Cut out the bottom. Ballet slippers need to fit snugly against the foot. Measure from the heel to the big toe and across the widest part of your foot. Round these numbers up to the nearest 1/2 inch and cut a piece of leather the length and width of your measurements, rounding the fabric at both the heel and the toe. For a more exact fit, trace your foot directly onto the piece of leather. Leave about 1/4 inch of space around the foot at the heels and the toes and round the shape into an oval on the side of the foot. You can use chalk on the back of the leather. Cut a hole for your foot. To determine where this hole should be, drape the piece of fabric over your foot so that it hangs off your toes and touches the floor. There should be at least 1/4 inch of fabric on the floor. You will need this much extra to sew the pieces together. Smooth the fabric along the top of your foot until you hit your ankle. Now, measure 1/2 inch past this point and mark the spot. 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Nike Kobe 9 Low EM Premium Laser Crimson,Holiday portaits give homeless people a different view of their lives There was the woman who wore her entire wardrobe at once and insisted on being photographed as she peeled off each layer. had a parka, another coat, seven layers of clothing . she kept going until she got to her T shirt and jeans, says Jason Kaplan, the photographer who captured the unique portrait series. was kind of a character, a little eccentric. Kaplan, 43, a freelance photographer who lives in St. Johns, has met many more characters in his volunteer work, which he calls the Portrait Project. Every holiday season since 2007, about 120 to 150 homeless or low income people who receive day services at the downtown Saint Andr Bessette Catholic Church sign up for a sitting in the church makeshift portrait studio, where Kaplan and two other local photographers take volunteer shifts taking photos. Their sessions run back to back for four days in early December. Two weeks later, the homeless and low income people return and pick up their two free 5 by 7 prints to keep or give away. There was excitement in the air Monday morning as Andrew Noethe, director of programs at the church, announced that the photos would be distributed that day. Several people rushed to a small table in the back of the room to claim their photos, many carrying their mugs of hot coffee and bowls of chicken noodle soup. The church, at West Burnside and Sixth Avenue, is open to homeless people for just two hours each morning, after which people either stand outside, attend a nearby Mass or find another shelter. The 100 or so folks at Saint Andr Bessette on Monday morning sat around tables with their soup and individually wrapped sandwiches, for some the only meal they eat that day. One man played guitar, others lounged with a newspaper, another man rested his head on the table. They sat with their bikes, sleeping rolls, backpacks and shopping bags, layers of coats and hats to stave off the chill. Many carried empty bottles and cans to recycle for cash. Most were talkative and in good cheer; after one woman let out an incomprehensible holler in the hallway, a man inside lightened the air: her more coffee!Jewell Ramirez was one of the folks who made a beeline for the photo table. The middle aged woman, who been homeless since 2010, when a medical condition caused her to lose her job, hadn been at the church when the photos were being taken, but wished she was. give them to my family, Ramirez says. Instead, she carefully selected four of the Christmas cards on the rack nearby. like the religious ones, not the ones that say holidays, she says. The church was handing out the cards to anyone who wanted them, as a way for people to give their portraits as gifts. The church also provides postage for the cards. Many, however, want to keep their portrait for posterity. is just temporary, Ramirez says about her condition. She awaiting an ear surgery in January that will allow her to hear normally for the first time in her life, she says. After the surgery, Ramirez expects to be able to resume work as a medical interpreter. Until then, she spend her days and nights floating between warming centers downtown. A sense of stability Noethe, the church program director, is thrilled with the response to the portrait project. it was just an idea for people to both receive and give a gift for Christmas, he says. After a year, it became evident it was more meaningful than anyone could imagined. they received the portraits, the fact that people were viewing themselves literally through a new lens was really empowering for people, to see themselves as beautiful, he says.
Buy Authentic Mens Nike Kobe 9 Low EM Premium Laser Crimson,Air Jordan 5 Retro Black Varsity Red Metallic Silver The use of diabetic shoes has been steadily increasing since the Medicare Therapeutic Shoe Bill was passed. For some diabetics, these are of vital importance to reduce shoe related foot complications. Unfortunately, overuse of these prescription devices and fraudulent distribution threatens the long term viability of this program. This article will discuss the appropriate use of these shoes and how patients and physicians can assure proper utilization and monitoring of these devices. The Rationale Behind The Use of Diabetic Shoes: Medicare began this benefit in order to limit the incidence of foot wounds and general injuries caused by the use of improperly fitting shoes. Shoes have been the source of many friction and pressure related wounds, leading to infection, hospitalization, and possibly amputation. They also have allowed for irritation of foot deformities already present, including bunions and hammertoes. As many diabetics have some level of poor sensation (peripheral neuropathy), shoe irritation pain cannot be readily felt and wounds form easily after a relatively short period of time. Combined with foot deformity like bunions and hammertoes, as well as chronic swelling (edema), the potential for the shoe to rub against the skin is dangerously increased. A diabetic shoe is defined as an extra depth shoe (especially in the toe box) to reduce pressure from above on the toes, as well as sized appropriately for width to reduce pressure on the inside and outside of the foot. This immediately protects feet with toe deformities or bunions, and benefits normal feet as well. The shoe material generally should have a construction to limit seams within the shoe, and should be durable to last one year's worth of daily use. Of vital importance is the inclusion of an insert made mostly of a material called plastizote. This material reduces pressure and shear forces. It can be heat molded to the foot, or in some cases must be custom molded to a foot if severe foot deformity is present. These severe deformities may be from amputation voids or a fracture causing disease called Charcot arthropathy. Medicare has defined the minimum thickness of this material, and the use of anything less is inappropriate. When the extra depth shoe and plastizote insert are combined, the likelihood of shoe related diabetic complications is significantly reduced. Unfortunately, diabetic shoes are over utilized outside the medical community. In order for a diabetic to need diabetic shoes, they need to have some combination of neuropathy, foot deformity, calluses or corns (hyperkeratosis), prior foot ulcer, amputation, or arterial disease. If none of these are present, a diabetic does not need the shoe as the risk for problems is low, and Medicare will not cover it. A proper medical exam is needed to determine if these components are present, as a diabetic with any of these conditions should be under medical and podiatric care anyway. This can be done by the physician managing the diabetes, but a foot specialist usually handles this. A proper prescription for the shoes and a determination as to whether heat molded or custom inserts are needed is made, as well as a determination for any other modifications needed. At times, some diabetics have such severe foot deformities that a standard diabetic shoe is in appropriate, and a custom molded shoe is needed. This requires a much different process. After the shoe prescription is determined, the physician managing the diabetes then certifies the treatment of diabetes and the need for the shoe. This documentation is required by Medicare. The above process is often ignored when medical supply companies and non medical entities are involved in the distribution of diabetic shoes. A common scenario takes place when patients are contacted by mail or phone by these companies (who are on a calling list due to their diabetes), and an offer is made for a "free" diabetic shoe. These patients are then fitted through the mail based on the shoe size they admit to, or they mail in a foam box impression of the foot sent to them. Events are also held in which patients go to a hotel or general conference center for a one day opportunity to be fitted. Rarely is an exam performed by the dispensing company, who rely solely on the certification of the treating physician to be in line with Medicare documentation requirements. Most of these physicians are too busy to scrutinize the source of the shoes, and simply want to provide protection to their diabetics, so they sign it. The patients are then sent the shoes, and no follow up is performed to determine if the fit is appropriate. If problems do develop, no one is available locally to inspect or modify the shoes. At times, the shoe styles used barely fit the qualifications for a diabetic shoe, as commercially available shoes are often used in place of a dedicated diabetic shoe, and the inserts used are of poor quality. Some companies will automatically use custom inserts whether or not they are actually needed as the custom inserts reimburse higher. All of this is done without the input or expertise of a foot specialist, or even the primary physician. As if all this was not enough, in many cases companies will write off the 20% Medicare does not cover in the event a secondary insurance is not present (or will not cover diabetic shoes), in order to keep the marketing of "free" shoes accurate. This is illegal, as providers and suppliers are obligated by federal law to collect this. In short, not all diabetics need diabetic shoes. Those who do need shoes that fit properly based on their specific foot, and a specialist is needed to create the prescription and follow through with the product. Medicare needs to be billed properly and accurately. The over extensive and fraudulent use of diabetic shoes for profit is threatening the long term viability of this program. The determination for the use of these devices needs to rest solely in the hands of the podiatrist or physician treating the diabetes. The shoes should be dispensed directly from the podiatrist or from a skilled pedorthist/orthotist to ensure quality and proper follow up of fit and function. Nike Kobe 9 Low EM Premium Laser Crimson jump to contentmy subredditswhat's this?TROPHY CASELate to the party and I seen some similar posts, but mine feels pretty cringeworthy, so. storytime: When I was in undergrad, I was a Creative Writing major for 3 years. I took some poetry writing workshops. One sorta wacky year I decided to also be an RA (resident assistant) in the dorm I lived in. It was free money, cuz I didn do shit and I lived in the dorms anyway. There were a bunch of RAs, most of them super goofy square type folks who thought they were saving the world by preventing freshmen from smoking pot. One girl in particular was extremely nerdy, unattractive, and large ish. She also probably had Aspergers and may never have seen a dentist, so I felt sorta bad for her. Incidentally, she was a Creative Writing major. She ended up in my poetry writing class, where one day she sat next to me and tried to chat me up about being an RA. We got on the subject of my dating life, and I told her I had a girlfriend. This did not deter her. A few days later, we had an assignment due. She wrote a poem TO me, and given that this was a workshop, she stood up read it in front of the entire class. Along the very obvious lines of:close this windowyou'll need to or register to do thatcreate a new accountall it takes is a username and password.
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