Dark Subliminal Suggestions
by Edward Morgan
In order to understand the System of Programming and Control � and even more so, how to escape
the Matrix � you have to understand the power of subliminal suggestion. The world
is full of dark and negative subliminal suggestions designed to influence your attitudes and inner
feelings � and therefore your actions. That�s how programming and control works. It�s
the constant subliminal drip-feed of fear, negativity, and the rigid intellectual opinions
of the world around you � all designed to influence your conscious and subconscious
human mind.
There is no way to maintain the quality of your own consciousness � without being able
to neutralize the dark and negative subliminal suggestions of the outside world. You have
to be able to neutralize the messages of fear, negativity, and the rigid intellectual opinions
of the world that disempower you � and counter them with opposite messages that empower you.
You also have to understand that negative subliminal suggestions may not necessarily
sound negative. �Positive-sounding� messages can conceal dark motives and agendas. Programming
is a very clever and deceptive thing. Things are not always what they seem. Many things
are the exact opposite of what they seem. So, you have to be clever and perceptive.
You have to look past the positive and negative sound of things to perceive the hidden agenda
behind things. You have to remember that the world of ego is the facade of the White Shadow,
and you have to look beyond that facade to perceive what is real, what is not, and who
is telling lies.
The world of ego uses �positive-sounding� messages to gain your allegiance and support.
But using �positive-sounding� ideologies to achieve dark economic, personal, or political
agendas is still a negative thing. It�s called brainwashing and manufacturing consent.
It�s called a con-job. And the world uses �negative-sounding� messages to gain your
allegiance and support by inducing fear and then selling you solutions and the Illusions
of Security. The backside agenda is always control, greed, and profit � all at the
expense of your liberation.
And while you may think that these dark subliminal suggestions come only from corporations, institutions,
and political agendas through advertising, media, and the mainstream news � the reality
is that the dark subliminal suggestions of fear, negativity, and rigid intellectual opinions
come through the very mouths of the people around you. Because even if you are wise enough
to turn off the television, it doesn�t necessarily mean that your family, friends, and co-workers
are. Just because you discipline your own emotion and mind � doesn�t mean the world
around you does. Just because you neutralize your own shadow traits � doesn�t mean
that anyone else does. This world has very little discipline � and even less perception
of these things. And just because you may have no hidden agenda � doesn�t necessarily
mean that others do not.
The world is born into the System of Programming and Control � the Evolutionary Path of Ego
and the Rigid Human Intellect � and the world is raised to sustain that system � oblivious
to the fact that it even exists. The world is living in an illusion. And people are so
accustomed to the Illusion, that they will fight and die to protect the Program. Every
single person that you see is a potential Agent of that System � because every single
person that you see is influenced by that System. The System breeds servants, dominates
the collective human consciousness, and becomes a self-regulating and self-sustaining program
executed by the very people within it.
You have to look at people with a soft eye. You can�t judge people too harshly, otherwise
you are just projecting your own darkness upon them. If you fall into anger, fear, negativity,
or rigid intellectual opinions � then you are the System of Programming and Control
itself � which is exactly what the system wants � minions. But you do have to pay
attention to what people are doing and saying, so that you can neutralize potential dark
influences. And you have to be able to do it silently within your own mind, so that
you don�t create conflict with others � because people think that their fear, negativity,
and rigid intellectual opinions are normal. And the ego considers anything that contradicts
it to be an attack.
The programming of the system is an onslaught of constant messages and dark subliminal suggestions
that degrade the quality of a person�s consciousness with doubt, fear, insecurity, negativity,
and rigid intellectual opinions. As long as you are powerless � you pose no threat.
You have been subjected to dark and negative subliminal suggestions from the day you were
born. It�s all designed to influence you to accept beliefs, ideas, and opinions without
question. It�s all designed to steal the inner power and perception to determine things
for yourself.
When you are young � you are too young to know. When you�re old enough to know � you�re
old enough to know better. When you�re old enough to know better � you are too old
to do anything. It�s a total subliminal mind-job that perpetuates limitation, restriction,
and control.
And everywhere you turn, someone is always interjecting their fear, negativity, or opinion.
Why? Because the Arrogance of Ignorance is everywhere. Self-importance is a subjective
delusion. The world is so self-centered that they post their petty little lives on Facebook
� and the world is so arrogant that they actually believe that the entire world is
reading about what they had for lunch. �What? You don�t know about that? I posted it on
Facebook.� � And so what? The world of ego is so arrogant, opinionated, and self-absorbed
that they seek your attention � but have absolutely nothing to say. Just random snippets
of worthless drivel. Someone�s always bitching about the weather. Someone�s always giving
you someone else�s medical report. Someone�s always whispering more emotional drama, gossip,
and mind diarrhea into your ear. Does any of it actually contribute to or enhance the
quality of your consciousness? No.
Enough.
One. There is no way to maintain the quality of your consciousness and transcend the invisible
fields of programming and control without first neutralizing your own fear, negativity,
and rigid intellectual opinions. You have to discipline your mind into Silence and Stillness.
Calmness. And you have to process and transform the programming within your subconscious mind.
Two. There is no way to maintain the quality of your consciousness and transcend the invisible
fields of programming and control � without being able to neutralize the dark and negative
subliminal suggestions of the outside world. You have to be able to neutralize the messages
of fear, negativity, and the rigid intellectual opinions of the world. You have to use the
Power of Negation to contradict any disempowering suggestions � and reinforce your own stance
with something empowering � to where fear, negativity, and rigid intellectual opinions
are denied access from your conscious and subconscious mind.
Three. If you cannot neutralize your own fear, negativity, and rigid intellectual opinions
� and if you cannot neutralize the dark and negative subliminal suggestions of the
world around you � then how can you possibly contend with the unseen etheric energies and
mystical forces?
Beneath the surface, there is a silent communication of etheric energies, thought forms, and vibrations
that have the ability to infiltrate a person�s conscious and subconscious mind and inject
dark and negative subliminal suggestions. Once such things enter your mind � it�s
hard to tell what are your own thoughts from what are not. You have to be able to call
their bluff and neutralize their influence. And the only way to do that is to have a disciplined
mind in the first place � Inner Power and Perception � to where you know how to neutralize
fear, negativity, and rigid intellectual opinions � to maintain an Inner Calmness and Stillness.
You don�t want to dwell on any of this. You don�t want to fall into fear, negativity,
and rigid intellectual opinions about it � otherwise it�s just another trap. But you do have
to understand it. Because there is no way to transcend the System of Programming and
Control � without being able to neutralize the dark and negative subliminal suggestions
of the outside world that are all designed to influence your attitudes, inner feelings,
and actions � to enforce limitation, restriction, and control. Be free.
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Student's racist outburst against his Asian science teacher - Duration: 1:11.
I stop talking.
You do not come up to me, Dr. Hsu!
Get in my goddamned face!
[Teacher] You go there! Sit down. [Student] Alright?!
[Student] You go sit down!
[Student] You go sit down, alright?!
Come up to me like that?!
Who the fuck do you think you are?!
Yeah, do it to your little fucking face.
Turn around and raise your fist like that, Dr. Hsu!
Do it again!
I'm not fucking playing!
Alright?!
[Student] Come up to me and do that to me!
[Student] I'll do it to you, bitch!
[Student] Alright?!
[Teacher] Go sit down.
[Student] Shut your fucking mouth!
Fucking tell me!
Who the fuck you think you are?!
[Scattered Laughter]
Fuck nigger!
Fucking bitch!
[Students Laughing]
Fuck nigger!
Pick up your fucking room!
[Teacher] You do not do that.
You play, Dr. Hsu, huh?!
You took the fucking trash can to me, huh?
[Camera Person] ..get out. Just get out.
[Student] Fucking whack-ass nigger!
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WELCOME TO MY CHANNEL! - Duration: 1:24.
so that when people come to it, they know roughly something about it
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SUMMER CLOTHING TRY ON HAUL 2017! TRYING INSTAGRAM BADDIE HYPED CHEAP CLOTHING - Duration: 7:33.
A summer clothing try on haul 2017 if you're new to my channel my name is
Myka and welcome and today we are going to do a massive summer clothing try on haul
I've seen a brand called shien kind of going around Instagram baddie and I wanted
to see is it really worth the hype this video is not sponsoring me to talk about
their clothes whatsoever but I'm really excited to kind of give an honest and
full proper review kind of tell you what I like and what I don't like - let's
dive into this try on all the very first item that I got is this gorgeous blue
top I've seen some girls on Instagram rocking a top very similar I saw an
identical shirt like this at Saks and it was so expensive but I really like the
way that it lays on my body and I think this is absolutely adorable every single
item in this video is under $20 which is totally awesome like I said this is a
cheap clothing haul so another huge perk the next item that I got is actually the
dress that I am wearing right now you'll see me wear it and this might actually
be one of my favorite items in the entire haul it is so cute as such a
tropical and laptop could be a formal dress or could be super incredibly
casual it could go either way depending upon how you dress it up and it looks so
good I would say this dress would look good on anyone's figure just because of
the way that it falls on your body so rub the material it is a win win win I
think I'm even gonna wear to my birthday party because I just I love everything
about this the next dress that I got this is probably my second favorite if
not my first because it's kind of like my runner-up and this is absolutely
stunning it has that palm leaf pattern it's such an incredibly soft material
and this dress was like I think it was 20 dollars it might be a little more or
a little less it can't remember exactly I love the fabric and I also love the
way that they have two straps on the back you wouldn't even need a bra with
this because it's double layered they're really nice polyester it's so soft like
it's seriously the softest material ever and it feels so good on so this dress is
a complete win I love everything about this so the next little shirt that I got
is a little bold t-shirt is you know me I am always rockin like little sports
tease just the tomboy in me I love it and I got this one I really like the way
it fits it's a little bit shorter than I thought
it was going to be and a material is really nice but it's not quite as
amazing as I would have imagined it to be but I still overall really really
liked the tee especially for the price I think this was like six bucks so it's
definitely work I just thought it was going to be a little bit more of like a
cotton material and it's more like a jersey a little bit of polyester all
right the next thing that I got is a really crazy super well-worn beaten up
dress this is so funny I kind of bought this out of left field just something
fun and something very different you can see all of like the different textures
we just kind of in right now you know to mean that grunge look and I'm going to
say that unless I dress this up I feel like this might have been a little bit
of a fail only because some of the slits for the bottom of the dress like if I
were just to have like a fall honor if I were to have like a smaller cheekier
underwear you looking my butt cheek so that would be the only fail that I would
say super soft material and doesn't look quite as amazing on as it did in on the
model but it's still really really cute the next top that I got I really really
like this one I'm super simple like a preppy little top I love the color combo
this definitely looks like something from like j.crew and the material is
awesome I think the only thing that's kind of funny about some of those shirts
is you don't know which one which is the front or the back because some of them
don't have tags but they're still honestly super cute the next thing that
I picked up was a bikini the top did come with some padding and I'm not a
huge fan of padding but this padding was super awkward at major boobs just look
all around funny so I took those out it kinda reminds me of the Victoria Secrets
them too I cannot tell the difference to be
honest with you and the next dress that I got is this purple blush little
bodycon dress is so soft I'm incredibly impressed this is
probably the softest shirt I've ever touched in my entire life
that may sound really weird but I love the way that it's on your figure I think
the only bad thing about bodycon dress is is that if you have any trouble areas
or if you have an area that you're working on or you just ate a huge
massive Thanksgiving dinner this is not the dress to put on because it
definitely shows everything and I also think it might be a little tricky I'm
not quite sure what kind of underwear I would wear or if you wear underwear with
a dress like this because even when I have like a song on for shooting I felt
like you could see everything so this one I really like I think it'd be
perfect for like a summer day like super hot or even maybe a date I would want to
classy it up a little bit not be as casual the next hop that I got I thought
was really really cute the material is not horrible
but it's not amazing and it could be really just something cute and fun to
wear I was like a cute pair of short shorts I would love that
the next item that I got this was a sale for me I thought would be like a cute
little like boho chic outfit has a really cute design and I'll put it on
and it just was a bust I felt like it looked really chinzy it kind of looked
like something that belonged on a table curtain or like and I don't even know it
just really chinzy home decorating or something I don't know but I was not
feeling this one the next two items I got or fails as well this white top I
like it but for some reason it's just not
fitting the way that I would prefer the material is a little bit chinzy it's
hard to do a good chiffon and keep it cost effective at least that's my
personal box and this one has a lot of like fraying at the edges so there's not
a lot of good precision in this entire so I'm not crazy about it but I do think
I could still rock it was like a really nice accent necklace and I don't long
maxi skirt or something different like that
the next dress was a big fail it has scalloped sides and it's a really pretty
dress I love the way that it looks on the model however when I'm trying it on
I just feel like it's not as flattering as I would have imagined the material I
wouldn't say there's anything wrong with the material that I wouldn't say that I
particularly love the material so it's kind of like not here nor there for me
um I just I can't really put my finger on it I'm just not crazy about how it's
looking I don't know if I'm just not used to discard or the scalloped design
or what it is but just for some reason and it's not even the companyís fault
it's just I don't like the way that it fits on me or the way that it was on me
I would overall I would say that most the items that I picked up were total
wins the all of the risk-taker items I feel like were fails but all of the ones
that I'm like wow that looks really pretty and I know that I would like that
they all turned out phenomenal so that is my review I would definitely shop
again I'm actually so impressed it was really nice and I you definitely could
see myself repurchasing if you guys like these kind of haul reviews let me know
in the comments below
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✔ Minecraft | How to make a racing car with controller | No Mods and Commands | ENG Subtitle - Duration: 3:07.
Hey Guys my name is Bearen
And Today i show you how to make racing car with controler
Without Mods or Commands Blocks
*Intro*
Before we start i want to show you some thinks
What you need if you want to build in Survival mode
And Let´s start
First we start with making hole about 6x6 Blocks
Now we make another hole about 4x4
There will be our raicing way
Now we put rails around the hole
And replace 3 Rails by Powered Rails
No we need to add restone signal
Next we place on rail Armor stand
And before Armor stand place Minecart
Now we need to give car with easy command.
you can find it in description
If we have car, put it on armor stand
And push the minecart
Car is working right now so we can build a road
We start with puting some slabs around
Now we need carefully put some stone slabs on rails
And last 4 slabs
Last think what we need to do
We need to rename our car cotroller
"Car controller"
And we done
Now we can play with our car
You can see building didn´t take us more than 2 minutes
And it was very simple
its all for this video and i hope I see with you in next video
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♫ Ding Dong Bell ♫
♫ Kitty's in the well ♫ ♫ Who put her in? ♫
♫ little johny johnny flynn ♫
♫ who pulled her out? ♫
♫ Little Tommy Stout ♫
♫ What a naughty boy was that, to try and drop poor kitty cat ♫
♫ who never did him any harm but ate all of the mice in the farmers barn ♫
♫ Ding Dong Bell ♫
♫ Kitty's in the well ♫
♫ Who put her in? ♫ ♫ little johny johnny flynn ♫
♫ who pulled her out? ♫
♫ Little Tommy Stout ♫
♫ What a naughty boy was that, to try and drop poor kitty cat ♫
♫ who never did him any harm but ate all of the mice in the farmers barn ♫
-------------------------------------------
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WEBINAR: OTC Hearing Aids: Rationale for Support - Duration: 1:02:27.
NANCY MACKLIN: Thank you, everyone, for joining us tonight for the presentation of Over-the-Counter
Hearing Aids: Rationale for Support. First I want to thank our captioner this evening,
Cindy Thompson of
Alternative Communication Services.
Thank you very much Cindy.
Tonight we have with us Stephanie Czuhajewski, who has more than two decades of nonprofit
leadership experience,
and is currently the Executive Director of the Academy of Doctors of Audiology also known
as the ADA.
We also have Dr. Alicia Spoor
who is the owner of Designer Audiology here in Maryland and she is the President-Elect
of Academy of Doctors of Audiology and also the legislative chair of the Maryland Academy
of Audiology. Welcome to both of you.
I'm very excited about this webinar tonight.
It is a hot issue right now and we're very glad that hearing loss is finally getting
some media attention and we're finally in a position to do something to help people with mild
to moderate hearing loss get some help so I'll go ahead and let you get started.
>> STEPHANIE CZUHAJEWSKI: Thank you, Nancy.
And thank you, attendees for joining us for this very important conversation.
ADA has actually been thinking about the topic of alternative hearing aid delivery models
for the past 40 years.
And part of the reason for that is because at the time that audiology started dispensing
hearing aids, audiologists were, themselves, an alternative model of hearing aid delivery.
So it's a very interesting dynamic.
ADA has been thinking about this more in earnest certainly over the past three years since
we had the opportunity to sponsor what was then the IOM or the Institute of Medicine
workshop on hearing loss and healthy aging which took place in January of 2014.
So there we heard so many compelling presentations about the gap between the number of people
who could be helped with a hearing aid and the number of people who actually get treatment.
So of course as many of you all know on the line tonight, the statistics are really staggering
and today literally hearing aid adoption rates stand at around 25%.
So hearing aids themselves have improved dramatically over the past several decades yet adoption
hasn't.
So why is that?
In my portion of our time together today, we'll discuss a little bit about the background
and then some of the information that's formed ADA's thinking about the issue of direct to
consumer or over-the-counter hearing aids, the problems and solutions around
affordable, accessible hearing care for adults and the role of those devices
in the hearing health care system.
So just a little bit of background on the history of ADA.
As I mentioned, there was a point where audiologists did not dispense hearing aids.
And really ADA was founded because there was a group of audiologists who were at the time
viewed as quite radical who decided they wanted to dispense hearing aids for profit.
So after a U.S. Supreme Court ruling in 1978 forbidding professional societies from having
codes of ethics that would restrain trade, ASHA actually rescinded ethical guidelines
that were in place at the time that wouldn't allow private audiology practices to dispense
hearing aids for profit So this really allowed the private practice
of audiology to flourish.
And practices grew in the 1980s.
So, too, did the profession in terms of it's qualifications and educational requirements.
In the late '80s it was determined that there really was a need for a clinical doctorate
degree to take audiology to the next level and really give audiologists the type of training
and clinical expertise that they needed to take care of patients in the future.
So with that was borne the AuD or doctor of audiology degree and ADA has always really
been on the bleeding edge in that we were one of the strongest components of bringing
a master's degree to a doctorate degree in a time when there was a lot of pushback around
that.
In the '70s we did something provocative in the '80s we did something provocative and
then in the 1990s the first AuD degree was conferred and by the mid 2000s it was the
entry degree for audiologists and training in private practice.
I don't know where -- there we go.
So we continue on this forward-thinking path.
In addition to talking about the Over-the-Counter Hearing Aid Act tonight we will touch a bit
on another piece of legislation working its way through Congress called the Audiology
Patient Choice Act.
So going back now from the workshop in 2014 that was held at the IOM, we know that in
2015, the President's Council of Advisors on Science and Technology or PCAST held some
sessions and formulated a report that was sent to the President of the United States
and also published and disseminated publicly.
And in that report were a number of recommendations that ADA carefully evaluated.
Someone told me once that it takes 20 years to become an overnight success.
As Nancy sort of referenced, that has certainly been the case with the well-deserved attention
that's been given to the importance of hearing loss recently.
So for the past 20 years there have been a lot of things going on.
And then really it's sort of come to a head over the last three years starting with the
IOM and then looking at the PCAST and some of their recommendations that came out.
So in looking at the four recommendations that they had, they included people from medicine,
technology, science, one of the folks who was heavily involved was Dr. Christine Cassel
who is with the National Quality Forum, Thomas Camber from older adults technology services,
Charlotte Yea from AARP and they even requested input from other professionals and experts
like Dr. Lin at Johns Hopkins.
So in looking at the recommendations themselves, one of them was that the FDA should designate
a distinct category of basic hearing aids, non-surgical air conduction hearing aids intended
to address bilateral, gradual, onset, mild to moderate age related hearing loss and adopt
distinct rules for those devices.
The second recommendation from PCAST was for FDA to withdraw its draft guidance on the
November 7, 2013 Personal Sound Amplification Products or PSAPs.
The third recommendation was for the Federal Trade Commission to look at the delivery of
hearing health care and make some determinations that were parallel with its Eyeglass Rule.
And require audiologists and the sensors who performed diagnostic hearing aid tests hearing
aid fittings to provide the customer with an audio gram and everything that goes with
it including the audio profile at no additional cost in a form that could be used by other
dispensers or hearing aid vendors.
And then similarly in efforts like the Contact Lens Rule to ask the FTC, again, to define
a process for patients to authorize hearing aid vendors instate and out of state to obtain
a copy of their hearing tests.
The results, everything that was around the results, including that audio profile so that
the testers would furnish those, again, at no additional cost.
So as we looked at those, we provided qualified support.
The ADA provided qualified support for all four recommendations.
And we did so for a number of reasons.
We feel that it is very important that we move the needle in terms of adoption rates.
We feel it's very important for competition to be increased in the hearing health care
space.
And we feel that this can be done in a responsible manner through the FDA and through the legislative
process.
So as we provided that qualified support, we did make every effort to ensure that the
audio logic care that's so important and successful for patient outcomes continues to be recognized
and continues to be implemented.
We requested that there be strong recommendations for example for patients to seek and obtain
an audiologic evaluation but we recognize that that pathway into the hearing health
care system is not going to be the chosen pathway for every consumer so we do not believe
that it should be required.
We also felt that the PCAST recommendations, they interchanged the term class and category
when discussing over-the-counter products.
We recommended that they only use the term category at that time.
We also wanted to make sure that the PSAPs would be appropriately labeled, if they would
be used as non-registered devices and encourage the development of PSAP standards.
We also believe that all companies and all manufacturers should be allowed to make truthful
claims about their products.
And we felt that the recommendations would allow that.
At the time we also put in an opposition to online diagnostic testing, although we're
very supportive of online screening.
It was felt at that time and still continues to be the case that a true diagnostic evaluation
can't be successfully achieved without having a good patient history, without having otoscopy
without having a lot of the things that an online test is not yet available -- or able
to do.
But we recognize that as these things -- as technology advances in that area, once that
is able to be achieved, we wouldn't oppose it in the future
So we looked at the PCAST recommendations in our subsequent position on those.
Moving into 2015, the NASEM committee is continuing to meet at the same time and subsequent to
that the Food and Drug Administration decided to hold a workshop on streamlining some of
the regulations that the FDA has imposed.
And they put a call out for comments and for participants in that workshop.
So ADA was represented there and discussed some of the barriers we thought were the -- the
biggest barriers to care at the time we discussed We pointed out that cost is an irrefutable
barrier it's not the only barrier but certainly is a barrier and one that's been discussed
by several governmental bodies over the last few years including Congress and administrative
agencies.
Many people are viewing a hearing aid purchase as the third biggest purchase that they might
have in their lifetime beyond a house and an automobile.
So it really is something that's substantial.
And I have to note here, too, that many audiologists also find cost as a barrier to providing the
care that they want to deliver to their patients.
So independent practices struggle in negotiating prices from hearing aid manufacturers and
many are moving towards unbundled delivery models that allow more transparency in that
regard.
Direct-to-consumers and OTC devices will undoubtedly lower the average selling price of hearing
aids.
And they will also expand competition and encourage a further movement by the audiology
community towards that unbundled piping model.
So additional major barriers that we identified to care during that meeting included unClear
Pathways to care for the consumer.
It's not always easy to identify the right provider, be it an audiologist, a hearing
aid dispenser or otolaryngologist and making sure you're getting all of the services you're
entitled to.
We know that HLAA has a fantastic resource that people can download from the HLAA Web
site that provides a checklist of what you can expect when going to an audiologist but
we know not every consumer can access that or find their way successfully into the hearing
health care system and also awareness is an incredible barrier at all levels.
So awareness by the consumer about the availability of products and services available to them
in the hearing health care space but also really the awareness among other health care
providers, including general practitioners about the importance of hearing health for
their patients, including a lot of the associated maladies, co-morbidities and the importance
really of getting treatment as soon as possible if hearing loss is suspected.
So as we continue the presentation to the FDA and in our subsequent comments, what we
were really seeking were two main requests from FDA.
The first of which was to eliminate the need for medical clearance for the purchase of
a hearing aid.
So as early as 1993, the FDA had already identified the requirement for a medical evaluation for
adults seeking to purchase hearing aids as something that was not working in the way
that it was intended.
There was widespread use of the waiver.
And there was just a lot of anecdotal evidence that people were not actually following the
regulation in the way that the FDA had intended when it was written in 1977.
We also know that roughly 90% of hearing loss is not medically -- is not medically treatable
so it makes sense for the person to come into the hearing health care system with an audio
logical evaluation and then be referred if it's identified by the audiologist that that
would be needed based on the red flag conditions that they can identify.
So we requested that.
And then secondly we requested that the FDA restructure regulations at that time to allow
for Class I medical device hearing aids to be sold direct-to-consumers.
We know that hearing aids have been sold over the Internet and through mail order for the
past 50 years.
This is nothing new.
What we were seeking is for there to be more standardized regulations in that regard and
more widespread access for the consumer to the OTC devices.
And in our view, again, this would allow the factual information to be presented.
It would allow for the consumer to have more opportunities to make an informed decision
about their hearing health care and more opportunities to determine where the device is purchased
from should they need a hearing aid.
We, again, wanted to have a requirement from FDA that the devices would have a strong recommendation
to obtain an audiologic evaluation, although again not a mandatory requirement for that
evaluation.
So working in parallel was the National Academies of Sciences, Engineering and Medicine who had
after the workshop in 2014 formed a committee to really take a more in-depth look at accessible
and affordable hearing health care for adults. Now, the committee included physicians, audiologists,
consumer advocates and other experts who met for about a year.
They had a series of workshops.
They had a number of presentations from a variety of different stakeholders.
And then they had what I can only imagine was a considerable amount of internal debate
before reaching consensus recommendations in June of 2016.
So they had 12 recommendations that came out of that And I think it really is important
that we think about those holistically.
So they wanted to improve population based information on hearing loss and hearing health
care.
Develop and promote measures to assess and improve quality of hearing health care services.
Remove the Food and Drug Administration's regulation for medical evaluation or waiver.
I think we can all start to see the pattern here in that thinking.
For recommendation No. 3.
Empower consumers and patients in their use of hearing health care.
Improve access to hearing health care for underserved and vulnerable populations.
Promote hearing health care in wellness and medical visits
Implement a new Food and Drug Administration device category for over-the-counter wearable
hearing devices.
Improve the compatibility and interoperability of hearing technologies with communication
systems and the transparency of hearing aid programing.
Improve the affordability of hearing health care.
Evaluate and implement innovative models of hearing health care to improve access, quality
and affordability.
Improve publicly available information on hearing health
And promote individual and employer, private sector, and community-based actions to support
and manage hearing health and effective communication.
ADA, as I understand it, is the only provider organization that came out in 100% support
and unqualified support of all 12 of those recommendations.
So when we -- we looked at it in a very holistic manner and not just looking at No. 3 and No.
9 and No. 8 and saying, well, we like those but not the others.
We feel like the committee really did its due diligence in terms of the type of research
and input that it was receiving.
We felt that it was a very independent body.
And that it came out with a -- the recommendations in earnest after really listening to all of
those stakeholders.
We did note with interest that the recommendations were consistent with some of the PCAST recommendations
and also with many of the presentations and thinking that were given at the FDA workshop,
particularly from consumers and then also through the ADA presentation, as well.
So subsequently, the National Academy had an additional meeting in December, which followed
on the heels of the initial OTC hearing aid bill introduction which happened very late
last fall.
And at that meeting, the FDA proactively stated that it does not intend to enforce that requirement
that individuals 18 years and older get the medical evaluation or sign the waiver prior
to purchasing hearing aids.
So ADA was very pleased about FDA's decision to seek enforcement of that.
And it's our understanding that they are taking steps to roll back the regulation itself.
But we do note that there are many states who also independently still require that
medical evaluation for the waiver and unless or until the OTC hearing aid act is passed,
you would have a very inconsistent model in terms of whether or not that would be required
from state to state to state.
So ADA believes that the national legislation, the Federal legislation, is needed in order
to ensure that that medical evaluation requirement is removed across the nation.
So that everything will be consistent.
So with that I hope I've provided a little bit of a background that sort of has been
forming ADA's thinking on this issue over the past several years And at least demonstrated
that we've had a consistent position across all of the different independent bodies and
then some of our comments.
So with that, at this time I would like to turn it over to Dr. Spoor who will actually
get into the legislation and the legislative initiatives themselves.
>> ALICIA SPOOR: Thank you.
So -- and thanks for attending and for HLAA for putting this together
So I want to start out with what I would call the most senior legislation that you're going
to see presented tonight and there's the Hearing Aid Assistance Tax Credit Act.
And full disclosure, I'm 36 years old.
I remember being in Graduate School when I was going to school in the district and I
think the tax credit had been introduced at that point in time.
So this is not a new concept to a lot of people.
But it is something that has been reintroduced and you can see the Senate Bill 48 that was
introduced very early in this Congressional session in 2017-2018 and basically what this
legislation says for anybody that's not aware of it that it would allow anyone who is purchasing
a hearing aid to take a tax credit up to $500 once every five years.
And the only stipulation so far is that the hearing aid needs to fall under the FDA's
Food, Drug and Cosmetic Act so there are a lot of unanswered questions which I'll come
back to in a minute and also if you take that statement one step further shows if you were
to buy two hearing aids, then you would have $1,000 tax credit.
In the prior legislation, there have been a $200,000 income eligibility cap for the
household.
So that rules out some of the people that might have a large income being able to take
advantage of this tax credit.
But some of the questions that have come up with this hearing aid tax credit bill since
the introduction of the over-the-counter hearing aid piece is what happens if you don't go
to a provider to obtain the hearing aids?
What happens if it's a PSAP which is equivalent to a hearing aid right now And they are not
being regulated, does that still fall under that category.
And there's a lot more questions that have been coming up.
With that being said, as Stephanie Czuhajewski just noted, we know that cost is a barrier
for many people.
It's not the only barrier.
But it is a barrier.
And you're going to see some of the evidence come out.
And there's lots of literature and studies that can show that, too, which I can reference
at the end but when cost is an issue this is one way to get around it and if cost were
truly not an issue then this piece of legislation wouldn't have the support it's having in Congress
over and over again.
So ADA has supported this as well as many other both hearing aid manufacturer groups
and provider groups.
And it's something that has been introduced for a long time.
But hasn't really gotten the momentum to move forward.
So this is really the brunt of why I think most of you are sitting on this webinar tonight,
which is the Over-the-Counter Hearing Aid Act of 2017.
And I do want to point out that this is technically the second time that it has been introduced
into Congress.
It was introduced at the very, very of the 2015-2016 Congressional hearing But as you'll
see it was reintroduced in both the Senate and in the House on March 21st of 2017.
So we're really going on about two months that this over-the-counter hearing aid bill
has been in Congress this time and it was introduced in December before so you're really
looking at a lot of information that's been out there for about the last six months.
And I do want to know, especially coming from the audiology standpoint and I think some
consumers which I cannot speak on behalf of, I can tell you my patient views about HLAA
-- but HLAA could probably give a better view on what the consumers are saying but there's
a lot of misinformation that's out there about this Over-the-Counter Hearing Aid Act.
So I would strongly encourage you, you can look these two bills up on Congress.gov and
they are very short bills.
They are only six pages.
They are essentially double spaced.
They have very small margins when you actually read them.
And I would highly encourage you to read it to see what is actually written in this legislation.
But basically the legislation is going to define what an over-the-counter hearing aid
can be.
And as many of you have heard, we have talked about mild and mild to moderate.
It provides regulations for the control of OTC hearing aid sales.
And so they are talking about safety and efficacy and outcomes that might be placed on this
type of device to be sold and it overrides the state licensure law which Ms. Czuhajewski
just referred to about the FDA guidance -- I'm sorry the state license law regarding the
medical evaluation and medical waiver for condition of sale.
And it also makes the FDA guidance from November of 2013 finalized to distinguish between hearing
aids and PSAPs.
So again, there's a lot of misinformation out there.
And especially with ADA as somebody who supports it, I want to note that there's a couple of
things that we see in this piece of legislation.
It does call out that there needs to be regulation.
So right now there are a lot of options available on the market direct-to-consumers you can
order via mail.
You can do catalog.
You can do Internet based sales.
And there are no regulations whatsoever.
So we don't see this as something that's going to open the floodgates.
It's really something that's going to put regulations so we have often termed it as
a reregulation hearing aids that are available direct-to-consumers.
So now with this you're going to see devices that have appropriate outcome limits, that
have appropriate labeling, that have appropriate standards, that have instruction manuals which
are already supposed to be there under the condition of sale for a hearing aid.
But aren't always being there.
And with this reregulation, there's actually a method that you can go back and actually
start to enforce some of these issues for companies that are or are not looking at it.
This would also allow the manufacturers of these devices to make truthful statements.
So again, Ms. Czuhajewski already referred to, there's a lot of things you can get out
there right now.
But you can kind of say whatever you want about these devices.
Some of them function the exact same way as a hearing aid.
They are just termed something different if they are sold over-the-counter or if they
are sold through a provider's office so you are going to see things that are actually
making truthful claims about what products can and cannot do.
And again, as I mentioned, the legislation as it's current written is written for mild
to moderate hearing loss.
And I know there's a lot of variations as to who agrees with mild.
Who agrees mild to moderate.
But in the case of ADA, we have agreed with mild to moderate.
And so pointing out kind of where we are in this situation, you've got the house bill
-- the House Bill this HR 1562 it's already been heard in the Energy and Commerce Committee
that happened on May 2nd it's very interesting to hear Dr. Schurr Dr. Powers and Dr. Lin
who were there speaking on behalf of physicians and Hearing Aid Association respectively and
it might be combined into the larger group of the MDUFA bill on the Senate side the legislation
was marked off on May 10th so you'll start to see that move forward a little bit more
in the next 24 hours, as well.
So as I mentioned, ADA does support this legislation.
It's consistent with everything that Ms. Czuhajewski has already said, it's consistent with the
PCAST recommendations.
It's consistent with our FDA presentation.
And it's consistent with the Institute of Medicine or the NASEM recommendations.
And so we have been supportive of that all along without a lot of qualifications and
of course ADA is supportive of the actual legislation, as well.
We also want to point out that you will see a lot of information that's available in peer
reviewed studies and research methodologies that talk about the use of non-treatment when
it comes to hearing loss may be greater than risk of self-treatment I think this is interesting
from an the audiological side in the fact that a lot of audiologists or hearing aid
dispensers or physicians who might be selling hearing aids have promoted there's a risk
of falls, there's a risk of quality of life decrease, there could be a risk of graduated
dementia and Alzheimer's and things like that when it comes to why you should actually obtain
hearing aids and go through this process.
But now that the option of obtaining hearing aids is out there, some of that information
has been kind of pushed under the rug in terms of why you should get something that might
be a little beneficial as opposed to not doing in the long run and as I mentioned before
the legislation does require the safety, the efficacy, the labeling and the reporting system
to be addressed.
None of that is written in this legislation.
That's all something that there are timelines put in place as to how long the FDA would
have to create those different types of regulations.
But they are not something that I can speak to because we are not -- they are not actually
being developed.
Within the legislation.
They are probably being looked at at FDA since the FDA mentioned they would be looking into
this at the NASEM meeting in December So the other thing that we want to point out
while you're on the phone call today is the Audiology Patient Choice Act of 2017 and this
is a House Bill that was introduced on May 2nd of this year.
So in this Congressional session, it has been introduced in the last two Congressional sessions,
as well.
Try saying that three times fast.
But this is -- this essentially does three things It's going to update the Title XVIII
of the Social Security Act which is essentially Medicare and it will allow any Medicare Part
B beneficiaries to have director access to an audiologist so as most of you may know
in order to see an audiologist at this point in time there's the requirement of a physician
order.
As well as a medical necessity in order for Medicare to actually reimburse for services.
So that would take off this extra burden of having patients obtain that physician order
before they actually come to the audiologist and go through the testing for medical necessity.
It would also reimburse the provider for any Medicare covered services that are allowed
under the state defined scope of practice so it's not any additional scope of practice
it's not any additional services within the Medicare system but currently if there's a
vestibular issue and you have poor balance you might see the audiologist for balance
testing but then you would have to go to a physical therapist to be covered under Medicare
for reimbursement for that type of treatment even though the audiologist is allowed to
administer that treatment under their state scope of practice.
They are just not able to be reimbursed so this is allowing for patients to have a one-stop
shop or a consistent place of service for both treatment and diagnostic coverage.
And then the third thing it would do is it would categorize audiologists as limited licensed
physicians and this would put us in the same taxonomy or category as other non-physician
providers before we jump off the deep end limited licensed physicians is not a term
that ADA or anybody else has come up with that's what Medicare happens to call these
non-MD providers so we're talking chiropractors, podiatrists, dentists, pharmacology is trying
to work towards this, as well.
So as I often tell people, Medicare can call me anything they want as long as they put
me in the category with all of those other non-medical doctor providers that are providing
the same type of care that I am and that would be the optometrists, the chiropractors, the
podiatrists and the dentists.
And being very upfront I love this piece of legislation because ADA has written it.
this is drafted by us and it is moving forward because of the ADA.
So obviously we do support it.
It would still allow patients to see a provider and purchase over-the-counter hearing aids
if that were something they would want to do.
It would allow patients to go direct to the over-the-counter model in terms of purchasing
hearing aids and then come to an audiologist if they wanted to do so.
It would just give them the accessibility of seeing a provider without extra barriers.
It is worth noting this does not say that Medicare should be covering the cost of hearing
aids.
That's a whole other finish to tackle This is really kind of looking at giving patients
access to professional care.
And to have Medicare cover some of the costs that they have already covered in other services.
But it does not specifically say anything related to hearing aids.
Right now hearing aids are excluded from the Medicare Part B system and we can talk more
into that but that's a whole other webinar, as well.
And again it doesn't add any new services to Medicare.
Just provides you, as a patient, the ability to see whomever you choose for the services
that you would like.
So with that, we wanted to make sure we provided an overview of but we wanted to allow ample
amounts of time for question and I'm sure, Nancy, you have quite a few coming in.
So I'm going to turn it back to you and we can move forward from there.
So thank you very much >> NANCY MACKLIN: Okay.
Perfect, thank you very much.
The first question comes from Dwaine Smelter he says please share your evidence for cost
being a real barrier.
When adoption rate is the same in countries where hearing aids are free.
>> STEPHANIE CZUHAJEWSKI: This is Stephanie, I'm happy to take that initially.
We would be glad to send you some of the studies that we have.
They actually demonstrate that cost is a significant barrier in the United States.
Where we have very low actually adoption rates versus what they are in other countries.
Certainly there's no country where adoption rates are approaching 100% or anywhere close.
But there are countries in Europe where adoption rates exceed 40% and cases where cost isn't
a barrier and even though over there they do have issues with access and very long wait
times from time to time, with their national health care systems and so forth, they still
are seeing adoption rates that are much higher than in the United States.
>> ALICIA SPOOR: And I'm going to piggyback -- sorry Nancy I'm going to piggyback off
of that too this is the actual NASEM summary report it is a book you can see that but Chapter
4 is dedicated to hearing technology.
And you can see a lot of their studies and research that they have obtained.
It starts on Page 196.
I have read it a couple of times.
But you can find some of the information and answers that you're asking for there, as well.
>> NANCY MACKLIN: Okay.
I was going to say I can attest to that because the financial assistance page of our Web site
is the one where people spend the most time and most frequently viewed.
And our phones and email are quite busy with people inquiring about how to afford hearing
aids.
We get between 3 and 8 every single day of the week and some days it's as high as 10
inquiries on that subject so it is a problem.
The next question comes from Brad if OTC hearing aids become available, what capabilities might
be provided by hearing aid manufacturers to hearing aid users to program their hearing
aids using hearing profile data provided by an audiologist?
Will that even be possible?
>> ALICIA SPOOR: I'm happy to start with that one especially being on the clinician side
and then Stephanie, you can jump in if you would like to.
But I can tell you that at this point in time, it's anybody's guess what might be out there.
There's a lot of speculation as to what these devices might be.
There's no rules or regulations or enforcements that's happening right now on devices that
are direct-to-consumers currently.
And so I think in terms of imagination, the sky is the limit.
But a lot of that is going to be yet to be seen.
Part of what I see as a provider is if you come in as a provider -- if you come in to
me as a provider this is my personal opinion I'm already providing you with your audiogram
and if you think you have a device you can program then all the more power to you if
there's that capability there are already devices now that let you fine tune and have
equalizers that are hearing aids from the hearing aid manufacturers that are currently
being provided.
Through and audiology or hearing aid dispenser or physician model.
And so I think you're going to see lots of things And that's kind of like asking what
new technology is there going to be in the next ten years?
Some of the things I think that are being developed we don't even know about yet because
it hasn't come to market and it's not regulated or it's not researched or hasn't been rolled
out so that's a roundabout answer to say I hope you have lots of ideas and lots of options.
>> NANCY MACKLIN: Stephanie, did you want to add anything to that?
>> STEPHANIE CZUHAJEWSKI: I think Alicia covered it beautifully.
I think the only thing that I would add is that really the sky is the limit in terms
of future technology.
We've been seeing things change so rapidly.
And as we think about direct-to-consumers opportunities in the future, I think we need
to move away from the sky is falling mentality to that sky is the limit mentality.
Because I think there are many opportunities to use telehealth and teleaudiology to couple
with what these technological advances will be in terms of phone applications and things
that we're going to be able to download.
I think in the future we're going to see a ubiquitous device really.
And I think a lot of your hearing aids are actually going to be software only.
If you have a good device, you're going to maybe even be able to switch up the kind of
hearing aid you have by virtue of just changing your software program.
>> NANCY MACKLIN: Exciting.
Exciting times for sure.
Vicki said what does it mean allow manufacturers to make truthful statements?
I think she might be pitching that one to you, Alicia.
>> ALICIA SPOOR: Yeah I'm happy to start with that one.
I think what you're referencing, and this is something I'm sure Stephanie will chime
in again, as well at the end, right now what that means is that you cannot sell a hearing
aid that's intended -- I'm sorry let me back up.
You cannot sell a device that's intended to treat hearing loss over the counter.
So what's happening is you're seeing a lot of devices that are four an enhancement of
hearing.
Or for those kind of hunter type of situations where you might want an increased sensitivity
of hearing or you might want better than normal hearing.
And so these are all advertising tricks that some of these devices are using.
And I'm not saying it's right or wrong.
But these are labeling things that PSAPs currently, personal sound amplification products cannot
say they are intended to treat hearing loss even though they may be used for that type
of situation or they could be technologically the same to a hearing aid that I as an audiologist
would sell in my practice but because it's not intended to treat hearing loss, you might
be able to purchase it through a mail order catalog.
But if it is intended to treat hearing loss and they make those advertisements, then you
are required at this point in time to come through that provider and provider being the
hearing aid dispenser, the audiologist or that physician.
>> STEPHANIE CZUHAJEWSKI: And this is Stephanie I'll just add so what the FDA looks at currently
and what they have counseled people through their drafts guidance and drafts PSAP guidance
which hasn't been finalized is that it's really about intended use.
So the technological components of the devices could be identical But because one device
is intended for use in the treatment of hearing loss, it either has to be deemed a hearing
aid and marketed and regulated appropriately, registered with the FDA appropriately.
Or it's not supposed to be marketed for the purpose of treating hearing loss, even though
by virtue of it's technological features, it may very well be able to do that.
So in a lot of ways the PSAP manufacturers and folks who are not currently making devices
that are FDA registered as hearing aids are doing things to sort of skirt that requirement
and really kind of getting right on to the edge of what legal -- what's legal or not
legal in terms of what they are saying about these devices.
From ADA's perspective, we would like the guidance to be perfectly clear so that the
playing field is level for all manufacturers, those of hearing aids and those of other devices
so everybody kind of has the same expectation and is held to the same standards.
And that way, in that regard, you feel that people can market their devices transparently
and truthfully.
And we believe that companies should be able to make truthful claims about their products
as is consistent with the First Amendment.
>> NANCY MACKLIN: Okay, the next question comes from Jeff, who will write the training
material for OTC sellers of the qualifications for OTC sellers?
>> STEPHANIE CZUHAJEWSKI: I think I can start.
And I can be corrected later.
I'll tell you that I'm not 100% true at the end who exactly will be sitting in a room
writing it.
I'll be right upfront with that.
But what the legislation calls for, the OTC hearing aid act is it calls for the FDA to
come up with the modification to the current regulations on the sale of a hearing aid.
So the FDA would be directed through the legislative process to make the regulations necessary
or to modify the existing regulations in order to account and allow for those OTC devices
to be sold safely and efficaciously.
Now, we know that when (inaudible) and Jeffrey Shuren (phonetic) tested at the House Energy
and Commerce Committee submeeting a couple of weeks ago, he made affirmative statements
and concluded that the FDA would be able to do that.
And to do so in a way that would be safe and effective to the consumer should the legislation
be passed.
>> NANCY MACKLIN: Okay.
The next question also from Jeff, does HLAA support the APCA?
And yes, we do.
But I think we might be behind on posting some information about that.
I know Barbara is on the webinar, and Barbara, if you have a microphone, I can have you answer
that.
If you want to provide more information.
I know I'm kind of putting you on the spot there.
And I'm not sure if she's -- she's on a microphone with a mic.
But you will be seeing more information about that, about our support of that.
Kathy writes age related hearing loss was the basis for PCAST and NASEM recommendations.
If someone has a medical history of chronic disease, trauma or ototoxic medications will
OTC not apply and cannot be sold and audiological management will be recommended first?
>> ALICIA SPOOR: Yeah, I'm happy to answer that question.
The answer at this point in time from how I understand it and this is from me reading
the legislation, is that, no, if you have any co-morbidity or pre-existing condition
that could be linked to hearing loss, there's nothing that would prevent you from buying
some type of OTC device.
That being said, I would highly recommend that you look at the energy and commerce hearing
that happened on May 2nd which that video is publicly available.
Because they did talk a lot about whether or not there would be medical conditions that
would preempt like a mild hearing loss versus a moderate hearing loss in terms of the treatment
that would be provided.
And because I am not a medical physician, I'm not going to answer that.
But Dr. Lin did go that route when he was asked that question So that's something that
I would look into, as well.
That being said, part of the good stuff that's coming out of this over-the-counter hearing
aid legislation and as we have tried to move forward, especially with the diabetes guide,
is that we need more awareness when it comes to hearing and hearing loss and hearing prevention.
And we need more awareness.
And we need more data.
And we need more data-based practices and best care and standards.
And everything that goes into these packages.
And I think that's one of the things that this is starting to show is where some of
these areas have fallen short and where some of these areas need more things.
And where some of this could be beneficial.
And that's not only good on the consumer side for people that are listening and also for
providers that are doing hearing and balanced health care but it's also good for those primary
care physicians and those internal medicine and family practice that are -- and gerontologists
that are kind of the gatekeepers at the moment of these people to help funnel them to where
they need to be when they do have those co-morbidities or co-diseases present.
>> STEPHANIE CZUHAJEWSKI: The only thing that I would add to that, I think Alicia -- Dr.
Spoor did a great job of covering that question is that the purchase of an OTC device and
the purchase of audiologic care or treatment by an audiologist is not mutually exclusive.
And this is something that we want to make sure that we continue to really put out there
into the universe is it's not going to be an either/or decision for many people.
We anticipate that the incorporation of OTC devices will actually bring more people into
the system as Dr. Spoor mentioned and with that they will be able to take these devices
and go into an audiologist or even better, start with the audiologist, get a fantastic
audiologic evaluation and get your Needs Assessment and get everything that's comprehensive on
the frontend and then if an OTC device is something that your audiologist recommends
that could work for you then great then go buy it and go back and get subsequent treatment
if that's what you want to do.
Or even better, we anticipate that many audiologists will actually sell these OTC devices right
in their practices and you'll be right there and able to purchase them on the spot and
then go back and get the care or treatment from an audiologist if that's what you choose
to do.
>> NANCY MACKLIN: Okay.
Do you know when it's likely that we will see these bills passed?
Like what's the timeline in the bills getting passed and actually seeing OTC devices on
the market do you think?
>> STEPHANIE CZUHAJEWSKI: So as we understand it, the way that the OTC bill is currently
attached to an FDA reauthorization bill in both the House and the Senate, the FDA reauthorization
bill by virtue of its deadline for renewal needs to be done by some time in September
as we understand it.
So we expect that if the OTC component and the OTC legislation stays attached to the
bigger bill, that it will pass along that timeline if it's successful.
That said, there's no guarantee that it would pass at that point.
If it does, I believe that the requirements to the FDA are a three-year timeline from
the time the bill passes until when a lot of these things would be implemented.
That said, the FDA on its own has the authority to do many of these things from a regulatory
standpoint without the mandate from the legislative body.
So as we understand it from their announcement in December, FDA is already looking at the
best approaches for implementation for OTC hearing aids as we mentioned they have already
voluntarily removed the requirement -- the enforcement of the requirement for the medical
evaluation and are looking at rescinding that regulation.
So we are really unsure about the legislative success for the bill.
But we're very hopeful that it could be passed before September.
And that with that the FDA is already working and could even be done in advance of that
three-year mandate >> NANCY MACKLIN: Great, Barbara Kelley is
online.
And can provide more information about HLAA's support of the Audiology Patient Choice Act
of 2017.
Go ahead, Barbara.
>> Hi, yes, we are definitely supporting that And we will have more information on that
on our Web site soon.
>> NANCY MACKLIN: Okay.
Do you have a timeline, Barbara, or when -- of when that will be posted?
>> No, I don't, we have written or letter of support and we're just about to submit
it to the Academy of Doctors of Audiology.
We were working on tweaking that.
>> NANCY MACKLIN: Okay.
Good.
All right.
I can see there's a lot of legislative activity going on in HLAA among our small staff but
we're doing the best we can.
(Chuckles).
>> NANCY MACKLIN: Okay.
I believe there was one more question here -- let me just scroll down
Will this presentation be available later?
Yes, absolutely.
It has been recorded and we'll post it usually it takes us about a week or so to get it posted
on our Web site along with the slides.
So definitely you'll be able to view it again and share it with your colleagues.
Walmart pharmacy departments in Texas are selling hearing aids now.
For about five years.
Do you think that's going to be the trend?
I know that CVS also has hearing centers in their stores.
What do you think about that?
>> ALICIA SPOOR: Yeah I'm happy to start that answer.
Yes, Walmart and Sam's Club has been selling hearing aids.
Costco has been selling hearing aids.
As Nancy just mentioned CVS especially around my office has been selling hearing aids But
I think there's a big difference to point out and right now all of that is still provider
sold devices and what we're looking at is something that will not necessarily -- it
should strongly recommend but nothing that necessarily requires that provider for that
sale.
So we're looking at different models.
So yes you might see more devices in big box stores, pharmacies, grocery stores, Radio
Shack, technology devices, things like that but the OTC legislation is looking at decoupling
the device from that provider.
>> NANCY MACKLIN: There's a question from Tricia what are consumers saying to you at
HLAA regarding this legislation?
Barbara, do you want to chime in on that, as well?
>> Oh, sure, I would be happy to.
Well, many of our members tend to have more severe to profound hearing losses with very
complicated fittings and they have enjoyed the good care of their audiologist and hearing
instrument specialists for many years So this over-the-counter category really wouldn't
apply to them.
But they understand that with the innovation in technology and opening up competition that
it would be good for hopefully bringing all of the costs of hearing aids down.
And some of them have said to me, you know, I wish I would have done something sooner
about my hearing loss.
And I might have if something like this were available And then of course we've heard from
other consumers who think this is a good idea because they can't afford hearing aids and
then of course as I'm seeing from the questions, there's some really good questions about PSAPs
and over-the-counter, and what over-the-counter will look like.
So I almost -- well, I know we won't be able to get to all of the questions so I'm almost
thinking we might need another webinar.
>> NANCY MACKLIN: I think so.
There are several more questions and unfortunately we are not going to be able to get to all
of them.
But one that really sticks out is from Priscilla she says as a physician what should I tell
my patients about the OTC devices?
Do you think to take that question, Alicia?
>> ALICIA SPOOR: Sure, I would be happy to start.
First and foremost thanks for being on the webinar because there are so many physicians
that I speak to on a regular basis that aren't interested in hearing about balanced health
care for their patients so thank you for being one of the select few and please lead your
colleagues along the way, as well, I think what you need to tell your patients is that
at this point in time start with the audiologic evaluation and then move forward from there
so this is OTC legislation is something that they could look into.
But it's not something that's going to happen overnight.
There are devices that are out there but because they are not the best regulated devices it's
not something that patients should go out and purchasing on their own right now the
model of care is still going through the audiologist I would think in terms of testified based
practices the best practices you would want your patients to have that baseline evaluation
before any type of treatment is there.
That being said I would strongly encourage them to be active and be looking at this and
be asking and be well prepared when they go see a provider so that they can say are there
low cost options, are there treatments that are available for me that maybe aren't hearing
aids but more assistive listening devices or hearing strategies and you have your elected
members to do what -- for you and your patients think are best that's why we elect them that's
what I would say to you as a physician and that's what I try to tell my physicians when
I meet with them.
Stephanie I don't know if you have anything to add from what you're seeing from our audiologists
as well.
>> STEPHANIE CZUHAJEWSKI: I think that's excellent advice, we are seeing that there are more
audiologists who are utilizing some of the PSAPs and other products within their practices.
So I think, again, if the patient starts -- seeks out an audiologist that offers some of those
types of alternatives and gets the evaluation and then know there would be some low costs
or alternative options for them.
>> NANCY MACKLIN: We hear quite often from people who say their physicians told them
it was just part of aging, just turn up the TV, and really nothing can be done.
So as long as you don't tell them that, that there is help available.
And we appreciate you being on the webinar tonight.
Thank you so much Alicia and Stephanie, unfortunately we are now at a time and I apologize that
we cannot get -- we are out of time and I apologize we can't get to all of the questions.
That makes me think we need to get on the calendar for a second webinar.
And maybe by the end of summer or fall, a second one would be timely and we'll be able
to give an update on what the legislation is doing at that point.
So thank you, all, for attending this evening and thank you Alicia and Stephanie so much.
This was very informative.
I appreciate it.
>> STEPHANIE CZUHAJEWSKI: Thank you, it's been a pleasure.
>> ALICIA SPOOR: Same for me, thank you very much
>> NANCY MACKLIN: All right, good night, everybody.
-------------------------------------------
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Rep. Joe Crowley: Strong Influence Of Russia In Election | Morning Joe | MSNBC - Duration: 10:02.
>>> THE RUSSIANS HISTORICALLY IN THE LAST COUPLE OF DECADES AND
THEN INCREASINGLY, YOU KNOW, ARE LAUNCHING CYBER ATTACKS.
AND THEY ARE STEALING VAST AMOUNTS OF INFORMATION.
THE RUSSIANS IN MY OPINION AND BASED ON THE INTEL AND
COUNTERINTEL PEOPLE I'VE TALKED TO COULD NOT HAVE KNOWN HOW BEST
TO WEAPONIZE THAT INFORMATION UNLESS THEY HAD BEEN GUIDED.
AND HERE'S -- >> GUIDED BY AMERICANS?
>> GUIDED BY AMERICANS. WE WENT AND TOLD EVERYBODY WE
COULD FIND IN THE MIDDLE OF THE SUMMER THE RUSSIANS WERE MESSING
WITH THE ELECTION. AND WE WERE BASICALLY SHOOED
AWAY. REMEMBER, YOU KNOW, COMEY WAS
MORE THAN HAPPY TO TALK ABOUT MY E-MAILS, BUT HE WOULDN'T TALK
ABOUT INVESTIGATION INTO THE RUSSIANS.
SO PEOPLE WENT TO VOTE ON NOVEMBER 8th HAVING NO IDEA THAT
THERE WAS AN ACTIVE COUNTERINTELLIGENCE
INVESTIGATION GOING ON OF THE TRUMP CAMPAIGN.
I SET UP MY CAMPAIGN. AND WE HAVE OUR OWN DATA
OPERATION. I GET THE NOMINATION, SO I'M NOW
THE NOMINEE OF THE DEMOCRATIC PARTY.
I INHERIT NOTHING FROM THE DEMOCRATIC PARTY.
>> WHAT DO YOU MEAN NOTHING? >> I MEAN IT WAS BANKRUPT, IT
WAS ON THE VERGE OF INSOLVENCY. ITS DATA WAS MEDIOCRE TO POOR,
NONEXISTENT, WRONG. >> WHOA.
JOINING US NOW IS THE CHAIR OF THE DEMOCRATIC CAUCUS
CONGRESSMAN JOE CROWLEY. CONGRESSMAN, WE'VE HEARD HILLARY
CLINTON BLAME COMEY, THERE'S RUSSIA, THERE'S WIKILEAKS,
THERE'S LOTS OF REASONS AS TO WHY THINGS WENT WRONG AND WHERE
SHE FEELS THEY WENT WRONG ESPECIALLY.
WE HAVEN'T HEARD HER TALK ABOUT THE DNC.
WHAT DO YOU MAKE OF THAT? >> I THINK THERE ARE A LOT OF
THINGS THAT CONTRIBUTED TO THE LOSS.
AND I THINK SHE WOULD EVEN SUGGEST THAT MAYBE HER
PERFORMANCE WASN'T THE BEST. >> RIGHT, NO --
>> BUT HAVING SAID THAT. AND SHE'S A VERY DEAR FRIEND OF
MINE AND I ADMIRE HER GREATLY, I DO THINK THERE WERE A NUMBER OF
THINGS THAT WENT ON IN THE NATIONAL ELECTION.
I THINK WE'LL BE ANALYZING THIS FOR MAYBE YEARS TO COME, I
THINK. BOOKS HAVE YET TO BE WRITTEN
ABOUT WHAT HAPPENED DURING ALL THIS TIME.
I DO THINK IT WAS A STRONG INFLUENCE OF RUSSIA IN THIS
ELECTION. ALL THE TOP INTELLIGENCE
AGENCIES HAVE SAID THAT. THE ONLY PERSON WHO KEEPS
DENYING IT OR NOT ACKNOWLEDGING IS THE PRESIDENT.
>> I KNOW. BUT WHAT ABOUT HER ANALYSIS
ABOUT THE DNC? BECAUSE I GUESS SOME MIGHT ARGUE
THAT THE DNC RIGGED IT AGAINST BERNIE SANDERS.
I MEAN, THERE'S LOTS OF NARRATIVES OUT THERE.
WHAT DO YOU KNOW? AND DO YOU AGREE WITH HER?
>> POLITICS IS A TOUGH BUSINESS. I'VE BEEN IN IT A GOOD BIT
MYSELF. I UNDERSTAND HOW DIFFICULT IT
CAN BE. IF IT WAS BANKRUPT THEN, I DON'T
KNOW WHAT STATE IT'S IN NOW. WE'RE IN REBUILDING MODE
OBVIOUSLY AFTER THAT LOSS. AND I THINK THE FOCUS REALLY NOW
FOR THE DNC HAS TO BE NOT ABOUT WHAT HAPPENED IN THE LAST
ELECTION BUT THE ELECTION NOW AND THAT'S INDIVIDUAL
CONGRESSIONAL DISTRICTS, IT'S HAND-TO-HAND COMBAT.
IT'S NOT A NATIONAL ELECTION, IT'S ALL POLITICS, IT'S LOCAL.
THAT'S WHERE WE'RE GOING TO BE SUCCESSFUL IN DISTRICTS IS
PUTTING ASIDE ALL THE RUSSIAN ISSUES, THAT'S A WASHINGTON
ISSUE. WHAT WE'VE BEEN TELLING OUR
FOLKS AND CANDIDATES TO DO IS FOCUS ON LOCAL ISSUES AND LEAVE
THE WASHINGTON STUFF TO WASHINGTON.
>> ALTHOUGH SECRETARY CLINTON DIDN'T MENTION HIM BY NAME, SHE
IMPLIED IN SOME OF HER COMMENTS YESTERDAY WHICH WAS AN
EXTRAORDINARY PERFORMANCE OF HER BREAKING DOWN WHY SHE MAY HAVE
LOST AND WHAT SHE'S GOING TO BE DOING GOING FORWARD SUGGESTS
PERHAPS PRESIDENT OBAMA AND THE WHITE HOUSE DIDN'T DO ENOUGH IN
TERMS OF CAMPAIGNING AND GETTING THE VOTE OUT FOR HER.
DO YOU THINK HE BEARS SOME RESPONSIBILITY FOR HER LOSS?
>> WELL, I SAW THE PRESIDENT IN THAT LAST MONTH OR SO
FEROCIOUSLY TRYING TO PUSH BACK AGAINST WHAT THEY WERE FEARING
COULD ULTIMATELY HAPPEN AND IN FACT DID HAPPEN.
AGAIN, I THINK IF WE'RE GOING TO CONTINUE TO LOOK BACK ON WHAT
WAS OR COULD HAVE BEEN OR WHAT DIDN'T HAPPEN, LOOK, IT TOOK --
I'M STILL NOT OVER THE RESULTS OF THE ELECTION.
I THINK MANY AMERICANS PARTICULARLY DEMOCRATS ARE NOT
FULLY THERE YET. BUT I DO THINK IF WE GET BOGGED
DOWN IN THIS, IT'S GOING TO MAKE OUR WORK EVEN MORE DIFFICULT IN
UNIFYING THE PARTY AND MOVING FORWARD.
THAT'S WHAT I'M ABOUT. >> WELL, I UNDERSTAND THAT, BUT
THEN I THINK THE QUESTION FOR BOTH JOES MIGHT BE AN I'LL TURN
TO JOE SCARBOROUGH, HOW DOES HILLARY CLINTON PERHAPS LEAD THE
WAY? WE'RE ONLY ASKING THESE
QUESTIONS RIGHT NOW BECAUSE SHE RAISED IT.
WE'RE VERY CLEAR ON -- GO AHEAD. >> YEAH, I MEAN, MIKA, SHE KEEPS
BRINGING IT UP. AND THIS IS A WOMAN THAT'S
CONTRIBUTED A GREAT DEAL TO OUR COUNTRY OVER THE PAST FOUR
DECADES. SHE HAS SO MUCH TO BE PROUD OF
AS HER ROLE NOT ONLY IN THE WHITE HOUSE BUT ALSO AS U.S.
SENATOR. >> UH-HUH.
>> JOE CAN TALK ABOUT WHAT A GREAT JOB SHE DID FOR THE PEOPLE
OF NEW YORK. >> FIRST LADY.
>> REPUBLICANS THAT WORKED WITH HER SAID SHE WAS ONE OF THE
HARDEST WORKERS AND HAD GREAT ADMIRATION FOR HER, GENERALS
THAT WORKED WITH HER HAD GREAT ADMIRATION FOR HER WHEREVER YOU
WENT IN WASHINGTON PEOPLE WHO WORKED WITH HER HAD GREAT
ADMIRATION FOR HER. BUT JOE, SHE KEEPS GOING OUT AND
SHE KEEPS BLAMING THIS ON COMEY, RUSSIA, MISOGYNY, NOW THE DNC.
AND, MY GOD, IF YOU'RE A DEMOCRAT, 2018 IS REALLY, I
MEAN, IT IS ONE OF THE MOST CRITICAL MIDTERM ELECTIONS
PROBABLY IN THE PAST 40 OR 50 YEARS.
SHOULDN'T ALL DEMOCRATS FORGET ABOUT --
>> LEARN FROM 2016 BUT USE THOSE DEMOCRATIC FORUMS TO HELP
DEMOCRATS STOP WHAT DONALD TRUMP'S DOING IN WASHINGTON.
>> I COULDN'T AGREE WITH YOU MORE, JOE.
BOOKS WILL BE WRITTEN ABOUT THIS IN YEARS TO COME AND I LOOK
FORWARD TO READING MANY OF THEM IF NOT ALL OF THEM, BUT WHAT WE
HAVE TO LEARN IS HOW WE WIN IN 2018.
AND I THINK IT'S CRITICAL IN ORDER TO BRING BALANCE BACK TO
WASHINGTON THAT DEMOCRATS ARE SUCCESSFUL IN 2018.
AND IT'S NOT GOING TO BE A NATIONAL ELECTION.
IT'S GOING -- PART OF THIS IS A REFERENDUM ON THE PRESIDENT.
PART OF THIS IS A REFERENDUM ON THE INABILITY OF THE REPUBLICANS
IN THE HOUSE TO GET THINGS DONE, BUT IT'S ALSO ABOUT LOCAL
POLITICS. YOU KNOW, THE OLD TIP, ALL
POLITICS ARE LOCAL, I THINK THE RUSSIA IS AN IMPORTANT ISSUE FOR
THE AMERICAN PEOPLE. THEY ARE FOCUSED ON IT.
BUT THEY'RE MORE CONCERNED ABOUT THE ECONOMY, CONCERNED ABOUT
PUTTING FOOD ON THE TABLE, CAN THEY AFFORD COLLEGE, WHEN THEY
GRADUATE COLLEGE CAN THEY PAY THE STUDENT LOAN, CAN THEY HAVE
A JOB AND MOST IMPORTANTLY, I THINK, JOE, WHEN YOU HAVE A JOB,
IS IT ME OR YOU GREW UP ARE YOUR PARENTS ABLE TO CONNECT WITH
THEIR GRANDCHILDREN? THAT'S REAL HAPPINESS.
AND I DON'T THINK WE FOCUS ENOUGH ON THOSE ISSUES.
THAT'S WHAT WE HAVE TO GET BACK TO.
>> I SHOULD ADHERE IN TERMS OF HILLARY GOING AFTER THE DNC, THE
GUY WHO RAN THE DNC DATA OPERATION HAS TAKEN STRONG
EXCEPTION TO WHAT SHE SAID YESTERDAY AND HE WAS ON TWITTER
LAST NIGHT SAYING THAT HIS OPERATION WAS TRYING TO WARN THE
CLINTON CAMPAIGN. THEY WERE MISSING THE SIGNS IN
WISCONSIN, MICHIGAN. THE CLINTON CAMPAIGN, HE SAYS,
DIDN'T WANT TO HEAR THAT FROM THEM.
CONGRESSMAN, LET ME ASK YOU QUICKLY, HILLARY CLINTON, AS FAR
AS I'M CONCERN SHE IS THE CANDIDATE SHE CAN BREAK THIS
DOWN ANY WAY SHE WANTS. BUT FROM A STANDPOINT OF A
DEMOCRAT LOOKING AHEAD TO 2018 AND LOOKING AHEAD TO 2020, IF
YOU TAKE ALL FT THINGS SHE'S PUT OUT THERE OFF THE TABLE, TAKE
WIKILEAKS, COMEY, RUSSIA, TAKE THAT OFF THE TABLE, WHAT WAS THE
BIGGEST FAILURE OF THE CLINTON CAMPAIGN THAT YOUR PARTY CAN
LEARN FROM? >> I THINK NOT RECOGNIZING WE
HAD TO HAVE A PRESENCE IN STATES WE TOOK FOR GRANTED, WHETHER
IT'S MICHIGAN, WISCONSIN, PENNSYLVANIA.
REAL CONCERNS ABOUT THE FUTURE OF PENNSYLVANIA POTENTIALLY
BECOMING A RIGHT TO WORK STATE AFTER THIS ELECTION.
HOPE THAT DOESN'T HAPPEN. AND IT SHOULDN'T HAVE HAPPENED
IN THE FIRST PLACE. I THINK PLACES LIKE WEST
VIRGINIA, LOOK AT THE MAP AND YOU CAN SEE WHERE WE ONCE WERE
STRONG AND WE NOW HAVE LITTLE OR NO PRESENCE AT ALL.
I THINK THAT'S WHAT WE NEED TO BE FOCUSING ON.
>> GOOD POINT. JOE.
>> AND, JOE, ALSO STATES THAT YOU HAD DIDN'T FOCUS ON AND
SUBSETS IN THOSE STATES THAT BARACK OBAMA FOCUSED ON AND THAT
OTHER DEMOCRATS HAVE FOCUSED ON, WHITE WORKING CLASS AMERICANS
WHO HAVE FELT IGNORED AND LEFT BEHIND BY THE DEMOCRATIC PARTY.
WE HAD JOE BIDEN, THE VICE PRESIDENT, WARNING US AT THE DNC
THAT WHITE WORKING CLASS AMERICANS WERE BEING IGNORED BY
THE CLINTON CAMPAIGN. WE HAD ED RENDELL AT THE DNC
SAYING, ON TV, THAT PENNSYLVANIA IS IN PLAY AND THEY NEED TO
FOCUS MORE ON WHITE WORKING CLASS AMERICANS, AND NOT
COMPLETELY IGNORE THEM. HOW IMPORTANT IS THAT, GETTING
THE WHITE WORKING CLASS VOTERS THAT VOTED FOR BARACK OBAMA AND
THEN VOTE FOR DONALD TRUMP BACK IN THE DEMOCRATIC FOLD?
>> UH-HUH. I THINK, JOE, THAT WE AS
DEMOCRATS THINK OF OURSELVES AS THE BIG TEN PARTY.
WE THINK WE'RE GOING LIKE THIS AND REALITY A LOT OF PEOPLE
AROUND THE COUNTRY THINK WE'RE JUST GOING LIKE THIS AND MOVING
THE TENT AROUND. ONE DAY THEY'RE IN THE TENT, THE
OTHER DAY THEY'RE OUT. I THINK WE FAILED NOT JUST TO
WHITE VOTERS. I THINK WE NEED A MESSAGE THAT
SPEAKS TO ALL VOTERS. AND THAT'S WHAT I'M ABOUT
WORKING ON, AN ECONOMIC MESSAGE, A JOBS MESSAGE.
THE NEED FOR A REAL INFRASTRUCTURE BILL THAT HAS
JUST BEEN WAITING IN WASHINGTON. WE BEG THE PRESIDENT IF THERE'S
ONE THING WE COULD WORK ON MAYBE IT'S INFRASTRUCTURE.
APPARENTLY WE HAD TO DO HEALTH CARE REFORM DEBACLE NOW TAX
REFORM WHICH IS MUCH MORE DIFFICULT.
AND THEN MAYBE WE'LL GET TO INFRASTRUCTURE.
AT SOME POINT THERE NEEDS TO BE SOME EFFORT TO TRY TO DO
SOMETHING ON BEHALF OF THE AMERICAN PEOPLE.
THEY'RE SUFFERING. THEY WANT JOBS.
THEY WANT LONG-TERM JOBS, JOBS FOR THE FUTURE.
NOT SHOVEL READY PROJECTS BUT PROJECTS LONG TERM DECADES LONG
THAT CAN PUT KIDS THROUGH SCHOOL AND COLLEGE AND BRING BACK THE
AMERICAN TEAM. >> CHAIR OF THE DEMOC
-------------------------------------------
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Here's My Canada: The Weather Is Beautiful - Duration: 0:23.
I like Canada because the weather is beautiful,
so many people live in Canada.
I like my school, I am lucky that
Canada has a lot of food.
-------------------------------------------
Faire reproduire ses tableaux facilement - Duration: 23:42.
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10 Riders To Watch At The 2017 Critérium du Dauphiné - Duration: 6:45.
- It is often seen as a preview
to the Tour de France,
because the Critérium du Dauphiné
by design and where it comes on the calendar,
is the perfect opportunity for the big contenders
to test their form and their legs
ahead of the biggest race of them all in July.
A quick look at the parcours for this year
reveals that our stage is suited to the sprinters,
to the breakaway specialists, and of course,
to the climbers as well.
There's even a visit to the famous L'Alpe d'Huez,
albeit, not via the classic 21 hairpin bends.
Stage four is a 23.5km individual time trial,
which could play as much of a part in the outcome
as the climbing stages themselves.
As ever, it has been difficult to whittle
it down to just 10 riders to watch,
but nevertheless, we tried our best,
so here they come.
The three-time Tour de France champion
arrives at the most important part of the season,
having only completed 19 days of racing so far.
Although that reduced race programme
does seem to have served him well
over the last couple of years.
This year, however, he has yet to take a win.
Now he'll be hoping that the long weeks spent
at the altitude on the island of Tenerife
will reap their rewards come June and July.
However, if he doesn't win the Dauphine overall,
or at least a stage, or show some signs of brilliance
over the course of the eight days,
there will be a few question marks hanging over him
as to whether he can dominate again in July.
Froome may well be the favourite
for the race this year,
but his former team mate at Sky,
Richie Porte, looks prime to challenge him
at the races this summer,
including the Critérium du Dauphiné.
He started off his season by finally winning
the Tour Down Under, a race he's been looking
to win for quite some time.
He won a stage at Pyrenees,
and took overall honours
at the Tour de Romandie.
His BMC squad will be entirely built around him
this year for the summer races.
And if they can get through the first few stages
unscathed, then he's bound to excel
at the individual timed trial
and the latter mountain stages.
We're still not entirely sure
whether this will be Alberto Contador's
final season as a pro,
but what we do know is that he has no plans
to wind things down gradually.
He was performing very consistently
throughout March and April.
He didn't take a win,
but he took eight second places
throughout races in that period.
The Critérium du Dauphiné is the ideal time
for him to test his form against his key rivals
for the Tour de France,
and perhaps get one over on his compatriot.
That person being, of course,
Alejandro Valverde.
The Movistar racer, in contrast to Contador,
has actually taken 11 wins so far in 2017,
including the overall honours at the Ruta del Sol,
the Vuelta al Pais Vasco, and the Volta Catalunya.
He then went on to take wins at the Flèche Wallonne,
and the Liege-Bastogne-Liege in the Ardennes.
He's won this race twice previously in 2009 and 2010,
and we fully expect the Green Bullet
to be among the protagonists again this year.
We are extremely interested to see
just how Esteban Chaves can do
in cycling's biggest stage.
This year he's using the Critérium du Dauphiné
as preparation for his first tilt
at the Tour de France,
which of course comes off the back
of some impressive podium placings
at the Giro d'Italia
and the Vuelta a Espana last year.
Like Richie Porte, he opened his season
this year at the Tour Down Under
in January, where he finished second
to the Australian.
However, he has not raced since,
partly down to an injury.
He's been training hard, though
back in Colombia with some of his teammates.
But it's only they who really know
where his form is at.
This time last year, the Frenchman
Romain Bardet of AG2R finished runner-up
to Chris Froome at just 12 seconds in this race.
And he then went on to replicate
that exact result at the Tour de France.
However, this year we haven't quite
seen the best of him.
Sixth place at Liège-Bastogne-Liège
was a very good result,
but he's never made the top five at any
of the stage races that he's finished so far.
However, to prepare for the Dauphine and the Tour,
he has been training at altitude in Southern Spain.
The second Frenchman on our list
is Tony Gallopin of Lotto Soudal.
He's a very aggressive rider
who's not afraid of going on the attack,
but he's also very good
at individual time trails.
In fact, that's where he's taken his only win
so far this year at the individual time trial
back in Étoile de Bessèges in February.
Whether he'll go for GC or go for breakaways
and stage wins remains to be seen,
but there's one thing that's for certain,
he will certainly be visible.
This race is going to mark Fabio Aru's return
to competition after he was prevented from competing
at his biggest goal for 2017.
That being, of course, the Giro d'Italia,
which started in his home of Sardinia.
Now last year was a bit of a disappointment
for the Astana rider.
He'd come off the back of winning the Vuelta
at the end of 2015,
but the only win he had last year
was a stage of this race,
the Criterium du Dauphine.
And I think that that, combined
with a disappointment from the start of this year,
is gonna make this period very important
for him indeed.
Particularly, given that 2017 marks
the end of his contract with his current team.
The opportunities for the sprinters
may be few and far between as ever
at the Criterium du Dauphine.
But that hasn't prevented Team Katusha-Alpecin
from bringing a very strong lead-out train
to support their sprinter Alexander Kristoff.
He's already taken six wins so far in 2017,
and with him he's got Tony Martin,
Sven Erik Bystrom, Michael Morkov,
and Rick Zable, to name but a few.
They are not a team to be messed with
in the closing kilometres of a flatter stage,
but they are going to need to get things right,
'cause the only stage which looks set to finish
in a bunch sprint are days three and five.
One of Kristoff's key competitors, though,
will be the Frenchman Arnaud Demare of team FDJ.
In the absence of GC rider Thibaut Pinot,
who's presumably kicking back and relaxing
after his successful Giro d'Italia campaign,
the team's emphasis looks like it will be
on the sprint train, which has already delivered
Demare to five big victories so far in 2017.
Although, as a cheeky little bonus,
they'll also both have to compete
against Nacer Bouhanni of Cofidis,
who's taken four wins himself this year.
Right, well those are our 10, or 11 almost,
to look out for at the Dauphine this year.
As ever, if you disagree,
you can put your own comments and thoughts
into the comments section just down below this video.
If you've yet to subscribe to the channel,
you can do so by clicking on the globe,
it is free of course.
And then we've got a couple more videos
for you to watch right now.
Just down here, you can see what is
in a bearded rider's suitcase at a Grand Tour,
because Matt Stephens took a look through the case
of Simon Geschke of Team Sunweb.
Meanwhile just down here, there's a look
around the bus and kitchen of team Bora-Hansgrohe.
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SUMMER CLOTHING TRY ON HAUL 2017! TRYING INSTAGRAM BADDIE HYPED CHEAP CLOTHING - Duration: 7:33.A summer clothing try on haul 2017 if you're new to my channel my name is
Myka and welcome and today we are going to do a massive summer clothing try on haul
I've seen a brand called shien kind of going around Instagram baddie and I wanted
to see is it really worth the hype this video is not sponsoring me to talk about
their clothes whatsoever but I'm really excited to kind of give an honest and
full proper review kind of tell you what I like and what I don't like - let's
dive into this try on all the very first item that I got is this gorgeous blue
top I've seen some girls on Instagram rocking a top very similar I saw an
identical shirt like this at Saks and it was so expensive but I really like the
way that it lays on my body and I think this is absolutely adorable every single
item in this video is under $20 which is totally awesome like I said this is a
cheap clothing haul so another huge perk the next item that I got is actually the
dress that I am wearing right now you'll see me wear it and this might actually
be one of my favorite items in the entire haul it is so cute as such a
tropical and laptop could be a formal dress or could be super incredibly
casual it could go either way depending upon how you dress it up and it looks so
good I would say this dress would look good on anyone's figure just because of
the way that it falls on your body so rub the material it is a win win win I
think I'm even gonna wear to my birthday party because I just I love everything
about this the next dress that I got this is probably my second favorite if
not my first because it's kind of like my runner-up and this is absolutely
stunning it has that palm leaf pattern it's such an incredibly soft material
and this dress was like I think it was 20 dollars it might be a little more or
a little less it can't remember exactly I love the fabric and I also love the
way that they have two straps on the back you wouldn't even need a bra with
this because it's double layered they're really nice polyester it's so soft like
it's seriously the softest material ever and it feels so good on so this dress is
a complete win I love everything about this so the next little shirt that I got
is a little bold t-shirt is you know me I am always rockin like little sports
tease just the tomboy in me I love it and I got this one I really like the way
it fits it's a little bit shorter than I thought
it was going to be and a material is really nice but it's not quite as
amazing as I would have imagined it to be but I still overall really really
liked the tee especially for the price I think this was like six bucks so it's
definitely work I just thought it was going to be a little bit more of like a
cotton material and it's more like a jersey a little bit of polyester all
right the next thing that I got is a really crazy super well-worn beaten up
dress this is so funny I kind of bought this out of left field just something
fun and something very different you can see all of like the different textures
we just kind of in right now you know to mean that grunge look and I'm going to
say that unless I dress this up I feel like this might have been a little bit
of a fail only because some of the slits for the bottom of the dress like if I
were just to have like a fall honor if I were to have like a smaller cheekier
underwear you looking my butt cheek so that would be the only fail that I would
say super soft material and doesn't look quite as amazing on as it did in on the
model but it's still really really cute the next top that I got I really really
like this one I'm super simple like a preppy little top I love the color combo
this definitely looks like something from like j.crew and the material is
awesome I think the only thing that's kind of funny about some of those shirts
is you don't know which one which is the front or the back because some of them
don't have tags but they're still honestly super cute the next thing that
I picked up was a bikini the top did come with some padding and I'm not a
huge fan of padding but this padding was super awkward at major boobs just look
all around funny so I took those out it kinda reminds me of the Victoria Secrets
them too I cannot tell the difference to be
honest with you and the next dress that I got is this purple blush little
bodycon dress is so soft I'm incredibly impressed this is
probably the softest shirt I've ever touched in my entire life
that may sound really weird but I love the way that it's on your figure I think
the only bad thing about bodycon dress is is that if you have any trouble areas
or if you have an area that you're working on or you just ate a huge
massive Thanksgiving dinner this is not the dress to put on because it
definitely shows everything and I also think it might be a little tricky I'm
not quite sure what kind of underwear I would wear or if you wear underwear with
a dress like this because even when I have like a song on for shooting I felt
like you could see everything so this one I really like I think it'd be
perfect for like a summer day like super hot or even maybe a date I would want to
classy it up a little bit not be as casual the next hop that I got I thought
was really really cute the material is not horrible
but it's not amazing and it could be really just something cute and fun to
wear I was like a cute pair of short shorts I would love that
the next item that I got this was a sale for me I thought would be like a cute
little like boho chic outfit has a really cute design and I'll put it on
and it just was a bust I felt like it looked really chinzy it kind of looked
like something that belonged on a table curtain or like and I don't even know it
just really chinzy home decorating or something I don't know but I was not
feeling this one the next two items I got or fails as well this white top I
like it but for some reason it's just not
fitting the way that I would prefer the material is a little bit chinzy it's
hard to do a good chiffon and keep it cost effective at least that's my
personal box and this one has a lot of like fraying at the edges so there's not
a lot of good precision in this entire so I'm not crazy about it but I do think
I could still rock it was like a really nice accent necklace and I don't long
maxi skirt or something different like that
the next dress was a big fail it has scalloped sides and it's a really pretty
dress I love the way that it looks on the model however when I'm trying it on
I just feel like it's not as flattering as I would have imagined the material I
wouldn't say there's anything wrong with the material that I wouldn't say that I
particularly love the material so it's kind of like not here nor there for me
um I just I can't really put my finger on it I'm just not crazy about how it's
looking I don't know if I'm just not used to discard or the scalloped design
or what it is but just for some reason and it's not even the companyís fault
it's just I don't like the way that it fits on me or the way that it was on me
I would overall I would say that most the items that I picked up were total
wins the all of the risk-taker items I feel like were fails but all of the ones
that I'm like wow that looks really pretty and I know that I would like that
they all turned out phenomenal so that is my review I would definitely shop
again I'm actually so impressed it was really nice and I you definitely could
see myself repurchasing if you guys like these kind of haul reviews let me know
in the comments below
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Top 10 Bizarre Ways Pharmaceutical DRUGS Change the ENVIRONMENT - Duration: 9:24.
Top 10 Bizarre Ways Pharmaceutical Drugs Change
the Environment
10.
Contaminates Water
While current sewage management systems remove a lot of waste from water, there are no sewage
plants equipped to filter out chemicals from drugs.
After leaving treatment plants, sometimes the water re-enters bodies where we get our
drinking water from.
There are cases of treated municipal sewage being released into waterways all over the
world.
In 2002, the U.S. Geological Survey tested 139 rivers in 30 states.
They found 80% of them contained traces of pharmaceuticals, hormones and steroids.
Many of these drugs are also found in our drinking water.
The good news is that the levels aren't high and the chemicals in the water aren't
harming us.
However, it's a growing concern for experts, as research into pharmaceuticals in the water
was started just over 10 years ago.
The long-term effects are still unknown.
9.
Makes Marine Life More Reckless
One of the most commonly prescribed medications is antidepressants, with 13 percent of American
adults having a prescription.
That makes for a lot of chemicals entering the water system through the toilet, and made
researchers curious as to how this would affect a species like shrimp.
In a lab, researchers exposed shrimp to a small amount of fluoxetine, which is one of
the main components in anti-depressants like Prozac and Sarafem.
In the ocean, to avoid predators and stay safe, shrimp tend to hide in dark places.
However, after slight exposure to fluoxetine, the shrimp became much more reckless.
They were five times more likely to go out into bright, open areas.
If this were to happen in nature, it would make the shrimp much easier prey, which could
devastate their population.
8.
Makes Aquatic Life More Aggressive
In a lab, researchers introduced a small amount of antidepressants to water that housed cuttlefishes.
Despite their name, cuttlefishes are molluscs, so they're similar to squids and octopuses.
Researchers put a shrimp, which is what cuttlefishes eat, in a test tube and dipped the end of
the tube into the water.
The cuttlefish that weren't exposed to the drugs gave up trying to get the shrimp when
they realized they couldn't get through the tube.
However, the ones that had been exposed to the drugs were much more aggressive and wouldn't
stop trying to get the shrimp, wasting a lot of energy in the process.
When they tested antidepressants on crayfish, they found that males exposed to anti-depressants
would fight longer and mortality rates went up.
7.
Can Be Devastating to Zooplankton
If anything in an ecosystem goes wrong it can cause a devastating ripple effect.
One species that's a major part of the foundation of freshwater ecosystems are zooplankton.
These microscopic plankton eat algae, and then in turn fish eat them.
If their numbers are depleted, algae would overgrow and fish mortality rates would go
up.
So a researcher at the University of Wisconsin-Madison performed a number of tests on Daphnia, a
genus of zooplankton.
She put the Daphnia into water with environmentally relevant concentrations of fluoxetine, a cholesterol
lowering drug, and five common antibiotics.
At first she subjected the Daphnia to one drug at a time.
She found that with the antidepressants, the Daphnia had more offspring.
When exposed to antibiotics, the Daphnia lived longer.
Both would upset the amount of zooplankton in an ecosystem.
But when exposed to a mixture of the antidepressant and cholesterol drug she found that 90% of
the plankton died.
When they did have offspring, they were mostly female and mostly deformed.
The cholesterol drug didn't really have much of an impact on its own, but when mixed
with just one other drug like it would be in nature, it was destructive.
6.
Feminizes Marine Life
Hormonal contraception, a birth control method, adds estrogen and progestin into the user's
body.
After the body uses the estrogen, it leaves through waste.
So while hormonal contraception is helpful to humankind, it can be devastating to ecosystems.
A researcher at the University of New Brunswick added a little bit of estrogen to a test lake.
Shortly after, male fathead minnows started to develop eggs.
Due to the feminization of the minnows, their population plummeted to
just one percent of what it was before.
The lake trout, which ate the minnows, had their numbers drop as well, while insects,
the minnows' source of food, had a population increase.
When the estrogen was removed from the system, the population of minnows replenished to the
numbers they had before.
5.
Contaminates Soil
It's believed that hundreds of millions of farmers around the world use human sewage
for fertilizer and wastewater to irrigate crops.
In fact, more than half the treated sewer sludge from American waste facilities is used
as fertilizer.
The U.S. Geological Survey did research on soil after it had been fertilized.
They found traces of pharmaceuticals, cleaners, cosmetics, perfumes and chemicals from soaps.
One of their worries is that these traces didn't stay on the top layer, but could
be found as far down as seven feet below the surface.
When chemicals get that deep they can affect water sources, which adds even more chemicals
to contaminated drinking water.
4.
Alters Plant Growth
With 30 million prescriptions written every day, diclofenac and ibuprofen are two of the
most widely used drugs in the world.
Researchers at the University of Exeter wanted to see how traces of these painkillers affected
the growth of different plants.
They found that the drugs affect vegetables in very specific ways.
For example, when radish roots are treated with diclofenac they have growth problems.
Ibuprofen, on the other hand, had an impact on the early development of the roots of lettuce
plants.
It's important to note that this is preliminary research, and the study used one drug at a
time.
In biosolids, the crops are exposed to a number of different chemicals from drugs.
It's still unclear what impact they'll have on crops and the people and animals that
eat them, especially when the chemicals are mixed with pesticides.
3.
Almost Wiped Out Three Species of Vultures
Humans aren't the only species to use pharmaceutical drugs.
In the United States alone, the animal pharmaceutical industry is worth hundreds of billions of
dollars.
While the FDA and other federal regulators have deemed treated animal meat safe for human
consumption, it can have pose a far greater danger to ecosystems.
In the late '90s, three species of white vultures were dying off in large numbers in
South Asia.
In 2002, researchers did a study in Pakistan and discovered that the cause was the anti-inflammatory
drug diclofenac, which was given to cattle to reduce fevers.
The researchers believe that the vultures ate from carcasses of cattle that had been
given the drugs, which caused kidney failure in the birds.
Diclofenac was responsible for wiping out 95% of the three species, which were put on
the critically endangered list.
With such a fast decline in numbers, a number of ecological problems emerged.
Animals like feral dogs and rats, which compete with vultures for carcasses, were able to
flourish.
Unfortunately, they're natural reservoirs for disease.
Without the vultures to keep their numbers in check, it's increased their chances of
spreading disease like rabies and even the bubonic plague to animals and humans.
2.
Possible Link to Prostate Cancer
Doctors at Princess Margaret Hospital in Toronto found that countries with high rates of women
using oral contraception also have men with a high prostate cancer mortality rate.
But they didn't find a significant link with other forms of contraception, like condoms.
Also, there was no difference between rich and poor countries.
The pill is the cheapest form of birth control, so it's used around the world.
Raises in hormonal levels being linked with cancer is nothing new — birth control pills
have a significant link to breast cancer.
The researchers believe that, while only a small amount of estrogen is passed into the
system via urine, there are so many women that have taken birth control since the early
'80s that it's caused low level environmental damage to both food and water sources.
However, the researchers also pointed out that they're not sure exactly what the cause
and effect is, and they don't want to encourage women to stop taking the pill.
1.
Antibiotic Resistance
People are becoming more resistant to antibiotics.
This is especially true in places like China and India, where most antibiotics are produced.
These facilities don't exactly have the highest standards for waste disposal, and
chemicals from drugs gets into drinking water.
Livestock and fish ingest the water, and then we eat them and build up more of a resistance.
Since the discovery of penicillin in 1928 100 classes of antibiotics have been discovered,
but no new compounds have been found since 1987.
Bacteria are constantly evolving to resist antibiotics, which means we're quickly running
out of effective antibiotics.
It's thought that having antibiotics in the water is only speeding up the process.
Resistance to bacteria is already becoming a big problem in Europe, and scientists believe
it's only a matter of time before we live in a post-antibiotic world.
Even common infections could then become deadly.
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