morning. Um Oh this mic works. Um I'm Chester Griffiths all most of you know me thank you very much uh for attending and for all the cyberspace virtual people thank you for attending. Uh Welcome back to the new normal. I was talking to another Event coordinator and uh she was commenting how now about 80% of people have gone into the virtual world of attending conferences so for all of you to actually come and show up. Thank you. Um And thank you to our staff daisy crystal and also chris for setting this all up. It takes a lot of work a lot of energy. A lot of corralling the doctors to get there slides in and preparation. So thank you for that. And also thank you to the faculty for putting their time and effort into this to really start the new normal getting back together learning the expansive aspect of what we do. So I've been on the faculty at U. C. L. A. In the family medicine department for 32 years and uh still attend and teach the family practice residents mainly because of the importance of E. N. T. In primary care. Um Some people estimate about 40% of the visits on the primary care day. Can include an ear nose and throat problem. So it's amazingly important. Um But also overlooked uh the amount of education that goes into primary care residency and ear nose and throat is definitely paling in comparison to I. C. U. Work which will probably never do but we can't really change that. And this slide just underscores that from the National Health Service in Britain Um they looked at 271 referrals to their e. n. t. colleagues. They estimated that 58% of those could have been taken care of by the primary care physician. Um And of course audiology and hearing problems are probably the number one issue that they refer. But as you see from snoring uh dizziness etcetera there's a whole property of uh conditions that the marines on the ground see so their nose and throat otolaryngology. Head neck surgery is a very unique specialty. I chose it mainly because I thought it was the most universal medical specialty that existed in the sense that there's a true primary care aspect to it. We have a very good office practice taking care of head and neck. Uh you know problems uh It's been uh classified as the specialty of the cranial nerves aside from it used to include the eye but they broke off all the other cranial nerves we take care of. And as in primary care uh we're cradle to grave. So in a day we may see a child newborn up to an octogenarian uh and as well as an adolescent and a young adult. So in that sense it's very exciting each day there's new things happening. Um Also in the outpatient environment diagnostic and therapeutic interventions can be performed without going to the hospital. Um So it's it's every day is a new day. But as the time has gone on, the specialty of otolaryngology has really become super specialized and that's really the point today to really uh give a bird's eye view of what's happening. What's exciting in our discipline from advances in head neck oncology, neuro Atala ji and cochlear implantation. Dr while gamma will be talking about head neck oncology. S and M. D. Anderson fellow and head neck oncology. DR Volker did her training at the house here institute after washoe and was a professor at USC and probably one of the most foremost cochlear implant surgeons on the west coast along with Becky Lewis who's here a very unique Audiologists who specializes in two very unique, complicated realms of cochlear implantation, pediatric and adult cochlear implantation. Um You'll be hearing from them today, facial plastic and reconstructive surgery. Everybody thinks about the aesthetic but really the reconstructive and functional aspect is a focus of otolaryngology. Uh dr Kochar is going to be speaking and telling you the new advances in his discipline of microvascular reconstruction and also really something that is groundbreaking in my opinion for patients that have suffered a permanent facial nerve paralysis and they can't smile. They can't animate, they have difficulty swallowing now with microvascular reconstruction you will see that they have very very good functional outcomes. Uh dr Madison today will be uh talking about voice and swallowing and as we grow older this is a big issue. And in our practice we are now developing a super specialized speech and language pathology department, sleep medicine. Um we're not going to focus much on sleep medicine today, but um we have a big agenda at the pacific neuroscience Institute to refocus sleep medicine. Sleep medicine Over the last 40 years has been, so to speak, hijacked by obstructive sleep apnea. But there's a pandemic of insomnia as a matter of fact, about 68% of adults over the age of 70 have chronic insomnia and it continues to worsen each five years of their lives, they just can't sleep. And um why is that? Um we have band aids for it, but the physiology, we're we're really going to focus on that in our brain health agendas, pediatric otolaryngology and of course rhinology and skull base, something that I've been Focusing on with Dan Kelly over the last 20 years. So I want to give a little quick introduction to the pacific neuroscience institute, what it is, what its goals are, what its vision and mission is. And basically, the four founders got together and we wanted to create the panacea of virtually vertically integrated healthcare in the sub specialties, in other words, bringing the Neurosciences under one roof. So we we developed a pituitary disorder center within neuro endocrinology and most of you realize what a rare specialty that is and what an important specialty for the future of wellness in our population in our communities is neuro endocrinology, understanding how uh hormonal and neurotransmitters uh impact our lives, the brain tumor center, the brain health center, which is really a very innovative center of specialists that are focused on dementia and just neuro degeneration which is happening. Movement disorder center, adult hydrocephalus stroke and neurovascular center. This is a really unbelievably exciting impact that we've had. Uh now we're in five providence hospitals uh and to be able to take someone that has had an m bolic stroke and return them to normal and have them discharged in two days without the stroke is really a phenomenal advance for our patients and communities, the facial pain center and of course what we're talking about today, the ear, eye, ear, nose and throat center, all of that is encompassed in our pacific neuroscience research center. And the main aspects is we want to advance in neuroscience is to promote brain health and neuroscience wellness through novel research and innovative clinical trials. Train the next generation of clinicians and researchers, neuroscientists and educate patients in the community at large on the vital neuroscience issues. The former train the next generation. You're going to be meeting the next generation of brilliant scholars today and they're gonna be tell you what they tell you about what they've been doing and dedicated their lives for for the next 20-30 years. So here's the neuroscience institute right now, we We have 37 faculty and this year we're gonna be growing to 50 faculty and all those centers and we're covering these missions in providence in the southern California area. And one of the visions of the pne was to not have patients have to go to specialty care but to have specialty care in the communities where the patients are living so that they can retain their primary care basis and support while getting high quality super specialized care. Um That's if you were to say what's the overall vision of the P. And I that's it to be able to bring super specialty care to the communities and backdoors of of of patients uh lives. So the faculty today dr Anwar is going to kick off the meeting today. Um He's going to be talking about olfactory dysfunctions after covid um Olfaction is sort of one of those cranial nerve bastard bastardized senses that you don't even think about until you lose it. And now after Covid uh there's a very significant amount of patients that are disabled Now with high pas mia oren Asman, he's going to be speaking about that dr Butler will be talking about reconstruction and in office procedures. I'll be talking about emergencies that we see and also emergencies that you see in your offices and I'll give you some tips and pearls on how to deal with them as well as chronic sinusitis which is really a big bucket dr Kochar will be talking about facial nerve paralysis, reanimation and microvascular reconstruction dr medicine today we'll be talking about their ecology and swallowing issues. Dr Volker will be talking about hearing loss and uh balance disorders. And with a focus on adult cochlear implantation um you will see that one of the big agenda items of our group is to develop a community based cochlear implant program for adults and all primary cares have the experience with your patients when they come in and they say my hearing aids don't work, I can't stand them and the families are upset because their mom grandma can't hear them and then become reclusive. They become isolated because they can't hear. And if you'd ever like to experience that, I would challenge you for one hour. Put two pieces of cotton in both of your ears, one piece in each ear and walk around. And then you could really experience the life that those elderly patients or middle aged patients are living in. And now with cochlear implantation with the advances of technology they can hear normally. And the big paradigm shift. Not normally but better is that we all have the concept that kids that are born deaf and with with hearing loss and that received cochlear implants. There are different cadres of patients than adult patients that have the memory and the neural plasticity of their lives. And now we're just exciting that they have their phonics, they have their vocabulary, they have their ability to uh comprehend. So it's a different. Ballgame but for those patients they're one of the group of patients are the most happy that they can. Now here this cochlear implantation availability has been locked in universities and with the quagmire we're going to open it up to the general population so that older patients can hear. And that's very exciting. And Dr Volker is a brilliant uh steward of that. I'm very excited that she joined us from USC. The doctor will gamma will be talking about head neck, surgical oncology, thyroid surgery and robotic surgery. He's gonna show you how robots are now being used in surgery. And Dr Lewis are as I said is our adult and pediatric uh hearing and cochlear implant specialists. And she'll be talking a little bit about that, our keynote speakers. How exciting. And the P. And I. We are doing psychedelic research where the first group in California that got California D. E. A. And federal D. E. A. Approval to conduct psilocybin research. We're on our third clinical trial. Our first one was in recidivism and alcoholism were now doing depression major depressive disorders. And we're looking to do movement disorders. Uh depression and movement disorders. Very exciting. Um Of course it's like the academy awards we have to wait two years to unseal the envelope to see how successful it is. But anecdotally it's going well and dr kelly will be explaining the trip program treatment and research and psychedelics. Um and dr martin we'll be talking about health care reform from the inside meaning from us. Dr Neil martin was former chair of neurosurgery at U. C. L. A. Trained at the Barrow Institute and he is a foremost, foremost world and national authority on health care delivery and organization. He went to Geisinger from U. C. L. A. For five years and integrated the entire Geisinger system which is equal to Mayo or Kaiser. I mean it's a huge system in Neurosciences and now he is heading up southern California uh providence clinical institute programs and integrating all the clinical institutes to have standardization and he's gonna really give us some insight about that. So there's doctor Kelly and doctor um martin. So kicking this off, Dr Anwar will have him come up and go from there. Thank you very much for attending. Okay great.