Hello gents! Big fan of the podcast and the YouTube channel. Thanks for everything you do! Question for you – which I realise is pretty niche so you may not want to cover it. I am in the fortunate position of reaching max pension taper threshold (due to a great salary, some even greater RSU awards and an increasing company share-price!). I have some pension contribution carry-forward but will have used this all up by FY26. My employer do a 7% pension contribution if employee contributes 4%. But for those reaching taper threshold, you can opt out and the company will instead just give the 7% on top of your salary (which is very generous!). Thinking ahead, my question is: – Would it be better to: a) take the combined 11% contribution and opt for a scheme-pays for the tax above the £10k allowance when time comes. I am thinking this way I still get a years worth of investment of the pre-tax money before the tax is paid – which might be beneficial? or b) opt out and take the post-tax increase in salary and put this somewhere else? My wife's and mine ISAs will be maxed already, so would have to be GIA most likely (or premium bonds!?). I'm thinking A makes most sense. I still get the £10k tax free and benefit from some further untaxed money working for me for a little while at least. The tax has to be paid either way, but I am delaying it till later. What do you both think? Thanks very much! Paul

Welcome back to our weekend Cabral HouseCall shows! This is where we answer our community's wellness, weight loss, and anti-aging questions to help people get back on track! Check out today's questions:  Amy: Hi Dr. Cabral. First, thank you for all you do for the health community! You are my most trusted source of information. I'd love to get your thoughts on a red patch under my right eye. I've suffered through it flaring up and going away over half of this year. My dermatologist has tried 2 creams and we recently did a skin allergy test. While this was helpful, nothing has made it actually get better. I have a sneaking suspicion that it is more gut related than contact allergen related. Do you have any thoughts on ways to go about finding this root cause? Thanks!   Melissa: Hi! I just moved out of state and am in my mid 40s with menstrual irregularities. I'm feeling overwhelmed trying to find a new primary care and OBGYN that practices holistically with functional medicine therapies. How does one go about finding one. Or should I opt to doing a hormone therapy specialist?   Anonymous: Hi Dr. C, For several mornings now Ive been having a weird, somewhat sour chemical taste in my mouth. I believe this is due to my chronic constipation as my morning bowel movements are often incomplete, and any subsequent movements I have after my first one will smell more strongly of this sour chemical taste I wake up with in my mouth. My urine will have this smell as well. It does not smell of feces, just sort of chemically. I also have lots of pain in the area right below the sternum and seems to be chronic, and only reduces with the more bowel movements I have. Im already taking many magnesium supplements, motility activators, tudca, and miralax but I still find myself in these situations quite often. My stomach will often make high pitch, squealing sounds as if its straining   Lynne: Hello and thank you so much for all you do for all of us! I'm trying to understand why I tend to get benign growths such as lipomas. I also have a lump on my breast that has been there since I was 20. I am 52 and have gone through menopause and thought it would dissipate after the estrogen level dropped so dramatically. I also had hyperparathyroidism...another growth. Finally, I have a lymph node that feels like a tiny hard nodule on my neck (at the top near the ear). I have been taking proteolytic enzymes, am not overweight, exercise daily and eat a very clean diet. I would greatly appreciate any advice. Thank you!  Sorry, I forgot to mention that I listened to previous HouseCalls and have tried all of those things: massage, rebounder, sauna, dry brushing, castor oil, detoxes, etc. I have been doing these for a number of years.    Jill: Thanks for sharing your expertise and experience. I have a history of hyperlipidemia but through diet & lifestyle efforts have kept my cholesterol levels in check. Within the last few years, the levels have begun to climb and some of my inflammatory markers are worrisome. I am 53, post menopausal, and live an active lifestyle. I would like to avoid statins; however, I have been taking Icosapent Ethyl and Ezetimibe for the past 6 months and have seen a lowering of both my triglycerides and cholesterol to normal ranges again. My APOB is 139, LpA is 102 but my CT cardiac score is a zero. Where do I go from here? Is there any other testing I should consider to understand if need to continue on these medications, such as a CT angiogram?     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 and Resources: StephenCabral.com/3263 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

Wir alle lieben ja Itchy und Scratchy. Und genau deshalb ist diese Folge so historisch: Mit Poochie wird ein neuer Charakter eingeführt. Und der wird auch noch von Homer gesprochen. Der gute Roy ist mit seinen flotten Sprüchen selbstverständlich auch mal wieder am Start! Viel Spaß und Vielen Dank an LPA für den Folgenwunsch!

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… Anonymous: Hi Dr Cabral. I have a question about fat pads. Like sacral fat pads and the “buffalo humps” specifically. I have read that diet and exercise hardly makes a difference for these. And liposuction seems to be the only thing that comes up to get rid of them. I understand we all store fat differently, but I'm curious about these specifically. Do you know if loss of body fat gets rid of these? Mine have gotten worse over a few years, and despite losing some weight ( maybe not enough yet) these areas don't seem to change. I'm a pretty petite person, but I do have some excess fat I would like to get rid of. This area troubles me and I feel a little hopeless that they don't change even with weight loss. Thank you!   Chelsea: Hi Stephen, thank you for all your helpful information and knowledge. I've recently developed dry crack skin in between my fingers and a lot of bumps on my upper back and shoulders. I can't seem to pop the bumps, it's not like they're pimples. I thought the cracking in between my fingers was potentially a fungus like athletes foot? But I tried yeast infection cream and it didn't seem to help. This might be TMI, but I'm also very itchy in my genitals. However, test results came back negative for yeast infection or STDs. This has all started at the same time. Could it be related to my gut? Is this a histamine response? I recently did a gut and sibo test, I get my results on Thursday. I've had sibo before but I didn't have these symptoms. Any advice is appreciated! Thanks!   Kayla: Hi Dr Cabral Thank you for all that you do, your podcasts bring me hope & calmness every time!I am 33 years old, overall good health, hypothyroidism 3.6 TSH, LPa high but all other markers (apo B, triglycerides etc good). I recently got my thermography results “cranial dental/thyroid exam” it shows I still have some inflammation around the sinus, neck, & thyroid resulting in possible nodules, last year I removed 4 cavitations, dead bone (dental surgery) & it seems I may still be infected on my upper left molar, I'm exhausted , I dont think I have the strength for surgery again , every year I do the big 5 labs, and overall my results are always very good since I continually do yearly protocols , I'm not sure what to do anymore, losing hope thyroid, neck inflammation.   Kayla: Hi Dr Cabral, Could you speak more of Lipoprotein A (LPa) blood marker, my LPa is 158 & all my other markers are pretty optimal (ldl, hdl, apo b , triglycerides etc) my question is, what now? How do I live with high LPa if lifestyle “doesn't change the marker level” .. It feels like this will creep up on me, I take omega daily but theres talk about Niacin flush , I just need you to speak more of this I trust your insight & I want to know how to live worry free.   Kellie: Hi Dr. Cabral! My husband really started focusing on improving his health over the past 5 years - annual physicals, routine dentist, exercise bike 30min/day, nicotine-free, homemade meat & veggie meals, etc. The only Rx the last 5 yrs is for HBP (lisinopril-hctz 20-25). He recently went through a Healthy Heart Screening and found out his Calcium Score is 39. Is that permanent or what can he do to get that back to 0?  Thank you for tuning into this weekend's Cabral HouseCalls and be sure to check back tomorrow for our Mindset & Motivation Monday show to get your week started off right! - - - Show Notes and Resources: StephenCabral.com/3257 - - - Get a FREE Copy of Dr. Cabral's Book: The Rain Barrel Effect - - - Join the Community & Get Your Questions Answered: CabralSupportGroup.com - - - Dr. Cabral's Most Popular At-Home Lab Tests: > Complete Minerals & Metals Test (Test for mineral imbalances & heavy metal toxicity) - - - > Complete Candida, Metabolic & Vitamins Test (Test for 75 biomarkers including yeast & bacterial gut overgrowth, as well as vitamin levels) - - - > Complete Stress, Mood & Metabolism Test (Discover your complete thyroid, adrenal, hormone, vitamin D & insulin levels) - - - > Complete Food Sensitivity Test (Find out your hidden food sensitivities) - - - > Complete Omega-3 & Inflammation Test (Discover your levels of inflammation related to your omega-6 to omega-3 levels) - - - Get Your Question Answered On An Upcoming HouseCall: StephenCabral.com/askcabral - - - Would You Take 30 Seconds To Rate & Review The Cabral Concept? The best way to help me spread our mission of true natural health is to pass on the good word, and I read and appreciate every review!  

Robert Moore is an attorney and research specialist with the Agriculture and Resource Law Program at The Ohio State University. Prior to joining OSU, Robert and his wife, Kelly, owned Wright & Moore Law Co. LPA, a law firm in Delaware, Ohio focusing on legal services for farmers and landowners. After 18 years of private […]

In this episode, you'll hear from experts, Jim Clement, Seller Strategy and Optimization Director, and Angie Wilen, Equitable Housing Senior Director, on how lenders can find equitable housing opportunities by breaking through long-standing myths about technology and embracing digitization and change to uncover “missed opportunities” within Loan Product Advisor®.

Despite heart disease being the leading cause of death in the United States, cardiovascular care has been an overlooked opportunity in digital health. With 1 in 3 Americans facing cardiovascular disease in their lifetime, how can innovation help turn the tide?In this episode, we explore heart health in the digital age with Dr. Jeff Wessler, cardiologist and founder/CEO of Heartbeat Health, the nation's largest virtual-first cardiovascular company.We cover:⌚If we can trust cardiovascular data from wearable devices (and what doctors call “Apple Heart Syndrome”)

In this episode, Jian'an Wang discusses a study investigating the relationship between elevated serum lipoprotein A (LPA) levels and the risk of severe degenerative aortic stenosis in a cohort of 742 patients. The findings reveal a significant association, particularly with LPA levels exceeding 100 mg/dL, highlighting LPA's potential as a therapeutic target and underscoring the need for further research into therapies aimed at lowering LPA levels.

In this episode, Adam welcomes Oscar Celli, who shares his aviation journey and awesome info about the LPA!

We dive into a powerful conversation with Claudia Zapata-Cardone, President of the Latino Pilots Association, for a conversation that's set to redefine your understanding of aviation's future. Get a glimpse into the LPA's groundbreaking initiatives and discover how they're making waves in the industry. Your next big opportunity could be just a listen away. So tune in!   WHAT YOU'LL LEARN FROM THIS EPISODE What's in store at the 2024 LPA Aerospace Industry Expo in Orlando How LPA's newly launched mentorship program is empowering aspiring pilots and aviation professionals across the industry Valuable lessons from her journey, offering tips on navigating flight training and avoiding common pitfalls. Is the LPA open to all ethnicities or just to Latino pilots? Ways to volunteer at the expo and play a key role in supporting an event driving the next wave of aviation talent   RESOURCES/LINKS MENTIONED Latino Pilots Association Organization of Black Aerospace Professionals United Airlines   Immerse yourself in the ultimate celebration of Latin culture and the achievement of the Latin aviation community! Join The 2024 Latin Aerospace Industry Expo this September 12 - 14 in Orlando, FL. Book your tickets now at https://s6.goeshow.com/lpa/aerospace/2024/index.cfm.   ABOUT CLAUDIA ZAPATA-CARDONE Claudia is a Captain at United Airlines with over 27 years of experience in the airlines and aviation industry. She is passionate about sharing the piloting profession with women and persons of color, empowering them through outreach programs and organizations.    Currently, she serves as the President of the Latino Pilots Association and is a proud member of Women in Aviation and the Organization of Black Aerospace Professionals. Claudia firmly believes that diversity and inclusion in the aviation and aerospace industry lead to greater company success by engaging different perspectives to achieve a competitive business advantage.   CONNECT WITH CLAUDIA LinkedIn: Claudia Zapata-Cardone   CONNECT WITH US Are you ready to take your preparation to the next level? Don't wait until it's too late. Use the promo code “R4P” and save 10% on all our services. Check us out at www.spitfireelite.com!   If you want to recommend someone to guest on the show, email Nik at podcast@spitfireelite.com, and if you need a professional pilot resume, go to www.spitfireelite.com/podcast/ for FREE templates!   SPONSOR Are you a pilot just coming out of the military and looking for the perfect second home for your family? Look no further! Reach out to Marty and his team by visiting www.tridenthomeloans.com to get the best VA loans available anywhere in the US. If you're a professional pilot looking for a great financial planning partner for your retirement, tax, and investment, go to www.tpope.ceterainvestors.com/contact or call 704-717-9300 ext 120 to schedule a consultation appointment with Timothy P. Pope, CFP®. Be ready for takeoff anytime with 3D-stretch, stain-repellent, and wrinkle-free aviation uniforms by Flight Uniforms. Just go to www.flightuniform.com and type the code SPITFIREPOD20 to get a special 20% discount on your first order.  

In this conversation, Liz Rohr interviews Jennifer Carlquist, a physician assistant with extensive experience in cardiology, who discusses the assessment and management of chest pain.They covered: - Assessing cardiac versus noncardiac chest pain- Assessing risk for MI and when to send patients to the ED or not- What EKG findings to watch out for, and how to learn more to build your ekg reading confidence (and what's new!)- What we can do for patients to assess and manage heart disease risk, including labs and tests to check in primary care (including the coronary calcium score, LPa, and homocysteine)- How to communicate and collaborate effectively with ER providers- Further resources to learn if you're in cardiology or interested in making the switch from primary careTakeaways- Consider both cardiac and non-cardiac causes of chest pain, especially in female patients with atypical symptoms.- Take a detailed history, including risk factors and family history, and be aware of red flags that may indicate a more serious condition.- Recognize the limitations of certain diagnostic tests, such as EKGs and troponin levels, and consider a CTA with FFR for outpatient testing.- Collaboration between primary care providers and the ER is crucial, and concise reporting of findings is key to effective communication.- Differentiating between hyperkalemia T-waves and hyperacute T-waves can be challenging, but hyperkalemia T-waves are pointy and hyperacute T-waves are more blunted and broad-based.- Inverted T-waves in leads other than AVR and V1, especially if they are symmetric, can indicate the need for urgent evaluation.- Q-waves can form within an hour of an infarction, and a small Q-wave in lead III without other abnormalities may be a normal finding.- When learning EKG interpretation, it is important to start with understanding what a normal EKG should look like and then focus on high-risk findings.- Inflammation is a significant risk factor for heart disease, and non-traditional risk factors such as psoriasis and early menses should be considered.- Lab tests such as the coronary calcium score, LPa, and homocysteine can provide valuable information in assessing heart disease risk.- Magnesium supplementation can be beneficial for patients with palpitations and hypertension, but the specific type and dose should be tailored to the individual.- Primary care providers play a crucial role in assessing heart disease risk and can collaborate with cardiologists to order appropriate tests and make informed decisions.- The three-day EKG challenge and the Cardiology Fundamentals Mentorship program are valuable resources for learning and advancing in cardiology.- The importance of fostering a supportive and collaborative environment in healthcare to provide the best care for patients.For a full transcript and conversation chapters, visit the blog https://www.realworldnp.com/blog/assessing-chest-pain______________________________© 2024 Real World NP. For educational and informational purposes only, see https://www.realworldnp.com/disclaimer for full details. Hosted on Acast. See acast.com/privacy for more information.

Take control over your property and financial affairs with the experts of LPA Now (01228 307 360) to make sure your assets are managed by someone you trust. Talk to an LPA expert at: https://www.lpanow.com/lasting-power-attorney-guidance LPA Now City: Brampton Address: 17 High Cross Street Website: https://lpanow.com/ Phone: +443336965858 Email: malcolm.roberts@lpanow.com

This week's episode is about atherosclerosis, a condition that leads to cardiovascular disease. Buck explains the role of cholesterol and lipoproteins in the development of atherosclerosis. He emphasizes the importance of understanding this topic as cardiovascular disease is the leading cause of death. The conversation covers the different types of lipoproteins, such as HDL and LDL, and their association with atherosclerosis. Buck also discusses the significance of apolipoprotein B (APO-B) in measuring the risk of cardiovascular disease. He explains how APO-B can penetrate the blood vessel wall and trigger an immune response, leading to the formation of plaque and potential heart attacks. Buck recommends keeping APO-B levels below 60 milligrams per deciliter to reduce the risk of atherosclerosis. He also mentions the importance of testing for lipoprotein little A (Lp(a)) levels, as high levels of Lp(a) are a major risk factor for atherosclerotic cardiovascular disease.

“The most charming person I have ever met” is how our host Beth describes the guest in this episode, so you are in for a treat. We have the dynamic, charismatic Colleen Gioffreda! Colleen is the Clinical Operations Program Administrator for the Greenberg Center for Skeletal Dysplasias in the Department of Genetic Medicine at the Johns Hopkins University School of Medicine. She handles patient inquiries, coordinates the Little People of America (LPA) Medical Advisory Board clinics at the national conferences and regionals, provides school/social resources to patients and parents, and also manages budgets and databases.    In her volunteer life, Colleen is LPA's Adoption Coordinator, and has helped facilitate the adoptions of over 400 children with dwarfism for the past seventeen years. She is also the Chair of the LPA Conference Management Committee and is a member of LPA's Medical Advisory Board.    Colleen is lucky enough to answer to the name of ‘Mom' to her four children, who also all happen to have achondroplasia, the most common form of dwarfism. She views having achondroplasia as an opportunity, and feels fortunate to have experienced such a unique and rich adventure in life.    Since our Executive Producer, Kira Dineen, is also a genetic counselor, she joins as a guest host in this episode.    Episode Highlights:   Understanding Terminology and Accommodations: Appropriate terms for individuals with achondroplasia and skeletal dysplasias. Vital accommodations for people with dwarfism in various aspects of life.   Home Modifications and Misconceptions: Recommended home alterations for individuals affected by dwarfism. Addressing misconceptions and stereotypes about dwarfism in her work.   Employment and Workplace Challenges: Employment roadblocks faced by little people and necessary workplace accommodations.   Career Path and Key Responsibilities: Colleen's journey towards helping the skeletal dysplasia community. Key responsibilities in her role, including patient inquiries and coordinating medical advisory board clinics.   School and Social Resources: Providing school and social resources to patients and parents. Importance of this support in managing skeletal dysplasias.   Adoption Advocacy: Motivations for becoming involved in adoption advocacy. Experiences and insights from facilitating adoptions of children with dwarfism. Countries with higher frequencies of children with dwarfism waiting to be adopted.   LPA Conference Management: Involvement in the LPA Conference Management Committee and the significance of organizing conferences. Memorable and rewarding experiences supporting individuals and families.   Parental Support: Approaching support and resources for parents raising children with achondroplasia.   Community Advocacy and Medical Collaboration: Pressing issues within the dwarfism community and advocacy efforts. Response to FDA-approved treatment for achondroplasia (VOXZOGO® (vosoritide)) and differing viewpoints. Collaborating with medical professionals and researchers to advance understanding and treatment.   Personal and Professional Perspective: Influence of personal experience with achondroplasia on professional approach. Current initiatives and projects to support individuals with skeletal dysplasias.   Future Hopes and Advice: Hopes for the future of care and support for individuals with dwarfism. Advice for professionals and volunteers supporting individuals with rare genetic conditions.   Colleen Gioffreda shares invaluable insights into the world of dwarfism, from personal experiences to professional advocacy. Her work with the Greenberg Center and LPA highlights the importance of community, support, and dedicated advocacy for individuals with skeletal dysplasias.   Stay tuned for the next new episode of “It Happened To Me”! In the meantime, you can listen to our previous episodes on Apple Podcasts, Spotify, streaming on the website, or any other podcast player by searching, “It Happened To Me”.    “It Happened To Me” is created and hosted by Cathy Gildenhorn and Beth Glassman. DNA Today's Kira Dineen is our executive producer and marketing lead. Amanda Andreoli is our associate producer. Ashlyn Enokian is our graphic designer.   See what else we are up to on Twitter, Instagram, Facebook, YouTube and our website, ItHappenedToMePod.com. Questions/inquiries can be sent to ItHappenedToMePod@gmail.com.

In this week's episode, we will discuss the significance of personalized blood testing and its revolution in health diagnostics. Let's also delve into the benefits of using blood serum and finger stick tests, particularly the FIT 176 and the gut barrier panel, highlighting the importance of identifying food sensitivities and gut health for overall wellness. Tune in for insights on why testing is preferable to guessing for optimal health management.   Key Takeaways: Importance of Personalized Medicine: Post-COVID, there is a significant shift towards personalized healthcare, where testing, not guessing, is essential for accurate diagnoses and treatments. Innovative Blood Testing: KBMO Diagnostics' FIT 176 test is a game-changer, enabling accurate detection of food sensitivities and inflammation, crucial for managing chronic conditions. Gut Health and Its Impact: The gut barrier panel provides insights into gut permeability and inflammation, essential for understanding overall health and systemic issues. Comprehensive Cardiovascular Testing: APOB and LP(a) markers in the cardiovascular panel offer advanced predictive capabilities for heart disease, emphasizing early detection and management. Simplified Interpretation: The use of intuitive, color-coded results (red and green) in tests enhances comprehension and compliance among patients and practitioners. SCHEDULE A FOOD SENSITIVITY TEST / GUT-BARRIER PANEL NOW AND GET A DISCOUNT USING OUR CODE:

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In our final episode, Erin Langevin, Senior Vice President, National Retail Operations, Guild Mortgage joins guest host Phil Treadwell, founder of M1 Academy and host of the Mortgage Marketing Expert podcast, to discuss the role strategic partnerships play in transforming industry practices

Learn more about LPA of NEW -- https://www.facebook.com/LPAofNEW 

Weekly conversation led by Dr Joelle Grogan that gives you an in-depth understanding of the law stories making the news and the legal decisions that could have a bearing on everyone in the UK. Whether it's unpicking a landmark legal ruling, explaining how laws are made or seeking clarity for you on a legal issue, The Law Show will be your guide.This week: Protest law has been tightened up a lot in the last year, giving the police more leeway to stop disruption. But parts of the new powers have now been deemed unlawful by the High Court. So what is and isn't legal when it comes to protest? And how should the police handle protesters? Joelle explores all this with barrister Dr Sam Fowles and with Andy Walker from the College of Policing.Is it legal to build on greenbelt land? Campaigners in Greater Manchester are taking legal action after Bury council announced plans to build 1500 homes on greenbelt.And: why you may need a "Lasting Power of Attorney", even if you're married. If your spouse were to be incapacitated, being next of kin is not enough to make financial or health decisions about them. Social media's "legal queen", solicitor Tracey Maloney, talks us through how and when to get an LPA. Producers: Ravi Naik and Arlene Gregorius Editor: Tara McDermott Production coordinator: Maria Ogundele

In this week's episode, Donna Spencer, Vice President, Servicing Relationship and Performance Management joins guest host @Phil Treadwell, founder of M1 Academy and host of the Mortgage Marketing Expert podcast, to discuss the importance of servicing for sustainable homeownership and creating new homeownership initiatives.

Original Air Date: 4/21/24 — Louisiana has a new specialty license plate dedicated to the Arts. Join host Pam Bordelon as she visits with Acadiana artist Denise Gallagher, who created the winning design in the Louisiana Partnership for the Arts competition. A portion of the proceeds from sale of the plate benefit LPA, which works to ensure that culture is recognized as indispensable to a healthy society.

If you struggled with binge eating disorder or BED before bariatric surgery, can it still be an issue now? Are there differences in binging before surgery versus after? How is BED related to binge-grazing and what does that really mean anyway? Dietitian Chaundra Evans and psychologist Kelly Broadwater join me to answer all of these questions and share helpful insight for your journey.Podcast Guests: Chaundra Evans RD, LDNwww.BeBariEDucated.comKelly Broadwater, LPA, LCMHC, CEDS-Swww.BeBariEDucated.comBariEducated on FacebookVisit Procarenow.com for all of your vitamin, calcium and protein needs. Use Code: Susan10 to save 10%You can share your message of hope, healing and transformation with your purchase from NewHopeGirls.com Use code TRANSFORM to save 15%Resources:Check out my freebie for 10 protein tips that work dailyRate, Review & Follow on Apple Podcasts:"I love Dr. Susan and Bariatric Surgery Success." If this sounds like you, would you please rate and review my podcast? Click here. Then click on "Listen to Apple Podcasts" at the top. Scroll down to where you see Ratings & Reviews and tap on "Write a Review". Yes, I'd love a 5 star review! LOL Be sure and let me know what you love most about the podcast. Thank you for your time! If you haven't followed the podcast, be sure to Follow/Subscribe now so you never miss an episode.TakeawaysBinge eating disorder (BED) is the most common eating disorder and is characterized by a loss of control over eating.Bariatric surgery does not cure an eating disorder, and BED can reoccur after surgery.Binge grazing involves consuming small amounts of food over a long period of time and can contribute to weight regain.Triggers for binge eating include emotional factors, such as trauma and untreated mental health issues, as well as environmental factors.Seeking help from an interdisciplinary team of professionals specialized in bariatrics and eating disorders is crucial for successful treatment. Chapters00:00 Introduction03:25 Understanding Binge Eating Disorder (BED)06:27 BED and Bariatric Surgery09:41 Binge Grazing: What It Is13:36 Triggers for Binge Eating15:57 Nutrition and Binge Grazing22:18 Mental Health Issues and Binging23:39 Seeking Help for BED26:51 Moving Ahead Successfully

On this episode of The Way Home, @Danny Gardner, SVP, Single-Family Mission and Community Engagement, joins guest host @Phil Treadwell, founder of M1 Academy and host of the Mortgage Marketing Expert podcast discuss how Freddie Mac solutions, technology capabilities, and innovative product offerings are bridging the home ownership gap.

On this episode of The Way Home, @Kevin Kauffman, VP, Single-Family Seller-Engagement, chats with @Eileen Tu, VP, Product Development and Credit Policy at Rocket Mortgage about how to leverage the lender partnership with Freddie Mac to approach technology advancements, ongoing regulatory changes and Quality Control (QC) in today's business environment.

In this week's episode, Katie Givens, Director of Sales, Single-Family Seller Engagement, and Rebecca Lopacinski, Account Executive, Single-Family Seller Engagement, chat with Juan Rodas, CEO and co-founder of New Story Lending, about the incredible story of how his company became a Freddie Mac Seller/Servicer to more powerfully serve underserved markets.

On this week's episode, Freddie Mac's Sonu Mittal, SVP and Head of Single-Family Acquisitions, and Ravi Shankar, SVP and Head of Single-Family Portfolio and Servicing, will join guest host Phil Treadwell, founder of M1 Academy and host of the Mortgage Marketing podcast, for a discussion on how to overcome market challenges, such as high costs and rates, the benefits of partnering with Freddie Mac, and upcoming priorities and initiatives for 2024.

This is the premiere episode of the fully analog (recorded & constructed) HAUNTOMANCY TAPES series of analog sound magicks kasted into the aether of the modern 'podcasting' current. This series that treats the medium like a Dharmic Vajra and wields heavy art and musings through Hauntomancy, Audiomancy, collaborations, exaltations and vexations.   This initial episode of the analog Hauntomancy (hauntology-of-the-self-audiomancy & magick) cassette cast was constructed with haunted and archaic ways of recording and production. Computers were only used for final sound quality and distribution.   All musick heard was performed live & recorded live to 4 track cassette tape.    The 2023 Videosigil Vigil live Audiomancy (Sound Magick) Dim Sessions tether the piece throughout. If a track is not noted, it is from this very session: https://www.youtube.com/watch?v=cfpI72K7dWM&t=2282s BIG NEWS! I HAVENT ANNOUNCED YET (WAITING ON THEM TO ARRIVE...) 2024 will be the YEAR OF THE DIVERGENT MAGICK ANARCHIC GRIMOIRE! A workbook and schema I published to assist in organizing, creating, and deconstructing the rituals, big and small, that make your own personal folklore!: https://a.co/d/e5GKbsP Use the PRAGMAGICK blank journal to help sketch your magicks or use with the DIVERGENT MAGICK grimoire! https://a.co/d/97iCJv8 DRT01: TRACKLISTING (BY TAPE SIDE): SIDE A “Many Named” live 4track demo by Revel Rosz Hauntological Audio Artifact (tape) of the host 20 years ago on NYE in Los Angeles December Dim Session Audiomancy Begins tethering with introductory words by Revel Rosz on tape “The Shadow - The Phantom Voice” compiled from Cassette Release Westlake Station, Seattle field recording by Revel Rosz with “Shadow Work” words recorded to tape Mary McKeever's improvised Cm Harmonica & Piano recorded to tape by Revel Rosz “Faith” ramble by Revel Rosz from a Patreon Only Stream composed in November 2023 “Father Karras” live 4 track demo by Revel Rosz “It Needed Tending Anyway” Poem by Jenny Rocky ∆ Introduction of Little Wind read by Revel Rosz from his “Haunt of the Aspectre” chapter via hauntmanual.com 4/8/23 LPA initiation Spiritbox session clip of Little Wind's name “Hymn To Little Wind” channeled lyric audiomancy session recorded live on 4track SIDE B Barry Admanson “Mr. Eddy's Theme” from the Lost Highway Soundtrack taken from an old cassette mix December Audiomancy Dim Sessions return to tether Side B Culmination of 2023's Shadow work, faith and the Spectre of ‘Travis' words recorded on tape DIVERGENT MAGICK GRIMOIRE intro recorded to tape Clip of “December Dim Session Liminalstream” of Revel Rosz discussing the Divergent Magick Grimoire “Dajjal” live 4 track demo by Revel Rosz “Donuts in the Rain With Erica” Poem by Jenny Rocky ∆ “I'll Be In Heaven Again” Channeled Lyric Audiomancy recorded Live to 4track tape ∆  Poetry recitations by Jenny Rocky, AKA Lily Gilder, with backing tracks by Revel Rosz. See growing document of Lily Gilder recitations at: tinyurl.com/lilygilderrecitations Why, oh, why care about such outmoded technologies? I aim to marry true communion with the thirdmind of neither analog, either/or digital in my audiomantic works, BUT BOTH with intentional and ritualistic means-- free from digital sequencing or using samples of any kind outside my own custom ones made from my somatic creating. I'm not going full Steve Albini as I still believe in the DAW as a magickal tool, but I will be utilizing the digital audio workspace only for distribution, audio cleanup and mixing / mastering -- largely keeping its infinite ease to "create" at bey, as the easing of many of rough and tumble processes of recording and songwriting, let alone audiomancy and podcasting, have fallen victim to indistinguishable and dishonest bores of same-y-ness. Staring at a computer screen to easily non-linear edit a cut-up of stock samples or auto-generating noise all have their place within the umbrella of audiomancy, just not with me! It's easy to make something clean and standard! I believe true audiomancy lies within the somatic experience -- the abandonment of expectation, and the invocation and celebration of human error -- to conjure my personal communion with the self and the other... so... Everything is performed live (aside from my haunted 70's analog rhythm machine, Herbert, and custom programming played from a Korg Drum Machine) - each sonick #musick #soundsigil is #improvised utilizing only #glossolalia to channel "words" where there were never any! Warts and all! HAUNT ON TO A HAPPY NEW YEAR, Revl∴ Keats Rosz 1/1/2004-1/1/2023

I'm Ellen Bernstein-Ellis, Program Specialist and Director Emeritus for the Aphasia Treatment Program at Cal State East Bay and a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's hosts for an episode that will feature Jocelen Hamilton and Theresa Yao from Stanford Healthcare. We will discuss how adapting the A-FROM to swallowing disorders can offer a person-centered approach to assessing and treating a person with dysphagia.   Guest Bios     Theresa Yao is a licensed speech language pathologist at Stanford healthcare and a lecturer at San Jose State University. Her clinical and research interests include head and neck cancer rehabilitation, voice disorders, dysphagia, and aphasia. She is passionate about serving people from diverse backgrounds with communication and swallowing disorders. She was a fellow for life of the Albert Schweitzer Fellowship program, and co-founded the Bay Area's Swallowing Support group. She has been actively volunteering in community groups for stroke survivors who need communication support. She has always been a strong advocate for her patients and profession. Jocelen Hamilton has practiced as a licensed speech language pathologist for 19 years. She specializes in management of communication and swallowing disorders in adults with head and neck cancer. She began her career at the University of Iowa Hospitals and Clinics, and then joined the Stanford Outpatient Head and Neck Clinic in 2020. She also previously served as a clinical assistant professor for the University of Iowa's Communication Sciences and Disorders department with a focus on supervising graduate students and helping individuals with strokes and brain injuries. Her current clinical interests center around the development of frameworks to facilitate whole person care for individuals with swallowing disorders.   Listener Take-aways Think creatively about how to apply the A-FROM to other communication disorders, like swallowing Learn how dysphagia can impact the participation, environment and personal domains Consider some PROs that help to capture the impact of dysphagia on quality of life of both the patient and the caregiver Explore some ways to adapt EMRs to incorporate A-FROM or Swal-FROM into your daily notes Show notes edited for conciseness and clarity Ellen Bernstein-Ellis So I'm excited to have both of you here today. Thank you and welcome, Theresa.   Theresa Yao  00:55 Thank you, Ellen. I'm glad to be here.   Ellen Bernstein-Ellis  00:57 And Jocelen you too.   Jocelen Hamilton  00:59 Yes. Thank you so much for having us.   Ellen Bernstein-Ellis (Interviewer)    Welcome both of you, again, to this podcast. And as our listeners get to know you, we like to open with a fun icebreaker question. I'm going to pose two different questions that you've selected for today. So, Theresa, let's start with you.   I guess for full disclosure, I want to admit that, I will share--I don't have to admit, I am sharing that I had the honor and pleasure of being your supervisor at Cal State East Bay in the Aphasia Treatment Program (ATP). So I know that may come up today. I just want to let our listeners know that we've known each other for a while. I have been really fortunate in that relationship and seeing you emerge and thrive as such a wonderful contributor to our field.   So Theresa, could you please share one experience or role that has been meaningful to you as an aphasia ambassador?   Theresa Yao  03:22 Thank you, Ellen. It was great experience when I was in the Aphasia Treatment Program at Cal State East Bay. So that's actually one of the experiences I wanted to share as an opening, because I was at the Aphasia Treatment Program as a co-director for the choir, Aphasia Tones. And that was one of the best memory in my life. And I remember one time, one of our members who had more of a severe expressive aphasia, and usually has minimum verbal output, and we all know him. But whenever he starts singing, Can't Help Falling in Love, this particular song, you can hear that those beautiful words just came out right out from his mouth, fluently, beautifully. He was always so happy every time that he heard the music, and he just enjoy singing along.   That was just a really amazing moment for me to realize that people with aphasia with minimum verbal output, they can still enjoy and participate in choir, and can still communicate that way. It's just showed me how powerful it was to use the Life Participation Approach to Aphasia. And in our choir at that time, we have all different levels of severity. All members join together, and then they all enjoy and engage in this choir experience. So that's really meaningful. Whenever I think of LPA, I think of him, I think of this song, and I think of Aphasia Tones.   Ellen Bernstein-Ellis  04:54 Thank you for sharing that. And Theresa, it was wonderful to have you as a co-director. And see you step up to the challenge of leading the choir. And you're right, we really have a strong motto of participation at every level. And you really worked hard to make sure that happened. So thank you for sharing that. And yes, that's one of my favorite topics, so I loved hearing about that.   And Jocelen, I'm also excited to ask you to share with the listeners something about one of your experiences. So would you like to share an Aphasia Access, favorite resource or moment? What comes to mind for you?   Jocelen Hamilton  05:28 Yes, well, this is really neat for me to be on this podcast, because it is this podcast that is a favorite of mine, and a major “aha” for me.   Ellen Bernstein-Ellis Well, thank you, just thank you.   Jocelen Hamilton I worked with patients with head neck cancer for about nine years. I then did a major shift and then worked in a graduate training clinic at the University of Iowa. And during that time, previously, when I was at the hospital with a very heavy caseload and working with individuals with dysphagia. And so then switching over and working with individuals with strokes and brain injuries, that was much more communication focused.   And I had this caseload I was taking over with the graduate students and learning about all the current treatment principles and treatment options and all the research that had been developed. It had been probably close to 10 years since I had worked regularly with individuals with neurogenic communication disorders.   I had knew nothing about LPAA. I knew nothing about Aphasia Access, the organization. And I was thinking about this recently, of how I even came across it. But I think probably I was searching one of these treatment modalities, and a podcast came up. So I listened to some of the other podcasts and I was like, oh my goodness, this totally resonated, LPAA. And the podcasts and other resources through the website, totally resonated with me, and helped me better understand what my frustration was within an impairment only based approach, which was in my training and my background, and things like that, to like see a whole different way. So I learned as much as I could. And I tried to share all of that with my students, we were all learning together of how to implement this. So it's really neat to now be a part of this podcast and participate.   Ellen Bernstein-Ellis  07:32 We're so glad you agreed. And I just want to thank you. If there was ever a wonderful plug for membership to Aphasia Access, I think you just gave it. Thank you so much. for that.   Well, let's dive in a little bit more to our topic of the day. We're going to be talking about how and why you both decided to adopt the A-FROM or the Framework for Outcome Measurement of Aphasia by Kagan and Simmons-Mackie to your work with head and neck cancer patients. So I know we usually focus on aphasia, but we're taking this really important tool and talking about how you adapt it. So many listeners are, of course already familiar with the A-FROM. But can you briefly describe the social model framework for our listeners?   Theresa Yao  08:16 I can start with just a brief introduction. I think everyone, if you're listening to this podcast, you are already very familiar with A-FROM, which is based on the World Health Organization's ICF model. They address a few health and social domains such as body structure, function, activities, participation and contextual factors like personal and environmental factors. And like Ellen mentioned before, Dr. Kagan and colleagues, adapted this ICF model to create a very user-friendly framework for the outcome measurement in aphasia. And this becomes the Living with Aphasia Framework Outcome Measures the A-FROM and it has the domain of aphasia severity, which is the body function or impairment level, and then also participation, environment, personal factor. So these are the core concepts of the LPA approach. Thats what we are based on using this A-FROM to adapt it to this Swallow-SWAL-FROM, we call it. The Living with Swallowing Difficulties framework of measures.   Ellen Bernstein-Ellis  09:22 So let's talk a little bit more about this. Jocelen, do you want to share your story as an SLP and how you came to introduce the A-FROM into your work at Stanford in the head and neck cancer clinic?   Jocelen Hamilton  09:37 Sure. So after about a year and a half of working with individuals with aphasia and applying LPAA and using the A-FROM with clients, I then changed gears back to working with people who had neck cancer and we moved to California and I joined the Stanford team and I was back into primarily working with individuals with dysphagia. I just kept thinking about how can I take this model the A-FROM and apply that to working with individuals with dysphagia.   How I would previously use the A-FROM is that Venn diagram. I would just draw it on a piece of paper and start writing my notes on that as I was maybe doing an intake or working with a client. I started doing some of that model just in my note taking and looking at these different domains that might be impacted. And this was just kind of over a series of months, and even a year, where I was thinking about how to apply this and shared it with my patients. Here are some of the things that I'm seeing and what you're sharing with me that shows your participation is being impacted.   Then I ended up talking with our director, Heather Starmer, about an idea of a project—like how can I move this ahead. Theresa had recently joined our team and Heather said, you might want to talk to Theresa about that. She might be interested in doing a presentation on this. And so it was great, because Theresa and I had not yet talked about our aphasia backgrounds together. It was really neat to then work together and begin to apply this with more of our patients. Initially, we kind of struggled with what the environmental domain look like for somebody with dysphagia. And it was neat to talk through different cases with each other to see how it could apply. And then that's where the Swal-FROM came from.   Ellen Bernstein-Ellis  11:39 Wow, that's wonderful that the two of you were at the right place at the right time. And I always feel that the expression “stronger together” seems really fitting in this situation. But Theresa, do you want to share how you brought a life participation perspective into your work at Stanford?   Theresa Yao  11:57 Yes, sure. Because I've always been a big fan of the ICF model. When I was a student clinician in Aphasia Treatment Program, I learned so much from this model, from LPAA, and from Ellen, you. And also, of course, our members in our Aphasia Treatment Program. And I just could see the huge benefit from the LPA approach in the client's life.   So that's why once I started working in real clinics, I always think about this model. And when I started in at Stanford, I started working with the head neck cancer patients. I just feel like so many patients, they live with long term dysphagia, or a sore throat because of the neck cancer treatment they had. And they sometimes just can't get rid of it. They have to live with it. It's just like aphasia. They live with aphasia. And then it just clicked.  I just think that it's pretty similar to the situation that you're living with aphasia, and it's that same impact on patients quality of life, on their participation.   Then I just started thinking, maybe we can do something with this model to help our patients. And then, of course, Jocelen was there, and then we were just talking about her experience with aphasia treatment and LPAA. And we just clicked. That's why we came up with this (ASHA) presentation, and this idea of how to adapt this A-FROM to our Swal-FROM. And then also, we're talking about this because I also started a support group because I feel like people wanted to get connected. They wanted to engage like aphasia group.  They wanted that community to be able to participate, to be able to share. So that's why I think this also helped me to try to initiate this project, this group, so that we can help more people so that they can, they can help each other.   Ellen Bernstein-Ellis  13:56 I really love that you saw the power of group therapy, and you then were able to bring it into a different treatment arena. I really don't remember hearing too much about separate support groups for people with swallowing disorders. I don't know how common they are. But it sounds wonderful that you started one, Theresa. So very exciting. What do we know about the incidence of dysphagia in stroke survivors, and then people in skilled nursing, and from there, head and neck cancer? The reason I ask because I think there's overlap. I mean, you're seeing the dysphagia in head and neck cancer, but we know that it occurs frequently. Do you have any numbers to share about the incidence in stroke survivors?   Jocelen Hamilton  14:39 Yes, so it's about 45% of individuals with strokes experience, some degree of dysphagia and there's been research that's shown 40 to 60% of older individuals in nursing homes have dysphagia. There's even some research out there that one in 25 adults will experience dysphagia. Then when we look at individuals with head and neck cancer, and this could be on the lower range, but one of the particular statistics is 45 to 50% of individuals with head and neck cancer experience dysphagia.   Ellen Bernstein-Ellis  15:11 The importance of considering the whole person (for dysphagia tx) is really going to affect a lot of people that we might be seeing as therapists. And the two of you saw that there was a strong impairment focus in dysphagia management.  Can you give an example?   Theresa Yao  15:27 I can talk a little bit about this. When I was in grad school, I know that most of the things we learned was how to identify the impairment of dysphagia. We learned all kinds of treatments and exercises for dysphagia. We learned like how to modify diet, how to look for aspiration, penetration. Almost everything we learned, and also what we've been practicing in our clinical practice are heavily focused on the deficit and impairments. That's basically how we trained to assess and treat the physiological changes or the deficit. It just, to me, sounds like it's really technical.   I recently just look up the ASHA NOMS, the National Outcomes Measurement System-- that's what we usually use as judgment of whether the patient is making progress or not. They use this particular functional communication measures to see there's like different levels. If you're really looking at this national measurement system, you can see that the wording and the definition of each level is pretty much impairment focus. They mention diet level, safety, efficiency of swallowing, compensatory strategies, or cues, etc. So these are really heavily focused on impairment, but you don't really see like things that relate to participation, quality of life, environment, and those factors. So the consequences that if all the clinicians are just looking at the impairments and not looking at other factors, then you are missing a lot, you're not treating the whole person.   Ellen Bernstein-Ellis  17:11 Well, that's perfect, because that leads me to my next question. Why is it important to go beyond the impairment level measurement with dysphagia?       Jocelen Hamilton  17:24 I would say, because dysphagia is more than a physical difficulty. That's our name for that physical impairment. But it influences more, just like we know, with aphasia, that it's not just how much they can say, what they understand in the different modalities, but how a change in this function in the body influences everything.   So one of the analogies that I can relate to, that I've heard before in terms of looking at accessibility, has to do with like, physical impairments. So if somebody is paralyzed, they can't move their legs, well, the physical therapists are going to look at their legs and see the range of motion, their strength and all of that. But they're also going to think about how are they going to get into their house? And how are they going to move around?   Well, sometimes what can happen with dysphagia, as Theresa already talked about, we're looking just at how does that epiglottis move? What is the airway invasion like? But then are we going to talk about well, what's going to happen? We just had the holiday with Thanksgiving and the holidays now. What are family meals going to look like? I think one of the things that sticks out to me is what would my day to day life and social life be like if I couldn't drink with ease and comfort, I couldn't eat with ease and comfort, if I needed to have special food and special liquids and special strategies? So this impacts so many things within a social realm, and personal realm as well. We'll get into that in more detail as we go. But it's not just about the change in a physical function. How does that influence the rest of our lives? And it really does. There's been research that shows about burden and quality of life and psychological health.   Ellen Bernstein-Ellis  19:08 Well, this really hits close to home for me. I'm going to share with our listeners a personal story, because I've always been very passionate about our field and an advocate for speech language pathologists, but being on the other side of the table, when my husband was diagnosed with terminal cancer, did nothing but increase my own respect and appreciation for the role we play in supporting our clients and their loved ones.   Through this process, specifically with dysphagia, and I want to give a shout out to my husband's speech pathologist at Stanford, Heather Starmer, (and another congratulations to her because she just was made a 2023 ASHA fellow), but I'll just always remember the day that we came in. I know that Heather was set with her treatment plan-- I could already guess what we needed to do for the day. And that plan went out the window because we both signaled, Steve and I, that he was just feeling an increasing burden of trying to manage all of the home tasks we were supposed to do for both PT and speech, and it was just really impacting how he was feeling. And so instead, Heather focused on the personal impact and the quality of life issues that we were bringing up. Steve wanted to be compliant. He wanted to be the best patient there was. But she really listened to him carefully. She brought her best counseling skills to the table that day, and helped us come up with a plan that we could manage in a way that would help us sustain his quality of life as best as possible.   So I really saw, personally, I mean, I saw day in and day out how his dysphagia from his head neck cancer really impacted, hugely impacted, his participation with our family, and his quality of life. I am grateful for this work that you're doing and the passion you feel for looking at the whole person as you assess and treat dysphagia. And thanks to you, I've been reading, since dysphagia is not usually in my wheelhouse as much these days, but thanks to preparing for this particular episode, I was able to read some articles by Rebecca Smith and her colleagues that showed me that there's some amazing work being done looking at this whole topic, so thank you for that. Okay, and taking a deep breath, because that's a story I've been thinking about for quite a bit.   Back into our next question. What is the speech pathologist's role in assessing and addressing health related quality of life and the associated mealtime quality of life? That seems to be talked about a lot in the literature right now. Jocelen, is that you again?   Jocelen Hamilton  21:57 I'm glad you mentioned Rebecca Smith's work. There are actually three papers, I think, that that group, she and colleagues, put out in 2022. And specifically, I'll share a few quotes from their paper The True Cost of Dysphagia and Quality of Life:  The Views of Adults with Swallowing Disability, but in a way, there's a call to action, and she's not the first to mention it. But for us to include social participation, and their overall well-being, as part of our dysphagia intervention. To make that routine, and then to also ask questions: How are you doing? How are the holidays? How are these social settings with eating? I like to ask patients and their family members, and ask them separately, not meaning like individually, within the same session: Are you participating in doing this, the same things that you did before your diagnosis? Or how is that looking? Are you going out to eat as much? What do you miss now that is different and you're experiencing changes in your swallowing.   And it's interesting, because sometimes the partner will say that they miss going out to eat, and they need to navigate feelings like, “Well, I don't feel comfortable eating this in front of my loved one who has difficulty swallowing. I feel conflicted about I get to eat ribs, and they don't.” Those kinds of things. The importance of eliciting these stories, so we can really see what are their challenges, because then we can, like LPAA teaches us, we can engage in this creative problem solving and how we can help navigate through some of these challenges. I think those are a couple of important things that we can look at to support people.   Ellen Bernstein-Ellis  23:45 Thank you. And I just wanted to let our listeners know that we're putting all these references into our show notes. I took some from your ASHA presentations that I attended. So those will all be cited in the show notes.   Well, to expand to the participation, environment, and personal domains, you started to think about using patient reported outcomes or PROs for assessment. Why don't we go through the domains and discuss potential tools and interventions to fill out this framework a little bit more. So what might it look like if you consider participation?   Jocelen Hamilton  24:24 When we're looking at participation, we're looking at these meaningful activities may or may not involve oral intake, but looking at their current levels of participation compared to their pre cancer status. So how often, and in what ways, is someone with swallowing challenges participating? I kind of already talked about that a little bit. And how are the family members doing?   Here's one of the interesting things that I've had patients share here. Sometimes, one of the swallowing strategies that a patient needs to complete is a purposeful throat clear, and a re-swallow, or some patients do naturally their throat clearing, or maybe they're coughing when they're eating and drinking. This is an area where it calls attention to them when they're doing this. And then during the pandemic, we were all super hyper aware is somebody clearing their throat? Is somebody coughing? I've had some patients where they really don't feel comfortable because it calls attention. And people ask, how are they doing?   And also, another challenge being that when swallowing is hard, talking and swallowing is extra hard. When swallowing is challenging, most people need to just do that, where we take for granted that meals are a very social time. So some of those issues can be really challenging. There's also some individuals where their difficulty with swallowing has to do with loss of the bolus coming out and so there's almost changes in appearance, where they may not feel it. Their lip, their chin might be numb, and they don't know that liquids are dripping out, or they have a piece of food sitting there. So, they might be hesitant to go out and participate in different social settings. Even sometimes we have patients where they don't feel comfortable eating with their own family members, where they will eat completely separate from their spouse.   Ellen Bernstein-Ellis  26:28 I am just really struck again about the overlap of some of the things in your head neck cancer patients with clients I see with aphasia. It's really striking. So should we take a moment and discuss how this might look if you consider the environment?   Jocelen Hamilton  26:44 I really didn't address a PRO at all.   Ellen Bernstein-Ellis  26:46 Oh, it's not too late. We can still do that.   Ellen Bernstein-Ellis  26:52 Why don't you go ahead?   Jocelen Hamilton  26:55 Sure. Okay. So we're looking in this interview, right, like gathering information, learning how these things are challenging for them. For patient reported outcomes, PROs, Theresa, and I both looked into different ones. And oh, this one has these questions. And this would fall within this domain. So I'll touch base on a few of them here. And then some of them, they have questions that actually apply to  all of the domains.   So for these, there's one the Swal-QOL, this is probably the most broad in terms of looking at all of the domains that are within this Swal-FROM. It has 10 different quality of life concepts that it has specific questions for. So for this one, there's one subset that's all about social functioning. Some of the questions, they're rating from either strongly agree five point scale to strongly disagree, One of the questions, for example, is “I do not go out to eat because of my swallowing problem.” That really tells you where they're at with that participation, or “Social gatherings like holidays or get togethers are not enjoyable because of my swallowing problem.” So that really hones in on that challenge.   Within our specific area of practice with individuals with head neck cancer, there's a scale called the Performance Status Scale Head Neck Cancer, PSS-HN. Now you might think, how might I use this? I encourage people to be open minded, even though this wasn't validated. And some of these are not validated on individuals who have dysphagia from a different cause other than head neck cancer. It doesn't mean that you can't use it as a way to gather information, engage, and perhaps re administer.   I'm also a big fan of, as people fill this out, having a conversation about their responses as they go to gather information. But with this, the Performance Status Scale, there's a specific rating scale about public eating. So zero means always eats alone. And 100 is no restriction of eating for any place food or company. So they would eat out at any opportunity. Where in-between might be one point on the scale, “eats only in the presence of selected persons and selected places”, or they would eat out but there would be another option,  “eat out, but be more selective about the diet textures and things they would consume in a social setting”, which is common. Some individuals will specifically choose different foods when they're when they're in a social setting.   There's also another PRO, the Dysphagia Handicap Index. So with this one, it's a 25 item questionnaire and it does specifically look at physical, functional and emotional aspects of dysphagia. And so a couple of questions from there that would fit with the participation domain include, “I'm embarrassed to eat in public” and “I don't socialize this much due to my swallowing problem”. Those could give some insight into these areas by selecting some of those questions.   Ellen Bernstein-Ellis  30:08 Well, I'm really glad you caught me. I think I was so struck about the overlap that, thank you for coming back and talking about those PRO's. Are we good? Can we transition to the environment next? What would this look like? What does the Swal-QOL look like if you consider the environment.   Theresa Yao  30:29 When you talk about the environment, it can be factors such as the availability of the appropriate food textures, and oral liquid consistencies across different social settings. For example, if you go out to the restaurant, are there any easier food texture that's available for people with dysphagia? And that's one of the environmental factors.   And then there's a new article from ASHA leader that just came out about dining with dysphagia. So that's actually a pilot program from University of Cincinnati that try to help restaurants to expand their menu options so that they have more choices for people with swallowing disorders.   Ellen Bernstein-Ellis That's amazing.   Theresa Yao Also, another factor that related to the environment is the attitude and level of acceptance or support the people with dysphagia can get from their family, their friends, or even just strangers in their eating situation. So just like Jocelen mentioned, if you're coughing or clearing the throat, what the reaction from other people will be like, -- if they're supportive, or if they're not so. Sometimes these factors can make a patient uncomfortable eating out because of those environmental factors. And then also, the attitude from people around usually can be impacted by culture. Which type of textures they prefer to consume, and how they consume. If you go to a different type of restaurant, they may have different types of food textures, that are specifically for that culture, so that's also another factor.   And then also, on the broader spectrum, is the attitude from the healthcare professionals or the public, because the attitude from healthcare professionals is basically, because dysphagia is invisible, and when you are in the hospital, not everyone can see it. If you have leg injury or arm injury, people can see it. But if you have dysphagia, you can't see it. And then when the health care provider is, prescribing your pills, and if you can't swallow, how can they take the pill? They probably are not aware of this, this type of disability, so they may not prescribe you the right pills.   These are the things that we can consider as environmental factors. And of course, even larger scale, there's health care policies, the service systems, that may impact the people with a dysphagia too, because insurance may not pay all the dysphagia services, or how often can people get dysphagia support or service? So those are all the environmental factors that we may consider.   Ellen Bernstein-Ellis  33:21 I think the importance of this framework is helping us as clinicians to continue to think just broader and more widely about what's impacting the person in front of us. I mean, wow, you are giving us a lot of factors, from the very personal to the broader social policy. And I want us to take a moment and also talk about personal factors, that whole domain.   Theresa Yao  33:41 Personal factors can also be very, very important. And  a lot of things can be involved. So we know that the person was dysphagia may not be the same person, have the same hobbies or same traits, as before their treatment. So that may cause anxiety, or they may feel embarrassed because of their eating habits, or the change of their eating habits. Because we know that eating and drinking is very individualized. Some people, if they're born as a slow eater, they probably are okay with their dysphagia diet or if we ask them to eat slowly and take smaller bites, that's totally fine. But if some people are born as a fast eater, they will have a huge challenge with, if you give them the strategy to eat slow, taking small bites, because that's just not them anymore. They just feel like they're a different person and then they feel disappointed or frustrated if they can't eat as fast as they used to.   And I always share this in my clinic. I  see two patients with similar procedures. One person can feel really happy with their diet. They feel okay because they're always eating soft foods or soups. And then another person just with a little bit of impairment of mouth opening, they feel like it's just really frustrating because they can't bite their sandwiches and burgers. And that just makes a huge difference. But if you're only looking at their swallow study, it's the same, they probably don't have any major impairment, but the impact on the quality of life on their participation, environment, and also personal factor. It's so different. So that's why I think considering a personal factor is really important.     Ellen Bernstein-Ellis  35:38 So you're giving us examples of the things we should be thinking about, you're giving us examples of some of the PROs that might help us measure. But if many of the EMRs, the electronic medical records are set up for impairment focused measures, how can you adapt the documentation to include these other domains? That's always a barrier, or can be maybe, not always, can be.   Jocelen Hamilton  36:00 I think sometimes it can be a barrier. If sometimes the entry is just you have to click certain things, there's not a lot of room for free text. With the EMR that we have, we can have a set template, but we can copy and paste anything in there. So what I did is I took the A-FROM--actually, in the same paper that put out the A-FROM, they put the FROM, Framework for Outcome Measurement, and actually suggest that you could use it for individuals with TBI and called it TBI-FROM.    I took that and put it into a template and have the citation for it there and then added a title. It gives a visual for other individuals reading the note of what I'm talking about. ‘Survivorship beyond body function domain: Dysphagia's impact on personal, participation, environmental domains', so I have that as a title. I have it as this set, we use epic, so I can do dot phrases (Smart Phrases). I can drop that into a note. And then as I go through and document, I have the subtitles of body function, participation, environment, personal factors in as I'm collecting this information. That's how I can organize my note.   I don't do it every single time with every single patient. Sometimes some of our sessions are more impairment focused, like we need to for safety reasons focus on this. Sometimes it's more a whole session all about how are they doing with their personal domain? I had a patient in the clinic today, and he is depressed, and we just had this quick talk of, “Okay, what do we need to do? Can you talk to your primary care doctor? This is common, many individuals with head neck cancer have depression.” But I'll organize my note, getting back to the notes, with those subtitles and putting the information in there. It also is a cue for me, because I keep needing cues and reminders to come back and broaden that focus, instead of always being in on the impairment and you monitor, document, and then monitor, as I'm reviewing back on their notes to see how they're doing across these different domains.   Ellen Bernstein-Ellis  38:19 That is a beautiful example of how you can adapt something. I'm sure a lot of our listeners really appreciate you describing it so carefully, and hopefully will inspire some of them to see what they can do to adapt their EMRs.   A little bit earlier, you mentioned the importance of getting perspective from both the client and the care partner. How does the caregiver or care partner experience fit into the Swal-FROM?   Theresa Yao  38:47 Caregiver or care partners, they play a really important role in this whole journey with individuals with dysphagia. And I'm sure Ellen, you probably were in that role before. Most of the time, it's the caregiver making the meals for the spouse. Making the meals for the patients with dysphagia can be very challenging. Because just the texture, you have to take care, and the taste. I have caregivers talking to me. They told me that they tried their best to make all the foods but the patient didn't eat at all or didn't like it at all. Then they feel super frustrated. These are all the challenges that the caregivers may face.   Dr. Samantha Shune and colleagues, they did a lot of work on this caregiver burden topic. Their study said increased caregiver burden has been associated with the degree of impact that dysphagia is having on mealtime logistics. Family members also report increased anxiety and fear and frustration, stress, embarrassment and social isolation. So these are very two critical things to consider when we're thinking about whole person care, because we can't just care for one person, the patient. But if the caregiver is also experiencing all the stress, all the anxieties, we also need to consider that factor.   Researchers in Australia, Professor Nund and colleagues, they also pointed out that this specific caregiver burden is third party disability. And it's the consequence of that person's impairment, which impacts the functioning and ability of their family members or significant others. That's why we want us to fit this caregiver experience into this Swal-FROM framework. Just adding the family caregiver in all the different domains to support patients with dysphagia. And caregiver can influence four domains. But at the same time, also, we need to take care of, examine, the four domains of the family member or the caregiver--going to check their participation, their environment, and their personal factors. Those are really important, because their health and well-being can be affected by being in the journey of taking care of people with dysphagia. So they're super tied closely. That's why we wanted to fit this framework as well.   Ellen Bernstein-Ellis  41:21 One of the clinical tools I've learned is available is a PRO measure called the CARES, developed by Shune and colleagues, and we'll again put the citation in our show notes. Theresa, could you describe that a little bit more?.   Theresa Yao  41:37 So this is a wonderful screening tool that developed by Dr. Shune and colleagues. It's full name is called Caregiver Analysis of Reported Experiences with Swallowing Disorders. It has 26 items in the questionnaire. And then there's two parts that explore a different aspect of dysphagia's impact on the caregiver. One is a checklist on the behavior and functional changes, and one is a checklist of the subjective caregiver stress. Basically, it's a simple yes/no questionnaire. You can give it to the caregiver and they can just circle yes or no. Then from that, you can figure out what area you may address as an SLP. Or you may want to refer them to a specific team or professionals to address that, because we have limited scope of practice, we can't do everything. But if we can help them to identify the issue and then point them in the right direction, to the right team. That may help a lot.   Ellen Bernstein-Ellis  42:43 In your ASHA presentation you also mentioned the Rome Foundation is a resource and another website that offers skill building around managing serious illness conversations. We're going to put both of those resources into the show notes for people, but we don't have time right now to go into them fully.   But Jocelen, can you address or share what benefits you've seen by adopting this framework? Does it help with goal setting? Does it help with acceptability of recommendations? What have you seen?   Jocelen Hamilton  43:12 I think it's helped me and I feel like it's helped patients and our families have a little more clarity about, okay, these are the areas that are challenging. And again, I'm a visual person, so if I write it out with them, and they're telling me things, and I'm explaining, I get excited about the diagram, and I'm like, you know, see, this seems like an area of challenge. Is there something that you're interested in doing in this area? Are you willing to talk with another person who's gone through this?   So I feel like it really can give clarity, I think, for myself, what you know that A-FROM does, and Swal-FROM now is to not, I professionally can get really hung up on the impairment. And I can't always change that, right? We can't always change it to the degree that we would like. Of course, we would like everybody to have complete resolution, right? And so there can be this frustration and powerlessness with that. And obviously the patients and our family members can be experiencing that also.   And with this broader view, we can say but here's what we can focus on what can we do to have you participate that would make you feel better? What can we do that would help you with your personal feelings? So I feel like it addresses things that matter and we can have more conversations about how is their day to day life being impacted? What are some small steps we can take in a direction that might help them and their families.   Ellen Bernstein-Ellis  44:43 That's beautiful. Thank you so much, Theresa and Jocelen. It has been a pleasure  and I've learned so much from both of you, listening to you apply this framework and look deeply and carefully at quality of life for people with dysphagia. I really appreciate it. Is there anything else you want to add?   Theresa Yao  45:03 I just wanted to add a little bit. So I think it's really important as clinicians to listen to our patients and caregivers, because we need to learn from their experiences, their perspective. And, like we mentioned dysphagia is invisible. I wanted to share one of the quotes from one of the dysphagia support members. He says,  “dysphagia is a label you carry with you inside.” And that's really just so true, because it's hidden. If you go outside, people see like you what you can walk, you can talk, but they don't know that this disability is hidden inside. And I think it's so important to address not just the impairment, but also listen to the patient's perspective. And then help them to address all the domains. I always think that you become a better clinician because what you learn from your patient. So that's all we need to do.   Ellen Bernstein-Ellis  46:08 I can't think of a better way to close this interview. Even though I could ask you several more questions, we could be here for another hour, I just want to thank you for bringing that patient's voice, a client's voice, into the discussion today, so beautifully. And let's end on that note of really learning from our patients' perspectives. So I want to thank you both. And I want to thank our listeners for listening today. And for the references and resources mentioned in today's show, please see our show notes. They're available on our website at www.aphasiaaccess.org. And there you can also become a member of our organization.   Jocelen Hamilton Yes, yes, Do it!   Ellen Bernstein-Ellis Thank you! Browse our growing library materials and find out about the Aphasia Access Academy. If you have an idea for a future podcast episode, email us at info@AphasiaAccess.org For Aphasia Access Conversations, I'm Ellen Bernstein-Ellis. And thanks again for your ongoing support Aphasia Access   Resources and References Ariadne Labs: Serious Illness Care Program https://www.ariadnelabs.org/serious-illness-care/serious-illness-care-program/ The Rome Foundation https://theromefoundation.org/   Chen, A. Y., Frankowski, R., Bishop-Leone, J., Hebert, T., Leyk, S., Lewin, J., & Goepfert, H. (2001). 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Highlights from this week's conversation include:The Ten Year Treasury and its Role in Booms (1:51)The End of an Era and the Impact of COVID-19 (5:09)Shocking Revelation of the Ten-Year Yield (9:31)Reset and Retooling (11:05)LP Perspective on Venture (13:11)Investing in Legacy Assets (15:21)Insider Segment: New and Emerging Trends for LPA (16:37)Raising capital in the current market (19:25)Limited partner agreement terms (20:38)Necessary skills for managers in the next decade (22:05)The time of opportunity (29:50)Safety is danger (30:52)Roxane Googin is a world renowned authority on macroeconomic technology trends and the Chief Futurist of the fintech venture firm Group 11. Previously, Roxane was the editor of High Tech Observer, a long running invite-only publication read by institutional portfolio managers focusing on disruption in the technology sector. Her bold predictions included an inflation-free stock market boom in the 1990s, culminating in the Internet boom from the depths of the LTCM credit crisis in 1998, the internet bubble demise in September 2000, and the introduction of smartphones and cloud computing in May 2002 through her much acclaimed article “Six Simultaneous Equations”, to name a few. In addition to engineering experience in development and manufacturing, Roxane has experienced finance from the cradle to the grave: from venture capital, through equity analysis, to term and finally to asset-based lending. She uses her broad experience to envision the disruptions that are bound to come our way. Roxane Googin has a BS-EE from the University of Tennessee and an MBA from the University of Virginia.Gunderson Dettmer is a law firm specializing in providing legal services to the startup and venture capital communities. With a primary focus on technology and life sciences sectors, the firm is known for its expertise in guiding emerging companies through various stages of growth, from formation to financing and beyond. Gunderson Dettmer's comprehensive legal support includes advice on corporate governance, intellectual property, mergers and acquisitions, and venture capital transactions, making it a trusted partner for innovative enterprises navigating the complex legal landscape. Swimming with Allocators is a podcast that dives into the intriguing world of Venture Capital from an LP (Limited Partner) perspective. Hosts Alexa Binns and Earnest Sweat are seasoned professionals who have donned various hats in the VC ecosystem. Each episode, we explore where the future opportunities lie in the VC landscape with insights from top LPs on their investment strategies and industry experts shedding light on emerging trends and technologies. Follow along and subscribe at swimmingwithallocators.com.The information provided on this podcast does not, and is not intended to, constitute legal advice; instead, all information, content, and materials available on this podcast are for general informational purposes only.

Watch the full video interview on YouTube here: https://youtu.be/wRjQCG4NU-Y Dr. Malcolm Kendrick is a General Practitioner and bestselling author.  He is now well worn around the edges, from battling the cholesterol hypothesis. This hypotheses states that an elevated blood level of LDL cholesterol causes heart disease. Malcolm's most recent book is The Clot Thickens: The Enduring Mystery of Heart Disease. In this episode, we discuss: The cholesterol hypothesis is wrong What is atherosclerosis? Saturated fat doesn't raise LDL cholesterol (why it's impossible) What makes an artery more prone to a blood clot? (vs a vein) What is the glycocalyx? The anatomy of plaque in arteries LPa is different than LDL The process of blood clotting Why doctors are stuck focusing on LDL cholesterol The thrombogenic hypothesis The REAL causes of heart disease Practical tips to repair the endothelium & protect the glycocalyx Show sponsors: ARMRA Colostrum

In this episode of the Active Bariatric Nutrition Podcast, I interviewed Psychologist Kelly Broadwater, LPA, LCMHC, CEDS-S and Registered Dietitian Chaundra Evans, RD, LDN. We discussed:Their experiences working together specializing in bariatric patients with eating disordersDisordered eating habits and behaviors that can be hard to recognize after bariatric surgeryAt what point a good intentioned movement goal can turn into compulsive exerciseTips for someone who may feel like they are getting overly focused on calorie intake, weight, body composition, or movementOnline resources and tools that they recommendTheir new book, BariEDucated: An Integrated Health Guide for Dietitians and Behavioral Health Specialists Caring for Bariatric Surgery PatientsHow To Contact Kelly & Chaundra:Website: https://bebarieducated.com/Facebook: BariEDucatedPurchase their book: BariEDucated: An Integrated Health Guide for Dietitians and Behavioral Health Specialists Caring for Bariatric Surgery PatientsResources Recommended In the Episode by Kelly and Chaundra:Compulsive Exercise Test Recovery RecordEating Disorder Alliance WebsitePsychology AllianceTo learn more about my 1:1 Bariatric Nutrition Coaching Programs, go to: www.activebariatricnutrition.comFollow Active Bariatric Nutrition at:Instagram - @activebariatricFacebook - Active Bariatric NutritionYouTube - Active Bariatric Nutrition

Welcome to the Aphasia Access Conversations Podcast. I'm Jerry Hoepner. I'm a professor at the University of Wisconsin – Eau Claire and co-facilitator of the Chippewa Valley Aphasia Camp, Blugold Brain Injury Group, Mayo Brain Injury Group, and Thursday Night Poets.  I'm also a member of the Aphasia Access Podcast Working Group. Aphasia Access strives to provide members with information, inspiration, and ideas that support their aphasia care through a variety of educational materials and resources. I'm today's host for an episode that will feature Paula Valente and Dr. Assunção (Maria) Matos from the Portuguese Institute of Aphasia (IPA). In this episode, we'll be discussing Paula and Maria's role in building three dimensional social, LPAA in Portugal from the ground up. Biosketch: Paula Valente is a Speech and Language Therapist, social entrepreneur and responsible for the creation of IPA. She realized that there are important gaps in the therapeutic interventions that are offered to the person with aphasia in Portugal. With the support of partners in Portugal and in another countries, and with a team consisting of a speech therapist, a psychologist, a social worker and volunteers, Paula is convinced that the path will not be easy, but it's possible.   Dr. Assunção (Maria) Matos is a Lecturer at the University of Aveiro in Portugal. Her work is grounded in the WHO-ICF model and social, LPAA approaches to aphasia rehabilitation. As one of Paula's teachers, she influenced the development of the IPA and is a crucial partner in the innovative programming that they offer. Take aways: Shift to Social Approach: SLPs in Portugal moved from a medical model to a social approach in aphasia intervention, realizing the limitations of traditional speech therapy alone. Comprehensive Support Program: EPA in Portugal offers a wide range of services, including therapy, psychology, and caregiver support, aiming to enhance the lives of people with aphasia and their families. Limited Services in Portugal: EPA is the sole organization providing such extensive aphasia support in Portugal, serving the entire country, with an emphasis on online services to reach distant regions. Professional Training Focus: Assunção Matos emphasizes holistic training for speech-language pathology students, preparing them for diverse practice settings by exposing them to various intervention approaches. Fundraising Challenges: EPA faces fundraising challenges in Portugal due to limited access to funds and philanthropic support. To sustain their services, they generate revenue through clinical services, therapy programs, online courses, and book sales. They also have associates who contribute annually. Despite challenges, they are working to demonstrate the effectiveness of their approach to gain government support for sustainable funding.   Interview Transcript: Jerry Hoepner: Well, it is my privilege today to have a conversation with Paula and Maria. So, we're going to just begin talking about the programming that they've started within Portugal. And I'm just really excited to have this conversation. I think this is a unique conversation for aphasia access. Because we're really get to talk about the process of building a program within a country from the ground up from scratch. So, I think we're used to stepping into this process partway through and again. This will be a really fun conversation. So welcome, Maria and Paula. And yeah, welcome to Aphasia Access. Assunção Matos: Okay, thank you. Thank you, Jerry, for the great opportunity of being here with you, sharing our experiences and our dreams. It's an honor to be here with you. Honestly, thank you.   Paula Valente: I make my [unintelligible]. It's the same. Thank you very much. Jerry Hoepner: Absolutely. I have to say I was really privileged to have some conversations with Maria and Paula at the IARC Convention in Philadelphia last spring. So got the opportunity to meet there. And obviously really interested in learning more about your work and programming that you started in Portugal. So. we were talking just before this podcast about your name, and then you call it the EPA or the I.P.A. I was saying that in a in English we'd probably call that the Portuguese Institute of Aphasia. But I'll let you explain the name a little bit from the Portuguese standpoint. Assunção Matos: So, IPA is Instituto Português da Afasia the so it's exactly what you were saying in in in English. I.P.A. is known as EPA all over all over the country and it was decided to call the association like this? It was actually it was Paula's decision. Paulo, do you want to say something about it? Paula Valente: No, we just at a name to our legal name is another one, because in when we did the registration of the organization, we had to choose another name. So, our name is Afasia. It's like, if IPA. Afasia Epaphazia. So, our organization of the legal name is Epaphazia. But the trademark Is Instituto to Portuguese Epaphazia. That was the Portuguese Institute of Fascia. When we choose this name it was a little bit scary, remember, as soon, so I don't know if because we were afraid to do. To tell people this is a big thing we are a Institute is an institute is a reference is something that sounds like very credible. And we want to do that. But at the time it was the beginning, and we were like, I hope this will work. So was like, okay, let's do. Let's do, Let's do this with this big name, impressive name. And what's also a strategic name to show the people that we were doing something with something good, something with good basis and good principles, and the with and impact to the person the people with the afasia. So, we were a little bit afraid at the beginning, but with the responsibility we were taking. But I think it was the right choice. Jerry Hoepner: Yeah, I agree. I think it's a great name and thank you for filling in a little bit of that background. In full disclosure. There's no way I could pronounce the Portuguese version of that name. So really happy to have you do that? But yeah, this really speaks to that kind of building from, you know, from the ground up from scratch. Paula, I'm interested in a little bit more on that. How did the EPA or the EPA come about? Paula Valente: Okay. So, I was. I've been a speech therapist since 2008, and I did my practice with a Assunção. She was my teacher in the hospital and maybe she can tell a little bit. She influenced me at the time because when I finish that practice internship, I was convinced that my mission, my life mission, and my professional vocation was to work with people with aphasia in a socio model or in more psychosocial model, because she taught me that in the hospital. So, from there I study about that, I did my master in that field like my master. I'm sorry about my English, so try to understand me, please. My master was about partner training aphasia partner training, communication training. And from there I was convinced that I had to do more to help people with the Aphasia to live better, besides the aphasia I was working at the same time in hospital context, public one. And I was also working in a private clinic with patients with a phase. So, I saw the difference of get to work in more functional and communicative way with the people, with the, with the person, with the patient and his family, and in a medical model. So, I was seeing the differences I was studying, and I thought no, I would love to help the people with the aphasia to in Portugal, because I was also understanding better the public services to this, this to these persons to person with aphasia, and I started to feel that I could do more. Something started to make me dream about a common community program or center and at the time I had to I did the A social internship course, Intensive program training program that give tools that I needed to start making my dream a reality. So, at the time after I did that social entrepreneurship course, I said goodbye to my jobs and I started a pilot project. The name of Pilot project was Aphasia 3D. Because at the time I thought already to work in 3 dimensions, person with aphasia, family and friends and community. So, to achieve a better life with the aphasia I needed to working that 3 levels. So, the pilot project was aphasia 3D was the name but when he I did my pilot project I called was from Zoom at the time she was my teacher, but also she gave me orientation in my thesis master thesis a project and I call, and I talk. I talk with her. We had a conversation about these, and she was a big supporter. So, she at the big since the beginning, she told me. Paula, I am with you and I will help you. I will be on your side. Let's go. So, she was very, very important. Since the beginning, since everything I don't know. So, add in the final of that. Here the pilot project began and we started to invite some people with the aphasia, some family members, some friends of mine to be the social organization. I don't know. How do you say in America. But we, when we, we have to have a group of founders to register our organization to founder organization, we have just say, let me see. I think it's the Board of the Association. Yes, it's like we have the board. We have a structure and we invited people to do that with us. And then, born the organization the ONG EPA institute together the maybe I can now talk more about what we do but maybe someone can explain better how she influenced me to do that, because is also our passion. Assunção Matos: Well, first of all, first of all, I think I need to do a clarification. My name is Maria. I'm also Assunção, so when Paula is talking about this and some, I'm the same person to say and all other people from other countries, what can I say? I started as an speaking language therapist in the nineties and my first job as an SLP was in a cerebral palsy center with children and their families and indicators and in this kind of center we were very already at the time we were very focused in intervention, on communication. So, it was really common to work with the children, with their family members with the augmentative and alternative communication systems, low high technology. So, this was very common for this population already. So when I changed my job 2 years later, and I went to a central hospital with people with aphasia, my idea of working as an SLP was, you know, focused in communication, and not just in speech or language but thinking about people with the aphasia at the time. The medical model of intervention was the strongest one in hospitals in Portugal, maybe around the world. I'm not sure so when I started working with my patients, I thought I have to do more. This is not enough, so I was not happy about what I was doing, because after months and months of therapy my clients, they were just looking the same. They were not improving their functionality, or they were not doing their lives, as I thought they could do if I did something different. So, I start looking. I went to congresses. I went to the International Society. How many different alternative conferences by the time in the Netherlands, and I started looking, for no one uses AAC with the people with the aphasia So I started also looking for papers, and then I could find Linda Worrall, Aura Kagan, Audrey Holland and I started dreaming. So, policies, EPA is my dream, and I used to say that Paula did what I wanted to do, and I was not able to do because I couldn't just quit my job As she did so, I started at the same time I started teaching in the SLP course and in 2000 the ICF appeared. I'm trying to jump, not to be too boring and everything made sense to me. So, I started looking for different ways of working even at the hospital, and I started bringing the family, bringing the family members to the hospital. I started them trying to train my patients with the total communication approaches. I tried to do my best, because it's not easy in a medical context, you know, to change minds and to change in. That's why, Paula, she's saying she came to me as a student. I was doing this this kind of job. I was trying to apply what I've learned from AAC and children with cerebral palsy, and I was doing some experiences with my patients And also suddenly I met some people in in the Isaac Conference that I told you about few minutes ago and I got involved in a multinational project where we were trying to develop a specific software for people with aphasia to communicate better with a portable AAC device, I can say I'm very proud to be involved in in that project. And so that's how I started. That's how I started. Jerry Hoepner:  That's fantastic. It's just been fun listening to your story kind of a microcosm of things that have happened in other countries, I think, in terms of moving from the sense of the medical model isn't meeting the needs of the people that we're serving. I heard, you know, just a little bit of some of my conversations and everyone's conversations with Audrey over the years so we shift from a very medical behavioral approach to one that is more of a social functional approach. I can just hear those same threads kind of being woven into your stories. And just really, really interesting, I mean. Assunção Matos: Sorry. Sorry, sorry, Jerry. It's just to say that in Portugal no one was then I know no one was working in this swaying, in a more social approach. And Internet wasn't like it is today. So it was really hard to get access to the papers. But I also remember buying the book beyond the fascia from the connect in London and I got in love about connect. Yes, I still have it here also. And I decided, I said to my husband, I have to go to London, and I decided to go to the connect and see how they were working, and do the training the trainers course that they were that they were well, I was trying. It was hard, but I was trying to do it in a different way, because I could see my patients after months and months of therapy linguistic therapy it wasn't enough, and I felt I have to do something else. Jerry Hoepner: So insightful. And I think so many people have come to that conclusion about social approaches and the life participation approach. That Doing those impairment-based pieces alone is just not enough right? Not that they don't have a place, but alone. They're not enough. I think it's really great. I was thinking about Paula's thesis on communication partner training, and how that must just sprung out of all of these discussions, and certainly just central to a life participation approach. The other thread that I kind of heard from both of you is this idea of the dream that you started to have to create something to fill this gap? Maria, I like the way that you said that? You know you started dreaming, and Paula made that dream happen. Paula Valente: Maria knows that I am the crazy, 2 of us is necessary courage conditions of obviously, because as the sun sounds said I was married. But I didn't have children yet. So, at the time I thought, Okay, it's now or never, because soon I will have my family, and it will be very difficult for me to do this kind of choices to quit my jobs. Goodbye, my jobs! No, so it's now, and never. My husband was still in love with me so at the time was easy to convince him that I wanted to do that. I quit my job at that time. For the beginning of EPA. I was doing voluntary work. I did all without receiving anything, so that was not easy. Choice but it was necessary. A little bit of courage and a little bit of  craziness like I was. We were doing something that's in Portugal. We don't. We didn't have a big organization behind us or supporting us. So, in terms of giving us the structure or the security to do something. So, It was like doing a house from the 0 from the ground, so didn't have any money at all. So, everything was started from the 0, and it was a little bit scary. And III admit that I was a little bit crazy, but I think and persistence, because the difficulties were, and they are so almost 9 years later it years later, 8 years later, we are here but this is a big adventure, and he in still is Jerry Hoepner: Courage, persistence, a little bit of risk taking I'm not going to say that you were crazy, but those are things that help you move it along, and I can see now why you so connected with Maura Silverman and the Triangle of Aphasia Project.   Paula Valente: Yes, she was the biggest, when I started. I also. II remember very well to be on the aphasia, because the book, because when I started, my internship gave me the book to read, and I was like I come from the school with a medical model mindset, like language and speech, and she gave me the beyond the feature read this. And let's think about this in your internship. So, when I started to, okay, let's think about these programs. This center I went to connect also was my first experience with the center personal experience. And then I contact there numerous centers around the world, mainly in America, of course, but also some here in Europe and Australia to learn from them, to learn from the programs, to learn about the programs, about the social, the about the business model, how they sustain their activities, how they communicate with the community, how they articulate with another organization. So I did a lot of contacts, and I talk with many people and Maura was one of the most the most easiest person. I don't know how to say that sorry was very available, and she talked and she wrote a letter of support. She was incredible, so that was very important to me at the beginning to start to organize the structure of our programs. I can explain how we work at the moment. what we do at the moment. But I want to say also that many things have changed through the years. We learn a lot with experience, with the errors, with the feedback. That person, either. Persons with aphasia and their families told us so. We learn every year we did changes about the protocols, about the instruments about the programs, about the number of persons that we involve, the number of Anyway, many, many changes were done. And I think we will. We will do that kind of adaptations along the way, because they are very important to achieve our goal better. Okay? So, we have to listen to be aware of the impact, the results. The feedback is very important to getting better. Okay? So, what we do now is, I think our better version of the programs but I think maybe in 2 years we will be doing things differently. Jerry Hoepner: That makes sense and I think you approach this whole process in the right way by connecting to those people. And you know everything you said about Maura rings true, right that she's available, and she is excited to get me going and to share my knowledge. So why, so I would love to hear about what you're doing right now. I think you said 9 years it's been so...   Paula Valente: We, 1916 was the founding year. I started the pilot project in 2015. So, I quick myself therebefore. So, it's almost 10 years in this adventure. It's all. But the organization is only 8 years. So, when our main objective with our association, our mission is to improve the quality of life of people with the aphasia and their families so to do, that we have to we organize our working 3 targets out all the targets. Population. Okay, audiences. Okay, we work with people we work with. And for people with aphasia themselves we work with and for family members and friends and we have we have to work to the community to a more inclusive and community communication accessible community. Okay, so we have activities actions in the these 3 main, groups. Okay, for these 3 main groups for the people with aphasia and the families we have. Hmm, 2  responses. Okay, we have resources and information we wanted to give them the more resources, more information about the aphasia, about how to leave with the aphasia, how to recover the path that the different teams that are important to them to learn more about what aphasia is  And now to leave with the aphasia So we work a lot to offer to Japanese to offer resources and information in our websites in our social networks, with lives in the Facebook, with conversations online, with the workshops, with events, to talk about aphasia, to inform, etcetera. So, we work a lot to give them resources and information free for free. Okay, that's when before EPA, It was very difficult to them to find anything in Portuguese. Okay? In the Internet, or in another ways, in books or in La leaflets, leaflets. Okay? So, they didn't have many choices, many options. So now they have. If they go to our website, to our YouTube channel, to our net, Facebook, page, Instagram, they have videos. They have aphasia friendly videos. They have informational videos. They have testimonials. They have documentaries. They have many things in English that we put legend, subtitles. So, we work a lot in this field of information and resources. Okay at the same time for people with aphasia and families, we develop programs. Okay, you call programs in America and we in Portugal, we don't call that programs but we called like therapies. Okay, it's more the term for us. Your programs for us. We call therapies. We develop different therapies to give responses to the aphasia, the necessities, communication, necessities, and the goals of people with aphasia ask us for help. More concrete, more rehabilitation help. So, at the beginning we were doing only group programs. Okay, with many different types of groups. Okay? But at some point, we saw that was not for some people that was not sufficient because they needed help to communicate better, to develop resources for themselves, to adapt better to aphasia to work some psychology, psychological problems or family problems. So, the group conversational groups, communication pho, functional communication groups, they were good, but they were not, some of them to respond to their particular needs. Okay? And we started to do individual sessions with them also. So at the moment we have like a program, a response to them. So, it's like a service. Okay? That when people with aphasia ask for our help to live with aphasia, to have speech therapy. They want to. They ask us for a specialist. So, they see if a specialist team, so they ask us to help them. So, the first thing we do is an assessment, and the that assessment includes not only the language, the impact of aphasia on the language domain, but also in the participation activities like psychological states, family members, networks social network so we have, we do a global holistic assessment and then we have a reunion. We have a session that we call decision reunion. In that decision reunion we discussed with the person with aphasia in an aphasia friendly way. So, with communication, support to conversation, communication and we show the results. We explain what the evaluation show us and we discuss in in with them their main goals and then we make together a plan and that plan is not only to do things in EPA is not that focus. So, the plan is out. What I can do at the moment to feel better, to achieve my goals. Okay, something, some things they can do with our support. But other things they can do outside. So, we also give them another options. We talk with another professionals or organizations, and we help them to make decisions and go through the process. So, if they want to do something with us, we have only three objectives in the center of the process. So, everything they do they do to achieve the objectives that were clarified in that discussion in that conversation initially and then we start doing. They can do with, not with us individual and group sessions of speech, therapy, psychology, neuro psychology, communication training. All of these approaches are personalized. They follow the pace of the evolution of the person and their needs. And we also and they are all very different. So, some of them do only individual start from start doing only individual sessions. Then they go to the groups. Some of them do only groups, some of them do groups and individual. It depends on their path, their situation, their goals, and the in the continuum of care. So, where they are okay, so with the family members is the same. They are very involved since the beginning, so we will offer to them individual or group sessions that go that will help them in their needs. So, from the beginning and along the way we are always talking with them and give them what they need. So we have also caregiver groups and communication training groups and communication training individual sessions everything to promote adaptation to aphasia, to improve the relationships, the well-being, the success of interactions. We promote also meetings with people with the aphasia, and there, another with them. Sorry. We promote. Provide also meetings with another family members and in in group sessions it makes sense. Sorry about my English. Jerry Hoepner: Totally makes sense, Paula. Well, you have a just a breadth of services that you offer, and I know those have evolved kind of over the years, but very collaborative, very person centered. It seems like, you've really thought this through. You've obviously brought upon a lot of resources to do that. A couple of things I wanted to know. One is you mentioned those video resources and other resources. We'll make sure that those are available on the show notes, so people can connect and check those out even if like. I watch some of them and just to get a little taste of what they look for obviously, I don't switch Portuguese, but just valuable just to have those resources. The other thing I'm wondering about is what's the area that you serve. I mean because it seems like you may be one of the only collaborative social programs in your area. Paula Valente: Yes, we at the moment. If you want to say something, please interrupt at the moment we serve. All the country we are. We are not a big country, but unfortunately, people with aphasia in Portugal they don't have many choices, and after the rehabilitation centers or the care the main public centers that in the acute phase they go, they get, they go there, and then they go home. When they go home, the choices to continue the rehabilitation are very few. And we in Portugal we are the only organization that are doing this work, and specifically with aphasia. We people with aphasia. So, we receive calls from all over the country and, but we are in Portugal and that is the second main city in Portugal. So, we have Lisbon. That is the capital, and then we have Porto is another big city, but in North and we are in Portugal. So, we can't see everyone in Portugal, mainly the people that live near us but with COVID we started to do many teletherapy and now we have almost 50 people with aphasia doing online services. So, at the moment, we have also online groups and individual online sessions and consultation sessions that are like a specialty consultation that we do to that families that only want some someone who helps them to decide things to understand what to do next, and that help us help them to decide what to do. So, we do a lot of consultation sessions that are more periodic and we go through. We. We've talked to them through the year to see how things are going. and to give them more information about what they should expect from the rehabilitation, from the therapist, from the communication, and give them psycho education, but also orientate them. We do a lot of that kind of in-service. Okay. So now, we have many people in our presential activities in our center. But we are the only organization in Portugal. So many people from other cities are asking for help and we are trying to go to Lisbon to create some groups and some enlistment. But Lisbon. But it's something that takes time. Okay, so it's another something that will take some time to happen. And this year as soon sound, Maria will start a group also in the university. So, it's something this kind of different points of presential group. Presential groups. I think, will be the next step to give other options to the, to the persons with aphasia in Portugal.   Jerry Hoepner: Wow! What an incredible breadth of services, and literally in in terms of area. I can't imagine serving all of the people with the face that in State of Wisconsin, which is probably smaller than Portugal. So that is that's really incredible. And wow! What a service! And I want to shift gears a little bit and talk about training professionals and students, because I feel like that might be an important step for having a broader network of people that concern people with a phage throughout Portugal. Maria, are you willing to talk a little bit about some of the trainings that you've done with professionals and your connection with the university and training students? Assunção Matos: Yeah, yeah, I can only tell you about my experience. There are other schools SLP, from my perspective. What I tried to teach my students is a bit of every type of approaches, because in one side, I know that when they go to their practices, they will find some places where the medical model is still very active, so I have to prepare them in order to know how to work with people with the phase in a more linguistic approach. But at the same time, I try to tell them about social approaches and about live participation approach. And II it's not easy, because I don't have much time to do it. But I try, you know, I'm a really big fan of the ICF so I try to prepare them to know how to work according to the ICF and how to work in the different domains the ICF suggests at the same time. We have established the Protocol with the IPA at our university, the University of Avairo. So, my final students, some of them those who want to work and wishes to do their practices in the field. Some of them are going to the EPA for 16 weeks and they do their practices there, and also during that that the time they have to develop an investigation project. So, most times I try to see with Paula we share the needs of the IPA, and we try, you know, to go and to work with the students and try to do some investigation that has an impact for the EPA and for the colleagues who work there. And this is this is great work. At the same time, just to finish me and Paula, we have been doing the SCA. The supportive conversation with adults in Canada and since then, we are doing lots of lots of workshops with the health professionals in many different hospitals. I'm also trying to do some investigation about it, because we don't have it in Porto. Well, so I tried to involve my master students and we are, you know, working together, trying to change minds trying to change the settings in order to people with the face you to leave better from the beginning, when they wake up in the hospital. If they have their health professionals prepared to communicate better with them. We read it from other countries, and which really believe it. So, we are trying also to make some changes and I've started also last year. Doing some SCA work with the other students from other courses. In my university we have nursing students. We have physiotherapists. And we have radiology students. So, at the beginning of the of the year we are doing some online courses to prepare them before going to their practical settings and communicate with the people, with aphasia, or with other communication disorders. So, this is my experience. This is what we are trying to do. Jerry Hoepner: Such important work I can't imagine. I've had so many kind thought leaders and researchers and clinicians that have guided me in this process, and that it wait so much of that groundwork out. So, I just can't imagine building that from the start. And what you're doing is so important. Assunção Matos: This year we are planning to start group therapy with people with the face, you know, because I am at the moment I am 100% at university. So I left my hospital and I really miss my patients and I miss, you know, to do the to be an SLP in practice And because there are not many groups in the country, as Paulo was saying. So, we are trying to organize group therapy for people with aphasia, maybe to do also some work with their family members and the idea is to do the group therapy and trying to do some investigation at the same at the same time. Now it's better going to be the challenge for this year for me. Paula Valente: I just want to say that at the beginning we were offering some workshops and training for the professional health professionals about aphasia, about how to communicate, and other topics that are important from for them to manage better the person with the aphasia since the beginning and we started to see that the health professionals. They don't have time to do training and they don't have money they don't have. They don't want to invest in this kind of training. They want training, but they want that accessible for them so it but the accessible means free without costs and preference in their setting. So, we have to go there to give them the training, because if they have to go some an another place, they don't go. So, where LPA was finding these things and was okay, what we can do. So, one of our works was to find funding programs to fund 2 projects that are, that the main objective is train, the health professionals to communicate. And so along these lines, we did a lot of free training in settings like hospitals and rehabilitation centers, and main mainly financed by those kind of funds. Assunção Matos: Let me just highlight that we are not doing this training alone. So, we are involving people with aphasia in the training. So, we, me and Paulo, we explore the more theoretical parts and then we have people with the aphasia, with us who are the trainers in, you know, in in practice. And II also would like to highlight that this is something that we have tried from the beginning to involve people with the phase in their family members. our Vice President is a woman with the aphasia we have some family members that belong to the Board of EPA. And we from the beginning. The idea was, as Paula already said, work with them and for them and I think this is something that is really is really important. And it's very, you know, for us it's very good. It makes us feel very good about it. Jerry Hoepner: Totally agree. And I mean, it is really impressive that the amount of work that we've been certainly important work. And I get the feeling that the 2 of you probably don't sleep a whole lot. You're certainly doing a lot. I don't know a lot of good things, and you're doing them the right way. So maybe I can shift gears one more time. To talk a little bit about the business end of things. cause that's a part of building from the ground up.  Would either, if you like to start talking about your model. Paula Valente: Yes, since the beginning we wanted to be a social entrepreneurship project. So, what is that? We want to solve a social problem that the public services weren't solving. So, we have innovative responses, services, resources but we also have business model near underneath that because we wanted to. We thought, and I think I'm sorry about my English. I can't I my English day. II feel like I have a aphasia because it's like II know everything. I know what I can. I won't say, but I can say it. I don't speak English every day, so I'm sorry I'm not in the academic field, so I don't have many, many opportunities to train my name, my English, what I am saying our goal is to be sustainable and I personally believe and I think that the EPA boards are completely aligned with this is that the solutions that EPA offers to people with aphasia are not only our responsibility to sustain, to provide is something that is a responsibility from all is responsibility. Okay, I, Paul, sound the board. All this, the people involved that we have the responsibility to, because we started that. So, we have the responsibility to provide the organization, and guarantee that all is working. But in the end, the solution doesn't depend only on EPA, we need the community to achieve our goal. We need the people and their families to achieve our goal. So, everyone as responsibility in this this is, I don't have anyone with aphasia in my family. I could have aphasia someday but  is not only my responsibility to bring this to the community, or somebody that has aphasia is our responsibility, because in the end some of us really have aphasia. My family member, my neighbor, also is our responsibility. So, when we started this organization, the social organization. We want it to be sustainable. But we don't want it to be depending on funding on the States because many of our social organization in Portugal. They have the tradition of being funded by the States. They are. They have a lot of funding that comes from the States and that is a problem, because states they don't have many money to owe it. So, they don't do the better job because they don't have money sometimes. Sorry about my English. So, we thought, if you want to do better than the State, we don't,  If they have a responsibility. We want them to participate, but they don't have the only responsibility we have the wrong responsibility. But the piece, the person with the aphasia and their families that are beneficiating from our services. From these services. From this organization they also have to compensate. And as organization, we have to be aware that to be accessible to all okay, we have to be open to different kinds of participation. So, people with aphasia will compensate will pay for some services in different ways, in different measures and that was the difficulty we had to the term to at the beginning. We have to think about how to do that. So, at the moment, we have different recipes.   Jerry Hoepner: If we put maybe multiple different funders sounds like that are contributing. Is that what you mean? Paula Valente: So, we go get money from different our services, clinical services, our programs group programs, okay and individual programs. So, people with aphasia pay for part of it. If go do fundraising to pay another part and our and our objective, our goal is the community, the municipalities and the state pay another part. So, we don't have to lose our sleep. Doing fundraising is very difficult in Portugal, I think, from what I learned from other centers, our reality is different in Portugal. We don't have many we don't have access to fundings and programs and investments. And the philanthropic minds is not something very easy in Portugal, very available. So, we do fundraising in Portugal and do fundraising to help people with the aphasia. What is aphasia? What is that? So that is very, very, very, very, very difficult. So, we need to involve people with aphasia. So, they pay for their services for our services. They pay for our therapies, but they don't pay for resources. They don't pay for information. They don't pay for workshops for some of if events that we do that are open and they are invited to come. But therapy with therapists that we have to pay. They have to pay also we have services. We sell courses some of online courses. We did. In our websites, you can see mainly in Portuguese. But we have online courses with very good programs, very good professionals, international colleagues that help us to do the courses. They are another source of income, not a big one, but they help. We did a translation of some communication books from Aphasia Institute, and then we sell them to give us also some in income. So, we have members of our association and pay a contribution. Yes, like every year they pay a contribution. So, we have, some associates that do pay an annual contribution. We do a lot of fundraising and we try to develop more services to, not to people with the aphasia, but professionals that give us income to sustain the organization. So, it's a hard work. But it's in the beginning, because we, it's difficult to involve the municipalities and the States. In these solutions we have to prove that they are better, or they have major impact in in the lives of the persons with the aphasia, but also in their pockets the state pocket, because we have to prove that our support, our kind of approaches make more difference and the people with the aphasia that stay in the State. The public services consume more resources during more time And they don't go. They don't achieve their goals in the end so we are now trying to show the Government our model of work may for the in the future they maybe support some incorporate some of these approaches in their public services. So, it's another way to support. Jerry Hoepner: Yeah, that's it. I was going to say, yeah, that's a lot of work to do. I mean, you're providing all of the services you're providing a lot of the fundraising and providing a lot of education to students and professionals throughout the country at no charge in many cases. So certainly, this is a grassroots ground up kind of work. it has been a really fun conversation. And I think we did continue this conversation for hours. It sounds like, but unfortunately, we have to close it up at some point. I just want to see if there's any last thoughts that you want to share with our listeners. Assunção Matos: I just want to say that it looks like it is a lot of work but I really believe in what I'm doing. I still dream Paula is doing one of my dreams, but I still dream that in the future, if I have aphasia, I will find one of my students doing the best job with me. This is my, this is my dream. That's why I believe so much in what I'm doing in And I'm always trying, you know, to move on into and to do different things and best things because I really don't want to face the difficulties people with the aphasia yet face in Portugal, because it's different to have aphasia in Portugal, or to have aphasia in Australia, for instance and I want to do my best job so I can enjoy it in the future.   Paula Valente: I just want to say it's really worth working on a live participation approach, because it really makes all the difference in the people. It's an adventure but it's worth it. And I hope that this conversation inspired other colleagues to do the same, or to continue doing the same. Jerry Hoepner: Absolutely. I think that's a great way to end. Thank you both so much. You've been just great to have this conversation with. Really enjoyed it, and I know that our listeners were will enjoy it like you said. I hope this inspires someone else to take on this kind of work. So, thank you so much.   Assunção Matos: Thank you, Jerry. It was a pleasure. Paula Valente: It was a pleasure. Thank you for the opportunity. Jerry Hoepner: You're welcome.   Jerry Hoepner: On behalf of Aphasia Access, thank you for listening to this episode of the Aphasia Access Conversations Podcast. For more information on Aphasia Access and to access our growing library of materials go to www.aphasiaaccess.org. If you have an idea for a future podcast series or topic, email us at info@aphasiaaccess.org. Thanks again for your ongoing support of Aphasia Access.   Resources: Online courses with national and international lecturers: https://ipafasia.pt/formacao/ Mobile application for communication support and functional and social interactions:  https://ipafasia.pt/aplicacao-movel-da-afasia/ Info-graphic videos: https://ipafasia.pt/videos-informativos/

In this week's episode I sat down with Eileen Norman. Eileen is the current President of Little People of America. We discuss what LPA exists for, the evolution of LPA's disability identity, the change that can happen when different disability organizations come together, what Dwarfism Awareness Month really means and much more. Follow Eileen: @eileenannsf Facebook: Eileen Norman Email: eileen.norman@lpaonline.org Follow Little People of America: Facebook: Little People of America Instagram: @littlepeopleofamerica Website: https://www.lpaonline.org Email: info@lpaonline.org    Follow Me: Instagram: @jill_ilana , @alwayslookingup.podcast Website: https://www.jillianilana.com Email: alwayslookingup227@gmail.com This episode was edited and produced by Ben Curwin.

In this exclusive episode, Claudia Zapata-Cardone, President of the Latino Pilots Association, sits down with us for a compelling discussion that provides insights into the multifaceted pilot community. Delve into the offerings of LPA and gain insights into the importance of tenacity and perseverance in aviation. This is an episode you definitely wouldn't want to miss!   WHAT YOU'LL LEARN FROM THIS EPISODE  What is the Latin Pilots Association all about? The issue of diversity within the aviation industry  How Latino Pilots Association and similar groups assist future pilots Top ways to qualify for the Latino Pilots Association scholarship program Why it's important to celebrate each other's victory       RESOURCES/LINKS MENTIONED Organization of Black Aerospace Professionals Professional Asian Pilots Association Southwest Airlines   If you aspire to advance your aviation career, an exceptional opportunity awaits! Don't miss the very first Latin Aerospace Industry Expo from September 14th to 16th, 2023, at the Gaylord Palms Resort & Convention Center in Kissimmee, Florida. Secure your spot by registering through this link: https://www.latinopilot.org/latinexpo2023    ABOUT WITH CLAUDIA ZAPATA-CARDONE Claudia Zapata-Cardone, a Captain at United Airlines, boasts a remarkable career spanning over 27 years in the airlines and aviation sector. She is genuinely dedicated to introducing the world of piloting to women and individuals of diverse backgrounds. Claudia achieves this by participating in outreach initiatives and affiliating with various organizations.   Currently holding the esteemed position of President at the Latino Pilots Association, Claudia takes immense pride in her membership within Women in Aviation, the Organization of Black Aerospace Professionals, and the International Society of Women Airline Pilots. Her staunch belief rests in the transformative power of diversity and inclusion within the aviation and aerospace domain. Claudia contends that embracing many perspectives fosters a competitive business edge and propels the aviation industry toward unparalleled success.   CONNECT WITH CLAUDIA Website: Latino Pilots Association LinkedIn: Claudia Zapata-Cardone CONNECT WITH US  Are you ready to take your relationship to the next level? Don't wait until it's too late. Use the promo code “PODCAST” and save 10% on all our services. Check us out at www.spitfireelite.com!   If you want to recommend someone to guest on the show, email Nik at podcast@spitfireelite.com, and if you need a professional pilot resume, go to www.spitfireelite.com/podcast/ for FREE templates!    SPONSOR If you're a professional pilot looking for a great financial planning partner for your retirement, tax, and investment, go to www.tpope.ceterainvestors.com/contact or call 704-717-8900 ext 120 to schedule a consultation appointment with Timothy P. Pope, CFP® 

This week we delve into the world of cardiovascular surgery when we check in with the group from Nationwide Children's Hospital and review a novel approach to managing the dreaded LPA stenosis or hypoplasia in the HLHS patient. Why does the LPA seem to be small or stenosed in this condition and how does a preemptive stent address this? Why can't standard PA plasty be used for this particular indication as is used in TOF/MAPCA's? Does one stent size fit all HLHS patients? These are amongst the many questions posed to the first author of this week's work, cardiovascular surgeon Dr. Sergio Carillo. https://doi.org/10.1016/j.xjon.2022.11.007

Live from Italy -  Panarea, Cefalù and Catania and my first LPA trip. Just a lil recap and some feedback for ya with Davide.  Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode. Go to www.kiwico.com/best for 50% off your first month and free shipping on any crate line   Go to www.betterhelp.com/pia to get 10% off your first month   Go to www.perelel.co and get 15% off your first 3 months with code BEST15   Go to www.vionicshoes.com and use code BEST at checkout for free shipping   Go to www.sephora.com/clean to learn more   Produced by Dear Media   

The following question refers to Sections 3.3 and 3.4 of the 2021 ESC CV Prevention Guidelines. The question is asked by CardioNerds Academy Intern student Dr. Adriana Mares, answered first by Brigham & Women's medicine resident & Director of CardioNerds Internship Dr. Gurleen Kaur, and then by expert faculty Dr. Allison Bailey. Dr. Bailey is an advanced heart failure and transplant cardiologist at Centennial Heart. She is the editor-in-chief of the American College of Cardiology's Extended Learning (ACCEL) editorial board and was a member of the writing group for the 2018 American Lipid Guidelines.  The CardioNerds Decipher The Guidelines Series for the 2021 ESC CV Prevention Guidelines represents a collaboration with the ACC Prevention of CVD Section, the National Lipid Association, and Preventive Cardiovascular Nurses Association. Enjoy this Circulation 2022 Paths to Discovery article to learn about the CardioNerds story, mission, and values. Question #26 Ms. Priya Clampsia is a 58-year-old never-smoker with a history of hypertension. Her BMI is 29 kg/m2. She also mentions having pre-eclampsia during her pregnancy many years ago. She describes a predominately sedentary lifestyle and works as a receptionist. You see her in the clinic to discuss routine preventive care. Her most recent lipid panel results were LDL of 101 mg/dL, HDL of 45 mg/dL, and triglycerides of 190 mg/dL. What additional step will provide valuable information regarding her CVD risk profile? A Send additional lab workup including C-reactive protein and lipoprotein (a) B Measure her waist circumference C Assess her work stress D Ask her about history of preterm birth E B, C, and D Answer #26 Explanation The correct answer is E – measuring her waist circumference, assessing her occupational stress, and obtaining history about adverse pregnancy outcomes including preterm birth all add valuable information for CVD risk stratification. BMI is easily measured and can be used to define categories of body weight. However, body fat stores in visceral tissue carry higher risk than subcutaneous fat and therefore, waist circumference can be a simple way to measure global and abdominal fat. When waist circumference is ≥102 cm in men and ≥88 cm in women, weight reduction is advised. While these WHO thresholds are widely accepted in Europe, it is important to note that different cut-offs may be appropriate in different ethnic groups. Work stress is important to ascertain as well because there is preliminary evidence of the detrimental impact of worse stress on ASCVD health, independent of conventional risk factors and their treatment. Work stress is determined by job strain (i.e., the combination of high demands and low control at work) and effort-reward imbalance. Pre-eclampsia is associated with increase in CVD risk by factor of 1.5-2.7 compared with all women. Both preterm (RR 1.6) and still birth (RR 1.5) are also associated with a moderate increase in CVD risk. Taking a thorough pregnancy history is important in determining future cardiovascular risk in women. The ESC guidelines give a Class IIb (LOE B) recommendation that in women with history of premature or stillbirth, periodic screening for hypertension and DM may be considered. Of note, the 2018 ACC/AHA guidelines include preeclampsia and premature menopause (occurring at age

Well this is a long time coming! In this episode we have the CMO of Revolve, and the person responsible for LPA, Raissa Gerona. We talk about absolutely everything. Big wins, big learning moments and everything in between. Revolve's influence is undeniable. We talk about Raissa's truly industry changing concept of harnessing influencer power to sell product, what it means today to be an influencer, past mistakes, future plans, becoming mothers - all of it.  Enjoy! Please note that this episode may contain paid endorsements and advertisements for products and services. Individuals on the show may have a direct or indirect financial interest in products or services referred to in this episode   Go to www.perele.co to get 15% off your first 3 months with code BEST15   Go to www.lather.com and use code BEST at checkout for 15% off sitewide   Use code BEST at check out for free shipping at www.vionicshoes.com   Brought to you by Better Help: Visit www.BetterHelp.com/pia  today to get 10% off your first month   Go to www.athleticgreens.com/Best to get a FREE 1 year supply of Vitamin DAND 5 freetravel packs with your first purchase   Stop throwing your money away. Cancelunwanted subscriptions–and manage your expenses the easy way–by going to www.RocketMoney.com/pia     Produced by Dear Media   

Pia Baroncini is the creative director behind her namesake clothing line for Revolve (LPA), host of the podcast Everything Is the Best, and co-founder of Baroncini Import & Co.—her very own line of Italian olive oil. Alongside her husband Davide, Baroncini has big plans for expanding the import business as well as the pair's other brand, Ghiaia Cashmere, where she is the CMO. But before this whirlwind of a career in which she currently thrives, Baroncini had a number of other positions within fashion and production. She served as a casting director for Diane Martel (the woman behind music videos for artists such as Miley Cyrus and Nicki Minaj), and she worked at famed New York City PR firm People's Revolution for PR maven Kelly Cutrone and Reformation in its early days, where she went from working in public relations to becoming design director in a matter of a few short years. This one is as inspiring as it is entertaining, and you're going to want to tune in to hear it all. See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.