Well, thank you very much for having us. Bruce and I have just been honored to be here, and really enjoying the program, the interactions. So my name is Larry Reagan. I'm from Penn State University at a Center for Online Innovation and Learning, which is a research and development hub for new ideas around how online innovations can impact our learning spaces. And Bruce, do you want to introduce now, or do you want to wait until you? So when Bruce comes up. So our topic really grows out of a program that we've been running for five years now, a relationship between Penn State University and Sloan C. Bruce and I have served as co-directors for several years on this program. And as it has grown, as the program has grown and evolved, we've developed a kind of observations of forces that are impacting today's leaders in online learning. And we want to share a little bit of our findings with you and have some dialogue and some exchanges. It's really interesting to us to know if this is the set of forces that we feel in the U.S. in the U.S. context, what do you feel in whatever context you might be sitting in? So we're hoping today that we can have that exchange and dialogue. I think Malcolm may have mentioned that we're not going to have a set time for questions at the end. We'd like to build those into the program as we go. So be prepared to hopefully be engaged. In order to do this, I'm just going to give you a little bit of a background on the Institute. But I'm not going to go into great detail right now, but I think it's important for you to just know sort of the setting. We use this thematically throughout our program, which is to really ask individuals who are taking a step into a leadership role to think about things from a very personal level. What do I think about leadership? Then talk about how that personal explanation or understanding of leadership expresses itself at the local level. So what can you do? How do you operate within the framework of an academy or an organization? And finally then, and this is the one I think for both has been most interesting and stimulating in the last couple of years is about thinking globally. One thing we've learned, and we were just talking about this last evening, we're reminded time and time again that 20 years ago, 40 years ago, we thought about our institutions as landlocked institutions. Our competition was really the competition 50 miles from campus, not someplace in Saudi Arabia or in the UK or wherever. Today's environment is very different, which calls upon a different set of skill sets for leaders needing to think about things in a broader context. So very quickly, we joined, as I said, in 2009, was our first year. It's a shared effort. We share faculty members. That is, we select faculty who represent the leading thought individuals in the industry. We invite them to participate. We typically have six to seven faculty members per offering of the program. We are addressing the next cadre of online learners. Bruce will often say, if you look around the room, we're not getting any younger. Our generation is beginning to look toward retirement, which means thinking about how are we preparing that next cadre, the next level of online leaders. The mainstreaming of online learning has increasingly become a theme of the program. As 10 years ago, 15 years ago, people were still trying to figure out what online learning meant and where it fit into the ecosystem. And today, the numbers of institutions who don't have an online learning strategy are in the minority. We already mentioned the grain of the online leadership. Oh, this career path topic is kind of interesting for us because when we started the program just five short years ago, which I guess in internet time is like what, maybe 50 years ago, let's call it. We had mostly individuals coming to the program who had not studied online. Most had some experience teaching or had some capacity. But they came from other fields. They were perhaps a director of an AV unit first or maybe a faculty member in a particular college. Today, what we're seeing then is are individuals coming to the online learning program who are beginning to represent the people who have had experiences in online learning. So more and more, we're seeing people who have degrees from online institutions. Or in some cases, as we saw this year, have a significant amount of years in the domain itself and now are being asked to step into a leadership role. And lastly is this topic of forces of change. We really try to help the participants understand all of the dynamics, at least from an ability to think about and talk about these forces. And this is what Bruce is really going to talk to you about. Framing this out, we're going to be looking at three things. We're going to be looking at that personal level, the institutional level. But we're going to start with the global level. And Bruce is going to walk us through understanding how these impact us a little bit in terms of preparing to be an effective leader in online learning. So I'm going to turn it over to my colleague and good friend, Bruce Shalu. As Larry said, we're going to flip the framing device here. I'm going to run through over the next couple of minutes some of our findings, if you will. Some of them are based upon the clear interaction we've had with our participants. As Larry said, up to 170 or so now. But also, from research and interaction with a variety of folks from our community. So global forces, and I have to admit, these are global forces a bit from a US perspective. Most of the students who participate, colleagues who participate in the Institute, are in fact individuals from US colleges and universities. There's a significant challenge in the US right now about the value proposition of higher education. It plays out, essentially, as is the investment of time and money that our young people are making in higher education for this credential, actually paying the dividends that it should. I have to say that in the US, this is probably the first time in maybe 50 years where we've started to have questions, very deep-rooted questions by policymakers being raised about the value of higher education. I think we have generally floated along as an industry, if I can use that term. And there was no question people needed to move into post-secondary education in the US, not a question about the value proposition. But it is now, in part driven by the enormous costs to attend a college or university in the US. And it used to be just in the private sector, it is now in the public sector as well. So pricing is a huge issue. This historical cultural legacy of the academy, the traditional academy, is under some significant change as well in the US. And it's going to be interesting to see how we define the academy over the next decade, because indeed it is changing quite significantly. I'll comment on that a little bit more momentarily. We're having interesting questions about what learning experiences should be, how long they should be. The traditional 15 or 16 week semester is a little bit under attack. In some measure, back to this point about the value proposition, time in seat is a cost. And the idea that it's going to take you eight semesters of full time study to complete a four year baccalaureate degree, which used to be the standard. The standard now is 150% of time, so over six years. And we have in the US, I'm not proud to say this, we have some 50 million working age adults, 25 to 62, although the age of work has been extended more and more. 50 million of them have some college credit, no degree. And we're working with a number of institutions to try to turn that 50 million not into a deficit, but into a market. And in fact, online strategies are being utilized. The second component of this is who grants the credential. Most of you have probably heard about badging. Badging has become amazingly popular. We introduced it to our IELA Well Group this year. And it's amazing how many of them are saying, well, I'm going to finish this because there's a badge attached to it. And we've kind of laid out a five badge strategy. The badges, in some instances now, are being turned into academic credit. The credit is being applied towards a degree. And who gives the credential is becoming more and more significant. The democratization of learning used to be the case that we would come to a university, such as the University of Nottingham. And our faculty would be generating research and findings. And the students would come to the university and we would deliver our findings sitting in a traditional classroom like this. You can Google just about anything these days. And in fact, you do not need to come to the traditional campus. So there has been kind of a flip, if you will, in terms of how we can acquire, how we can access, where we access knowledge and learning. So there's a democracy at play here. None of you, of course, have any reduction in funding, right? And in fact, if I'm not mistaken, I've read a few headlines about the UK. It's getting a little bit more expensive for your students to attend university in this country. Welcome to our world. We've been in this world for the last 25 or 30 years. As I mentioned, we've got this double issue now, double jeopardy, if you will, of not only having dramatic increases in the price or cost, it's been pushed in some measure by reductions, particularly in the public sector, of support or resources. So the policy makers in the U.S. continue to extol the virtues of higher education at the same time slashing budgets. And they've essentially said to institutions, you folks make up the difference, and so we've seen huge tuition and fee increases, which has become a huge burden for many families and students. The online markets continue to grow. These are, in fact, global in nature. They become much more competitive. Launch a program, reach students, we used to be reaching students, hello John, we used to be reaching students, we used to be reaching students locally, then regionally, then nationally, and now internationally, and particularly at the graduate level, the competition for institutions that are launching online graduate programs is intense, quite intense. Whoops, excuse me, we have this fascinating situation where we were in London earlier in the week and we saw that there was a Pepperdine University office right across the street at Imperial in one of those marvelous flats. We saw that Fordham University from the U.S. has a presence. That's not to say that U.S. institutions are still not reaching out across the globe, but they can reach out in far better ways using the technology, and indeed the students have that same capability. So there's far greater mobility both in terms of institutions and who they serve and where they serve them and the learners. And the last point I want to make on this global force component relates very directly to the comment I made earlier about particularly graduate programming. We have had this historical, at least in the U.S., challenge, this pendulum kind of swings back and forth on the liberal arts versus vocational education or education that would lead directly to vocation. That pendulum has swung well away from the liberal arts now in part driven by increasing demands on institutions to make sure that the students who graduate from colleges, universities, and the U.S. are in fact employable, have marketable skills. And so many of these programs have become much more applied in nature. And again, at the graduate level, the expansion of particularly MBA programs, engineering programs, online or in blended formats has increased pretty significantly. So those are eight kind of global forces at play. And if I click this button, Larry can explain to you what this means, because I can't. So we were interested in looking at this issue of the global forces and learning a little bit about how your institutions are dealing with what are the forces that are enacting on your institutions as well. And that's where we wanna get a little feedback, because we're kind of checking basis here. Are you dealing with the same kinds of pressures at the global level as we are, or are there different unique issues that you're dealing with? So if I can, now we're gonna need to get a mic to you. And I understand we have mic runners, is that correct? Do we have people who are gonna use mics? Yes, would you come up please? We've got two. So as we're getting the mics there, I have to tell you at our institution, this issue of globalization at Penn State has a very real presence as well. So we feel it in how we have to make decisions. Stephen Freeland's Open University in the Netherlands. I think it depends on the language in which you're teaching. As a small language area, we don't feel the same, well, we feel pressure as well from outside, but most of our students are still touch speaking. So that somehow limits competition. Interesting, I hadn't thought about that. Okay, so the language itself creates kind of a smaller geography, if you will. All right, interesting. Other thoughts, questions? Our force is different. I think what we're trying to drill down to a little bit are these forces that we outline, and there are others, but certainly stopping at eight is a pretty reasonable number. Are you engaged in dealing with troubled by? I was just gonna say, we have... If you tell us who you are, please. Sandra Partington from City University. So right in the center of London, and we have a lot of postgraduate courses, and they really are students from all over the world.   So you're filling a force from your constituent base, your students, demand for continued access. Things like assessment and feedback, results online, feedback online, quickly and globally accessible. And how is City in responding? Are you putting together programs that serve their needs? Because if not, we have some that we'd like to offer. Yeah, trying to extend, you know, something like encouraging people to mark online and do their feedback digitally, which can be quite, you know, doesn't suit all lecturers, but it really does suit a lot of the students. So it's tipping that way now to make that, make more of an effort to hand things back and communicate, especially as I say, marking and feedback. Sandra, if I can just extend that a little bit, because I'm curious about this particular force. Is it happening now, or do you foresee it happening where this desire for the online component will begin to change what you do in the face-to-face component? Do you know what I mean by that? I do, I just don't know how it's, you know, big, I don't know if I could comment. Yeah, okay, I was just curious. Yeah, yeah. Interesting, okay, thank you. Malcolm, and then we have... We have two more hands. Hi, Malcolm Ryan, formerly of the University of Greenwich. Just to follow up with the question that you just asked about, does going online change what happens face-to-face? I'm not sure if you're aware in the UK over maybe the last three or four years, there has been a growth in the idea of blended learning. What I think's very interesting about that is the flexibility of the definition of blended learning. Some people at the base level think that just means, well, you carry on doing what you did very much face-to-face and you put things online that people can access or not. But I think more sophisticated use of blended learning where people have thought very carefully about the affordances of the technology as Diana Lorelar speaks about, and have actually used the online elements to do things that you might not be able to do or do as well face-to-face. And I think the more complex decisions made around that, I think the better the actual learning experience would be. But I don't think many people are doing it. It's a force to be reckoned with. We'll have one more here and then we're gonna ask Bruce to move to the next level.  Sorry. Charlotte Cork from the Liverpool John Mores University. I just wanted to say that your final point about the vocational importance of vocational courses, that's absolutely been the case at our university. Yeah, that's good. I'm actually from the careers department and we run a World of Work Skills certificate, which it was originally an optional extra thing that students could do on top of their degree. We got reasonable good take up, but the university took the decision two years ago to make it the first stage of that program compulsory for every level four, every first year student coming in. So we've just come, we're just starting now the second year of running that, but that's 5,000 students doing an employability focused program. So it's very high on the agenda at our university. Set in your session yesterday and it was really very informative, very educational to learn more. So I appreciate your comment. We're gonna slip this question in as well and then I'll catch up. Roy Williams, you hear me? Yes. Roy Williams University of Portsmouth. I've seen some interesting research recently in relation to free future learn. And that says that there's a divide, I don't know what the figures are on the divide, but there's a divide between students who want to engage with UK universities for the whole English experience, whatever that is, but it's an inculturation process. They would like to become incultured, whatever they think that is. So they want to be here wherever here is. And they want to get those goods, whatever those goods are. And then there's another whole group who don't actually care about the inculturation. They might get the inculturation where they are or it might not be relevant to them. And they just want, as in where the technical skills. So there seems to be a split in the demands of those people. The interesting question is, and I think it goes back to what Malcolm was saying, can online learning give them some of the inculturation goods that they're after? I think it can some, but I think it can't others. Yeah, I actually have six grandchildren. The oldest is 12. He will go off to university. We live in Atlanta, so maybe he'll go off to Georgia Tech, very fine institution. I want him, and I'm not anti-campus at all. I mean, I love our campuses. Our campuses must continue to exist for a lot of the reasons you just mentioned. But the instructional activity and how the teaching and learning environment has created a place like Georgia Tech or any other institution, I think is going to be the change. My hope is that he does not get put into a 500 seat theater as he stands in front of a 500 seat theater here, and someone lectures to him 50 minutes, three times a week. And I know that's not what is happening at a place like Georgia Tech where students are heavily engaged in technology. So I do see that the need to create a cultural environment. I think that is clearly part of, if you will, a traditional university experience, but the instructional activities within it, I think, are changing and in fact need to change. So don't give me too far off on that. Let's talk about institutional forces. A few of these things that you mentioned are gonna come up. We're into, we have a lot of attorneys, too many attorneys in the US. In fact, I mentioned this notion of trying to reduce time in seat. President Obama came out a week or 10 days ago and said, law school, which has historically been a three-year experience, needs to be pushed to two years. And there was a hue and cry from law schools. And why was there a hue and cry? Because our entire model, our entire institutional model, and take it out of law school, put it in almost any institution, is tied to how many individuals, how many seats we put in seats, whether those are real seats or virtual seats. And if you start playing with that formulation, then you've got a challenge on the revenue side, on the resource side. And despite that, the movement clearly in the US is clearly kind of going back to the 60s. We've gone retro with competency-based activities. So this notion of the contract for learning or with a learner is changing. Obviously, the financial impact of online learning, I'm gonna catch up here, make one quick comment. With the internet revolution, if you go back into the mid-90s and through the early 2000s, online learning, e-learning in the US was promoted with policy makers as a way to save money. We can give you a quality educational experience, but we're not gonna charge you to mow the grass, to keep the lights on, to do all those other things. Yes, there were fees, technology fees, so it was the term that was used. But students typically were paying maybe a little bit less than what they would be paying if they were attending university in a more traditional face-to-face manner. That model is, it's 20 years old and it's just not applicable anymore. And what is happening in the US market, particularly at the graduate level, come on in, is what we call market pricing. What will the market bear? What can I put my Duke University Executive MBA Online International or Global Program on the market for over 100,000 US? And then seven miles away from Durham in lovely Chapel Hill, North Carolina is the University of North Carolina, Chapel Hill, a marvelous public university. If you go to the campus, the MBA program's probably $15,000. If you take it online, it's $50,000 and it's approaching $100,000 for their global online program, which is about the cost of what is happening with the Duke Executive MBA program. So the market strategy or market pricing strategy has changed. You had to mention MOOCs. I'm not sure what else I wanna say about MOOCs other than this fascinating bandwagon, whether it is evolutionary, revolutionary. It's going to change our thinking. What the next iteration of MOOCs will be is very unclear, that it's going to impact how we do our business early in the States is without question, without question going to happen. I'll give you one quick example. Larry and I are one of the things we were talking about last night. Historically, the number of students that you teach in a class, the full-time equivalent student credit hours that you generate are tied to 20 or 25, depending upon the level of the course. Occasionally, we'll get a large lecture kind of activity, but generally, faculty wanna teach classes with 18, 20, 22, 24, and most institutional policy is wrapped around that number. And so now how do we react to Sebastian Thrun teaching 150,000 students in his artificial intelligence MOOC some time ago, or the tens of thousands of students who are engaged in MOOC classes, and the policy makers in the US are now saying, no, so wait a minute. Faculty are saying we can't teach more than 25, how can this faculty member be teaching 150, and it's free. So you have to think about the policy notions here and what our policy makers are saying. Lifelong learning, I think one of the true attributes, one of the beauties of online learning is its potential to serve learners throughout a lifetime. In fact, I think that's really the great spot for MOOCs. It's this notion of continuing the learning experience for individuals who have a particular interest or a particular need. This relates to one of the global aspects. This notion of return on investment is driving a lot of the data collection and driving a lot of the discussion around policy in the US.  And what is the return on investment, both from the learner, from the investment that governments are making in the public sector? It is not something that we actually have done quite, let's go to job as we need to on. We have a huge issue with retention in the US. I mentioned that earlier, a number of 50 million working age adults who have some college no degree. We're bringing them back to degrees in part because they are not working, they have families, and we are engaged with them in programs that meet their needs. We still need to do a better job of having those complete when they in fact can complete. And that number, as I've said to some colleagues of 50 million, we need to reduce but it's going to take decades for us to in fact get to that point. One other quick comment on that. I think it used to be the case where institutions and maybe even those in the policy environment would say it's the students problem. The fact that the student didn't finish is that he or she didn't have the wherewithal, didn't have the resources, had an issue at home, it's them, and I think we have probably put to feel the notion that this is all about students. There are not 50 million US students who couldn't cut it. In fact, many of them are coming back and are doing quite well. And then Larry, I'm gonna stop on, I'll just make one quick comment about disruptive forces. I think we probably, one of the centerpieces of the discussion at this conference, and at most of our conferences, has been about disruptive forces of technology and the changes in pedagogy, which we could go into our own session on that. So let me stop there on institutional forces and Larry's gonna take another temperature. I think maybe what we'll do is have you go through the next batch and then we'll do a set of questions. So what he's telling me is I need to speed up. Individual forces, I'll take these off fairly quickly. Part of what we are looking to do with the institute is to get our emerging leaders to think differently about more broadly learning, higher education, but also e-learning or online learning, and they should be much more progressive in their thinking. They typically want to deal, not with strategic, broader framed issues, but more operational kinds of questions. And we work very hard through the setup. Larry's gonna take you through quickly the program frame. Work very hard to try to get the participants to think much more strategically. That means more progressive and that means much more collaborative leadership. To be aware of the emerging global markets, to have a much greater business orientation for a lot of the reasons that I mentioned under both global and local or institutional, that the demand certainly on institutions in the US for financial management, for maintaining a reasoned balance between resources and expenditures is significant. To be quite agile, nimble, if you wanna use that term in the changing waters, sometimes tsunami-like of higher education. This drinking from the fire hose, it's probably a US term. It really relates more to we collect so much data. We probably collect more data than we know what to do with the data and we need to do a much better job of framing the case for what we're doing. And then we want our future leaders to be thinking about opportunities and our greater orientation to opportunity. So let me stop there. Now this looks like it's really taking a temperature in both C and F, so there you go, Larry. So thank you, Bruce. So we're gonna combine just a quick, get some feedback from you on those two. We talked about institutional forces and then also forces affecting the personal level. So can I ask, are we on the mark? Are these the same things that you're feeling in your organizations or maybe feeling personal? Do we miss any things or something from your context that might be a little bit different than what we're experiencing? And Bruce, if you wouldn't mind, maybe we'll go back and leave it on the screen just to freshen the memory there. Any thoughts or comments? Do you use the term drinking from the fire hose here? So think of the metaphor, right? You've got this amount of information flowing out.  How do you do that as a leader? How do you simply manage the volume of information, of new ideas, of new technologies?  And it's that feeling of, how do I just manage the pace of these changes in this amount of technologies coming in? It's not easy. I asked Stephen Downs, who will be your speaker tomorrow, that question, how do we help leaders, emerging leaders do that? And he talked about building the network and understanding who your thought leaders are and tapping into those as guides and so forth, which I thought was really sage advice. How are you feeling about that? What other kinds of institutional dynamics are going on? We had a lot around the global. You don't see any around this one. Okay, so. All right, I'm gonna hand this back to you and just keep in mind that Malcolm has a pink card, which is like a red card in football, so let's be sure we don't get that, all right? Okay, so thank you, Bruce. So what we, in the institute this, we call it IELOL, we kind of joke that before you graduate from the program, that has to roll off your tongue like a new word. IELOL is really our experience of helping to prepare this next generation. I'm just gonna give you a little bit about the format of the project or the program. Frankly, our hope is that people may be interested in participating and collaborating with us on this project. One statistics that's kind of interesting to throw out is over the five years we've had over eight countries represented in the program, including the UK, thank you Malcolm, Ireland, Singapore, and Australians as well, so it's been a nice group. So very quickly, it's really about a four or five month program. It's a blended program. It begins with a two week online primer, which this year we're gonna turn to actually, I should say for 2014 will become a three week primer because of the level of engagement going on. We do an immersive experience where our participants travel to Penn State, which is in the center of Pennsylvania. For four days, that's, we call that the immersion or the intensive experience. We then send them back and after a few weeks of getting their semesters up and running, we start a three week online. This is where they take the lessons of the Institute, pick a particular project and begin working on it. And the goal of that is multi-fold. One is that you pick a project and hopefully move the project along in your institution, but the other is a little bit more subtle. It's a way of getting that emerging leader some visibility within the institution. So we encourage them to work with their senior leadership and say, hey, what problem would you like me to work on for the institution? And by the way, when I'm done my project, I'll bring the results back to you. So you immediately get this sort of lifting of their awareness and of their visibility within the institution. Finally, we meet at the Sloan Sea Conference in Orlando. That is generally in October, November timeframe. And we have a pre-conference workshop. That workshop, as much as individuals would like the opportunity to share all of their project ideas, we try to reserve for more conversation about that transition of moving from sort of the operational nose to the grindstone type perspective to one where you lift your chin up and you're looking at some of these broader, more global issues. Our audience is typically professionals in the middle or upper middle management level. So typically these are people who are sort of poised for next level leadership. Those individuals who wish to be leaders or who may have been identified as potential leaders by someone in their organization. We have a broad mix of institutions. We get profits and non-profits. It's really interesting. And we also get community colleges, two year type schools as well as research institutions. And that mix makes it very interesting. And as I've mentioned, geographically we've been getting more of an international draw which I think if I've heard any one comment more than others is about the opportunity to learn and to meet people from different cultures and different contexts which really raises your awareness of what global online learning is all about. These are the dates for next year. I'm gonna leave you with a website if you're interested or if you wanna chat with one of us we'll be happy to do that. There is a fee of course and that information is all contained on this website. So if you go to i-e-l-o-l.psu.edu it'll give you all the information about how to register, how to participate. And then these are the emails for Bruce and I and I think we're probably about at our time. Thank you so much for participating as you did and providing us feedback. We're more than interested in engaging with you on these kind of issues and topics and I wish you an enjoyable rest of the conference. So thank you.


So I was interested in this case because there's this fairly recent article that talked about this new vascular phenomenon in the retina and there was this case that I was dealing with at the VA and I thought that this would be an interesting way to kind of highlight this new disease phenomenon and also talk about the possible ways that we can alter our management in terms of dealing with hard to manage leaky vessels. Thus the title of this presentation. So it always starts with a case, right? So we have a 75-year-old male who came to our clinic complaining of zig-zag curvy visual disturbance. He said it's been ongoing for about three days, occasionally noticing a dark spot in his visual field from the center of his visual field, but denied any flashes, floaters or headaches. His past ocular history was just significant for cataracts and some mild diabetic retinopathy.  On dilated fundus exam, as you can see with his right fundus, it's pretty much unremarkable, no issues to speak of. With his left eye, left fundus, it's probably hard to appreciate but if you look in the center, you might be able to tell that there's his blunted foveal reflex as well as this kind of this rayish, indistinct area to the fovea. On OCT of his right eye, as you can see it's pretty much unremarkable except for an ERM. With his right eye or with his left eye, you can see that he has this, based on the infrared on FOSS view, you can see that there's this central foveal hyporeflectance and then when you go through the OCT, what you notice is that he has this Cirrus PED and in terms of the central macular thickness, it was about 403 micrometers. IVFA, as you go through time from the early phase down to the bottom with the late phase, you can see that as it starts to evolve, you can see this hyperfluorescence significant of a pooling effect in the foveal area with an appreciable notch to the pooled area as you can see in this image here. So again, we have this 75-year-old male who had this three-day onset of left eye metamorphopsia with the central negative scatoma and then on examination had this mild visual acuity change subretinal fluid on OCT as well as the Cirrus Notch PED. So when you think about a differential for a Notch PED with subretinal fluid, all of these vasculopathies can potentially cause a Cirrus Exudative Process. However, what we need to do is further delineate what could be the cause of this particular patient's issue. So this will need, this requires further testing. And so with ICG and geography, we can actually highlight what may be going on in the Coroidal area. So as you can see in this video, what you first notice here is the central hypofluorescence to the ICG. But for the most part, pretty much unremarkable ICG angiography. And then even later on in the angiography, you can see, again, the underlying Coroidal vessels are unremarkable except for this overlying hypofluorescent area. And again, highlighting that Notched region to the area of the hypofluorescent region. And then OCT angiography is another means that we can actually identify and even look at the vasculature. This is a representation of a normal individual with an OCT angiography. And what I wanted to highlight is just from looking at these top four panels here, you can see this is the inner retina with the superficial plexus, capillary plexus, this is the deep capillary plexus. And then we get into the outer retinal area. And then we go into the coriocapillaris. And this is pretty much what you would expect to see on a normal OCT angiography. In our patient, what you see here is, again, normal inner retina layer, capillary plexus, outer retina layer seems unremarkable. But then when you look at the coriocapillaris area, there's this large hypo, or just large dropout of vascular tissue. And then, of course, you can see where that corresponds to in the OCT itself. So at this point, our plan for this individual who has this Notched PD, we wanted to start with anti-vegfs. So Avastin was a common first choice of what we used in the clinic. After about a three-shot series, we would then re-evaluate to see what changes might have occurred as a result of therapy. So over a segment of three to four months, you can see that as we were injecting the patient with the anti-vegf, you can see that initially he had a decrease in his central macular thickness, but then eventually plateaued at some point. And so we were kind of at this stage scratching our heads as to what's going on here. Essentially, you have this process that's not amenable to anti-vegf therapy. Could there be something else going on that might explain why this is occurring? And should we alter our treatment as a result? So this gets into this recent discovery of this perifovial exudative vascular anomalous complex, or PVAC. I was first discovered by some French authors in 2011. And so this case report, they looked at two individuals and noticed these large perifovial aneurysms that weren't associated with any type of retinal inflammation or vascular disease. In their paper, their initial paper, what they talked about was these aneurysms that had these intra-retinal pathologies, but had no abnormal coroidal findings. And in terms of their OCT, they were able to show that there was this hyper-reflective lesion around what they call this PVAC disease, as well as this surrounding intra-retinal cystic edema. And then they obviously tried and attempted to treat with anti-VGF, in this case, locentis. But again, they had no actual improvement to these patients' condition. And so their hypothesis at this point was, could this be some type of retinal vascular endothelial cell degeneration? Thus explaining why an anti-VGF therapy may not be effective. Later on, this paper came out which talked about expanding the spectrum of PVAC and isolating or at least trying to figure out what are the multimodal ophthalmic imaging features associated with this disease. And in order to help us understand better how to classify this disease. So this is a retrospective cohort study, a multi-center approach looking and they were able to isolate 15 eyes with a mean age of 73 for their patient population ranging again between 46 to 90 years of age. Their inclusion criteria, they were looking at individuals older than 18 who had this unilateral lesion associated with this perifogial large retinal aneurysm. In terms of exclusion, they wanted to just exclude any other type of retinal or systemic issues that could confound the findings that they were looking at. So this is a very busy slide. What I wanted to basically highlight in this graph or this table is just to show that the, again the mean age was somewhere around 73. It was a unilateral process and some of these individuals actually had other conditions associated with it like ARMD as well as myopia. But in terms of the best visual, best corrective visual acuity, the worst visual acuity note it was about 2040. So not much in terms of visual acuity deterioration. And so the authors in this paper basically concluded that this disease phenomenon has pretty much a stable course. Although it's not successfully treated with an anti-vegeta therapy, functionally and anatomically it seems to just maintain a stable condition. And so what they were able to find out with OCT was that, you know, when you're looking at individuals with this PVAC phenomena, they typically have this round hyperreflective lesion. They have these intraretinal cystic spaces. And again, the most important part is there is no curidoneobascularization associated with this disease. And this is a representative sample of a patient from their study. And as you can see, there's just intraretinal vascular lesion here with no signs of any curoidal change whatsoever. And in terms of their ICG and IVFA, they were able to show that there is these well-defined retinal hypoforacin lesions with variable leakage in late frames. And that shows here, again, with this representative of ICG and IVFA, again, just kind of this late leakage with no other findings on the imaging. And then, of course, with the OCT angiography, what they were able to find was that there's this rarefaction of retinal capillaries around the lesion with no connectivity between the retinal capillary plexus as well as the coriocapillaris. And again, this is a representative image showing the capillary system in the retina versus the coriocapillaris. And there not being any type of connection between the lesion here with the coriocapillaris and, of course, this rarefaction of the surrounding capillary bed. So there are many hypotheses regarding the pathogenesis associated with PVEC. But for the authors, they thought that this is probably associated with an idiopathic retinal vascular abnormality. One thought is that this may be a variant of type 1 mactel. But this is most likely not the case because with mactel, you can see that there are differences in the anatomical changes as well as the demographics of who are affected, as well as their response to anti-vegeta therapy. The other thought is that could this be a variant of, say, type 3 neovascularity, a rap lesion. Again, this is probably not the case because when you look at the actual anatomical changes associated with the type 3 corioline vascularity or neovascularization as well as PVEC, they're different. And then, of course, the response to vegeta therapy is totally different between the two. So this then goes back to our patient. Does our patient have this PVEC phenomenon? And now, what I want to do is compare their representative sample or patient versus our patient. And, again, showing the differences in the OCT with his intraretinal pathology versus more of a sub-RPE, sub-SIRIS-PED, as well as some sub-retinal fluid, but not much in terms of intraretinal changes. And then, looking at the IVFA, again, their patient shows this anomalous aneurysm with this late leakage. In our case, we had this patient who had pooling along with this notched PED. And then, finally, when you look at the OCT angiography, you see that there's this lesion here that has no connectivity to the coriocapillaris and this peri-lesional dropout of capillaries. In our patient, the inner as well as the outer plexus was unremarkable. And then when you look at the coriocapillaris, there is this large dropout here. So, again, going back to the question, does our patient have this PVEC phenomenon? Most likely not. This is probably more likely a polypoidal-coortovascularopathy. And our plan in terms of treatment is to try a different approach. Instead of doing a vasten, we wanted to try ILEA and see if there's a possible response with ILEA. Otherwise, if there is no response to three trials of ILEA, then we could go into either photodynamic therapy or even a sub-threshold micro-pulse laser as a potential way of treating it. And that's it.


vailable on all models order during open week and you'll get three years free servicing terms and conditions apply call into the citron open week this week at highly motors mountaintop letter kenny homeland fuel offers keeping you warm for less 20 kg super therm by five bags get one bag of hardwood logs free 10 kg wood pellets by 10 get one free board namona briquettes by three for 16 euro shop in store or online at homeland dot i applications are now open for the donnie gall enterprise awards hosted by local enterprise office donnie gall the awards celebrate the diversity and strength of the small business community in donnie gall and the role they play in our local economy a prize fund of 12 000 euro will be awarded across seven different categories this is an excellent opportunity to promote and showcase your businesses all finalists will be profiled and attend the award ceremony in december apply before the 15th of november at local enterprise dot ie forward slash donnie gall email info at leo dot donnie gall coco dot ie for more information or call the local enterprise office on 91 60735 it's flu season so if you're 65 or over it's time to get your free annual flu vaccine while anyone can catch the flu you're more at risk of getting seriously ill or needing hospital treatment and the new flu vaccine is the best way to protect yourself from the flu so make an appointment with your gp or pharmacist today visit hse dot ie forward slash flu for more from the hse at letter kenny shopping center we're already dreaming about the festive season so why not make a start park for free and enjoy your christmas shopping this year letter kenny shopping center bringing you the time at 16 minutes past 11 now later government officials meet the hospitality sector today about the lack of compliance with covid rules the department of the t-shock sought the meeting on friday after new esri data was released it found 34% of customers in restaurants aren't having their covid certs checked and 37% in pubs carol mean is owner of the yellow pepper restaurant in letter kenny a member of the restaurants association of arland good morning to you thanks for joining us today carol good morning thank you right so um i mean obviously you know um there is a lot of people not checking these certs what's what's your information i mean your company is your businesses do you feel that user outliers do you think compliance is as high as the sariah saying all i know is what we do is we check everybody coming in we ask first we have a sign on the outside of the door now because of the change in weather so people aren't queuing and getting cold or in the rain so we have an extra sign saying please have your covid cert ready we check everybody on the way in we also have a booking system so we have the contract tracing that's done most a lot of people are booking online now which is a great thing and even if you call that all goes into the system for us but i do hear at the door they're a bit flustered and they don't know where it is they haven't they haven't seen it in months and weeks and they're saying oh we are the first person that's asked us we haven't been asked so i was really surprised because we're doing it correctly and we're diligently doing it but that then then even for those who have vaccinated being they may not like this covid cert system because it does divide society uh could it be damaging your business like in other words your reputation for enforcing these rules is that a benefit or a disadvantage do you think i don't know i you know interesting i got one email the ly it graduations is a very busy time for lefkenny and we everybody does really well i've been in restaurants hotels and bars and hairdressers and everybody and i had one very nasty email sent saying and she said in it i see your restaurant prefers to take cover certs over my money you know and i thought i didn't make the rules and we want to stay open we want to be safe and maybe people don't realize the importance of it and you know that for society and for businesses to stay open and survive we need compliance there's a there's a silent majority as well out there and they contact this show off there um who don't want to go to a restaurant unless they're enforcing the rules because they don't feel safe so they are fully with the public health message now given the rate of vaccination this country they are in in in the majority so you know maybe those businesses that aren't enforcing this are are excluding a lot of clientele that want to be in a place that they feel is compliant and safe yeah yeah great i do people really appreciate it and you know sometimes people get up and close the windows and then you go over and you open it and you just explain i just want to keep the airfield going and you know that you're just you're trying to do it right you know for interesting we see we had three tables outside on saturday night so i just decided now this isn't is you know it's not very compliance survey or anything but i just asked people why they were outside you know it's it's not weather for eating outside now ours is covered it's roofed and we have heaters but it's still freezing and i was saying to them why why are you outside are you not fascinated just wanted to know you know where people were coming from one table were a younger couple they were um he hadn't been vaccinated mostly because he doesn't get around to it and i said what why is that and he said i just never got through it and i said you can go everywhere you know you can go to the pharmacy and it's walk in and and another table chose to be outside because someone in their family wasn't well now they were all vaccinated men but they had a family member who wasn't well and they were protecting that person and i thought it's not really brilliant as well the people doing that and the other person somebody wasn't vaccinated at all and didn't want to be so that was you know i just knew they didn't want to say so i didn't ask anything then you see i i get it and i understand it i don't think anyone's comfortable with this really to be honest with you that we have to be in this situation but it's who's speaking out it's like you know the the people i talk of earlier on that want this so that they feel safe for inside maybe that group of individuals you talk of might be amongst them they're not really speaking out and and even by having this conversation like i know they'll be very pointed and and angry text either at you or at me and they've already come in today by speaking about this even by having this conversation there is a smaller group of people that are much more vocal and and targeted in in the report approach it's a very unfortunate societal situation we find ourselves in right now at the moment yeah well you know i think the thing about it is we didn't make the rules you know and you're trying to have your business and the most important thing to me is be open and have the jobs for all the staff and to do it in a safe manner that we stay open and that we keep people safe that's really what i you know where we're coming from and if that's what it takes you know we're following as you say we're following the recipe you want to make something you do it right you know that's what we're trying to do but i there's two options here isn't there there is mass enforcement of this or scrap it because this sort of half and half system we have it's doing no one any favors it might be disadvantageing businesses that are being compliant it might encourage those less likely to follow public health guidelines into the one place that's not enforcing it i mean we should do one or other shouldn't we this sort of half and half half compliance half non-compliance i don't think it's doing anyone any favors or what's your view carol yeah well you know i still think the the compliance bit is the way to go you know i think you know you take the advice you know if you're unwell you take the advice of your doctor if you were in an unwell country at the moment so we have to take the advice of an effort and that's the way i see it i look to those experts are there they're not there to annoy people they're there for the greater good and that to me is the way the path to follow there are people out there though that believe there's some sort of ulterior motive it's about control and power that there is some global influence over all of this but i mean you can have that conversation with them at the restaurant front door i presume no i don't think so but listen you know we've been lucky in that you know and we've had great weather over the summer and we and lots of us did get to eat outside in very nice places and really learned a new way of being and a new way of kind of socializing in Ireland that we never thought would happen and i suppose you could say look at the good it has come out but we were able to develop a lovely place in a horrible old lane to the side of the restaurant and the compliments it gets is incredible and you know there's a lot of good feeling around you know this this change in in the way of being in the way of socializing and i know we have to go through two probably very cold months for the next for november and december but isn't as they say spring is never too far away and things will be back again all right so i i presume i mean we it's not hard to to guess what will come from this meeting the government will say look if you want to avoid restrictions over christmas these measures have to be fully introduced adrian commons will say that's grand but give us a time when we can get rid of these these certs you know what is the critical mass of those vaccinated that it's no longer required that's what's going to go on at the meeting i expect that yeah exactly can i ask if you had anyone visit your premises to check about enforcement out of interest um we didn't have particularly around that we did have um the one of the local health inspectors did come in a good while ago then but mostly he was checking around what what we you know why the operations at the beginning you know how did your door open do you have the signs did you have you know have we pvc in front of the tell all those type of things and he did you know asked us to make sure that we had contract tracing and you know he looked and he said yeah and he had a little form and he ticked you know he had a little thing to say and i'd say it's satisfactory and i was saying to him satisfactory that sounds like i'm not doing good enough and he said no it's either satisfactory or not and i always think that that's not a good word you wanted a slightly bigger pat on the back all right carol listen thanks for joining us this morning i appreciate it all right take care of yourself uh that is carol mean and their owner of the yellow pepper restaurant letter kenny a member of the restaurant's association of arland uh that meeting's taken place later to say you know you could print out the what's going to come out of it right now and you wouldn't be too far off uh we were talking about that trial that concluded yesterday this caller says read the pay master the dogs in the street have long known their identity however despite bluffing bluster the establishment will refuse to give one of their own up especially when the pay master knows where the political bodies are buried that's how things work in this country um i was called by the doctor for the booster i'm in the age bracket it's not five months since my second vaccine when i went to the doctors nobody asked check date of last vaccine when i pointed out it wasn't five months ago i was told i couldn't get the booster doctor obviously calling people on age not date of last vaccine how many people have got the booster earlier than they should say is that caller there uh hi greg this is a bit random i know but does anyone else notice that the time clock on the sky tv screen is still on summertime i i haven't had any contact from that but uh i know other people out there have been commenting on that it's it's a minor distraction but something of an annoyance is there a fix for it someone's clock uh on their skybox is still on summertime uh hi greg a quick question but i've just seen a post up from a doctor's surgery about having to provide a covid passport or vaccine passport to attend the doctors now for face-to-face appointments this is a bit ridiculous at this stage vaccinated or not we still spread the virus this seems unfair to other people who feel like they don't have a choice anymore they believe it's uh just another tool to uh that's what they probably believe to to coerce uh a word they might use the final uh 7.5 percent of adults that haven't had their vaccine yet but uh it is interesting you know regardless of what anyone's views it is interesting how that study as it relates to uh viral load and transmission in the home has uh now become you know common discourse for talking about vaccinated versus unvaccinated uh and i imagine not an awful lot of people perhaps have have actually uh read that study right it is the 9 till noon show here on highland radio back with more after these get your tires winter ready drop into ulcer tires and letter kenny and body buffet today are you a self-assessed income taxpayer use ross revenues online service to pay and file online by november 17th if you're not yet registered for ross do so today at revenue.ie avoid a surcharge interest penalties and a possible tax audit don't miss the november 17th deadline pay and file on time at leadle this week we've a deliciously authentic taste of italy irresistible deluxe pistachio ice cream just 199 gorgeous deluxe ice tiramisu just 399 and melt in the mouth deluxe amaretto only 199 bellissimo as they say in rome and on the radio when we want to sound italian leadle more for you getting married don't leave it too late book with us today at the groom's room in evolved clothing letter kenny retail park candles lanterns christmas trees decorations and all types of lights everything you need for christmas experience the magic of christmas at coonies our biggest and best christmas shop has outstanding value on lights and trees there really is something for everyone at coonies letter kenny retail park auctioneers estate agents letting agents and property management agents operating in the republic of ireland must hold a property services regulatory authority psoray license an auctioneer may auction land fine arts antiques or animals at a mart when engaging an agent don't assume your agent's license check the psoray register of licensed agents at psor.ie unlicensed agents are breaking the law report unlicensed operators to info at psor.ie remember no psoray license no psoray consumer protection the national inpatient experience survey is now underway if you stayed a night or more in a public hospital during september this year you will have received a letter by post asking you to participate in the survey sharing your experience with us will help us to improve the care our hospitals provide for more information visit your experience dot ie from the hsc the health information and quality authority and the department of health store and go springtown dairy the north of ireland's only temperature control smart access individually sized storage units store and go offers storage for personal storage house moves and renovations business storage for excess stock or finding systems once signed up you can access 24 hours a day through an app on your phone gaining access through four levels of security to your most precious possessions call store and go springtown dairy on 02871 278 900 to discuss your needs and get bespoke advice or get a free quote at store and go dot net all right so did you have an overnight stay at least one night at letter kind of university a hospital and over the age of 16 well you're being invited to engage in a survey on inpatient experiences it's from hick with a health information and quality authority the director of the national care experience program is rachel flinn and she's on the line now rachel how are you good morning reagan i'm good right okay so then between what period of time and who do you want to hear from as part of this program okay so all 40 public acute hospitals are participating in this survey and that includes letter kenny university hospital so there's about 891 patients discharged from letter kenny university hospital during the month of september and each one of those will receive an invitation asking them to participate in the survey and the survey will look at i suppose their care and their experience so there are number of questions on admission to hospital care on the ward some questions around examination diagnosis and their treatment when they're going home and we've added this year for the first time some questions around care during the pandemic relating to COVID-19 so just maybe to give your your viewers and your listeners sorry an example of that and so we have questions on were you told you had COVID-19 at any time during your stay and while you were in hospitals did you feel you were at risk of catching COVID other questions relate to you know communication with staff it's obviously more difficult with PPE and masks so we ask a number of questions around that and did you understand and when you were communicating with with staff and also there are questions around being able to connect your family when you're in hospital because of the restrictions and the lack of the ability to go in as much as pre-COVID so there are a number of questions on that and what will come from this though because you know let's just give an example there will be people that will respond and say i presented with my elderly relative uh who has you know we know what they have uh and they displayed respiratory illness and they were popped through the COVID pathway and sitting with other suspected COVID patients even though they knew we knew and it turned out that the respiratory issue that had was not COVID related we feel they were put in a position of danger okay i imagine that will come up on the form how is that actionable though what do we learn from that uh you know what would be the purpose then of someone submitting that to you what could the outcome be okay so it's listen we this is the first year that we've conducted the survey we've conducted in 2017 2018 2019 um albeit that that was pre-COVID there are a number of questions about being treated with respect and dignity um if you had to ask a question that you you know that you could ask that and you understood the answer so there are items that will come out of this that we will need to improve um regardless whether we have COVID or not um one of the areas in particular that we found from the last number of years in the survey was the patient told us that they felt that the discharge home um was very rush they felt on the last day they were given lots of information they didn't have time to plan going home and as a result the hospital put in place lots of initiatives to improve that okay so it can work are people who are people who um are people who didn't have the perfect experience more likely to have perhaps engage with you do you know if we get out of hospital and everything went well and we're home it's like thank god i don't even want to think about that and but if that is the case uh is that okay too i mean maybe or does it do you need people regardless of their experience to engage oh we want as many people as possible to engage whether they had a good experience or whether that it needs improvement um and the reason for that is that we feed this back to the staff so in the previous years when we've conducted the survey nationally 85% said that they had a good experience and again i think staff you know have huge pride in that and and and you know getting that feedback is hugely beneficial for our healthcare system 15% then said that they had either a fair to poor experience i think that's really important as well it's not you know we need to hear why that experience was poor and what can we do to improve that experience so we want to hear from everybody actually because it's very difficult and different you know when you're a health care professional delivering care in a hospital versus a patient receiving that care and sometimes it's that kind of fresh perspective from the patient and that really hits home with it with the health care professionals they've very much taken the feedback on board over the last number of years and again it's not Hick was saying it it's not the HSE saying it it's the patients from the community saying this about the health services and the majority of health care professionals are there to provide high quality and safe care so they want to hear from this whether that's good or whether that can be improved um so that they can make improvements in the care that they deliver yeah and patients and here as well for the health care professional yeah for sure and patients themselves have an opportunity I suppose to to feel to have a system to feed back into yeah and the the reasons why we we administer the questionnaire send out the questionnaire two weeks after they've been discharged is to allow the patient to think about that admission so it's not given the last day kind of a rush process asking them their experience to be delighted that they're going home and again there might be a true reflection so they it allows two weeks allows people to think about their experience and allows them to to absorb it and to then um participate in the questionnaire so I think it's really important that we hear from as many people as possible and as I said there's about 891 patients discharged from Lashkeny University birth of the hospital during the month of September so we would like to hear from as many people as possible on that. Will all will all of them receive this invite or if they don't get it by a certain time can is do they contact you guys or do you think you'll have everyone covered? We we we should have everybody covered but if anybody wants to contact us they can either email us an info at yourexperience.ie we have a website called www.yourexperience.ie but they should have received the invitation by now there will be reminders sent out as well and just inviting them to participate in in the in the survey but there is criteria as you've said at the introduction of this interview they have to be over 16 they have to have an address in the republic of Ireland and they have to have stayed in the hospital greater than 24 hours and to have been discharged in September I think you mentioned that of course yeah all right thank you for that Rachel appreciate it all right take care Rachel Flynn there director of national care experience program with Hickwer. Hi Greg my sister-in-law got paid sorry she paid 40 euro for an antigen test in a pharmacy which seems very expensive for an antigen test but anyway because she was traveling international she was just uneasy about the way it was done so she decided to book a test in St Connell's the pharmacy antigen test came back negative and yes you've guessed it the St Connell's test came back positive so why are we putting our faith in these antigen tests when they are not flawless the schools of mass infection but yet antigen tests are supposedly the early warning sign for prevention the government at this stage are filling us with total misinformation I'm not going to unpack all of that it's very expensive for an antigen test 40 euro that doesn't seem right to me antigen tests works at certain times if they're done regularly you know the only way they're way they're employed in different countries it's not that you just text text take one and then that's it it's they're you're supposed to take them over a period of a certain amount of days and it'll pick you up at a certain level of infection I don't know the internet speed Greg super fan of sugar babes the most loyal historic fan in the short-lived history of the sugar babes do you ever meet them in the past I bet their concerts were the best thing ever back in the day I'm also a fan I'm not slagging um I'm a super fan of sugar babes I don't know I do I think they're one of the best bands yeah I'm not a big fan of theirs I think there was a couple of good songs of theirs definitely um a lot of mixed messages out there if you want to go to a dance you have to be vaccinated but if you book into a hotel you do not have to be vaccinated you go go to the hotel bar dance dine and do what you want without a vaccine how does the virus know what you're doing it doesn't know what you're doing at all people have fed up there is such a vast amount of mixed messages and changes in the information the anxiety that you're causing over the head of this people who were sitting outside of premises should not be asked if they're vaccinated this is discrimination to the highest I think what you'll find is is uh that was asked uh in a in a very casual conversational and indirect way you know why are you sitting out here do you not feel safe is it uh do you not have the vaccine pass um it was not to interrogate them it was just to get a straw poll and I'm presuming as to say it was done as part of a general sort of casual conversation which I think people are having uh up and down and across the country was that last night in Donegal as I have family down from up the west was in four bars not once was any of us asked for a covid card my family could not believe because up in westport you have to show the covid 19 card and um I'd to prove and to prove it to you as well yeah it depends where you are we're it's different up here in the northwest you know uh attitudes are very different down the country Aiman Ryan tested positive for covid so why is he traveling to scotland I don't believe about him being asked to have a second test why would he be asked if the first test was done correctly they say that the first test was actually inconclusive and that's why morning Greg sick of this government and all these politicians one rule for them and another for us another it's unbelievable what typical of government they can do what they want it'll continue as long as everyone lets it continue threats of election doesn't even bother them at this stage they know that the obedient little people will just do what they're told without question I mean is following the public health guidelines being an obedient little person it's that kind of language uh them and us regardless of who's them and who is us uh it's horrible really where we're at now uh that people think their neighbors who are um following public health guidelines are obedient little people whilst the neighbors might look across and say well they're right wing conspiracy theorists that's the space we're in now and it can happen within families within friends groups within neighborhoods um Greg proof as if we need more the PCR tests can be used to give the result the controller of the strings wants for the puppet he is controlling and therein lies the problem uh with how the government handled that it will uh it'll it leads that point of view very little thought seems to be given in any road layout decision in letter kenny I see a crossing at the bottom of the hill at gaunt lee also in the front of our yit where cars are stuck in traffic in the middle of a junction they can no longer see a red light for the pedestrian crossing well that's not necessarily the layout I think that's uh motorists not following uh the layout maybe going between those traffic lights on orange and find themselves sitting in between them as they turn red um okay uh reinsurance brokers a caller says he's been trying to get a quote for house insurance and there are certain brokers that won't quote against one another and then when he called another broker to ask for a quote wouldn't disclose which broker was insured through they refused to quote him as anyone else experience this our insurance brokers allowed to refuse to quote against one another um I don't know the ins and outs of that I've never come across that before I've never really engaged with a broker and it's it's not for any particular reason I just would price around myself it's just never been part of how I go about getting insurance as I say I'm not in any way saying it's not the right way to do it but I don't know what the story is there um it wouldn't be very competitive would it if that's the case uh stick with the roads just before a break here I'm so glad the pedestrian crossings are being discussed last week my husband parked beside the zebra crossing at super valley in bon crana as I went into the shop he sat there for the 10 minutes that I was in the shop and he said that 10 cars drove through the red light at the crossing one of which the driver was on the phone furthermore the crossing at scolese gone causes me great concern on a daily basis I see cars stop when the red man is flashing and wave children across the road parents also cross when it's red I've witnessed a school boss in a patrol car wave children across at the very time they should not leave the footpath please ask drivers to adhere to the rules of the road so that when we teach our children to do the same they are safe do not tell a child to cross when the man is red it's giving mixed messages plus parents guardians please lead by example these little changes uh these lights change very quickly so there's no excuse to cross when it is red that's coming in signed from a concerned parent get your tires ready for winter call into ulcer tires and letter kenny and bally buffet today cent clumbers college denerler are accepting applications for first year enrollment for the 2022 2023 academic year from monday november 8th until monday november 29th application forms are available on their website cent clumberscollege.ie or from the school office on<PHONE_NUMBER> make christmas for everyone this year with great gift ideas at done stores there's a gift set for everyone in the family from brands like dove simple and nivia now half price or surprise the coffee connoisseur in your life with a crops piccolo coffee machine was 49.95 now 29.95 plus with our 10 or 50 grocery voucher you save even more done stores make christmas for everyone terms and additions apply that you can be used on grocery shop with 50 or more did you know the personal injuries assessment board is ireland's state body for assessing personal injury claims we are fair and independent and use the exact same guidelines as the courts to calculate compensation but our process is nearly two years faster on average our costs are low too an average of 20 times lower than the cost of litigation the personal injuries assessment board similar compensation faster resolution fairer for all visit piab.ie for more information it's november madness at crofford tiles and more castle fin for one week only there's 20 off all tiles in stock 10 off all bathware and 5 off carpentine vinyls footers and delivery service available that's crofford's mad giveaway sale for one week only ends wednesday the 10th of november call 9143942 are you looking for a full-time permanent job in dunigal as zoos in edakini continues to grow machine operators are now wanted to join their production team go to work at zoos.com to apply zoos is a family-owned company that puts people first they offer competitive pay and benefits and a fantastic work environment to learn how you can join the zoos team visit work at zoos.com today that's work at zoos.com highland radio weather updates with national fuels delivering home heating oil to letter kenny and the surrounding areas at competitive prices national fuels 91137400 okay let's look at the weather forecaster for today now patchy reynald drizzle has cleared the region at this point it's leaving a day of sunny spells and passing showers behind temperatures of 11 to 13 degrees in mostly moderate southwest breezes now tonight a few showers overnight but becoming mostly dry clear spells will develop widely and it'll turn quite cold temperatures down to three to seven degrees patches of mist and fog will form as winds fall light now children who have a good relationship with their father are happier they feel less anxious and are more engaged in physical activity new esri research finds most nine-year-olds report getting on well with their father we're joined now to discuss this by professor emir smith who's the lead author of the report good morning to you and thank you very much for taking the call today good morning it's good to have you with us right okay um what was the purpose of this research to begin with like what what question will we try and to get an answer to or maybe it's obvious no it's not obvious at all there's been a lack of research on fathers in Ireland but the growing up in our island study provides very rich information because we interview the fathers of all the children and we followed this group from nine months to nine years of age so really the focus was to look at the kinds of involvement the fathers have in their children's day-to-day lives and to look at the kinds of relationships there are and the implications of those relationships for child outcomes so it's not just if fathers are present or not it's the relationship with the children if they are present with them yes we focus very much on on two parent families so we were able then to to look at fathers who were present for that whole period of the child's life all right pick up for you what were the key findings for us the key finding I think really was the importance the critical nature actually of involvement of fathers in the first year of the child's life because we find that sets the tone for later on so fathers who are more involved when the child was a baby are more likely to be involved than when they get to five and nine years of age it also helps foster a more positive relationship between the child and the father and that has positive benefits for fathers and children so for children it helps enhance their well-being and it means they're more involved in physical activity and for fathers it means they're less stressed in their role as a parent if they have a good relationship with the child do we have any previous information to compare this to like you know are we seeing an improvement in the situation or a dis improvement and we haven't because actually this is the first longitudinal study of children in Ireland we get some hints from other sources like the health of school age children which is a kind of cross sectional that's a snapshot study and they've shown that over time children are more likely to say they have a positive relationship with their father and we'll talk to him about a problem so there just seem tentative evidence there of the improvement but we haven't had an evidence base to look at fathers involvement in kind of previous generations so we know then that a father involved early on it bodes well then for later in in life that's from a child's perspective did this look at the benefit for fathers in well the benefit there is it's really around kind of feeling less stressed in the role as a father we didn't look at other father outcomes but we could do in the future but definitely it made parenting easier if they were more involved in a way and had a better relationship what about father's relationships with girls versus boys we saw kind of two things that seemed kind of quite contradictory we see first of all when they're babies there's no gender difference in father's involvement but as they get older fathers spend a bit more time or more frequently kind of doing things with their sons and they be around play and also about kind of outings but on the other hand then fathers say they get on better with their daughters and daughters say they get on better with their fathers than their their male equivalents do yeah do we know a father's more likely to be good or bad cop we don't know that actually we didn't get into that and actually we try to focus on the kind of more positive involvement because I think just focusing on like discipline or you know it's not that it's it's not the whole story so yeah um but you know there is quite a bit and this is not pitching one sex against the other there's a lot of focus on moms rightly so and because they have to carry the child they go through through the birth and you know if they decide to breastfeed they're ultimately almost responsible for that obviously you know you can bottle it as well but you know where I'm coming from yeah not a necessarily a great deal of feelings sorry focus on how fathers feel you know in terms of new dads particularly you know how their lives changed the pressures on them it could be financial maybe they could be the sole worker though that's obviously not going to be exclusively the case what did we learn about that well we find that that um definitely you know the whole period of uh parenthood at the beginning of parenthood and especially for first time fathers and mothers both are are kind of more stressed than they'd be later on but we do definitely kind of conclude that there's been a lack of discussion about fathers role I mean there's a lot of good information by the Department of Children uh who cooperated with this study and the HSE for parents but maybe we need to name fathers and say well you know reassure fathers that they have a role to play obviously mothers are key and we've spent a lot of time researching their impact but but this kind of fills out the picture a bit yeah and also to um and as I say I'm not sure if it's contained really or examined much in this report you know like I'm thinking of fathers here of nine-year-old childs who couldn't spend time with their as much time as they want now it could be maybe because of a relationship breakdown or it could be because of work commitments that they felt they had to be absent they're listening to this going yeah I can I can hear that but you know life dictated this this was my decision to disengage absolutely and none of this is saying it's it's driven by fathers in fact we strongly emphasise the fact that working hours long working hours in particular are a barrier to involvement especially in the first year of life and this cohort of children were born before fathers were entitled to pay paternity leave but at the same time we have good information on whether fathers took up more flexible or family friendly working arrangements like flexible hours and say working from home a bit and we find that that really pays off in terms of father's involvement so there are there are barriers and constraints and you know the situation has improved in terms of parents leave and uh you know uh being available but sometimes financially it might be difficult to to take that up now the study also says fathers who had a more traditional view of the role emphasised their financial responsibilities a male parent tended to be less involved with the children and have less positive relationships with them I mean we talk maybe to to the type of you know father figure that we might have seen generations ago is that what a like what is a traditional view of yeah we ask fathers kind of like about different aspects and how important they thought they were in their role as a father and and most almost all the fathers emphasised as you would expect love and support and care for the child but there was a group of fathers who placed quite a strong emphasis on themselves as a financial provider and that does seem to influence their kind of nature of their involvement in the role uh as a father their hands whether their hands on actually and and that group ended up feeling a bit more stressed as a parent yeah okay and given other than sort of giving us a view of this a snapshot of it what comes from this do you think uh aimer like where do we go with this information well this was part of a kind of research partnership with the Department of Children um so they will be looking carefully at at the findings I think there is two sets of implications for policy the first is is the need to kind of facilitate fathers uh you know we need government and employers to facilitate fathers could that also extend to the courts for example you know there are dads perhaps listening here that through a court order feel that they're even though it's not on the basis of any you know abuse or or anything like that there that feel they're not permitted to have the level of access that they feel they could have to be more beneficial to their child would extend to that area as well potentially and in the future we did collect information from fathers who weren't living with their children but that hasn't been released yet okay we did ask the children themselves about the relationships with dads who weren't living with them and we do find that the level of contact especially staying over uh fosters a more positive uh relationship and also that where there's a positive relationship maintained with between the mother and the father that that helps you know so they're kind of key things in terms of maybe about around family breakdown people can draw the road conclusions from that but but what our conclusion I think you could can draw and obviously you know it's not easy all the time but if uh both parents can at the very least be civil and and accommodate the child with both parents as much as possible it's putting the child first yeah obviously that might have implications for kind of having funny mediation services and so on available to help that you know but obviously there are cases where you know things are more complex and I think people will be able to sort of insert their own situation into the various categories that we're talking of and okay interesting stuff but I suppose the takeaway uh most nine-year-olds report getting on very well with their dad yeah and I think that's very positive yeah they get on as well with their dad as with their mother okay professor thanks for your time this morning thank you very much enjoy the rest of your day thank you very much indeed okay that's professor emir smith there 08 660 uh 25 thousand uh does anyone know the answer to this one if I leave letter cunny shopping center I'm heading over the pierce road which lane do I take uh on the two lanes that are there they have only one hour each one says left to the other right so if you're going straight which lanes you get into I've only ever used the left but only actually notice the signs this morning if that's if you're s exiting out of the shopping center and I suppose then you're meeting traffic that's coming I don't know the names of roads that would be coming down from here uh mountaintop uh joining that I was in the left lane going straight on I'm not I probably shouldn't admit this I thought I was in the right lane but then someone on the inside lane uh cut straight across me maybe that left lane is for left only uh or straight on if you come in out of the shopping center it's all very confusing anyone know the rules of the road get in touch I'll wait 660 25 000 that's something we're going to have to return to tomorrow that's all


This 2019 Ford F-250 Supercab Short Box is stock number 11976Z. We are here at Summit Automotive in Fond du Lac, Wisconsin. You're new and used heavy-duty truck headquarters. This 2019 Ford F-250 Supercab has the 6.2 liter V8 motor. It has been fully safe and inspected by our service shop. The service shop has a fresh oil and filter change. All the fluids have been checked and tapped off, and this truck is 100% ready to go. Oxford White is the color. We shoot all of our videos in 1080p, 60 frames per second. So if you have HD capabilities on your computer, tablet, smartphone, or television, turn them on right now, because it is definitely your best way to check out the quality and condition of the truck before seeing it in person. And if you like the video and want to subscribe to our YouTube channel to check out all the videos we do each and every day, in the lower right-hand part of the screen is a subscribe button. Click that, and then click the bell notifications. You'll get updated every day we do videos here at Summit Auto. This one has the painted alloy rims, and it has Goodyear Wrangler Ultra Terrain AT tires. These are LT27565R18s, and they have probably about 80% of the tread left on them. I'd say a pretty good tread. Frame and underbody looks really good. Almost no corrosion on there. Driver's side front fender looks really good. Didn't see any dents or dings. Headlight lenses are nice and clear. And the front bumper is in excellent condition. I didn't see any dents or dings on there. And the lower valance looks really good as well. You do get the chrome-trimmed grille. The hood is in very nice shape, too. No dents on that. It does come with the clearance lights. Passenger's side front fender looks good as well. And the passenger's side rim, no scuffs or scrapes. As you go down this side of the truck, take note of how clean the body is, how reflective, and mirror-like that paint is. We take these HD videos, so if you are far away, or even if you're close by, and just cannot make the trip down, you can still see the truck, hear the truck, and have confidence in the vehicle that you're looking at before you even get here, so that when you do get here, there's absolutely no surprises. And you can make a smart and informed buying decision from the comfort of your own home. Now on this side of the truck looks really good. Didn't see any dents or dings. This back rim is in excellent condition as well. The back tires have just as much tread as the front tires. And the frame and underbody is exceptionally clean on this truck. Has all the remaining factory exhaust. And it is like new under there. Comes with some Magnus step bars. They look really good. Has a tractor supply company toolbox. Has the FX4 off-road suspension package with the skid plates. Full towing package, which includes a receiver hitched 4-pin and 7-pin wearing. That rear bumper is in great shape, as is the tailgate, no dents or dings on there. Spray and bed liner. Very nice condition. The bed, I didn't see any dents or dings on that. And as you go down the driver's side, just as clean as that passenger's side. No dents or dings on the box. And for full disclosure, I'll show you this back room here. No scuffs or scrapes on there. Looks really good. Whole truck looked pretty much perfect all the way around. Down the driver's side looks really good as well. Does have the heated telescopic tow mirrors. They have directional signals in those as well. They telescope all like so. They fold in like that too. Inside the XL package gives you the gray vinyl seats. No rips or tears on the seat. Look really good. Has lumbar rubber floors. It also has a set of custom fit floor mats in here. Auto headlamps. Tilt telescopic steering wheel. Power windows, power locks, power mirrors. We'll hop inside, turn the ignition on so you can check out the radio and the miles and everything in here. This one has 23,664 miles. You get a distance to empty. Compass display and the instrument cluster is very nice and clean. Cruise controls and information center controls on the left. Bluetooth and audio controls on the right. And it does have the six speed automatic transmission with the optional tap shift. AM FM radio. And let's see if this is... That's where your backup camera shows up. You can actually zoom in over your receiver hitch to get hooked up to your boat camper trailer the first time, every time. Stability control, downhill assist control turned out four wheel drive factory brake controller. Climate controls down there. There's for your heated mirrors, 12 volt power point, 110 volt 400 watt plug-in. You do get a USB and a 12 volt power point down there as well. Passengers side format and seat are in excellent condition too. No rips or tears, smells very clean inside this truck. I don't think it's ever been smoked in. And the headliner is in excellent shape as well. You do get six auxiliary up-fit switches and map lights up there. We'll take a quick look. The back seats. And then we will take a look under the hood and start it up.  No rips or tears back here. It does have the latch child safety system for any child car seats. These seats do fold up like so. Floor is very clean back here. And we'll start it up. Take a look under the hood. Starts right up. No check engine lights or anything like that. I would personally like to thank you for checking out the video today. And hopefully from this HD video you'll be able to tell just how clean this truck is all the way around, inside and out. Under the hood we have the 6.2 liter V8 engine. Engine base is very clean, runs very smooth. Once again this truck has been fully safe and inspected by our service shop as a fresh oil and filter change. All the fluids have been checked and topped off. And this truck is 100%. Ready to go. Shocks work really good on there. Here's your emission sticker. I would highly recommend this truck from a quality and condition standpoint. And to see more pictures of this truck or one of our other 450 new and used cars, trucks, SUVs, minivans, Wranglers, half tons, three quarter tons, one tons. You name it we got to go to our website right there. www.SummitAuto.com Full pictures and descriptions of every single vehicle from two locations all at www.SummitAuto.com. And if you'd like to check out more HD videos you can go to www.YouTube.com slash www.SummitAuto.com. Remember to like, subscribe, and share on this video and all the videos that you see there. In fact, in a second you will see a link to subscribe to our YouTube channel in the upper left, a link to more up to 50 videos like this one in the upper right. Link to this vehicle on our website in the lower left and a link to one of our latest YouTube videos in the lower right. Click those, check us out. And we're super excited to help you with this Ultra Clean 2019 Ford F-250 Super Cab Short Box XL FX4 in Oxford White. Thanks again for checking out the video. Remember to like, subscribe, and share.