« Back You are using an outdated browser. Upgrade your browser today or install Google Chrome Frame to better experience this site It is with great sadness we announce the passing of Nicolina Sciacca (nee Bavetta) on January 20 with whom she shared 59 years of marriage with and her daughter Melinda (Matthew) Sciacca She will be missed by her brothers Vince Bavetta She was recognized for her hardwork and her passion for her career she was a hairdresser at 13 years old and owned her own salon at the age of 14 owning many successful property’s within the Windsor-Essex area Visitation will be held at Windsor Chapel - Banwell Chapel (11677 Tecumseh Rd E) on Thursday 2025 from 3:00pm to 5:00pm and 7:00pm to 9:00pm 2025 at 11am until the time of service in the chapel at 12pm Entombment to follow at Heavenly Rest Cemetery Online condolences and cherished memories may be shared to windsorchapel.com Get Directions Central Chapel | (519) 253-72341700 Tecumseh Rd Banwell Chapel | (519) 253-723511677 Tecumseh Rd South Chapel | (519) 253-72363048 Dougall Avenue Proudly Canadian | Owned & Operated by Arbor Memorial Inc (FOX26) — The Madera County District Attorney's Office announced murder charges against Lenny Sciacca have been dropped Sciacca of Visalia had been charged with the February 15th homicide of Nicole Kunz Kunz was found dead at a residence in the 40000 block of Bailey Flats Road in Raymond in Madera County MCSO Detectives served search warrants at Sciacca’s Visalia residence Based on evidence recovered from these searches he was detained and later arrested on March 29th He was been booked into the Madera County Jail on charges of first degree murder The Madera County District Attorney's Office said we believe that the 12 Madera jurors would no longer be able to unanimously agree on the defendant's guilt." Anyone with information on the murder of Nicole Kunz is asked to call the Madera County Sheriff's Office at (559) 675-7770. This website is using a security service to protect itself from online attacks The action you just performed triggered the security solution There are several actions that could trigger this block including submitting a certain word or phrase You can email the site owner to let them know you were blocked Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page Seton Hall University’s Women in STEM (WiSTEM) is a movement toward inclusivity and breaking down barriers for women and gender minorities in science With a mission to bridge the gender gap in STEM WiSTEM provides a community where students and opportunities to grow professionally and academically a junior biology major and president of WiSTEM said that the organization’s mission is to be leaders for women who are joining STEM although the club is open to anyone passionate about supporting women in scientific fields “We want to bring more awareness to the subject,” Sciacca said Sciacca emphasized the importance of community within the organization “We pride ourselves on having a diverse background and connecting with our members,” she said making sure our members know they’re supported.”  WiSTEM provides a personal mentorship experience creating a network of encouragement beyond structured programs “There are other mentor programs on campus a genuine connection between women in STEM who understand each other’s struggles,” Sciacca said WiSTEM also strives to make an impact on the community One of their current initiatives involves launching a STEM program at Maplewood Middle School including e-board members and new positions,” Sciacca said allows WiSTEM members to visit elementary schools and conduct science experiments with students said that the Adopt-a-Class Program has been fun I would have loved something like this,” Elliott said “It feels like we’re making a positive impact on our community.”  Women and gender minorities in STEM still face challenges including being underestimated in academic and professional settings “I’ve experienced moments in the lab where I’ve been talked over,” Sciacca said “Women and gender minorities are sometimes seen as less capable but we help address that by encouraging members to find their voice.”  a senior biology major and WiSTEM’s PR chair also highlights common biases: “Some people think we’re not smart enough or that we don’t belong in the room but if we support each other and encourage more women and minorities WiSTEM actively collaborates with SHU faculty and professionals to create new opportunities for its members acknowledges their faculty advisor’s role in fostering connections [Angela] Baglio has been super helpful in reaching out and trying to find shadowing opportunities for us,” Osborne said “She also shares our information with her classes WiSTEM has been successful in their academic and professional journeys “One of the biggest things for me is when girls come up to me after meetings asking for advice on getting research opportunities,” Osbourne said “Being a support system for them has been really rewarding.”  a junior biology major and event coordinator said she hopes to leave a legacy of mentorship and I want our leaders to be mentors for them,” Cinquino said “We want to expand the club’s reach both on and off campus.”  WiSTEM also prepares its members for life after graduation a senior psychology in the honors college and secretary of WiSTEM shared how the organization shaped her professional growth: “WiSTEM helped me build leadership experience in the sciences which is exactly what I want to do after graduation It also gave me networking opportunities that will help in my career.”  Burns emphasizes the importance of resilience as well: “In STEM “We’re at different fairs where students can sign up but anyone can reach out to us or just show up to a meeting,” Osborne said and so many ways for people to get involved.”  As a final message for students considering STEM careers “Don’t let anyone tell you that you can’t do it proving that women and gender minorities not only belong in STEM but can also succeed in it Victoria Sanders is a writer for The Setonian’s Campus Life section. She can be reached at victoria.sanders@student.shu.edu Please select what you would like included for printing: Copy the text below and then paste that into your favorite email application This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply Service map data © OpenStreetMap contributors WESTMINSTER — Nola Sciacca has been named the September Elks Student of the Month for Bellows Falls Union High School is the daughter of John and Amy Sciacca of Westminster excels in academic analysis and logical thought She can always be relied on to produce original and creative work Nola works hard to develop her writing skills in addition to learning an enormous amount of content she is even more passionate about debating and discussing controversial topics and always willing to offer her own insights into class activities as she adds a new dimension of depth and insight to class discussions Her tremendous enthusiasm and interest in life and the world make her a positive role model for others She is courteous and respectful to all and works hard to include others in activities Nola attended a school board meeting and spoke passionately in support of the Advanced Placement classes and how the curriculum had added value to her life She comes to school every day ready to learn and participates in a variety of activities She has emerged as a leader within the school community and is well respected by her peers and the staff at BFUHS Students gravitate toward this courteous and respected young woman Nola has served as Secretary and President of the Class of 2025 over her four years at BFUHS she has been treasurer and a valued member of the Student Council Nola is looked upon as an honest and dedicated student who is nothing short of a pleasure to have in class One of the attributes that places Nola above her fellow students is the respect that others have for her her peers or even parents in the stands at athletic competitions she is revered as one of the school’s finest Nola represents BFUHS and the community proudly and enthusiastically in school and at events that she attends and participates in BFUHS and the Elks are proud to have Nola represent us as a Student of the Month Get the latest headlines every morning in TheBeat Breaking news delivered directly to your inbox Everything you need to know about the arts and culture scene in Southern Vermont Your browser is out of date and potentially vulnerable to security risks.We recommend switching to one of the following browsers: Get up-to-the-minute news sent straight to your device Perfect order Italian arancino with pasta salad a counter-service spot that opened in September is Italian in origin — owner Alfio Sciacca moved here from Sicily at the age of 24 — but as he’ll tell you specializes in arancini (fried Italian rice balls) which he stuffs with dishes from these countries and regions filled with chicken tikka masala; the Birriacino and seasoned rice that’s a fried version of spicy jambalaya but my favorite is the original: the classic Italian arancino it has a crisp golden exterior and a center filled with rich meat sauce It’s served with marinara sauce on the side for dipping every bite Each $8 rice ball comes with your choice of fresh-cut fries or a housemade pasta salad Opt for the latter — it’s made with a light touch of mayo which adds just the right amount of crunch and brings this international restaurant right back around to Chicago Tags: Dining & Drinking, Neighborhood Finds Chicago magazine newsletters have you covered One of the problems was a lack of an alternative robust option to offer patients you have to offer them something viable as an alternative to dialysis can mean not only a “conservative approach,” as in non-invasive/less aggressive but also an effort to “conserve” what kidney function remains We get right down to the nitty gritty of kidney supportive care techniques they incorporate in clinic For more info on the CME credit, go to https://geripal.org/cme/ ABIM MOC credit will be offered to subscribers in November, 2024.  Subscribers will claim MOC credit by completing an evaluation with self-reflection questions. For any MOC questions, please email moc@ucsf.edu Eric 00:09 Alex 00:12 Eric 00:13 Alex 00:15 who’s a palliative care doctor at Dana Farber Cancer Institute in Brigham Women’s Hospital And I saw that he actually wrote a post on GeriPal    back in 2013 when he was a fellow Eric 00:35 Alex 00:36 Josh 00:39 Alex 00:42 We’re delighted also to welcome Sam Gelfand who is a dual certified nephrologist and palliative care doctor also at the Dana Farber Cancer Institute in Brigham and Women’s Hospital Sam 00:55 Alex 00:57 who’s a palliative care nurse practitioner at the Dana Farber Cancer Institute and Brigham Women’s hospital Kate 01:05 Eric 01:06 So we got a lot to talk about today about palliative nephrology or kidney pal Sam 01:18 we would love to hear down Under by Men at Work Eric 01:24 Sam 01:27 a lot of what we do in kidney palliative care derives from the worldwide pioneers in this kind of medicine where Kate and I both got to rotate when we were still fellows Eric 01:42 nice shout out to our Australian colleagues Alex 01:51 Alex 02:16 Alex 02:21 Eric 02:32 Sam 02:37 I think we should get our Australian colleagues on the line to explain it There’s a lot of vocabulary in there Eric 02:43 Alex 02:45 the next chorus features the word “chunder” which I googled yesterday and learned means to vomit Josh 02:59 Especially if you drink your beer thickened Eric 03:03 And a head full of zombies is a reference to… Alex 03:08 Josh 03:15 Eric 03:17 Alex 03:20 Eric 03:23 You think it’s early in the eighties Alex 03:24 Eric 03:25 that is not the topic of today’s podcast So I think this is started because we heard of a pretty interesting service at Dana Farber when did this service start and what does it do Josh 03:48 Eric 03:49 Josh 03:51 It’s a service we started in about 2018 Kind of realized that we had put so much of our energy into providing palliative care for people with cancer diagnoses And so there’s an institutional strategic planning process to figure out how to do something differently How do we get palliative care to other populations the Brigham identified a few areas where we could really lean into to do a better job getting palliative care to people The nephrologists and all the staff that worked there were hungry to have a palliative care team come and join them So we did some work building an embedded service for patients with kidney disease kind of within the nephrology division at the Brigham We were very lucky to get a full interprofessional but an inter professional palliative care team dedicated to providing specialty palliative care for people with kidney disease Eric 05:03 Josh 05:05 Kate 05:11 Eric 05:16 Kate 05:20 And then we have a social worker position that’s open Eric 05:40 Kate 05:42 I think January 1 of 2019 was kind of the or January 3 but we’ve been open in so since then We opened our clinic in the spring of 2020 Alex 06:03 Kate 06:04 got derailed for a bit and then kind of have been picking up steam over the past two years Alex 06:15 how do you integrate with the nephrology service Sam 06:23 We partner really closely with the nephrologists and we actually hold our clinic in the same physical space where the nephrologists see their patients Eric 06:32 I can imagine you partner very well because you are both pallor Sam 06:38 Tuesdays I am with Kate in our kidney pal clinic We are often partnering closely and co managing patients with advanced kidney disease in the clinic And occasionally our nephrology colleagues who would rather focus on other parts of care just ask us to take over their patient’s care And I act as the nephrologist with Kate and our social worker as the palliative care branch Eric 07:09 So you’re actually switching hats a lot You’re not just acting as a palliative care doctor Kate 07:19 She’s learned beautifully to wear two hats at the same time Sam 07:25 how do you feel about taking four medications Which actually is how maybe we should always approach that But it’s been a process to meld the two approaches Eric 07:40 And real quickly about the patient population And that’s where your team is getting involved Kate 07:56 where our whole entire program first started back in 2019 we started with just patients who were on chronic hemodialysis and they had already kind of established an IDT structure for those And then we did something really cool over the whole entire origins of our program This is what we’re going to be helpful with and we’ve just kind of flowed naturally towards more being more involved in the decision making process around dialysis and the outpatient space and more and more towards that space over time still doing symptom management for people on dialysis still having conversations about stopping dialysis it’s kind of grown more and more towards that decision making support around initiating or discontinuing dialysis Sam 09:00 because I think there was a huge learning experience for the nephrologist to see how can we be most useful to them the first pain point and patient population that come to mind are the ones who are really suffering talk about what’s going on and break bad news this team can really help us way upstream with the patient with Aki who needs a much more in depth conversation about their options and what makes sense for them before they’re on dialysis as a default And so the consult origin shifted to the general consult service of people coming in with new kidney disease asking our team to be involved in those kinds of consults Alex 09:50 It sort of mirrors the trajectory of palliative care in other serious illnesses like cancer can you help us with symptoms like pain and other distressing symptoms And then as they realize and build trust and relationship and comfort level and they see the skills that palliative care has to offer they become more and more comfortable with upstream conversations about goals of care could we jump to talking about how you help with those conversations around conservative management versus dialysis Eric 10:31 I love that because we actually had a podcast with Karen Ladin about that issue And I remember the thing that I remember from that podcast was that she did these qualitative studies with patients and patients didn’t know it was a choice because two thirds of nephrologists didn’t bring it up as a choice So there was this need for this type of intervention that you’re doing So what are you actually doing around this peri Dialysis versus conservative management space Kate 11:08 we’ve kind of naturally gravitated more towards this decision making space And then a huge thing that’s grown out of that is our work in the conservative management space I’ve done a test on patients who are on dialysis And I think Sam and I both feel really passionately about then there has to be something on the other side of that bridge you can do conservative kidney management and then send them out along their way It can’t be defined as the absence of dialysis Eric 11:59 And so that’s conservative kidney management Kate 12:03 Eric 12:05 And so that’s where it’s a real thing now Kate 12:07 growing efforts to kind of define what conservative kidney management is and provide support and guidelines and teaching around And what do you need to have a rigorous CKM clinic Eric 12:25 Sam 12:28 And what I think the most positive outcomes have been achieved is when it’s a team based holistic approach to the care of kidney failure for the patient who has kidney failure and their family It can’t be done by a single nephrologist or a single palliative care specialist It should be ideally from an interdisciplinary team tackling we’ve broken it down into four big domains or categories The symptoms of uremia or kidney failure can be managed with medications a huge part of conservative kidney management is the conservative part Conservative means to some people that you’re not doing something but it can also mean conserving what you have Alex 13:31 Sam 13:35 The idea is that it’s really a continuation of conventional CKD care with Ras and anything that we know might actually extend the shelf life of the kidneys that you have what makes sense for the individual in front of us how long do they have to benefit from certain medications Is this a benefit that accrues over ten years or is it over six months of being very picky about how long we get and how often we take labs and all of that as part of the CKD management bucket And then the two other buckets that I think are essential are the psychosocial support piece and the advanced care planning piece which is really for conservative kidney management to not turn into a 01:00 a.m starting dialysis in the emergency room picture You need to talk about what the expected course of things is likely to be what an action plan is going to be during the setbacks and all of the things that maybe aren’t spoken about too much in typical nephrology practice We focus a lot on those in our conservative kidney management discussions Eric 14:53 I’m just thinking back to our Gretchen Swarzy podcast about when we’re thinking about surgical interventions There’s fundamentally four things that surgery does When you think about this type of conservative kidney management versus let’s get them into dialysis Alex 15:28 we’ll link to it in the show notes associated with this podcast huge financial pressures towards dialysis in this country Eric 15:38 What do we know about the outcomes of conservative this type of conservative kidney management versus let’s get them onto dialysis over the course of the last couple decades an early and earlier initiation of dialysis with higher gfrs Sam 15:55 I think you just nailed it because people overestimate their survival with dialysis and underestimate survival with conservative management And then Kate and I always like to say it’s rarely about survival If you ask people what really matters to the most if time is uncertain talking about what life can look like with one versus the other is where we spend a lot of our time I think the observational data that exists shows that the survival and quality of life benefit from dialysis is attenuated or completely erased in patients who are very seriously ill as well as patients who are more advanced in age over 80 So that alone can’t tell us whether dialysis or conservative management is the right answer but it’s certainly the starting point Eric 16:50 And I also love there’s another study looking at the time given But if you include hospital time and dialysis days Kate 17:12 and we have shown patients it visually before Eric 17:17 Kate 17:18 this may not extend your life as long as dialysis but it may give you the same amount of time at home And so we address that right at the start of when we talk about conservative kidney management And it’s a pretty good litmus test to see whether somebody would be a good candidate and want to do CKM versus whether they might have more hesitancy around it Sam 17:57 the people who chose dialysis lived more than twice as long if that’s what I’m going to be spending my time doing Eric 18:15 There’s an article ways ago about nursing home patients initiating dialysis their functional status is maybe they’re uremia coming out And if you just fix the uremia with dialysis But nobody improved on dialysis in this population Most people either died or had a decrease in function after dialysis Alex 18:47 Eric 18:49 How do you talk about function and prognostication around function when you’re thinking about conservative versus dialysis decisions Sam 18:58 You guys are hitting all the greatest hits every single study we try to talk about when we educate clinicians that New England journal study is so sobering because dialysis initiation in people living in a nursing facility maybe we can just get you a little less edema in your legs people who work in clinical medicine know that that doesn’t seem to be the typical experience but the one that we sometimes show is from the UK I think it’s 75 people who chose conservative management and they did functional status assessments by the Karnovsky monthly until death And then looking back from the year leading up to death it turns out that those people’s functional status stays relatively stable remitting type of curve that we know our patients on dialysis have Conservatively managed patients with kidney failure look as though they stay pretty stable up to the last month and then have a really precipitous drop right before death Kate 20:31 that’s what we see that ties into how we talk about their advanced care planning we can sort of identify where they are on that trajectory kind of why we do so much time talking about that transition point and thinking about it amongst ourselves Alex 21:02 at what point do you introduce the idea of hospice Or is hospice able to layer on top of the services that you provide in KidneyPal Kate 21:15 We talk about hospice at the start and say that at some point when your body starts to decline or your kidneys start to get worse and it makes more sense to bring the care to you we’ll probably recommend hospice services That’s like part of the initial discussion Eric 21:36 The groups also who that’s heading towards dialysis Kate 21:41 Eric 21:43 Kate 21:44 Josh 21:44 Kate 21:46 Eric 21:47 Josh 21:50 It’s hard to get people who are on dialysis hospice services in a timely manner I suppose because of the regulations around hospice It’s complicated and there are models out there where they’re trying to do concurrent dialysis in hospice care in Pennsylvania while the rules say someone could continue dialysis on hospice if they have another diagnosis the trend that I understand from the hospices lately is that Medicare and regulatory agencies still often consider kidney disease as a piece of what’s causing that person to get sicker and I think I’ve heard anecdotally elsewhere more hesitant to try and carve out the dialysis side of things which means in order to enroll in hospice for someone And for most people who’ve been on dialysis it’s hard to kind of realize the benefits of hospice for that group We do do preparatory work for people about thinking about stopping dialysis but less of it is about the hospice piece of things because it is just a short piece of that care They’re often so sick by the time they choose to stop that there’s not a lot of time Eric 23:15 We did a podcast with Melissa Walkerman about all of these issues around dialysis and hospice We’ll have that and a link to another article that Melissa Chimero and myself Alex 23:34 Eric 23:35 how do you talk about symptoms in conservative kidney management versus dialysis Sam 23:51 Alex 23:53 Sam 23:58 I think the sad reality is that kidney failure is a highly symptomatic illness I don’t say end stage renal disease or ESRD because technically that’s defined as the illness treated by dialysis or transplant because kidney failure is what causes the symptoms is a modality that can provoke more symptoms and they can be severe and frustrating with either pathway We do know that symptoms within dialysis care are not structurally addressed or incentivized to be part of the The quality incentive program that all dialysis units need to sort of try to do their best on their report card really doesn’t have a symptom control metric So there are some worries that symptoms are under reported and under treated in the dialysis population when people are deciding on dialysis versus conservative management we try to emphasize that that’s a huge part of how we partner with patients and families is that kidney failure is likely to cause you some problems And we have ways to help you with those nephrologists specifically we don’t get a lot of education on non dialysis forms of treatment for uremic symptoms So we sort of have a boilerplate of tell us your symptoms and we will go from there So we spend a lot of time sort of trying to get a whole sense of what the person’s going through Eric 25:51 And I’d love to hear about how you address very common symptoms in both how do they compare for those who get dialysis versus those who get conservative kidney management Is it more for those who do conservative kidney management Sam 26:13 So the number of symptoms is roughly the same Four to five severe symptoms is the average which symptoms are most prominent seem a little bit different Fatigue is the number one most common symptom in all patients with kidney failure pain is the number two most common symptom patients on dialysis tend to experience things more like anxiety and muscle cramping from fluid shifts whereas patients with being treated with conservative management tend to report more nausea Any other trends that you’ve noticed in our cohort Kate 26:55 Sam 26:56 Eric 26:57 You want to talk about each of those from a perspective of kidney pal Alex 27:10 Just more dialysis or in conservative management Kate 27:16 Like oftentimes in conservative kidney management And so we try to really target whatever is driving the fatigue Eric 27:45 the more evidence we have around the importance of physical therapy actually moving and getting up helps with fatigue Do we have any around similar data around dialysis Josh 28:02 there’s that one study you always share where they have people in the dialysis units with the little exercise bikes Kate 28:11 Sam 28:12 Eric 28:13 You’re sitting three times a week in this dialysis unit in the afternoon after your morning sessions Sam 28:23 that you can do stationary bike with your legs you can do weights with your non access arm who have amputations and prosthetics doing it The data for that is at least the data that I’m familiar with is mostly about anxiety and depression scores the most is when fatigue is the most common or the most serious thing bothering someone is we talk about their mood We talk about what they enjoy and how to get more of it and all of that acknowledgement and exploration I think itself does have a bit of a therapeutic effect we’ve been doing conservative management for almost two years now we go through how you’ve been sleeping I’ve never been not tired a day in my life Some patients were giving methylphenidate in low doses when it’s truly like isolated fatigue with no other aspect of identity or lifestyle And other patients were just talking through it and acknowledging it and trying to help brainstorm Alex 29:50 I love that holistic approach to treating fatigue Also very difficult in cancer and heart failure Eric 30:13 Alex 30:15 Because most people wouldn’t have guessed Most people would have guessed pain number one Eric 30:23 Alex 30:24 Eric 30:25 Alex 30:26 Sam 30:29 The initial question that we should always be small fiber neuropathy does respond to certain medications what do we know about what your pain’s from How much are you willing to go through to get a diagnosis of what the pain is from What are some functional goals that you would have if pain wasn’t limiting you so much I actually think nsaids are really underused I’m going to be come after by the Nsaid police But nsaids are used in patients with kidney failure for good they have so many risk factors for complications But particularly in patients who are already anuric on dialysis Eric 31:29 You don’t have to spare the kidneys anymore Sam 31:31 You’re not trying to preserve 260 of urine a day which I actually think does have a prognostic benefit for patients who are still oligaric But if you’re anuric and you’ve got inflammatory musculoskeletal pain Eric 31:49 And I just want to highlight one key point here is just because they have primary thing you’re thinking about is the kidneys Alex 32:01 Eric 32:03 Sam 32:07 Since diabetes is number one cause of kidney failure diabetic neuropathy is definitely one of the top syndromes But the amount of sciatica and musculoskeletal pain we see is huge Eric 32:20 because we often then start thinking about And how do you think about that with people with severe kidney disease Kate 32:38 But we use it a lot in low doses and people with really poor kidney clearance like 100 every other night and somebody with really compromised kidneys Eric 33:08 Kate 33:12 and then if it doesn’t work or works to some degree then we oftentimes go to lyrica as kind of a second choice Eric 33:24 you just dose gabapentin just post dialysis and no other additional doses Sam 33:33 The starting dose would be usually three times a week after dialysis at about 100 milligrams a day Many dialysis patients can go up to 300 milligrams per dose We’re talking 25 milligrams per dose which sound homeopathic when you’re not working in relation And because it’s clusters of not just neuropathy but also itch also poor sleep can have a really positive effect on all those Eric 34:07 Sam 34:13 The data is sparse and you’re supposed to avoid or dose reduce in kidney failure But we do use a good amount of duloxetine at low starting doses Kate and I use a lot of really low dose buprenorphine and low dose methadone Alex 34:36 Sam 34:40 fentanyl and dilaudid are the safest for people with kidney failure hydrocodone and tramadol are the most used Eric 34:57 I always thought dilaudid and oxy were kind of middle ground Sam 35:15 I’d say that’s fair in low doses is where you run into more toxicity with oxycodone Eric 35:28 Kate 35:31 Eric 35:33 Alex 35:35 Kate 35:37 it’s elderly patients who have a lot of pains things like that that really inhibit their quality of life And a low dose butrans patch is like easy for people to remember to do and it can increase their function quite a bit and is safe in kidney disease Alex 36:04 Sam 36:06 you can start it in an opioid naive patient Eric 36:11 because it only delivers like ten or twelve omes per day with that poach Alex 36:20 Eric 36:21 Alex 36:23 Eric knows I handed off the service to him last week and I think maybe every patient was on the buprenorphine patch Eric 36:30 any special concerns of buprenorphine and kidney disease Josh 36:36 the only one we run into is if the pain is going to be severe enough that you’re going to hit a ceiling effect Eric 36:41 So when we see the patch technically maxes out per FDA at 20 So then you got to switch to either higher Sam 36:53 But the number of people in their eighties with back pain who have a GFR of 16 who really only need that much Like we get a lot of bang for our buck with that much and they don’t tend to experience as much constipation or sedation Eric 37:20 What pushes you towards methadone instead of butrans patch Kate 37:25 like the vascular pain will go towards the methadone and we use that Thats kind of our go to vascular pain medication ease of use a lot of times is what pushes us if you have an 89 year old person whos frail and at home going to be so much easier for them than measure this liquid methadone into this syringe three times a day Sam 37:56 particularly if you commit to a butranth patch it takes several days to get to steady state If you have a more dynamic situation or something you want to be able to titrate a little bit faster Eric 38:14 Also takes a while to reach a steady state Sam 38:16 Eric 38:17 You could continue to go up on the dose versus like a buprenorphine patch We’re going to do more lightning now because we got more Sam 38:33 Dyspnea manager so it’s like all these symptoms the sort of underlying disease management piece I don’t care what it’s coming from So if dyspnea is coming from volume overload in a sort of person with heart disease I’m leaning hard on diuretics and sort of daily weights sliding scale That has been really effective for a lot of our conservative management patients If it’s not effective or if the dyspnea is coming from another non volume mediated thing For low dose dyspnea or for low degree dyspnea Alex 39:15 Josh 39:17 Alex 39:21 Josh 39:26 This is like what you taught me about Coalesce when I was in Eric 39:29 Turn off Josh’s microphone right now Josh 39:38 Eric 39:39 Kate 39:44 Eric 39:47 Kate 39:49 Sam 39:51 It’s not actually histamine mediated so we treat it the same way we treat other neuropathies Eric 40:03 maybe even three times a week or daily or q other day Sam 40:14 I need to say that going straight to the medicine is not right you really have to make sure it’s uremic Eric 40:25 Because dry skin is super common in diagnosis Alex 40:27 Kate 40:29 that’s what my answer should have been Alex 40:33 Kate 40:35 Those kinds of things is always the first line Alex 40:47 Eric 40:49 I can’t remember if it’s for renal disease Sam 41:03 We haven’t used it for that indication which I’m so proud to just be able to pronounce because I’ve never prescribed it Eric 41:15 Sam 41:16 Listeners have used it and know how to get it covered But our secret ace in our pocket is uv light Kate 41:33 Sam 41:34 They had two incredibly refractory uremic pruritus cases So our patients come back to us and are like Eric 41:53 Sam 41:56 Eric 41:58 Alex 42:03 Sam 42:05 Kate 42:05 Eric 42:06 Cause you try to fix the underlying reason there when you think about symptom management Sam 42:11 one of the most common underlying causes of nausea is diabetic We often use a motility enhancing agent first constipation is so common that we also make sure that that’s not contributing And we try to make sure they’re not using constipating anti nausea medicines like undance Alex 42:35 Sam 42:37 0.5 milligrams orally for that as first line or metoclopramide Kate 42:48 I think the kind of mistake with nausea related to uremia is to say I don’t care if you feel nauseous or not If somebody is actually nauseous from uremia Eric 43:13 So making sure that they’re standing well but I want to thank all of you for joining us on this podcast we want to do another shout out to our australian colleagues Alex 43:27 We really appreciate how much you’ve taught our colleagues who are joining us today Eric 43:34 Here’s a little bit more special song for you Alex 43:41 Buying bread from a man in Brussels he was six foot four and full of muscles He just smiled and give me a vegemite sandwich Web beaters flow and men shunder Chunder can’t you hear Eric 44:22 Sam 44:28 Josh 44:29 Eric 44:30 We’ll have a bunch of links on our website to learn more including about the articles that we’ve discussed on this podcast a very big thank you to all of our listeners for your continued support “doing their own research.”  Self-identified… I read Farah Stockman’s article in the NYT on why… We invite the brightest minds in geriatrics, hospice, and palliative care to talk about the topics that you care most about, ranging from recently published research in the field to controversies that keep us up at night. You’ll laugh, learn and maybe sing along. Hosted by Eric Widera and Alex Smith. Learn more Please enable JS and disable any ad blocker the Governor of Sicily Renato Schifani made an extremely important announcement for the sector: sicilian spa sector restarts after the troubled events of the past few years a Public-Private Partnership (PPP) will be pursued to revitalize the Acireale and Sciacca spas The last bureaucratic difficulties have been overcome and the window for private parties to submit their projects opens these days The available share is 49% of the establishments and the private party will be responsible for renovating the two prestigious complexes The region has earmarked 90 million euros for redevelopment with private parties to provide 94 million euros This news can be better understood by taking a step back and looking at the history of these two spa complexes Sciacca became an important agricultural and commercial center and its name may have come from the Arabic word for "bath" or "cleft." Under the Normans the town continued to prosper and until the 16th century was one of the wealthiest in Sicily the baths went into decline until the nineteenth century when physicians such as Giuseppe Licata worked for their revival deputy Saverio Friscia promoted its the importance at the national level Economic recovery came through the exploitation of thermal waters and the discovery of corals leading to the construction of new establishments including the Art Nouveau complex between 1928 and 1938 has a long history linked to the presence of sulfur springs known and used since Greco-Roman times for their curative properties attracting the attention of doctors and scholars who began to study their beneficial effects the first facilities were built to exploit the springs for therapeutic purposes which marked the beginning of a new phase of growth for Acese thermalism the baths of Acireale experienced a period of great splendor which helped make the city one of the most prestigious spa resorts in Sicily the complex was expanded with new facilities the complex entered a phase of gradual decline culminating in the final closure of the spa in 2010 the Baths of Acireale represent an important historical and architectural heritage with neoclassical and Art Nouveau buildings set in a fascinating landscape "The spas of Acireale and Sciacca have been closed for 10 years but today the region is ready to turn over a new leaf when the previous bid to redevelop them was unsuccessful due to bureaucratic and managerial obstacles this time the context is completely different the region has solved a number of critical issues that only a public entity could address removing the impediments that had discouraged the participation of private companies in the revitalization effort This new scenario can pave the way for real interest on the part of operators in the sector who can now count on more favorable conditions to invest and contribute to the revitalization of the spa The goal is not only to reopen the facilities but to transform them into thermal tourism excellences to offer an authentic and sustainable experience for visitors with positive spillover effects for the territories Precisely to emphasize this vision of quality and innovation the region chose to present the relaunch project within the Thermalia Village at BIT in Milan This decision stems from the conviction that the private individuals who will participate in the upcoming public notices must represent excellence in the sector bringing expertise and strategic vision to revive these facilities and make the most of our land's potential With 90 million euros allocated from the Development and Cohesion Fund and a Public-Private Partnership model Sicily wants to finally transform spas into a reference point for wellness tourism at the national and international level to deseasonalize the offer and thus attract new flows This is the right time to breathe new life into a heritage that deserves to be enhanced in the best possible way The change in thermal water concession fees included in the Stability Law's draft bill is another step forward toward the revitalization of the sector in Sicily allows us to align ourselves with the best practices adopted in other regions finally making investment in the sector economically advantageous with a taxation of 5% on turnover and therefore gross of costs did not allow adequate attractiveness for operators limiting the possibilities of development." This was said by the president of the Sicily Region commenting on the publication in the Official Gazette of the regulation that reduces fees to 0.5% including the design and execution of the works." What to say Good luck to those who will engage in this meritorious work of recovery to return this enormous heritage to Sicily and Italy as a whole dubbed the "Bo Fire," broke out Saturday afternoon in Billings Heights north of Alkali Creek Road prompting firefighters to respond quickly and urge the importance of fire safety before the Fourth of July there are no active flames but the area is continuing to be monitored “We received an alert through an app called I Am Responding that told us there's a fire at this location 'There's a good chance this could get bigger,'" said Annemarie Overcast the disaster and emergency services coordinator for Yellowstone County they were lucky to have caught the fire when they did “It started off Alkali Creek Road and it pushed towards the new Skyway Road We mapped it this morning at 250 acres," said Ellis Recent high winds made the fire unpredictable and difficult to manage We probably had 15 to 20-mile-an-hour winds pushing it The fields out here are ponderosa pine and grass understory which looks green but it's very dry,” said Dustin Sciacca including firefighters in Yellowstone County Yellowstone County Disaster & Emergency Services came to the rescue to ensure no homes burned they have not determined the cause of the fire but our priority right now is to make sure the forward progress and the fire stays inside the perimeter,” said Sciacca All three responders stressed the importance of staying safe for the upcoming holiday and avoiding another potential wildfire “The burn permit system is turned off through July 8th We haven't had a number of fires in the area So we want our firefighters to focus on those fires and reduce the potential for new fires to start on accident,” said Overcast Make sure you have a clear area if you're lighting fireworks off If you're having campfires make sure you have a tool and water to put them out," added Sciacca Taking a chance has proven a valuable asset for Haub Law alumnus Thomas Sciacca over the years Sciacca Law is a busy full-service law firm handling all types of Trusts and Estates matters representing the needs and interests of those in the LGBTQ community through his trusts and estates practice is also very important to Tom He believes in two keys to success (1) never stop improving and (2) never stop giving back Tom cannot imagine practicing in any other area of law and credits two Pace professors with shaping his career Your Pace Law story actually started before you were officially a student at the Law School – talk to us about that I was an employee at what was then known as Pace Law School working as an assistant to Professors Black I really had no intention of going to law school (or any other further education for that matter) working with these professors really opened my eyes to everything one could do with a law degree; they really impressed me with their dedication to scholarship which of your professors at Pace really stand out in your memory There are two Pace professors that shaped my career – without them I would not be where I am today Professor Bennett Gershman – he is the reason I decided to go to law school Funny thing about it was that I never actually discussed going to law school with him until after I enrolled – just by working with him and observing his scholarship and passion for justice really inspired me who was an adjunct professor teaching Wills I took the Wills class thinking I would not have any real interest in the subject matter – it was just one of those classes students were supposed to take prior to the bar exam Professor Rosenthal showed me how one could take an interesting practice area and develop it into a rewarding career where I could help people with important personal decisions and help them through tough times She hired me part-time at her firm while I was still in law school and invested so much time into developing me as a professional in 2007 – was that always your plan or what led you to that point which was a touchy time for the job market shortly after 9/11 I was very fortunate to take a position as an associate in a small Trusts & Estates firm in Midtown Manhattan and was thrilled to have a job in the field I wanted (as opposed to just a job for the sake of having a job) I worked there almost four years and learned a lot that firm did not do much litigation work and I really wanted to be a Surrogate’s Court litigator So I started looking around for a new position While running one’s own firm at age thirty can be scary it is one of the best decisions I have ever made (professionally or otherwise) I was busy and profitable almost immediately Your firm handles all types of Trusts and Estates matters – why those areas in particular and with all due deference to readers in other fields Trusts & Estates is the best thing that an attorney can do with their law degree but doing it well requires such a high level of knowledge in many different Wills Estates touch everything – substantive law of Wills in Taxation from New York University School of Law) I couldn’t imagine practicing in another area Every day I go to work is exciting and there is always something new to learn Your firm also has a focus on trusts and estates related to LGBTQ individuals and families in particular I am very fortunate to work with so many clients from the LGBTQ community While I have only been practicing just shy of twenty years LGBTQ couples had little to no protection under the law and often faced Will contests brought by family members they haven’t spoken to in decades Trusts & Estates attorneys would have to draft estate planning documents to protect against this often depriving clients of having a simple and streamlined plan The Will contests would often be incredibly distasteful with family members coming out of the woodwork and saying incredibly offensive things to challenge the Will – alleging that people lacked testamentary capacity because no sane person could be gay claiming that a couple who had lived together for over forty years were just roommates I’ve appeared in Court when blood relatives attempted to set aside someone’s cremation plans over the wishes of the deceased and her surviving domestic partner I had a client who was HIV+ and a Judge told me that he didn’t feel comfortable having someone like that in the Courtroom Courts have made a real commitment to inclusion and education of judges and non-judicial staff Even though gay marriage is now federally recognized why is it important for LGBTQ individuals to consult an attorney with experience in LGBTQ estate planning specifically a gay attorney will better understand that not every LGBTQ couple wants to get married even though they may A gay attorney will be sensitive to the needs of older gay adults who came out during a time when they had absolutely no family support often moving to Manhattan from rural communities to escape their homophobic families A gay attorney will understand that LGBTQ people often form “family of choice” rather than just the traditional heteronormative definition of “family.” A gay attorney understands the importance of language in legal documents and in verbal communications to ensure that a client hears the pronouns that best expresses their gender identity A gay attorney always has a backup plan – sure but what if you are in a car accident in some exceedingly backward part of this country where a hospital refuses to recognize your marriage – sure you can go to Court but the better plan is to have a Health Care Proxy that gives each spouse rights to make medical decisions independent of their status as a spouse there is a lot of nuance to learn and those of us who are a part of this community are You keep a very active law focused blog on your website focused on changes in the law and more – how do you stay abridge of it all and why is it important for an attorney to do so I believe there are two keys to success: (1) never stop improving myself and (2) never stop giving back When I started my blog over five years ago I wondered if I would quickly run out of things to discuss in twice-monthly blog posts that never happened even though we are quickly posting 200 articles (we recently had to add an index due to the sheer volume of content) The blog is a great way to ensure that I continue learning and continue listening to what is important to people with legal issues in my field I write the blog to be informative and free and people contact me all the time to tell me that the information has helped them navigate their own estate planning or Surrogate’s Court experiences It’s also a great marketing tool – it shows a perspective client that an attorney has the substantive knowledge in their field but also the ability to explain complicated legal concepts in a manner that a lay person can easily understand For any attorney considering starting a blog what were some of the most impactful experiences during your time as a student I was president of the Student Bar Association Executive Productions Editor for Pace Law Review Pace Law Review published my law review note I served as a Teaching Assistant to Professor McDonnell and a Research Assistant to the late Professor Gary Munneke I also had part-time work at Rosenthal & Markowitz LLP and the NYS Attorney General’s Office in White Plains Pace offered lots of great opportunities and I decided to participate in everything I could – nobody could accuse me of missing out Do you have any advice for current or future law students Law as a profession offers many opportunities consider taking some courses before applying to make sure it is a career in which you will be happy I would encourage them to keep an open mind when it comes to their field of interest I wanted to be a union-side labor attorney I knew I wanted to be a Trusts & Estates attorney I knew I wanted to not only do estate planning but also litigate inheritance disputes in the Surrogate’s Court What are some of your passions aside from the law I love teaching and I have been on the adjunct faculty at NYU’s School of Professional Studies since 2006 – I get to work with students ranging from high school students to attorneys attending CLE programs I also love learning new things; after law school I took up American Sign Language classes and now I am learning German my husband Jeremy – by far my greatest passion students from Pace University’s Seidenberg School of Computer Science and Information Systems joined forces with peers from Parsons School of Design for an unforgettable game jam experience themed around scientific phenomena After spending the last 35 years pursuing a career in finance Todd Jacobson ’27 decided to switch gears and pursue a law degree the potentially negative longer lasting consequences became abundantly clear – from educational outcomes to healthcare access I would like to pursue a career in public policy to work on these issues.” this list has everything you need to kick off your Pace experience the right way Copyright © 2024 Pace University Privacy Policy The RealReal prices its items based on several variables measured through search volume and how quickly items sell out These are the hottest brands to buy this season to be on-trend — and avoid overpaying for — next year "Bally is super hot right now," Naiman said of the Swiss brand It's only a matter of time before it goes mainstream telling "The Cutting Room Floor" host Recho Omondi that if she wants to buy an item from Bally The brand began to surge earlier this year; Bally sales were up 42% year-over-year in August Romeo Gigli is "really trending right now" for vintage-lovers The Italian brand became a staple in the 1980s and early 1990s for its romantic style and soft tailoring Although its popularity dwindled over the years Styles from the designer's heydey are "particularly captivating consumers," Sciacca said Miu Miu is among the hottest labels of 2024 with retail sales up 86% in the first half of the year Sciacca and Naiman don't foresee that changing particularly for the brand's bags and sunglasses with queries up 100% and 212% year-over-year Handbags from Loewe continue to be popular as well The label's Puzzle Tote "is selling for an impressive 90% of its original price while searches for the Flamenco bag have jumped 87% year-over-year," Sciacca said "Moschino is a brand to watch as expressive styles gain momentum over uniform dressing," Sciacca said "We're kicking off 2025 with a Moschino spotlight on-site." The Italian designer is known for its lighthearted take on fashion Both Ralph Lauren and Alaïa are seeing surges in search queries on The RealReal The former is experiencing a 57% increase in searches this quarter compared to last year while searches for the latter have risen 29% year-over-year including the most recent styles and vintage pieces from the 1980s and 1990s We have the address for the funeral home & the family on file If you're not happy with your card we'll send a replacement or refund your money Online streaming is available upon family\u0027s request held within our funeral home chapel \u003ca href=\"/resources/webcast-viewing-instructions\"\u003eRead More\u003c/a\u003e The family of Sarah "Sadie" Sciacca created this Life Tributes page to make it easy to share your memories © 2025 Daley Murphy Wisch & Associates Funeral Home and Crematorium Made with love by funeralOne © 2025 Slippery Rock University Athletics Thanks for visiting The use of software that blocks ads hinders our ability to serve you the content you came here to enjoy We ask that you consider turning off your ad blocker so we can deliver you the best experience possible while you are here A sale of terracotta cribs and crib figurines (pasturi) was held in the hall beneath Ta’ Pinu sanctuary in aid of the sanctuary’s retreat house who runs one of the storehouses of Cascio Ceramiche in Sciacca a town and comune in the province of Agrigento on the southwestern coast of Sicily The storehouse is located in the historic centre a few steps from Piazza Angelo Scandaliato At the sale there were other ceramic items from Cascio lampstands and Our Lady of Ta’ Pinu baubles He has already exhibited on the island and also in Malta The Knights of St John in Malta used to order their ceramics from Sciacca Among the many items bought from Sciacca were decorative vases used for medicine which are found at the Sagra Infermeria in Valletta Ceramic objects brought over from Sciacca are found in several palaces and museums in Malta Proceeds from the sale of items are being used for Ta’ Pinu sanctuary’s retreat house please register for free or log in to your account A €20 million freezing order against Sciacca Grill has been dropped by court order, after it was cleared of all criminal charges related to the Vitals concession deal earlier this week which runs a chain of eponymous restaurants had been named in criminal charges filed against Joseph Muscat chiefly because of its previous associations with Schembri.  Magistrate Rachel Montebello ruled that prosecutors had failed to provide sufficient evidence to justify the company’s continued inclusion in criminal proceedings.  David Bonello and Marion Camilleri challenged the freezing order against the company arguing chiefly that once criminal proceedings against the entity had been dropped The challenge was filed within the seven-day time limit imposed by law almost a month ago and in between then and the actual date of the hearing Sciacca Grill had since been acquitted of wrongdoing in this case The company said in its filing that it had no involvement whatsoever in the hospitals concession and that Keith Schembri had sold the company to the restaurant’s current owners in 2014 the prosecution said there was still a possibility that the Attorney General could appeal the decision and order Sciacca Grill to be arraigned afresh the funds would not be protected and this is why the order should continue to be upheld Madam Justice Edwina Grima said that while the AG did indeed have a right to appeal the decision to acquit Sciacca Grill it had not filed an application seeking a warrant for the arrest of the discharged entity Sciecca Grill must be considered acquitted of all the charges levelled against it “The Court is not given the privilege of waiting for the Attorney General to decide whether or not to contest the decision to discharge and request this court to arrest the discharged person anew,” the judge said noting that the one-month timeframe in which freezing orders can actually be challenged is “quite short” While the law did not envisage the current situation Sciacca Grill found itself in it still held at its core that the company should not remain subject to a freezing order when it had been acquitted of criminal wrongdoing.For these reasons the court revoked the freezing order issued against Sciacca Grill The Madera County Sheriff's Office (MCSO) arrested60 year old Lenny Sciacca of Visalia for the February 15th homicide ofNicole Kunz according to a press release late Friday night was found dead at a residence in the 40000 block of Bailey Flats Road in Raymond "I was really upset because we didn't have any answers or anybody to hold responsible," said Heidi Cox he was detained and later arrested on March 29 He has been booked into the Madera County Jail on charges of first degree murder "The relationship was full of toxicity," said Cox "I would say there was a lot of red flags not during the whole course of the relationship but definitely over the last few years." Cox said Kunz worked as a realtor with Sciacca and developed an on-and-off relationship with him six years ago "It's not just her life that he that he took," she said this is a choice that was made that has horrible effects for everybody that's involved." According to the Sheriff's Office inmate booking site personal and intentional discharge of a firearm during commission of specified crimes resulting in great bodily injury possession of a controlled substance while armed with a loaded firearm "We feel like a little bit of weight off of our shoulders that justice will be served for her," said Cox Sheriff Tyson Pogue states in press release “I am immensely grateful for the dedication and meticulous investigation by our Investigations Unit Their tireless efforts to uncover the true circumstances surrounding Ms We offer our condolences to her family and friends as they mourn their loss.” Cox just hopes her best friend gets justice "I don't know why he thought that he had the right to take her life," she said but that's something that he's going to have to deal with on his own and I just hope that he does carry that guilt every day." A GoFundMe account has been set up to help with expenses for Kunz was placed on probation for a year and ordered to pay fines and costs of $918 after he pleaded guilty to filing a false police report Sciacca had reported that he found an armed man inside one of his downtown buildings on Sept 21 and began to wrestle with the man and was shot in the side He said he suffered a graze wound and later told Battle Creek police that he had lied.  Sciacca pleads guilty to filing false police report Developer who said he was shot charged with filing false police report Police investigating reported shooting downtown as 180 UrbanDevelopment, several vacant buildings downtown but in November they returned them to Battle Creek Unlimited defense attorney Wesley Todd told Calhoun County Circuit Judge John Hallacy his client "was overcome with emotion and he simply had a very bad day." "I understand what I did and accept responsibility He has no criminal record and can apply to have the felony reduced to a misdemeanor after successfully completing his probation Contact Trace Christenson at 269-966-0685 or tchrist@battlecreekenquirer.com Please include what you were doing when this page came up and the Cloudflare Ray ID found at the bottom of this page.