The S-285 is a committee bill. We had gone through some consultant reports, one from the task force on affordable accessible health care. We also heard from Donna Kinzer, who was a consultant for health reform oversight committee. We also heard from the Green Mountain Care Board, and we also have looked at the financial sustainability report with regard to our hospitals. We had chosen as a committee to look at moderate needs group, and the blueprint, and some language there. As we discussed, I went forward and met with Jen Carby, Nolan Langwell, and Donna Kinzer in particular, and others to bring forward a recommendation in S-285 that we can go through today with Jen. I know there'll be questions, and so we'll go through it with Jen. We'll try to understand what's there. I hope that each of you has had an opportunity to read it. I think after reading it a couple or three times, it begins to join the meeting. It begins to gel. Good morning, Lorraine. I don't know how to do that on mine. That would be fun. Jen, thanks for being here. I know that your time limited and compressed because of where we are, but why don't we look at S-285, and go through that language. Great. For the record, Jennifer Carby, Office of Legislative Council, do you want me to put the language up on the screen? Yes. I think that helps. I do. Yes. Everybody's N is on the same page. I'm sharing the right document. Okay. Hopefully you can all now see this and strike all amendment draft 1.2. This was S-285, the underlying bill is the one that you had introduced as a committee bill, but really with placeholder language, just expressing some intent to address the blueprint and access to home and community-based services. That was the moderate needs group. This would be a strike all amendment, and it would put in a number of new provisions. The first group dealing with payment and delivery system reform, and so this is based in part on the Green Mountain Care Board proposal. This would appropriate 1.4 million to the board in FY23 to engage one or more consultants to assist the board to develop a process for establishing and distributing global payments from all payers to Vermont hospitals that would help move the hospitals away from fee for service and provide them with predictable, sustainable funding that is sufficient to enable the hospitals to deliver high quality affordable healthcare services to patients. That's the first thing is to develop the process for establishing and distributing global hospital payments. Second, determine how best to incorporate hospital global payments into the board's hospital budget review, ACO certification and budget review, and other regulatory processes, and build on the board's existing work on healthcare data collection and analysis through V-Cures and the healthcare expenditure analysis by performing per capita benchmarking analysis by hospital service area and by cost category, and providing meaningful comparisons to spending levels for the same services in other US states and regions. That also incorporates some of the recommendations from Donna Kinzer. That's the 1.4 million. Then it would also appropriate 600,000 to the board to support the board and the director of healthcare reform in the Agency of Human Services in the design and development of a proposed agreement with CMMI, the Federal Centers for Medicare and Medicaid Innovation to include Medicare in the hospital global payments described in subsection A. That's the 2 million then that the Green Mountain Care Board had requested, but including also some data collection and benchmarking work as part of that. This would have by September 1st, the Green Mountain Care Board provide an update on its use of the funds to the Health Reform Oversight Committee, and then by January 15th of 2023, the board would report on its use of the funds and the status of its efforts to obtain Medicare participation in hospital global payments to House Healthcare, this committee, and the Finance Committee. That was the payment and data collection, one of the data collection pieces in Section 1. Section 2 is looking at the delivery system transformation and additional data collection and analysis. This would appropriate $3 million to the Green Mountain Care Board in FY23 to engage one or more consultants to assist the board. First, in facilitating a patient-focused, community-inclusive redesign of Vermont's healthcare system to reduce inefficiencies, lower costs, improve population health outcomes, and increase access to essential services, including both providing the analytics to support delivery system transformation and leading the regional stakeholder community engagement process and supporting hospitals and communities with change management following the redesign. That comes from the Green Mountain Care Board's proposal. Then also using the funds to enhance the state's data collection and analysis by connecting clinical and claims data through an Enterprise Master Patient Index that collects data while preserving and protecting confidentiality of individually identifiable patient information, including determining how best to first optimize coordination and alignment of that Enterprise Master Patient Index with V-Cures and the Vermont Health Information Exchange. In using the data on patient care and outcomes to inform the work of the blueprint in collaboration with the director of the blueprint and the director of healthcare reform. So informing the work of the blueprint, the state health information plan that's adopted by the Agency of Human Services and the Interactive Price Transparency Dashboard developed by the board, Green Mountain Care Board. And finally to detect potentially avoidable healthcare utilization and low value care and identify additional opportunities to use the data for quality improvement and cost containment initiatives. These are some of the proposals from Donna Kinzer and others. Again, this would have by September 1st, the Green Mountain Care Board provide an update to the Health Reform Oversight Committee and then by January 15th of 2023, the board reporting on the use of its funds appropriated in this section, including the status of the delivery system transformation process and efforts to improve the state's healthcare data collection and analysis to the same committees as earlier, this committee, finance committee and house healthcare. So that was the payment and delivery system reform provisions. Then we move into a new group of sections on the blueprint for health. So the first one here would amend an existing blueprint statute to add to the blueprints initiatives, the use of quality improvement facilitators, which is something that blueprint already has but is not specified in statute, and other means to support quality improvement activities, including using clinical and claims data to evaluate patient outcomes. So tying back into that enterprise master patient index language in the previous section and promoting best practices regarding patient referrals and care distribution between primary and specialty care. And this is one of the recommendations that came out of the hospital wait times report that just came out last week. Section four would specify an increase, although it doesn't specify yet, puts in placeholder for you to determine the appropriate increase to the per person per month payments that go through the blueprint to medical practices for contributions to the shared costs of operating the blueprint for health community health teams, just currently reflected in the blueprint statute and quality improvement facilitators, which are not. The increase would also apply to Medicare to the extent permitted by CMS. And then this would appropriate a sum of some amount that goes along with that increase to the per person per month payment and global commitment dollars to diva and FY23 for the Vermont Medicaid portion of the increased blueprint payments. And if CMS does not allow federal financial participation for the increase, then it would be done with state dollars only and would direct the department to reconcile the difference in its FY23 budget adjustment proposal. Then we move into some options for extending moderate needs supports. And so this would create a working group but also infuse these concepts into the next global commitment waiver. This would direct the department of disabilities, aging and independent living, Dale, to convene a working group comprising representatives of older Vermonters, home and community-based service providers, the office of the long-term care ombudsman, the office of the healthcare advocate, the agency of human services and other interested stakeholders to consider issues related to and develop recommendations for extending access to long-term, home and community-based services and supports to a broader cohort of Vermonters who would benefit from assistance with one or more activities of daily living and their family caregivers. And so they would be looking at issues including the types of services such as those addressing activities of daily living, falls prevention, social isolation, medication management and case management that many older Vermonters need but for which many older Vermonters may not be financially eligible or that are not covered under many standard health insurance plans. The most promising opportunities to extend supports to additional Vermonters such as expanding the use of flexible funding options that enable beneficiaries and their families to manage their own services and caregivers within a defined budget and allowing case management to be provided to beneficiaries who do not require other services. How to set clinical and financial eligibility criteria for the extended supports including ways to avoid requiring applicants to spend down their assets in order to qualify. How to fund the extended supports including identifying the options with the greatest potential for federal financial participation. How to proactively identify Vermonters across all pairs who have the greatest need for extended supports and how best to support family caregivers such as through training, respite, home modifications, payments for services and other methods. You would direct Dale to collaborate with others in the agency of human services as needed in order to incorporate the working groups recommendations into the agency's proposals to and negotiations with CMS for the next iteration of the global commitment waiver so that the extended moderate needs supports can be available to Vermonters beginning on January 1st, 2023 just when the next global commitment demonstration should be in effect. An honor before January 15th of 2023, the department would report to number of committees including this committee, House Human Services, House Healthcare, House Appropriations and Senate Appropriations with the working groups findings and recommendations including the portions of the recommendations that were incorporated into the new global commitment demonstration and the amounts of any associated funding needs. Getting close to the end, next we have the summary, summaries of Green Mountain Care Board reports. So this would add to an existing provision in statute on the duties of the Green Mountain Care Board that the board summarize and synthesize the key findings and recommendations from all reports prepared both by and for the board including its expenditure analysis and focused studies. This had been a recommendation from Donna Kinzer and this would make all reports and those summaries prepared by the board available to the public and posted on their website. Finally, the act would take effect on passage though you could change that. And I just noted that you would likely want to update the title of the bill to reflect what is ultimately in it. Take that. Down in step. So questions committee.  I always try to hesitate, so I'm not the first one to ask the question. Good. Cheryl, Ann, anything? Sorry. Question about the blueprint part of the bill. Does that, the payments there are vague? So is it just for anything that they're doing or is it for a specific pro?  Right, so the language that is in existing statute talks about supporting, I believe supporting specifically the community health teams. So I expanded the language to include the quality improvement facilitators, but I don't know, I think there's also appropriations that come or funding that comes outside of the per person per month. Those are really the payments to the practices. Okay, I just want to wonder if it covers, and maybe Josh knows this, covers the stuff they do with both the MAT and, you know, the- Hub and spoke. Hub and spoke. It would be, yeah. The diabetes work that they're now doing. You know, all the many different programs they're doing or if it's for a specific one, that's, it's unclear to me. I think it's general, overall. So- Josh, do you have an answer? Do you know? So there, I'm not sure of the dollar flows from the state to the practice. So I'm not certain how the community health teams are paid. I believe they all get state checks. And so I'm not sure. You know, I don't know the answer to the question. We need to ask the department how those dollars actually flow. Okay. Yeah. I think it would be important to find out, yeah, from the department, from AHS likely, how they fund the individual initiatives within the blueprint for health. Okay. Is that really the question is, how does that, how do the per person per month payments to the practices relate to all of the various blueprint initiatives? Exactly. Exactly.  So I wouldn't want that to be left out. And one of the things that we're hearing obviously right now is that the hub and spoke work is even more important than ever. And so I wouldn't want that. Anyway, I just want to know what the money's for. And then in the section about the moderate needs supports, one thing that we heard pretty clearly from the people who came in and testified was the need to reorganize their wait list to make sure it was reflective of the highest needs, moderate needs, the highest moderate needs. And I didn't, maybe this is in here, Jen, but I didn't see that as part of it like reorganizing the... It's not specifically in here. I think that was reflected in the conversation about the existing choices for care program because this is looking to kind of expand the universe of people and services, people services and funding. I don't know what that would necessarily look like or whether there would be prioritization or wait lists in the future. We can certainly look at adding something reflective of that. I'm just not sure exactly how to... Yeah. How to reflect that. With that, it might go in that introductory statement in A somehow because they're currently doing that. We could just say in addition to looking at, because I think Senator Hardy is right that there's something that they're doing that we probably should reference. Yeah, I just, as we're expanding the number of things that they're doing, I don't want them to not serve the highest needs people with moderate needs. The highest moderate needs. The highest moderate needs. So that was just, and also just one more thing on this section is the timeline seems pretty tight given how overwhelmed they are. I mean, I know it's sort of in conjunction with the global commitment, but it's a lot for them to do in a short amount of time. But it's just an update. I think it was just in a matter of looking at how organized, what their organizational structure was. But at that point, I don't think there's any, I don't think we would expect any robust report. But just, yeah. And then I just assume we're gonna have the Green Mountain hair board in to comment on this. Oh yeah. Okay. I just want to make sure that the first part works for them as well, so. Yes, yeah. We should, we'll reach out. I think, Jen, if you can reach out to Diva about the initial question on the reimbursement or not on Diva, AHS, whomever. Yep, I think I'll start with Ina. Yes, I was thinking that. And then, and we did meet with Ina. I did meet with Ina and others on this, but it's, this is the first framework. So it's important to get some of the details. This is good.  I got a note from Jessica Holmes this morning. So I just want to make sure they get a chance to come in about the language. Yes, absolutely. We'll do that. Thanks. And everything they asked for, we've modified some of the things I've asked for, understanding that we also looked at Donna Kinzer's report. So we're, it's hard to be, have two masters, but that's what we're trying to do, maybe three or four, five or six hundred. Senator Cummings. Yeah, I would like to hear from the home health agencies. Okay. I've gotten an email from my local one and they're losing money hand over fist at this point. So have some real concerns about expanding the responsibility. Well, I think the, but the bill does is to ask for analysis of what is possible, which is why we didn't put in an expansion, but we can bring those folks in. That's a perfectly good idea. Would be helpful. All right. All right. Anything else? That would be Jill Olson probably and maybe Laura Pelosi. That's a nursing home. So I'm thinking visit home health. You want home health? Yeah. That's hitting, that's where this is going to land. Yeah. Do you have a suggestion of someone you'd like to hear from? You could try Centralmont Home Health and Hospice, Sandy Rouse. Okay. But I don't know if they haven't... They may not have, they might not have the global, but... They may, I think they have, I think they have a lobbyist, the whole organization. Yes, Jill Olson is the... Jill. Yeah. That's why I thought. That's why I mentioned her. You could... We'll bring Jill in and she may suggest some additional testimony. All right. Any other questions, comments? Okay. Wow. Okay. So my Josh Slain is here. Do you have any questions for Josh or Josh? Do you want to make any specific comments in the blueprint, moderate needs area? We tried to use at least some of the information that you provided to us. And last time we went through, you may have had some concerns. So I'm just asking for your thoughts here. No, I appreciate that. And I'm happy to be constructive in this conversation here. With the reservation that I would like to read through this a second time, because we went through it quite quickly and there's a lot in there. And it's all connected as we know, right? So each piece is connected. And so, but what I would say is that Senator Hardy's comment regarding the moderate needs group and the prioritization exercise that the department has said they are going through now, my administrative experience would say that it is helpful to have some language that recognizes that it's a priority to have a prioritization and then let the department come back and do that. So I would support that. I think that's a good thing to do. And because once you start doing that prioritization, actually it's good to have legislative language behind you that says you have to do it because it gets thorny when you actually start prioritizing, right? So that's why I say it that way. And then I would say for the blueprint that really that fund flow is important but recognize that any dollars that get given to a primary care entity are fungible once they hit that entity. So there's a substitution that can occur. So that's just We're just saying don't get too specific but we don't wanna be too unspecific. But it's got Well, I think we go in two different directions here, right? One is to say you can only use this money for this very specific thing. And that's pigeon holes it and requires lots of reporting. And the other is just here's dollars for the primary care facility. I think actually given where we are in workforce and given where the blueprint is that that discussion about how to target it is one that should be had after the fund flow is discussed with the blueprint about how to best put this money to use so it doesn't just be absorbed without going specifically where you want it to go. And with the least amount of administrative burden on the providers. So I think everyone can support that generally but it's good to have that explicit conversation so that we don't pump money into the primary care practice and it goes somewhere you didn't intend it to. So that's one other comment. And then I am very interested and look forward to hearing the Jill's comments on the home health agencies and how that rolls out. And then finally my last comment that may be helpful is for the moment is that the question about timing and how fast the department of aging independent living could move forward and do some of the moderate needs changes. I think that regardless of the amount of effort necessary the conversation with our federal partners happening. And so that has to proceed the implementation could be pushed out but the actual global commitment submission this has to go in that whenever it goes in. So I guess my point would be we should be clear if we can in the legislative language that it needs to be in this version of the global commitment not miss that train. And then after that the actual administrative thing could be delayed by a quarter or something. The actual implementation might be delayed because we get backed up but the submission needs to happen and this should be in it. So I think we could be a little more, we could point at that issue in the language a little bit. Okay, that's helpful. May as well be specific. All right, any other questions for Josh? Joshua. Okay. Jen, are you still there? And Nolan. So in terms of the quadruple Xs that we have in the blueprint section then we'll have to sort out what exactly goes in there. I'm trying to think through what goes there what might better be there and maybe Nolan or as, but as we hear from AHS that may help clarify. Okay, so we'll hold that thought until that time. Right, I think you need to identify what the additional funding need is. So you can back into the amount of the per person for a month payment and then that will inform the amount that needs to be appropriated as well. So I think until we have a better sense for what the need is. Okay. We won't know how much to increase it. And for the record Nolan will join this class. So I also think that it would be important to hear from Ina particularly because blueprint is an integral part of the global commitment waiver negotiations. And so our ability to increase payments may be tied to whether we even can use their blueprints always a part of a negotiation. So that's going to play into that piece as well. Right.  What we would like to do is to invest more fully in primary care as prevention and then get savings at the other end. And those are the savings that we'd like to invest but initially you need to have a resource investment to make it happen so it gets catch 22-ish.  Thank you. Just in going through the language a little bit more this section on page two paragraph B the $600,000 to Green Mountain Care Board in the design and development of the agreement with CMS does what do they do versus AHS in that agreement renegotiations? Do you know, Jen or Nolan or Jen? I mean, I think it's definitely a partnership. They were both signatories on the original version. I think there is my understanding that it's important to the federal government that they're both signatories going forward. So the funding is appropriated to the board but it's to support the board and AHS. I think they would need to tell you what their specific roles have been in the past and what they see going forward. Okay. Oh, I see it says the board and the director of healthcare reform in AHS in the design. Right. Okay, so it's for both of them because I thought it was a partnership so I didn't want to make, I wanted to make sure AHS was not left out but I see that it's there. The second question or comment on page three this is the stuff about the, you know, community engagement. I guess I would really like to double down on making sure that we have a really good community engagement process as we're talking about how to redesign or, you know, alter things in our hospitals because so it says community inclusive redesign but I think it would be important to have in their language specific about community engagement with actual people or... Senator, Senator, let's go through it together because that's a whole section that begins on number one and then you're going through with the communities that B, A and B and then two or that so that's, Jen walk us through that because this is a really important point that's being made about making sure that people are fully engaged and it isn't just the, we're not just talking about hospital administrators here. Exactly. We're talking about everybody who's in this healthcare world. So how can we make, how can we put language in that really suggests a robust, you're talking about having a really robust community engagement process. Yeah, I mean, just having been through the Act 46 process I just know that this is not exactly the same but it's kind of similar in some ways and we want to make sure that people know what's happening and it's not just the hospital administrators who know what's happening it's actual people in the community. And I guess I would also include the healthcare advocate in this process too so that there's really somebody at the table who's paying attention to how this will impact patients or consumers as some people like to call them but the people who are using the healthcare. This is, yeah, so that's a good point to be made. So let's think about how best to do that. I see Jen is taking notes on this, this is important. And I think this is a real key part of any transformation that's gonna take place because if people can't work together it isn't gonna happen. So, and when we have the Green Mountain Care Board in we'll have to follow up as we're looking perhaps at some new language that modifies this we'll have to have them in and follow up. Okay, anything else? Committee folks at this time. Do you want to go quickly through the bill one more time? Not at the two foot level but maybe let's go a little bit at a slightly higher level that will help reinforce what's here and then it may raise some questions for Jen as we're going through. So why don't we do that? I think that's repetition is not a bad thing. Okay. Yeah, let's do it.  All right, so the first section then is the 1.4 million to the board to engage consultants around hospital, global budgets incorporating them into the board's regulatory processes and building on the board's existing healthcare data collection analysis work through V-Cures and the expenditure analysis by doing per capita benchmarking analysis so that there can be comparisons to other states and regions in the US. That's the 1.4 million and then 600,000 for the board and AHS to design and develop a proposed agreement with CMS or CMMI in this case to include Medicare and the global hospital payments. And then reports to September 1st, 2022 and January 15th, 2023. And just to reiterate that early 2022 is just to let us know that things have started. That, so. Right, it's really an update. It's an update. Section two is the $3 million for the, to the Green Mountain Care Board for consultants for facilitating the patient-focused community inclusive redesign of the delivery system and supporting hospitals and communities with change management and also to enhance the state's data collection and analysis by using this Enterprise Master Patient Index and figuring out how to coordinate and align that with V-Cures, the Vermont Health Information Exchange, the work of the blueprint, the state health improvement plan, the interactive price transparency dashboard and use the data to look for ways to identify potentially avoidable healthcare utilization and low-value care and other ways to use that data. And again, reports due September 1st and January 15th. Sections three and four are on the blueprint. The first one about using kind of codifying this idea of the quality improvement facilitators and other ways to support quality improvement activities and section four being an increased, some increase to the per person per month payments to medical practices, both for community health teams and quality improvement facilitators. I'm looking to get federal participation and also appropriating some amount as needed and for the Medicaid portion of that. I don't mean to interrupt the flow here, but I just like to make a comment that every time we hear about the blueprint, regardless of whether it's from someone locally or someone at more at a national level, including our consultants, we hear that the blueprint is an outstanding nationally known program. And so that it might not receive a blessing from CMMI would be, I couldn't understand why it wouldn't. So anyway, keep going. Any? Yes. Just, I'm looking at all the millions that we're appropriating. Yep. Is this in the house budget? I don't know. Okay, does appropriations know it's coming? Yeah, I've talked with Senator Kitchell and I'm going to talk with her again and we don't know what will happen to it in appropriations, but I do know there is some interest in having this go forward. So we'll continue it. I just wanted to make sure because I have to get out some tax bills because all the money is spent. Yes, I'm sure it is. So I just check it. I do know that the BAA had money in it for some of this. Okay. Okay, section five is looking at options for extending moderate needs support. So having Dale convene a working group to look at issues and come up with recommendations to extend access to home and community-based services and supports for more Vermonters. Having them look at the types of services, most promising opportunities to extend supports including things like expanding use of flexible funding and allowing case management only, setting criteria for the supports, how to fund them, identifying Vermonters who have the greatest need and supporting family caregivers. And this would have Dale collaborating with others in AHS to incorporate the recommendations into the next global commitment demonstration so that these supports would be available beginning on January 1st, 2023, which is when the next demonstration should be taking effect as we're in a one-year extension right now. And having a report back on January 15th of 2023 on that. Then we have the requirements that the Greenland Care Board summarize and synthesize the key findings and recommendations from its reports, the effective date and the placeholder for a title change. Oh, we forgot the title. Okay. Well, I think once you have decided what's in the bill we can make the title reflect what's in the bill. Okay, we're good. Good idea. Okay, that's it for now, I guess. Thank you. Any questions, committee? At this point. So we have some folks we'd like to have in on this, not the least of which are Green Mountain Care Board, the Healthcare Reform Director and Home Health. Those are the ones we've been looking at most specifically that will have them come in. Let's see what we can do about getting them in sooner than later. Maybe also the healthcare advocate to see where. Yeah, I got him on the list too, thanks. Yeah. Thanks. Thank you, Jen and Josh. I will say, let me just say there are a lot of interested parties who will want to comment on the bill. We've already taken a lot of testimony from a lot of different interested parties, whether it's Dale or whether it's individuals with concerns about access. I think our goal here is to listen to the folks that we've identified and then try to move the bill before crossover. So that it's gonna be hard to have miles and miles and hours and hours of testimony at this point. We've already heard a great deal from many people, whether it's been in the task force process, a truck process, the healthcare, healthcare committee, health and welfare committee, appropriations, everyone's been taking testimony on this and listening. That's it. Okay. So it is 949.


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What is up guys karma medic here and welcome back to another dose if you're new to the channel then hi My name is Nasser and I'm now a fourth year medical student studying at Kings College London And in today's video I'm gonna be talking about how listening to audiobooks and reading books in general has completely changed my life It's completely shifted my focus and my thinking my perspective on a whole variety of topics And I want to share that experience with you guys that hopefully if you're like me and you used to not read at all When you were younger, you'll change your mind about that and start reading more a little bit of background about me I used to never read books as a child and when I say never I mean never If we ever got assigned a book to read for English class when I was in high school I would put it off and it was at the very bottom of my priority list if I had homework for maths physics Chemistry you name it I would get it done as soon as possible But being asked to sit down and read a book for me just had so much like activation energy in order to do That task I did not want to do it. I did not find it fun and I thought it was a complete waste of time I actually didn't read a single book for fun or for pleasure until I was about 21 years old This is towards the end of my degree in Canada studying immunology, biotechnology and molecular biology And I think the reasons that I didn't enjoy reading when I was younger are threefold stimulation visualization and sensation So as a child when you're a kid and if you were anything like me You would just be bouncing off the walls with so much energy constantly moving from one activity to another Constantly bored you do something for a little bit of time get bored move on to the next thing get bored move on to the next thing And so sitting down to read a book provided almost zero stimulus for me in comparison to doing other activities Like running around outside with my friends playing sports playing video games watching a movie You know these types of activities have infinite stimulus coming into my eyes picking up all my different senses and you know engaging me in the activity So as a kid wrapping my head around the idea that sitting down in front of this black and white piece of paper where there's no pixels There's no colors. There's no moving parts. There's no sound. There's no smell Just literally sitting down in front of a black and white piece of paper It was difficult for me to associate that with some form of entertainment with something that is fun something That's exciting something that you know gets me out of bed in the morning I always thought that if I was gonna sit down and do an activity or dedicate hours of my life towards something that I would kind of have a Physical tangible result from doing that thing whereas with reading you don't really get anything physical or tangible all the sort of gains or experience or Positive value that comes from reading books. You can't really see you can't feel it.  It's nothing you can sort of put your hands on and touch and feel And so as a kid who got really bored really fast and was constantly trying to do one thing to the next to the next I couldn't see the value in sitting down and reading a book for hours on end And then not having some sort of result or something that I can show as this is what I've done with my time So the positive gains that you get from reading books from listening to audiobooks. They're completely invisible You know your increased understanding of different cultures your widening perspective Just general increased knowledge and understanding of different people in different situations These are things that you know, it's not like I don't know how to describe like academic intelligence It's not something that you can then write on a piece of paper and score out of a hundred on a test These are invisible skills that are obviously invaluable to developing as a person and things that are going to be very valuable later on in life When it comes to interacting with others and learning about the world and about going to university as a kid I couldn't see that at all And then the last reason is Definitely a bit of a strange one and very personalized to me Which is that I really really really do not like the sensation of feeling a book like the old Paper books. I'm not talking about textbooks that are like laminated and shiny I'm talking about like a book that you would buy it like the bookstore the library You know what I'm talking about like with the paper pages I that feeling of that paper in my hands just feels so strange to me similar to how I eat different textures And I find them whipped cream or foam or toothpaste those types of things and make me feel very strange when I eat them I have that same sensation when I hold a physical book and as stupid as it sounds as a kid I feel like that really put me off from reading that really put me off from sitting down To hold this thing in my hands. So to make a very long story short. I hated reading as a kid I did not enjoy books one bit and I just could not see the value I could not understand the value that could come from reading a book building out these worlds and imaginative play Creative thinking and all of these invisible intangible skills that I would gain And I want to shift to talk about why I love reading sort of what's changed over the last couple of years That's made me fall in love with this idea of listening to something and building out these imaginative worlds in my head And how it's sort of being able to make me feel and process my emotions in a way that no other form of entertainment or media Can do for me. I would love to hear your personal book recommendations I'm open to absolutely anything fiction nonfiction. I want to broaden my horizons of reading as much as possible So please let me know your favorite books in a comment down below and I'll get around to reading them eventually So I think my love for reading started a couple of years ago when I moved to London for medical school And I suddenly found myself having upwards of an hour an hour and a half of commuting time every single day moving to the hospital or to University so during this commute time I would either be staring at an underground tube Which is obviously really really boring and soul-crushing or listening to music which is fun for a while But you know, you're obviously going to get bored of that after some time Even if I wanted to do some studying by pulling out a textbook or an iPad There's literally not enough space on the underground when you're commuting in the morning and in the in the evening You're literally like this like a sardine just packed in between a whole bunch of people There's just no way to get it done And I just couldn't come to grips with the fact that I was going to be Wasting three hours of my life every single day commuting to and from somewhere without doing anything useful without bettering myself Without doing something productive and I started off with nonfiction books because you know That's sort of the background that I came from and I wanted to be able to read a book or listen to a book And then have sort of takeaways where I know, okay, this is what I learned from reading this book I have x y and z and this is something tangible that I can take away from this experience of listening to a book I honestly enjoyed that so much. I read a whole bunch of autobiographies for ilan musk, jeff bezos Phil knight the ceo of nike or co-founder of nike was ceo Something like that and then as time went on and on and I listened to all kinds of different books I started listening to fiction as well one or two fiction books I'm still I'm getting better at it But I've really enjoyed the fiction Fiction books too and through the listening of these audiobooks when I tell you that my eyes were opened seemingly for the first time in my life And I was exposed to this world of books and listening to books and all this knowledge that I could gain from this new form of entertainment I was amazed it's it's almost like discovering a new form of entertainment So it's as if you've never watched movies before in your life and then you start watching movies Or you've never played video games before in your life and then you start playing video games It just opened up this entire world of a way to entertain myself and learn something and be productive in my life So i'm personally a big big fan of video games I've been playing video games my whole life starting on you know the game boy advances the game boy What was it sp? I think it was no the game boy color. That's what it was before the flip screen Playstations xboxes you name it. I've been playing video games my whole life And I absolutely love them and they are a form of entertainment a way of passing time That is unlike anything else in this world when you try to explain to someone who's never played video games or never Got an into video games what it's like to control the character in a movie or in a story that's on your screen It's impossible You just you just kind of have to do it And so that's what I discovered with books is that it's this entire different form of entertainment that you cannot get From anything else and I've discussed this at length on my podcast the karma cast which if you're not subscribed to already You should definitely subscribe to and listen to but anyways This is something that took me a long time to figure out and to realize about books is that they give you sort of 20 percent of the story They just give you black and white words on a piece of paper literally and you have to build out the remaining 80 percent You have to put in the effort of the thinking and the creativity Of imagining what this world looks like and what the reader is trying to get you to feel and to imagine It's incredible It's something that no other form of entertainment forces you to do listening to podcasts listening to music watching movies playing video games Those are all sort of things are being thrown at you and you are digesting them Whereas a book is they give you the ingredients and then you have to go and bake the cake You get what i'm saying and for that I appreciate books so much more because books respect you as someone who's digesting that content They respect you that you are going to fill in the gaps and you are going to imagine and you are going to create The world that they are sort of seeding to you Now I love audiobooks for a lot of reasons But the main one is that they've allowed me to explore and enjoy this whole realm of books and reading While doing things that I would normally be doing anyways, for example when i'm commuting when i'm on a run when i'm walking around the city I can be listening to an audiobook and gaining knowledge and gaining information and entertainment at the same time Which is literally incredible It's it sort of it feels like a cheat code that i've unlocked in life That I just didn't know about before it's amazing. It just sounds too good to be true You know if I was reading a physical book I would have to be sat down somewhere on a couch or at a desk on a chair and literally immobile I would just have to be sitting there looking at this one thing Whereas with audiobooks I can gain the same value from that while also moving around or running or doing some other activity Which is just incredible. I cannot stress How much of a beneficial thing this has been in my life? How much value I derive from being able to listen to books while moving around and doing other things Now that's not to say that you should always be moving around because some of the best times I've had listening to books are when I get a coffee and I go to the park and I sit on a bench And I just sit there and take in my surroundings and people watch while listening to a book. I mean, oh, oh my god The entertainment and the serenity and the happiness the zen that I get from that experience is unmatched I there's nothing else in this life that I do that gives me the same feeling as that The second thing that I love about audiobooks is that I can listen to things at two times speed Which is amazing because I consume most of my content at two times speed anyway All the lectures I've ever had at university or in medical school I listen to at two times speed because most people talk way too slow and I can be digesting the same amount of information In half the time and so that's why I always play things on two times speed Now sometimes I'm listening to a book and two times speed is too fast for me I'm not able to understand and comprehend everything that's going on And so I'll slow down to one and a half or 1.75 times speed You know not say that two times speed is like this golden rule that you always have to follow And the third thing that I enjoy about audiobooks is that it's a didactic experience. The book is talking to me I'm not going through the actual physical effort of reading the book and processing the words on a page I'm just sitting back relaxing and the audiobook is talking to me and I'm just listening to it So that makes it a little bit more of a passive experience And I recognize that if it was more of an active experience like reading it would be a little bit different I'm just not willing to sit down and read something physically sitting still somewhere I love the idea that I can listen to something and do other things at the same time Listening to audiobooks in that way has just been life changing for me All right, I want to finish off this video by giving you guys a couple recommendations of books that I've read that I have found Incredible that have made me cry or almost cry almost cry I should say All right, so let me just quickly scroll through what's on my phone. So this is the next book that I'm reading It's about the CEO of Walt Disney. This is the book that I just read war doctor, which was Unbelievable unbelievable. It's probably at the top of my list of recommendations for this video. Read that book Then we've got blood oil Just all all these books. Just have a look if any of these sound remotely interesting to you google them Just go have a read the autobiographies that I mentioned before we have Jeff Bezos, Elon Musk, Phil Knight And also Edward Snowden very very very good autobiographies bad blood if you're into science and technology That's an incredibly great book very very thrilling keeps you on the edge of your seat and then into thin air by John crack hour Hope i'm pronouncing that right tells the story of an expedition to Everest that happened I don't remember the day but several years ago where I think 13 people died on the same day and there's a couple movies about it There's some documentaries about it All right guys and that brings us to the end of the video if I can close this video on one thing It is to reach out to anyone who was like me when I was younger and thought that books were a waste of time And they were useless and they were not fun and they were not entertaining. I'm talking to you Please please please try reading give it a go think of any topic you like and just start there It's definitely made me so much happier genuinely and allowed me to get in touch with my emotions I didn't even talk about that in this video. It's incredible. Just just trust me on this start reading and all right guys Thank you so much for watching I hope you found this video useful and if you don't already read I hope this video has convinced you to start reading and if you do already read Well, then I guess you know everything that I've already said and happy reading All right, that is it from me. I'll catch you guys in the next one. Peace


Okay, I just sorted that out so let's turn the volume up. I'm going to go about 15 inches, about 1.5 ounce. Now I was going to be like, oh yeah, I was going to be able to iron the motor on. I've lost it. Oh, here it is. The table's got a lot of new wires on it. Hee hee. Alright, let's try and set it on my plate. Go check it out. Connection there. Let's take that off just for a moment. Try that again. Yeah, it says it does want to play. It's happy to play like that. But it's just not happy to play like that. If I turn it all the way on, let's check that on and start from there. Here we go. There we go. So let's start spinning it away. Get that one down and move it. So we've got 16 volts. Oh, I've got a really good view from here. You've got to turn the pull bar. So you can see what we've got. So that's pretty cool. It's a lot of motor. I'm good to have a really good view of this. Let me just turn it down again. The darn thing. Spin that meter away. See what I'm doing with this without the whole thing coming in pieces. There we go. Stay still. Here's your easier. That should do it, shouldn't it? We've got a lot of time to move the time so we can keep that momentum going. If I turn it all the way back on, I'm not going to be able to see the sweet part of this one. So now I've got 20 volts. I'm going to slide the speed down. I'm going to try to pull up power and just... There we go. Start again. Just do it. Right down there. So, 50 volts on the... Right, 20 volts.  They're going to be pretty bad. There's our sound wave. So we're at a... I don't know. 630 kilohertz. Yeah. 62763. That's a 20 volts. That's going to be 5 volts. He's only moving like that on the sound wave because he's getting past that. Maybe they're probably, but there's things probably to be placed on that. I think it was pretty... I'm going to do it if I can get it to a quick enough. Just do that again. 10 volts and 40 volts. Let's just turn that down a second. I'm catching people if it hits any of these connections. But I didn't. At least I turned it off. Yeah, so it's definitely better all around because I only have two turns on this thing. Definitely better all around. It would be nice if this was perfectly level just to stay on there nicely. So here we go. A good old spin out. Let's just give it four passes. Let's give it four passes. Let's give it four passes. Let's give it four passes. Straight up in. So I'm going to catch it. So that's pretty good. I bet this bulb doesn't work anymore. What are the temperatures like? They're still like like lukewarm cup of tea type temperature. I bet this doesn't work anymore. I mean it's actually got holes out so I can't see. No, it's just not going to work. No. I don't know if any of that is it. It's just reacted to me. Got it. All right. We've got two points on board. A bit 18 volts or something. It's always a nice one with the old bulbs. A little bit like only the bulbs. It's not bad. Oh, it went straight from your finger. Nice. That's my brand new flash now. That's always nice, isn't it? That was my screw driver. On my finger. That's not happening. But it still works, don't it? Yeah. This is a real simple circuit. I'll put it on the other wheel. I've got it caught on. Stay still. There we go. Back in. Push this. Let's check some of this. Ah, it's cold. It's real simple. I wonder if this is going to be different now with the different capacitors. What's that? 22 volts. Let's say 25 volts. Can you see that? There we go. 24.8 volts. There you go. A couple of inches. Kick in all about. It's quite a good distance, actually. We're just going to take measure. I've got one. Ta-da. Something like the law now. It's off. Oh, no, this is metal. That's going to be quite hard to do, isn't it? That's not going to work. That's not going to work very well. You've got to take my way for it. That's about an inch. Oh, that's small. Yeah, that's burning a lot of time. I think that must have been burning the something. There's just a bit of plastic on there. Never mind. That's okay. We don't mind that. What can I do with this thing? We big bulbs and that. We do little bulbs. We've done that. Ah, we're going to change the capacitor. We're going to do that in a minute. We're going to see who's going to make any difference. I just have to get no heat in it or anything like that. Let's try this electrolytic because we're going to do this on the polarity. These wires are set to the polarity. I know there's an LED and there's a resistor because I was prepping around and charging it and discharging it and washing it on me. It's quite cool, actually. I think about that sort of thing. I'm going to set it up a little bit. I'll get it back to about 25 volts. I think that's an inch. I'll get it back to about 25 volts. This is pushing this out because it's bound just really. That's what it's supposed to be. 24.6. Let's see what we get. I'm not sure it's actually making any. I'm not sure that's making much difference. Let's try a different capacitor. It's connected, isn't it? Yeah, seems to be. I'm going to try this double-ganger. This is like a 1200 volts AC. 4DC 1, schematic. 0.33 nano- sixteen units. Zero, so, I'm right. So0.33 micro-files. 330 micro-files, at piece. 64. 25 volts again. There we go, 25.3, that's what it's done earlier, 25.5. Where's that screwdriver? It's just doing a little time to break out the way it's solved. The screwdriver's back here. You can see that. That took some hours, I agree with you. How does this start? It's only using, well, it says 3.7, and it's like that. But when I start doing it, it's like 2.1, 3.1, 1.9. That's pretty good. Let's turn that down again and let's try another capacitor. I think that might have been a little too strong with new ones. Now I'm going to try a... This is a sixth colour volt ceramic. It's amazing, I can't seem to get me on the leg. It's not that difficult. It's got leaves on it, leaves are slightly warm on this now, so I think I was actually giving it a little bit of work. I'm going to try it with that capacitor. I've got one more capacitor to try. A couple of new shades. That's about right. That's about right. There we go, we use that. It's already at 2.9 ohms. Just setting it by itself. Trying to see that breakout by itself. I'm not sure if that's as good as it was. No, I don't think it is. I don't think that's as good. It's done to 1.6. I don't know. I don't think... I mean, there's not much difference, but I don't think that did as much as the other couple. The last one I want to try it on is this couple here. And this is what I use on my MOSFET. Well, there's a combination actually. There's a few I've been trying. Different values of these ones. I've got some other ones here. These are slightly different values to that. Different value on the MOSFET. Zero voltage switching circuit. And I built a four-year Royer circuit as well. We took that out of it to test that. I was a heating doctor. I still got to play around with that here. I don't know anything with it. Just built it and left it. So, we've got 24.5, which is a lot of that. And we're doing my 22.9 amps. So, well, let's put this out slightly. So, 25.1. Now we're on 3.3. Just sat there by itself. That's drawing more current. This will be getting a bit more action out of it. Okay, so we do, because that's just kicking out by itself there again. So, there is a difference between using the different capacitors. I'm going to try one of these other single ones. There's not much difference, but there is a difference. We're just trying to tune. Because that's better than the other one. That's ceramic capacitor. I'm going to try it now without one more test with the capacitor. I'm going to try one of these, these single microwave oven capacitors. Cooky capacity, you can find them in there. They're MKPs. All of the ones that are hot and strong are MKPs. So, let's plug this in. A bit of voltage. Follow that a bit. Not quite as much. Really? While I'm just doing that. I need to just turn it down just for one second. Just do a quick heat check. Wow, let me know. I still wouldn't drink it. It's still not hot enough to be a semi-drinkable lukewarm cup of tea. The way I look at it is, if the actual heat sink is cold, my chip is just like, oh, I've got my circuit. It's not going to help, is it? Probably killed it though. What do I do? What do I do? I'm going to pull that out. That's what I'm just going to do. Put it right around. Not the best connections going on here, but let's just give that a quick check. Yep, that circuit right here. 24.1. And that's with, yeah, that single cooker. I think that's a .23. Yeah, yeah, .23. Okay, now, I'm going to see what it's like without a capacitor. So I'm just going to undo these. So there's absolutely no capacitor connected. Temperature, yeah, I still wouldn't drink it if it was a cup of tea. Too cold, probably. So I think it's on. No capacitor, this time. 25 volt.  I do take 4.5. I'm not that impressed with the performance of the capacitors, they actually perform us all. I'm drawing 3.3 amps at 25. That was something that turned up a little to one bit, so I got 4. Yeah, that's pretty good. And that's with no capacitors. So I'm going to check there why they're made. It's not actually making. You know what I mean? That's actually better. I'm out of it. It's still all very good fun. This is going to be on for way too long. I might have to edit some bits out, but cheers for watching anyway, guys. If there's any sort of place that needs anything else you want me to try with this thing, I'll give it a go, so let's know in the comments. So anyway, shut it down. Bye, guys.


Hello everyone and welcome once again to another edition of the Red Brown and Williams real estate show I'm Shannon Deskins along with Jennifer Brown day fresh from a big marathon run in Disney World I have to mention that half marathon only half of it only half crazy as they say be yes me and my Lovely mother went down to Florida When it happened to be just as warm in eastern Kentucky that figures, but that can happen sometimes Anyway, congratulations to you and your mom. Thank you now What we're gonna talk about today are five listings that if you're in the market to buy a home That's gonna be great. Hopefully you may want to purchase one of these But it may spark some interest whether you want to sell your home or I don't want to plant the seed if you're thinking about maybe being a realtor there looking for someone She'll talk about that at the very end in the real estate minute So let's start with to go right into a listing now. This one's out of the paintsfield office This one is actually located in the Van Leer area of Johnson County And right off 1107 in the pal addition Area, and this is one that I kind of figure people will really be interested in because this is not something you see a lot No, but this is something a lot of people are looking for now What we've got here is six acres of property. There's no home on this But you've got a really nice barn and pasture and riding ring So I personally know a lot of people who have horses and they have to rent a place to put their horse So they have to drive far away because a lot of times where you live is just not gonna fit for a horse But there's a lot of horse owners out there looking for something exactly like this exactly and this is like you said It's got a 14-stall stable city water septic fence paddocks over six acres total And it's got a riding ring lots of flat acreage It's really one that has all those amenities if you are a horse lover and One that kind of property and with with the development of so many riding trails around here It has become really popular for people to own and ride horses Absolutely, it really would be and this is one that they can easily drive by because like I said It is located directly off of highway 1107 going through Van Leer So if it's something that you have an interest in I highly recommend doing a drive-by on this one and then giving our paint To the office a call for more information This could be an income potential for you because a lot of people pay good money To rent a stall or have their horses boarded So if you're looking at getting into this kind of business you've got 14 stalls a riding ring I mean this could be an income producer exactly and this could be one if you've got one or two horses yourself You can have a place to put your horses and then like you said You still have 10 to 12 stalls that you can rent out for other people have some income coming in For taking care of the other horses that are there and boarding you can do riding lessons with because you've got the riding ring You can have past your land so I'm hoping a lot of wheels are turning on this one Let's hope and the price on this one including the barn and the acreage only a hundred ten thousand So the price is reasonable as well and this one's out of the paintsfield office, correct? It is and anybody can call any of the agents out of our paintsfield office or really any of our office if you would like But that number in paintsfield is six oh six seven eight nine eight one one nine All right Now this is the six acres of property and a barn and the Powell edition of Van Leer now moving along We're gonna stay in Johnson County, but let's actually move this one into downtown paintsfield Okay, this one is located off of Court Street in downtown paintsfield and for anybody that's familiar with where paintsfield How it lays out that is right downtown very close to paintsfield elementary school Right between our lady of the mountain school or the Mayo mansion and the Methodist church And then you've got big sandy community and technical college campus right there That's one side of it Then let's look at eating and shopping because paintsfield is is becoming known for a lot of its eclectic shops and Diners and coffee shops and things like that all of that is within walking distance and then of course let's not forget October and Apple days great opportunity for this house now. That's just on the outside Exactly it doesn't even count on the inside on the inside. It's got over 1700 square feet It's a three bedroom two bath built in the fifties and you're looking at the pictures you can see that it's a house It's got paneling and somebody may want to come in and do some updates and stuff But when we tell you the price I think they're gonna be really excited to know that they can come in and do those updates But it is a really nice laid-out house. It's got a first floor bedroom, which is huge right now with potential buyers It's just a really good house really good bones and something that somebody could come in and really make their own And with this one I'm thinking and a lot of people go the way with the banks and get pre approved So you know what you already can purchase. So it's really nice to be able to go I'm approved for X amount, but this property is $50,000 less and the seller on this one is motivated. So they're willing to assist with closing costs Something like that. So if somebody is looking to make an offer, but that may be something that concerns them This is one that you can throw in an offer and ask for a little bit of assistance on closing costs as well Wow, and on this one a hundred thousand dollars is the price and like we said downtown Paintsville Great neighborhood and this one comes with a one-car garage, too So it's not off-street parking and or on the street parking or anything like that You actually have a garage you do you have a one-car garage, which like you said in downtown Paintsville is a big deal Because that means you've got some off-street parking storage that kind of stuff as well So yeah a hundred thousand dollars on this one the mls number one zero four two eight zero Now this is another one out of the Paintsville office It is it's also out of Paintsville and if you wanted to if you don't want to call But you just want to look for information feel free to go to our website. That's rbnw.com All right, okay Now the next one is is also Paintsville also downtown just down the street from the previous listing Yeah, this one is on west street and again if you're familiar with Paintsville, that's very close to where the remota In is that's kind of the closest thing to it. You're right there very close to main street Like you said very close to all the shopping schools Coffee shops all of that's within walking distance again And this is one that it's a little over a thousand square feet. It's a two bedroom one bath Again built 1950 has a one car carport and this is one that has so much charm I think we talked about it before a couple weeks ago and the one thing that everybody kept mentioning was the sunroom Because in the picture you can see it's the wood walls all windows around it It's a really really nice room that would make a great living room or extra family room or something like that Or just the place to have your coffee in the mornings open those blinds up look outside So I would normally say this time of year maybe one more snowfall, but I don't think that's going to happen this year So let's talk about spring flowers because they're gonna be blooming soon They will if they're not already But you can see in the yard it's got some You know the landscaping is well established and that kind of stuff So hopefully it's not one you'd have to come in and completely redo the yard and that kind of thing So schools shopping Dining all kinds of opportunities and you know you even with the sip theater renovation And we'll have live music from time to time So Paintsville is really growing as far as those kind of things and this would be a great house If that's the kind of thing you're looking for yes, absolutely And it's just convenient and it's it's going to be a great house for somebody the price on this one Jennifer Is 195 okay in great price for this one as well and the mls number 107 197 so give the paintsville office a call. Absolutely 606 789 811 9 All right Now the next one is I think all of these today you're out of the paintsville office But this one is cliff bennett's listing So you're going to give him his information at the end of this one, but this one's also in paintsville No, this one's in sayersville. This one's in sayersville We're going to throw everybody off a little bit moved in mcgawthon county for a minute But it is in downtown sayersville right off broadway If you're familiar with sayersville and you know where route 40 in the post office is You're going to be on bailey street It's right on the corner of bailey and broadway is where this house sits and almost 2000 square feet So this is a large home and I like the picture of the kitchen. It shows a big spacious kitchen And actually everything in here looks spacious and you can see the fireplace in one of the pictures And then look at that tub in the bathroom. So I love the photos on this one Absolutely, and you can tell from the photos you're talking tile and hardwood flooring So you've got those amenities. It's kustin kitchen cabinets It's all city utilities, which is great concrete driveway You actually have on this one And I didn't have a picture to include it But it has a sewing building out in the backyard Really that they've used for sewing obviously for a sewing business But could very easily be made into a guest house or a little efficiency apartment Or if you really wanted to put, you know, your big screen tv in a pool table out there It could be a really nice man cave or something like that A lot of potential and think about it if they used it for sewing whatever your hobby may be as well And you just want to take it out and have your own space to do that This offers so many different options Exactly and then you of course have the attached garage as well That that is not included in that for storage and cars and all that kind of stuff And then the location in Sayersville with the expansion of the mountain parkway and the ease that it is now to get to central Kentucky I predict this this location to get more and more popular as the convenience comes around Absolutely, I really think that it's going to and again a great location very close to the mountain parkway Into the downtown Sayersville area an area that is growing and will continue to grow Right and the price on this one two hundred ninety five thousand On this one in Sayersville now we mentioned this was Cliff Bennett's listing. So let's give his information Okay, cliff is out of the paintsville office and his email is benet at rbnw.com. That's b-e-n-n-e-t-t Correct. All right Now let's move back to another one of cliff's listings, but this one is closer to paintsville But just off of us 23 This one is off dogwood fork, which if you're traveling from paintsville towards louisa And you're going to go about five miles and then dogwood is going to be on your left You're going to go up dogwood You're going to take a left at the fork and this is going to be the last house out there So right there the word says privacy. There you go. Exactly. It's going to be it's a newer house But it is really located in the country So if you're looking for some privacy if you're looking for room to grow a little bit of acreage Perfect location. Well, I mean you're looking at over 37 acres and that's a lot and it looks like some of it It's going to be flat and usable. So there you're thinking gardens as spring comes along think of all the things that That spring fever gives you you want to plant things and you've even got room for a pool If this summer you decide you want to add one Yeah, I think they estimated around five or six acres was flat and usable acreage Which is great and you can see in one of the pictures that are included of the exterior You've got that flat kind of pasture looking land with the detached Building down there great for storage if you want to use it as a small barn or something like that It also has those abilities and it's still even though it's north of paintsville It still has a paintsville address. So that lets you know it's still close to paintsville. So Convenience is huge right there right off us 23 If you have to travel to toward huntington west virginia or louisa, you're convenient But then look also back the other way precious burg and paints filler right there too exactly And then on the inside of the house, it's a four bedroom two and a half bath. Like I said, it's a newer house built in 2007 Hardwood flooring through a lot of the house. It is a story in a half So it's a great functional home with a lot of room Right and this one would be great for a family because you're looking at almost 2000 square feet So and with all the acreage and stuff you've got room to let the kids play outside animals You know we talked about horses in the in the first listing, but you've got room to put a small barn in a riding ring here Exactly. So you've got a tons of potential if you're the outdoorsy type Or you just you know, you work in downtown or whatever and you just want to get away in the evenings and weekends This this has got you covered. Exactly. All right. Now. This one is is one that everything we just told you about We're still under 200,000. We're 185,000. So the price is very attractive on this one Now this one is also the paintsville office and cliff benets listing. So let's give the paintsville office number one more time Okay, that number<PHONE_NUMBER>. All right, and you mentioned the website earlier in the show But let's give that again because you guys cover such a large area We only have the time in this show to show you five listings, but you all have hundreds of listings I'm sure maybe more of different kinds of things from commercial to land to leases everything Somebody can just go to one website and see every bit of that. Yes, they can go to rbnw.com. All right So we have given you five listings from mostly johnson county And then there's of course one in mcguffin county But like we said, no matter where you're looking even if you're looking to list Redburn and Williams can take care of you So i'm going to step out now and let you talk about something that you guys are actually looking for We are Are you interested in a real estate career? Now is the time to get started Opportunities are available for new realtors in eastern kentucky. Call any of our redburn and williams offices for more information Thank you for joining us for another episode of the redburn and williams show. See you again soon


Dear students, in this topic, we shall discuss the control mechanisms of intestinal and pancreatic secretions. Epithelium of mammalian small intestine secretes intestinal juice. This intestinal juice is actually a mixture of two fluid secretions, which are released from the Bruner's glands and crypts of Libar cohen. The Bruner's glands are present in the first part of duodenum between the pyloric sphincter and pancreatic duct. They secrete a viscous enzyme-free alkyline mucoid fluid. This secretion of the Bruner's glands is present at that time or at that place when the pyloric sphincter enters in the duodenum and is not present in the pyloric sphincter and the pyloric sphincter. This secretion is present before the pyloric sphincter and this is an alkyline secretion. Therefore, it enables the duodenum to withstand the acidic chimes coming from the stomach. This action is very necessary because the acidic chimes can damage this portion of the duodenum because there is no secretion of pancreatic juice or pyloric sphincter here. That is why the secretion of the Bruner's glands is a protective function and a neutralizing function which initially neutralizes the acidic chimes. The crypts of Libar cohen are also called mucosal glands. They are dispersed throughout the intestinal folds. They produce a thinner enzyme-rich alkyline fluid. This fluid mixes with the duodenal secretions. The secretions in the duodenum are mixed with the Bruner's glands. Dear students, now we shall discuss the control of these intestinal secretions. Several hormones regulate the secretion of intestinal juices. For example, secretion, hormone, gastric inhibitory peptide hormone and gastrine hormone. Secretion of the secretion of intestinal juices is also under neutral control. Neural control is because the vagus nerve innervates the small intestine and when it stimulates, it increases the secretion of intestinal juices. Distention of the intestinal wall also elicits a local secretary reflex which is caused by the presence of food. Dear students, now we shall discuss the secretions of pancreas. Pancreatic juice enters the duodenum through pancreatic duct. It is an alkyline fluid which is also rich in bicarbonate ions and digestive enzymes. Various digestive enzymes present in pancreatic juice are alpha amylase, trypsine, chymotrypsine, elastases, carboxypeptideases, aminopeptideases, lipases and nucleases. The secretions of pancreatic juice are controlled by a variety of hormones which include peptide hormones, gastrine, polycystokinine, somatostatin and ancafalins. First we shall see the effect of peptide hormones. The peptide hormones sacritin and vasoactive intestinal peptide stimulate the secretion of pancreatic enzymes. The gastrine, when secreted from stomach lining, starts a slow flow of pancreatic juice. When food is in stomach and gastrine hormones are secreted, it affects pancreas and it releases a little bit of it. It is in anticipation of the food coming to duodenum. In this anticipation, pancreatic juice secretion starts. Polycystokinine also affects pancreatic juice secretion. It is an upper intestinal hormone which is secreted in response to fatty acids and amino acids in the spine and elicits secretion of pancreatic enzymes. It also stimulates release of bile from the gallbladder. Dear students, somatostatin has an inhibitory effect on gastric acid and pancreatic secretions. In comparison, N-cafaleins inhibit the secretion of gastric acid but they stimulate pancreatic enzyme secretions.


This is the week for the VBS 2024 and our VBS kit for 2024 is called Thanda Island. At our registration desk we've had a very busy week starting on Monday when we recorded about 594 children. On day two we recorded about 680 and today the numbers are increasing. But one good thing that we have found at our desk is that the number of non-adventist visitors that we have had has continually increased. We registered about 160 yesterday and today we are still calculating the numbers and expecting more. In this kit it provides for programs of a period of five days. There is Monday to Friday, coming Sabbath is the climax of the entire VBS, Vacation Bible School. We have various stations, we have Bible station, we have prayer station, we have craft station, we have health snack station, we have game station, we have music station where we learn, the kit has five songs but we will do minimum eleven songs. I am a volunteer in the lifeguard station, also known as music station. Here we teach the kids all the songs that you will be seeing this Sabbath. It has been an amazing experience, they are wonderful, willing to learn and we hope to have a wonderful time. Welcome to Suncastle Crafts, this is VBS 24 Thunder Island and in Suncastle Crafts we teach the kids how to create crafts that actually go in line with the lesson. Each craft is something that teaches the kids about acceptance, about forgiveness, about the love of God which is basically the whole theme about Thunder Island. The name of your best friends, all of the name of your best friends around here. Wow, good job, look at that. So each and every day we are learning something which teaches the kids about Jesus love for us, Jesus forgiveness for us, His acceptance for us, His value for us and that's what Thunder Island is all about. So every child needs to go home with a craft that is a reminder of that lesson for the kids. I have been the actual leader for mongos this VBS that they are eight year olds. So technically they are primary bee in our church and I've had the best experience with them. They are a very calm group of children, they don't disturb, they follow instructions. So I can say they have, they are very disciplined and I've had so much fun with them. So what is the reason for man about three prayers? What we do in this station is that we dive deep into prayer. Every day we look at various prayer points, we encourage the children to spend time alone with God in prayer. We have prayer points where children can come and thank God dedicate themselves, ask for forgiveness and ask for guidance. And we want to encourage you to make prayer your lifestyle even as you bring up the children and lead them heaven once. So thank you for joining us at Skuba Shack this week where every day is about Jesus and we always focus on prayer. For the preschoolers, our class is for between four years to five years. We are participating in all the stations, the Bible station, prayer station. Right now it's break time, they are having a snack, they have had a snack and now they are relaxing. Yes and then we will have our crafts and music after that. So far we are doing good. Welcome to the Coconut Cafe. My name is Slamak Mito and this year's VBS has started on a very good note. At the Coconut Fantasy Cafe we tend to use snacks to relate to the various topics that have been selected to teach our children. So we welcome them here, they come, they enjoy the snacks after the learning. And we believe that will actually stay to their minds as they live on trying to live by the standards that they've been taught. Hello everybody, welcome to the Coral Beach. Today we are going by a different name but always known as the Game Station. We've had so many activities from day one from Monday to today and we've had a bunch of activities.  So when you go to the next station, as always remember, God values us so much. So much that he gave his most valuable thing in heaven to serve for you. We hope that you will join us next time and we are so excited as a team, Coral Beach. See you next time and have a blessed day. It's been a wonderful time. For this year we decided to use a lot of data analytics, driven decisions. For example we've been able to get statistics and use charts to give our decisions based on the number of visitors, number of children. So decisions are being made based on the information that comes from day to day. So one thing that we've learnt from this VBS data is power and we are glad that you're here. Thank you for supporting us, we look forward to see you in 2025. Remember, VBS 24 Tanda Island, where Jesus is always with me. Always relax. And how we pray that the message where we are saying because every day has a Bible verse, we have a Bible verse that is coming from John, the book of John chapter 13 verse 34 to 35. It is talking about the love of God and really loving one another. So we welcome each one of you for those parents or guardians or sponsors who are not able to be with us this time. We look forward to 2025, vacation Bible school, the rest the Lord will provide. Thank you so much. God bless you. Tanda Island, where Jesus is always with me. Amen.