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Episode 17: The Conference Valuation

The book inspired an episode of CBS's The Big Bang Theory. In The Conference Valuation, Episode 17 of the twelfth and final season, which aired March 7, 2019, Sheldon Cooper discovers a copy of Experimenting With Babies, and he and his friends attempt to experiment on the Wolowitz children.[6]

Episode 17: The Conference Valuation

Though relatively common, syncope is a complex presenting symptom defined by a transient loss of consciousness, usually accompanied by falling, and with spontaneous recovery. Syncope must be carefully differentiated from other conditions that may cause a loss of consciousness or falling. Syncope can be classified into four categories: reflex mediated, cardiac, orthostatic, and cerebrovascular. A cardiac cause of syncope is associated with significantly higher rates of morbidity and mortality than other causes. The evaluation of syncope begins with a careful history, physical examination, and electrocardiography. Additional testing should be based on the initial clinical evaluation. Older patients and those with underlying organic heart disease or abnormal electrocardiograms generally will need additional cardiac evaluation, which may include prolonged electrocardiographic monitoring, echocardiography, and exercise stress testing. When structural heart disease is excluded, tests for neurogenic reflex-mediated syncope, such as head-up tilt-table testing and carotid sinus massage, should be performed. The use of tests such as head computed tomography, magnetic resonance imaging, carotid and transcranial ultrasonography, and electroencephalography to detect cerebrovascular causes of syncope should be reserved for those few patients with syncope whose history suggests a neurologic event or who have focal neurologic signs or symptoms.

Vasovagal syncope has three distinct phases: a prodrome, loss of consciousness, and a postsyncopal phase. A precipitating event or situation (e.g., emotional stress, trauma, pain, sight of blood, prolonged standing) usually is identifiable. The prodrome, characterized by diaphoresis, epigastric discomfort, extreme fatigue, weakness, yawning, nausea, dizziness, and vertigo, results from increased parasympathetic tone and may last seconds to several minutes. Lying down or removing the stimulus may abort the syncopal episode. The postsyncopal phase may last hours or, rarely, days and may include protracted confusion, disorientation, nausea, dizziness, and a general sense of poor health.9,13 A prolonged postsyncopal phase may be associated with causes more serious than vasovagal stimulation and should prompt a more extensive evaluation.

In patients without focal neurologic symptoms and signs, syncope from cerebrovascular disease is extremely rare. Transient ischemia may result from vertebrobasilar insufficiency and may cause syncope. Concurrent neurologic symptoms including vertigo, ataxia, or sensory disturbance often will be found.7 Headache, vertigo, dysarthria, and diplopia also are suggestive of syncope resulting from neurologic causes. Neurologic causes should be suspected if headache or dizziness occurs during recovery from syncopal episodes.

The cause of syncope can be identified by history and physical examination alone in more than 60 percent of patients.3,10 Assessment should focus on verification of a syncopal event, presence of heart disease, presence of other life-threatening causes, and clinical features of the history that suggest a diagnosis. An algorithm for the evaluation of patients with syncope is shown in Figure 1.6

Head-up tilt-table (HUTT) testing (Table 65,26) is used widely for the evaluation of patients with unexplained syncope and is particularly important in those with structurally normal hearts.5 HUTT testing uses changes in position to reproduce the symptoms of the syncopal event by inducing bradycardia or hypotension suggestive of reflex-mediated syncope. After arrhythmias have been excluded as the cause of syncope, the specificity of a positive HUTT test is such that it is considered diagnostic for reflex-mediated vasovagal syncope.11 For patients in whom HUTT testing provokes loss of consciousness despite no change in blood pressure or heart rate, psychiatric disorders should be considered.27

Today's learner has a myriad of educational options to choose from-both online and off. The programs we offer are rigorously researched and largely developed by practicing appraisers using their real-world residential and commercial valuation experience.

Certainly, in the past, it wasn't always thought instantly by a professor, "Oh yes, you're right. I went to a conference last year, and I did present this." So we do have to dig a little bit on that. Sometimes we do find out unfortunately that maybe it's past the grace period, and we can't really do a lot with it. But if we can, we try to educate them. "Okay, you've gotten to us early enough. What are your publication plans?" Because often, the publication serves great purposes. If you're like, "We've got a manuscript ready. We're going to send it in, and we hope to get some feedback. And then we'll make the corrections and hopefully be published, "we often say," "Perfect." We'll take that manuscript. We'll send it to our patent agents that we work with, and they'll start to craft a provisional patent application. We'll make sure we get the deadlines right, before your manuscript is actually online," and we have to remind them that it's not just when it appears in print, it's when it's online, it could even be the galley proofs that end up online, "so that we've got to the patent office hopefully before that point to just give us as many options as possible if we go forward with that intellectual property."

Lisa: You're listening to Canadian IP Voices, where we talk intellectual property. In this episode, Mark Weber, the director of Innovation and Partnerships at McGill University explained some of the misperceptions and mistakes around commercialization of academic research. Mark explained that protecting intellectual property in research is often an enabler of conversations with industry and can provide a launching point for students and researchers. The Innovation and Partnerships office works with researchers to create a plan that enables the protection of IP along with publications and, often, continued research.

The Center for Medicare & Medicaid Innovation (CMS Innovation Center) is developing new payment and delivery models designed to improve the effectiveness and efficiency of specialty care. Among those specialty models was the Oncology Care Model, which aimed to provide higher quality, more highly coordinated oncology care at the same or lower cost to Medicare. Under the Oncology Care Model (OCM), physician practices entered into payment arrangements that included financial and performance accountability for episodes of care surrounding chemotherapy administration to cancer patients. The Centers for Medicare and Medicaid Services (CMS) also partnered with commercial payers in the model. The practices which participated in OCM committed to providing enhanced services to Medicare beneficiaries such as care coordination, navigation, and national treatment guidelines for care.

The goal of OCM was to utilize appropriately aligned financial incentives to enable improved care coordination, appropriateness of care, and access to care for beneficiaries undergoing chemotherapy. OCM encouraged participating practices to improve care and lower costs through an episode-based payment model that financially incentivized high-quality, coordinated care. The CMS Innovation Center expected that these improvements would result in better care, smarter spending, and healthier people. Practitioners in OCM were expected to rely on the most current medical evidence and shared decision-making with beneficiaries to inform their recommendation about whether a beneficiary should receive chemotherapy treatment. OCM provided an incentive to participating physician practices to comprehensively and appropriately address the complex care needs of the beneficiary population receiving chemotherapy treatment, and heighten the focus on furnishing services that specifically improve the patient experience or health outcomes.

OCM incorporated a two-part payment system for participating practices, creating incentives to improve the quality of care and furnish enhanced services for beneficiaries who undergo chemotherapy treatment for a cancer diagnosis. The two forms of payment included a per-beneficiary Monthly Enhanced Oncology Services (MEOS) payment for the duration of the episode and the potential for a performance-based payment for episodes of chemotherapy care. The $160 MEOS payment assisted participating practices in effectively managing and coordinating care for oncology patients during episodes of care, while the potential for performance-based payment incentivized practices to lower the total cost of care and improve care for beneficiaries during treatment episodes.

Third, it's unclear which method is most suitable for classifying micro-expressions. The micro-expressions have the following characteristics which are different from the ordinary facial expressions in the following ways: (1) low-intensity facial movements and (2) partial facial expressions (fragments). Therefore, previous methods that were suitable for classifying ordinary facial expressions may not work well for micro-expressions. We provided this database and a baseline evaluation, so future research may compare with our initial results.

"What this episode, this crash in crypto prices, shows is that cryptocurrencies are by and large speculative financial assets that are subject to macroeconomic forces, such as changes in interest rates," says Eswar Prasad, an economics professor at Cornell University.

Fed Chair Jerome Powell speaks during a news conference at the Federal Reserve Building in Washington, D.C., on Wednesday. The central bank raised interest rates by three-quarters of a percentage point, its biggest hike since 1994. Olivier Douliery/AFP via Getty Images hide caption 041b061a72


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