Hey guys, it's Nate, aka The Foot Account, and welcome back to the channel. It is Sunday, week and the excel off is in full swing, but this weekend I wanna talk about some specific things related to this week and the excel off that I am noticing with A, the rule breaker cards, and gold cards on this game, especially some of the lower rated gold cards. The market is kind of trending and moving like we would expect it to, but of course when you see it in the real time, when you have some of these players in your team and you see a lot of these price drops on some of the lower rated gold cards, just because of supply continually coming and even some higher rated ones, we just need to talk about it and just kind of notice that. And I'll also talk about some things we might be able to do tonight with squad battle rewards because gold cards are still most likely gonna be flippable, but it just has to be very meta cards because people like to buy teams on Sunday nights. So we'll talk about some of that stuff today. As of right now, I wanna show you the rule breakers to squad price update as well. A lot of these guys bounce around today. One thing that I've been doing and I've noticed in the past, even this happened last year, I did it a couple of times, is promo cards that get panic sold from on Saturday. The second day they're out in packs, during the weekend league, there's still some demand. They get sold off in the morning. There was a huge drop in all the rule breakers today. It's from set two. After they started really inflated yesterday, big drop into day two. And then there was a bit of a rebound after the six p.m. content. There's no big six p.m. content on a Saturday. The cards that are the most popular that a lot of people are using the new promo cards, right? The most popular of the new promo cards usually bounce back. Last week, Harry Kane went from like 1.3 mil back to almost 1.5 on Saturday. And today, I knew that something like that was gonna happen again. I went for Lukaku because I saw such a big drop off in the morning. I bought two of these, or one of them at 385,000 coins. And I sold mine actually at 437 at almost the peak right back here. So I made a nice little chunk of coins on that card. There were a couple others that did that today. DeMaria, Royce was 450, he went to 500. Teixeira was 375, he went back over 40000 coins. So those were like the ones that made the biggest movements. Ben Onholt was 130 and he went to 150 as well. So, would I expect that same thing to happen today on Sunday? Not really. There's a very few times where we see cards drop off into the nighttime on Saturday and then rebound into Sunday morning. Cause most of the time, foot champion stuff is over, there's not as much demand. And that's where a lot of the demand comes from on the weekends. So some of these cards could drop off just too much tonight and they could rebound a little bit in the morning. But I wouldn't expect that to happen a lot. There might be some other out-of-packs cards that that could happen to. I'm kinda watching the rule breaker set one cause I think a lot of these cards, the reason why some of these are dropping right now is partially due to the fact that team two cards are a bit cheaper across the board and they're more packable which is driving their prices down and that's kinda making some of these rule breakers drop in price as well. Also, we have some over-investing that definitely happened on some of these rule breakers from set one. In my eyes, this Kamara and Andre were gonna be over-invested in the whole entire time. Just did not seem to sit well with me. After I saw a lot of people hype these up and want them to go up out-of-packs, like this card going up out-of-packs does make sense but I think it was over-invested in and even though team one was more rare, I just think that a lot of over-investing happened on these and you're seeing a lot of these listed up with basic Kem styles. Yeah man, five owners, tradable, no games played, right? When you see a card like this with a couple owners, right, it's not first owner, it's not fresh, it's been bought and then somebody is selling it without playing games, that is somebody who is a trader that is selling that card and losing coins on it. They're selling their investment and that's what it looks like is happening right here. Somebody is taking the coins on their Kamara's right now because he's literally not going up in price. Same thing with Benjamin Andre. I really feel like those cards were just over-inflated. Now does that mean that they won't rise in the future? No, sometimes what you see is the second week after a card recovers from the over-investing and it gets sold off and it drops back down, people have sold that card and now it actually has room to go back up and go up and as it would have normally before, but since you had that over-investing in there and people are trying to make coins on that card, it stopped it. So if I see Kamara at 50,000 coins or below, if I see Andre in the low 50s, I'm probably gonna snag a few because again, that's a 50,000 coin card. All we need is for that to go up to 65, 70K in the next week or two and that's a huge W. So that's one thing you could see but I honestly do think that the set two of rule breakers is kind of pushing the set one of rule breakers down a little bit because some of these guys really haven't risen much. Yorente is up a decent amount, Ocampos is the same, Mertens is up some, Kane is up some, Douglas Costa was up at like 480, almost 500,000 coins and now he's back down to 440. This card's still very cracked in this game, very good. And Golan's kind of down as well. So just be careful with these guys. I feel like there is still more sell-off gonna happen today on these rule breakers set twos and even set one, some of these special cards out of packs. I do feel like some stuff has to go down a little bit more today. Just because these cards set two cards and I don't know if I'm actually showing you guys this on stream but the set two has such a higher pack weight than set one and this is something that we always said set one was so rare. I don't know if they upped the pack weight or what it was today but these guys are actually getting supplied on the market a lot and I think that yesterday what was happening was people were trying to snipe them when they were extinct. People were buying them up when they were extinct. Again, as we talked about EA likes to inflate prices with price ranges, moving them around, making cards extinct, making you think that card is worth that amount or more and then actually when it comes down to it it's not gonna actually be that much because the true market value for that card is not as much as the price range that EA had set maybe at that first time where it went extinct. Kind of like that Lukaku at 400K. So that is something interesting with these cards and I do think they are gonna drop a little bit more today but let's take a look at some gold cards man because this is where people are losing some coins right now whether you're invested in rule breakers whether you're invested in some of these gold cards they are dropping. Now a couple of these guys are out of packs right now because like Joe Gomez is in team of the week, right? This is a card tonight at squad battle rewards that I would keep my eyes on. All right, I'm gonna be involved in a Joe Gomez at 130,000 coins right?  He was almost 150 I believe on Friday night right? This guy's out of packs. I know he has a lot of demand but I do think this could be a type of card that rises back up into the morning on Monday. I wasn't expecting to actually win that buy. So I'm gonna try to flip that Joe Gomez for probably 140 mids probably Sunday night into Monday after squad battle rewards just because people like to buy stuff tonight rewards but again, the rest of the gold market a lot of these cards are down. I'll just take you over to flip in and show you that a lot of these cards are freaking low man. Sun's 167K, he was 200K on the weekend. Ben Yetter, I literally sold Ben Yetter on Friday afternoon after the promo drop for 68,000 coins as a striker with Hunter Ben Yetter, right? I sold multiple them at 68K. He is now under 50,000 coins. Usman Nabilia is down 10K. Werner is down, Veran was at 330, he's down to 307. Allen was like 48,000 coins, he's now 38. Some of these gold cards really got hammered this weekend. Lucas is back to 50. Pug was out of packs right now. This card at 200K again, is a bit interesting to me. At this stage of the game, a lot of people can afford this card. There's a lot of French links to go around. I would expect this card to rebound just like Joe Gomez into the first couple of days of the week on that one. Valverde will be an interesting watch. Obamiong's down, Hazard's down, Wynaldum's down a lot. Langlia's down almost 10K now from Weekend Excel Off. Bale's getting hammered of course. He's down a lot. Bruno Fernandez is down like 15K. Susoko is down. So a lot of gold cards are really getting sold off and that's what happens every weekend, right? But again, we also have to remember what the natural progression of cards like these low-rated cards is in FIFA, right? This is an 83-rated gold card. Yes, he went from 50K up to 70, peaked at 72 and then has now crashed all the way down to like 20,000 coins. This graph on an 83-rated gold card for the first month or so of FIFA is 100% expected. This is what we saw last year and we knew this was gonna happen, right? We knew that some of these low-rated cards were just gonna get supplied and they were gonna lose a lot of their value. Actually, one of the craziest graphs to look at would probably be this Bale card. He was just way too inflated to begin with this year being 100,000 coins, he really was, right? This guy went from nothing up to 100,000 coins out of packs, of course, for ones to watch, stayed for that same price even when he came back into packs. Then, of course, he had the big market crash but you just see this guy going from 100,000 coins literally in two weeks from 100K down to 18,000 coins just because of continued pack supply, promo packs and this card getting packed and people are moving on from the Gareth Bale, right? You know, maybe they played with Gareth Bale who's a 100K card here but they've now moved up in coins. They maybe have a different team. They've got maybe a guy like Salah and their team at right wing. Even though right wing's a very rare and we need some more right wing in forums, EA Sports, there are still a lot of people that are, they're past. The whole point is they're past some of these players even like an Usman than Bale, like a Lucas. Now, Lucas is bouncing up a lot every week at Thursday for Rivals Rewards in Weekend League. The past two weeks, he's gone from 50K to 66. He did it again, 50K to 61K. And this is just because lack of right wings in the prem and in the game. And of course, he fits the meta and he's Brazilian. He's had some Brazilian special cards that have come out recently. But again, that's why you're seeing these low rated cards just continue to tail off in price and continue to drop down. It's just because they're continuing to get packed and supply it and supply it and that's just making them drop even lower. So some stuff that would be interesting to buy tonight on Sunday night with squad battle rewards. Now, just a reminder, we like to buy on squad battle rewards actually before squad battle rewards come out because if you don't do that, what happens is everybody else knows that hey, Sunday after squad battle rewards, that's when stuff on the market gets cheap because there's supply from the market, especially if you're buying a gold card, some packs, that's when stuff starts to get cheap, right? So if you buy before, a lot of times, you A, the price is about the same unless you're buying a card that's in packs and B, especially if it's a gold card or a inform that is out of packs, which is what I would recommend buying tonight for a quick flip into Monday or Tuesday. If it's an out of packs card, there's a lot, there's no supply coming to that card after squad battle rewards. So watch the panic selling on out of packs informs tonight, a guy like Jamie Vardy, who right now is 195K according to Foot Bin, or even like Upamakana, who is over 300,000 coins, who is now down on the 260s, just watch these kind of cards today on Sunday, right? Icons as well, out of packs, informs the new promo cards even that are out of packs, like rule breaker set one, watch those cards tonight, ones to watch as it be ones that you would wanna keep an eye on too. Cards like this, like I'm really keen on team of the week three. Kyle Walker is a very interesting one because he scored the only goal today in Manchester City's win. His inform has obviously been very inflated for the center back position change. This guy was up at 600K this weekend, now down to 550. If Kyle Walker gets a right back inform, I still feel like this card might get panicked for a little bit, but that'd be a huge opportunity to buy because of that position change, because of the chemistry that you could have in a team, you could have a center back walker on 10 chem. This guy's gonna retain his value a lot, I think. I think this card might even be more expensive than right back Kyle Walker if he gets an 87 inform. So we're definitely gonna be keeping an eye on this card throughout the week this week. But team of the week three, Thomas Partay and Firmino and Ramos. Like watch all of these guys on into the night on Sunday, right? Ramos is a card, it's got a lot of hype right now. Because of his links to Valverde, he's up, he's from like 230K, he is up a lot, right? But he's down still. He was in the 330K range 320, and now he's in the 290s, 280s on PlayStation. And on Xbox too, these guys are dropping. It's across both consoles. But definitely keep an eye on these tonight because without the supply from squad battle rewards, people are still gonna build teams and some of these cards are gonna get in people's teams. I like Firmino a lot because Firmino is Brazilian, links to a lot of the new Brazilian players that are in this game. He was 250K this weekend, I've already traded with him so I kinda know that this card has some demand. And he's low, man, 225. So a lot of open bids, right? You see these open bids. That's just a clear sign of weakening sell-off. Definitely keep an eye on those tonight for a quick rise into Monday. You can probably still buy gold cards on tonight at squad battle rewards if you wanted to wait until after the supply kicks in, you could probably still snag some gold cards that are very popular that people might wanna use.  All right, like this is a card that bounces around all the time. Even though he's low rated, there's just a lack of like value center backs in the prem. This guy went from 22 to 30K on rewards on Thursday and right now he's back down in the low 20s. If this guy keeps going back down, I mean, you might see this guy bounce up a little bit on Sunday night after squad battles. And the best thing is, if this guy is 22K tonight at rewards, right? I'm just getting a guess, 22K tonight at rewards. And you buy for like 20 to 21K during the rewards supply for your first little bit. All you really need to do is bounce back up to 24, 25K. You're making two to three K a card. That's a solid 10% profit on your investment, right? You're spending 20,000 coins to make two to three K a card. That's a solid return for literally like a 12 hour flip, right? Because these cards usually rise into Monday as people do buy some teams and stuff on Sunday nights because that's when it is historically the cheapest. So definitely keep an eye on some of that stuff today. If you do want to make some buys or rewards, just think meta, right? Look at the graphs. Look at the cards that fluctuate around the most that have gone up every single week for the past two weeks for a week in league, right? Lucas would be one. St. Maximon is somehow still 30K. That'd be one I get interested in. And if you do want to make a buy on the team of the week or rule breakers two. Now, this is the thing about rule breakers two cards. If they drop off a lot more today, this could get interesting, right? If they, after 6PM UK time today, if these cards really tank off some more, this could get interesting. Now we're expecting probably another promo on Friday, possibly road to the final. We'll be talking more about that this week and that possibility. These cards are only in packs until Tuesday at 6PM UK. That means on Tuesday, when we will be getting UCL Markey matchups, these guys won't be in packs, they won't be getting supplied. So tonight at squad better awards might be the last time that these guys get supplied and they're actually tradeable packs unless we get a tradable supply on Monday, which we haven't got a tradable packs supplies to be seen in a while. So that might be some of the lowest time for some of these cards and possibly for a team of the week. Now, of course, if there is UCL Markey matchups what there should be, these guys will be in packs for that. But what we've seen is the team of the weeks have been basically at their absolute lowest on Sunday nights or on Sundays, Saturday nights into Sundays, right? If Valverde is like under 250 on the PlayStation or maybe in like the two, let's say in like the low 230s or under 230 on the Xbox, like if he drops 10 to 15K on either console, I'm really liking this card because the links that you can get with Valverde, the new Jimenez card, Mendia left back, you have a nice triangle right there with the green links. Zaha, I'm a huge fan of with the five star skills being so necessary this FIFA. And this card's really good. If you see this close to 200K, that's a snag. Gomez at 400K at flat is a really good buy as well. Kimmich is my sleeper for this week's team of the week. This card fluctuates a ton, right? And this is like the CDM in the Bundesliga if you're gonna use a card. So really like this card for an out of packs investment. If that can get to like 110, I would love it. And I even like this Paulinho, right? 110K for this card would be nice. I do think you would see some rise on this because of Taliska, because of Tashara and just Brazilian links. This is a really good card overall. So I kind of like this week's team of the week for possible investing, I'll be honest. But again, when you're investing in team of the week, there is a little bit of, I guess you could say, risk in there.  And of course, we always remember the second week out of packs or the second week that they go out of packs, team of the week four. This is tend to their first week out of packs, I guess. But Rashford is absolutely boomed. He's over 700,000 coins. Just be careful with some of these cards this week. I know this card is insanely cracked and he's so good, everybody loves him. If you wanna buy a card like this tonight, if you wanna buy an out of packs inform, probably tonight's gonna be your night because that's when there will be the most panic selling as we head out of the week in league or not panic selling, just sell off, I guess you could say, as we head out of the week in league. So I know there's a lot going on right now. I know that the market's kind of going crazy. A lot of stuff is dropping down but I wanted to kind of bring you this video today just so that you can realize why some of this is happening, what's caused some of this. And if you're trying to make some coins right now, icon flipping is still, I think the way to go in my opinion, a lot of these cards are still fluctuating in price, a decent amount. There's still some decent demand but just remember these guys will drop off as well. It's a great time on the week in league sell off to trade with some of these cards because as you can see here, I was watching some Pierlos at 640 hoping for one more undercut and now his cheapest on the market is at 680. So I missed out on an opportunity there. Even had one on bid here that I missed out on. So definitely watch the icons this weekend too. There's a lot of fluctuations. This Raul was like 750, now he's 770. If I saw another 750, I would snag because I know I can sell this card right around like almost 800K range on the weekend. So just watch some of the undercuts, right? A lot of open bids on icons too. That's a way that you can actually continue to try to flip cards as the sell off is happening this weekend but again, it'll be interesting to see what content comes today. I know I said I thought we were gonna get an SBC on Saturday like a player SBC but since this promo is over on Tuesday, I don't think we'll get another player SBC for the rule breakers promo just because that'd be like a really short timeframe to complete it. So I don't expect that today. I'm not sure what I expect for Sunday content but probably won't be anything too crazy. Sundays are usually a little more low key as are Mondays. So if this helped you guys at all, make sure you smash a thumbs up on it. Comment down below if you do have any questions of course and subscribe to the channel if you're new, all right? Thanks for watching the video today boys. I'll catch you guys later. Peace out.


And so right now I would like to introduce our amazing speakers for this session, for this evening session. I don't know where you're joining from, but it's evening where I am right now. I'm joining from Florida, United States of America. And we have two presenters tonight and they'll be doing justice to the topic, babies, breast and bone, which is an international qualitative survey of individuals with pregnancy and lactation associated osteoporosis. And so the first, we have Dr. Susan Rachel Condon, who is a clinical assistant professor of midwifery at Sony Downstate. Since 2004, Dr. Condon has been a partner in private practice in New York, Hudson Valley, providing primary care across the lifespan and home-based perinatal services. She would also be presenting alongside Madeleine Beach, who is an academic librarian at the State University of New York at New Powell. She's interested in information seeking behavior and social justice in library. So at this point, I would like to hand the moderator over to Susan Rachel. Please take it away. Thank you. Jimmy, I'm not seeing the advancing. Okay, so Lauren, okay, let me make you. Okay, no, I'll just make her a presenter. Hang on. Thank you very much. Thank you very much. So thank you so much for the introduction. I wanted to take a moment first. This is us, of course. I wanted to take a moment to thank VidM for inviting us to present and especially Jimmy and Lorraine for all their support of this session. I also want to thank the administrators and the members of the International Osteoporosis and Pregnancy Support Group, without whom we would not have been able to do our study. So before I start, I wanted to mention that we're going to be referring to this condition as pregnancy and lactation associated osteoporosis or PLO for brevity. But I want to acknowledge that in other parts of the world, it's referred to as pregnancy associated osteoporosis or PAO. This is a quantitative study with qualitative elements that we consider preliminary research into the long-term physical and psychosocial impacts of a rare and often debilitating condition in an already vulnerable population. For the next half hour, we're going to talk about pregnancy and lactation associated osteoporosis, its incidence, the predisposing factors, as well as bone metabolism and pregnancy and lactation more broadly. And then we're going to discuss our results, which come from an international survey we did with people who had experienced PLO. We, in our survey, sought to answer questions about the psychosocial implications of this condition and the healing process and how it might impact decision making about future pregnancies and about breastfeeding as well. And finally, we'll conclude with the implications of our study for midwifery practice. So PLO is a rare and temporary osteoporosis. It's thought to affect about 0.4 in 100,000 pregnancies. But mild presentations may be missed, which would lead to an undercounting of cases. Typically, it's identified due to the discovery of one or more fractures, either very late in pregnancy or in the first two months postpartum. The symptoms usually arise in the first eight weeks after birth. So we're talking about primarily fractures and weight-bearing bones, and bones of the spine are the most common. And pain related to fractures is going to increase in those weeks after birth, bringing people to seek care. And yet there is no standard for diagnosis or treatment of this disease. X-ray and MRI and DEXA scans to look at bone mineral density are common as our laboratory tests for bone turnover and referrals to oncology to rule out osteosarcoma. The average time preceding diagnosis is usually within eight weeks of the onset of fractures or a fractured pain. One thing to consider is that people may be less inclined to present to their perinatal providers for this because they may not associate the pain or dysfunction that they're experiencing with pregnancy or lactation. And this, of course, can lead to a significant delay in diagnosis and, therefore, future and further fracturing. Hospital admission and inpatient rehabilitation are common with this condition, and as you can see here, almost a third of our survey respondents were hospitalized. Another fascinating thing about PLO is that the etiology is really unclear, but what have been identified are a number of predisposing factors. So we could see osteoporosis in a first-degree relative, low body mass index is common, malabsorption disorders in poor nutrition, particularly celiac, and then the long-term use of certain medications that can affect bone density, low dietary vitamin D and calcium, not surprisingly, and a sedentary lifestyle or physical inactivity, and then prolonged periods of inmenorrhea. And these can be the result of the history of eating disorders or hormonal fluctuations and the use of meds like depoprovera. The research is inconclusive about whether PLO is actually caused by pregnancy and lactation or if low bone mineral density is unmasked by pregnancy and lactation, which, and this is what we're going to now talk about, always will result in some transient bone loss that's typically going to return to baseline about 12 months after weaning in those who breastfeed. So let's take a look at the actual bone metabolism. So calcium regulation is going to be orchestrated by the endocrine system, and there are three primary hormones associated with bone mineralization. These are calcitonin and calcitriol, which is the active form of vitamin D and parathyroid hormone. So what happens is when serum calcium is elevated, the thyroid gland will secrete calcitonin, which stimulates osteoblasts to move calcium from the blood into the matrix of compact and cancerous bone. When serum calcium is low, calcitriol, that active form of vitamin D will increase calcium absorption in the GI tract and the parathyroid glands will secrete parathyroid hormone, and that's going to stimulate bone resorption by osteoclasts. Calcitriol is also going to signal the kidneys to restrict calcium excretion in the urine. It's noted that adequate levels of calcium and calcitonin will inhibit secretion of parathyroid hormone, and that's going to help maintain that bone structure. So now we'll take a look at how pregnancy and lactation are going to impact bone density. Generally speaking, pregnancy facilitates calcium absorption. So during pregnancy, if there's adequate calcium and vitamin D intake, the parathyroid hormone levels will appear to be normal. They can sometimes rise early in pregnancy, but by term they should be normal. And then we have the mineralization of the fetal skeleton, which is predominantly going to happen in the third trimester, and that's going to increase the demand for calcium at that time. These are physiologic adaptations, and research has not demonstrated any correlation between parity and bone density or fracture risk. The maternal kidneys and bone regulation are also responsible for ensuring that there's adequate calcium for milk production. And finally, up to 10% of bone density will be lost, and that's normal in the first few months of lactation, and will be recovered spontaneously after weaning. And this illustration, you can see the adaptive physiologic means by which the increased demand for calcium during pregnancy and lactation are met if you follow the arrows. So now I'm going to hand it over to Madeline, and she's going to talk to you about our study. Thank you so much, Susan Rachel. And I think Lorraine, are you able to make me present her with the next stretch of slides, and then at the end we switch. Madeline, you're muted. Whoops, sorry. Oh, okay. And now I'm presenter. Wonderful. So I was actually myself diagnosed with PLO in 2019 after the birth of my little one. And one of the things I learned at the time is that there were very few studies that looked at larger groups of people with PLO and very few that could answer the questions I had. And I know my clinicians had about what recovery might look like, what kinds of support would be needed, and what I could expect in terms of mobility in the long term. There were a lot of case studies that addressed small numbers of people with PLO or that looked in a more focused way at specific treatments, and these tended to come out of endocrinology. As we've mentioned, our study focused on psychosocial impacts and really sought to identify trends and experiences related to diagnosis and recovery, as well as outlook about future pregnancies after PLO. When I was still in the hospital with my fractures, a doctor at Columbia, Dr. Adi Cohen, who I had been emailing with because of an ongoing clinical research study she was conducting, referred me to an online support group. And when Susan Rachel expressed interest in collaborating and research on PLO, we knew that this would be a great population to survey because of its size. At the time, it was over 300 members, and now it's close to 400 members. And we were able to get 69 respondents to answer our study. They came from 12 countries, primarily the US, the UK, Australia, and other countries in Europe. So just to tell you a little bit more about the respondents to our survey, the median age of the time of survey was late 30s, and most had been diagnosed in the last 10 years. The majority had had their fracture onset with their first birth. So for almost a third, the diagnosis didn't come until after their second. The vast majority had no previous diagnosis of osteoporosis or osteopenia before their incidence of PLO, and very few had had the type of minimal trauma fractures that might indicate low bone mineral density. So this suggests that for most of our respondents, there was no obvious indication that they were at risk for PLO. Were they to have known about it as such a rare condition. I'm going to talk a little bit about the onset of fracture pain, which Susan Rachel talked a bit about earlier. So a little over half of our respondents started having fracture pain before birth, or sorry, after birth, but before three months. But about 20% had their onset of pain in pregnancy or while giving birth, and another 17% beyond three months postpartum. But it's noteworthy that that window between birth and three months is when lactation draws most heavily on the maternal skeleton in order to provide minerals for the baby through breast milk. Delays and diagnosis were reported almost across the board with only 5%, which is three out of our 69 respondents receiving a diagnosis in less than four weeks from the onset of their pain. So for almost 70% of respondents diagnosis came somewhere between one and six months from the onset of their fracture pain, which means they likely spent weeks or months struggling with pain and impaired mobility leading up to that diagnosis. In this graph, the x-axis is the number of reported fractures and the y-axis is the number of respondents. So around 60% of our respondents reported having between four and eight fractures as a result of their PLO. One limitation we've had to address in our study is that it's possible that individuals with more fractures may be more likely to have found the support group and to have seen the call for participants simply because they were pursuing greater levels of support. So by far the most common fractures we saw were thoracic and lumbar vertebral fractures. This is likely because when the body needs calcium, beyond what diet can provide, either to maintain safe levels in the blood or for lactation, the first stores that it pulls from is the spine. And you'll see that there was a distribution of other fractures, including sacrum, pelvis. Though we didn't have respondents with femur fractures, those do appear in the literature as well. Okay, so I want to talk a little bit about the healing process and the experience that our respondents shared with us. Healing from this condition is a multimodal process. Overall, one of the things respondents mentioned was a lack of team-based approach in their care. So people with PLO reported having to make a great number of decisions from when to wean, how to adjust their diet, whether and when to pursue physical therapy. And for some of those decisions, there could have been greater guidance and coordination between midwives, endocrinologists, orthopedists, and physical therapists, among others. Most respondents did discontinue breastfeeding either immediately or sooner than they had initially planned. Once weaning takes place, not only is the source of bone loss removed, but as Susan and Rachel discussed earlier, there is that rebound effect in which the body seeks to recover lost minerals in the skeleton. So weaning commences what's typically described in the literature as about a year of more intensive bone rebuilding. Many respondents sought to balance their diet or supplement vitamin D and calcium. So the advice for healing is to avoid bed rest and to encourage weight-bearing exercise as tolerated, but with a caution around lifting especially. And this can be really challenging because often the weight limit is going to be less than the weight of a baby. So in terms of parenting, that's a real challenge, but this is essential to preventing further fractures when bone mineral density is dangerously low or additional compression of existing fractures which can be equally damaging. Okay, so medications, anabolic medications specifically teraparitide may be prescribed, though a significant number of our respondents chose not to take medication, likely because there is that natural recovery period after weaning. Teraparitide is the drug thought to be safest for those who would like to pursue future pregnancies as antiresorptives such as bisphosphonates could impact future fetal skeletal development. The research on this is incomplete. Braces and assistive devices are used to immobilize the spine during healing or to support mobility in the case of canes or walkers which may be used. In some cases, as with the use of a back brace, it seemed from the experience of our survey respondents that there was no clear consensus among clinicians about when to use a brace. So out of our respondents with 12 or more fractures, none wore a brace while half of those with one to two fractures did wear one. So there seems to be not a clear consensus on the use of the brace. Majority of our respondents did pursue physical therapy or physiotherapy and about a third of those went for a year or more, so it can be a lengthy process. But to talk a bit more about impacts on mobility. The long-term impacts on mobility can really be quite devastating for a new parent. For the 43% of our respondents who could not care for their children alone within six months of fracturing, this means they had to put together a support system out of family, friends, paid support structures if possible for in-home care during the period where they were healing and unable to care for their baby or other children alone. The reported gap among our respondents in support was really striking. So almost 20% of respondents said they never stopped caring for their children by themselves. But the vast majority of those said that they were not ready for it and it caused additional pain when they were trying to heal. Overall, almost a third of our respondents said they were forced to resume certain activities before they were ready and it was painful. Respondents noted feeling alone and having to arrange for care for their children and for themselves. And I think this is where a holistic team-based care approach could really help tremendously in helping people to craft these support structures. When it came to support, respondents reported that the International Support Group in which we launched the survey was almost as important to them as a partner or spouse. This indicates how important it is for people with rare diseases to find others who can truly see them and understand what they're going through. There's also a desire to share, validate, and learn from how others are parenting with the condition. So how do you get your kid in and out of a crib or a grocery cart? How do you manage night feedings? What about things like bathing children or helping them in the bathroom? I know for me, and these are some photos from my own recovery and adventures in adaptive parenting. One of the things that led me back to the support group frequently was that shared knowledge grown from real experience. That was something I couldn't get from any of my clinicians or from my family who were struggling through this alongside me. So I was grateful for that. Before I talk about this table, I want to note that 35% of our respondents, so over a third, had hoped to have more pregnancies but have chosen not to because of their PLO diagnosis, while another 16% are waiting to see how their fractures and bone mineral density improved before they make that decision. But here what we're showing in this particular chart are the 28% of respondents who are planning for a possible pregnancy and the 15% of people who've already had an additional pregnancy since their diagnosis. And the notable changes, as you can see, in approaches to pregnancy after PLO, whether it was planned or actualized included choosing not to breastfeed at all to limit that bone mineral loss, to use DEXA scan right after birth to inform decisions about breastfeeding or just to think about course of treatment following pregnancy. Some chose to seek out clinicians who had worked with high risk pregnancies in the past or to have a scheduled cesarean. I want to share this quote which is taken from the free text responses to our survey. We asked people to talk about what they wish clinicians would have known or done differently in treating them and their PLO. And I think this quote just really speaks well to the impacts of delayed diagnosis. So this person writes, I was continually told my pain was due to incorrect breastfeeding posture. I was told back pain is normal after pregnancy. This made me really question myself, if this is what all mothers endure, then why can't I handle it? What's wrong with me? Am I really in this amount of pain? Maybe it's not as bad as I think. You feel like you're losing your mind. Meanwhile, I couldn't lift a cup of water without pain. Trying to pick up my newborn resulted in excruciating back spasms as did simply getting out of bed. I could not lift my arms to wash or brush my hair, etc. I wish one of the medical professionals I saw during this period would have stopped and asked me about my pain. Not one asked me how severe it was and how it was affecting my daily life. Surely had they listened to the things I couldn't do, they would have asked for tests. So as I mentioned earlier, delays in diagnosis are extremely common with PLO. And only around a quarter of respondents reported that they were diagnosed within two months of their first fractures. But over a third of respondents had seen a chiropractor prior to their PLO diagnosis and over half had seen a physical therapist. Some of these respondents reported having been directed to do exercises or having been given physical adjustments that are contraindicated for acute fractures or low bone mineral density. So these delays have real consequences and could cause not only increased emotional distress, but further fractures or structural damage. An expression you sometimes hear in medicine is when you hear hoof beats, think horses not zebras. Many of us who were eventually diagnosed with PLO were worked up for the zebras, which include bone cancer, slipped discs, but very rare diseases are more like unicorns. And so even when we're thinking of horses and remembering that zebras are possible, the unicorn needs to be kept on the table. Someone's going to be the unicorn, which I can say from personal experience. And I'll turn it back over to Susan Rachel to talk about medical trauma and the conclusions of our study. All right. Thanks, Madeline. So what I want to say here is that as a provider, as a midwife, I certainly have witnessed among my colleagues the tendency to want to clear the board and that many medical encounters are often really transactional. And further, that people are frequently dismissed if they present with confusing symptoms or psychosocial complaints. You know, sometimes we have this way of just wanting to check the boxes on the list or in the electronic health record. Sometimes we don't have the time or the knowledge or the skills or the resources to engage in follow up. When Madeline first asked me if I'd ever heard of this condition, I've been a midwife for almost 30 years and I said, no, never, never heard of it.  So 37% of our respondents did pursue some sort of mental health counseling. And some of them noted in their comments in the free text that they had PTSD and depression and even periods of suicidal ideation and that many felt really lonely and isolated. An overwhelming majority of the respondents said that they were dismissed when they first presented with their symptoms and even used words like, you know, we were begging for help or stating that they wish that anyone had taken them seriously or really listened to them. And several reported that their pain or their osteoporosis, in fact, was interpreted as psychological or that they were blamed for doing something wrong, even not drinking milk in childhood. And were told that they were being selfish because they were so focused on their own pain instead of focusing on their babies. So, in conclusion, there were a number of things that we looked at. One of the key features is that early diagnosis is key to preventing long term sequelae and long term suffering and in fact further fracturing because if they're not, if it's not diagnosed and treated and there's not a large approach from every angle, they're going to have significant changes, including height loss and long term pain and spasms. Another thing is that coordination of care across teams and access to home care is going to vary a lot in internationally and in terms of individual communities. The ability of access to long term care for those with prolonged, although temporary disability is really inconsistent. And we also were thinking a lot about the cost for home care for long term physiotherapy for childcare for those who needed it, which can be a significant burden for some families and individuals. About pharmaceutical treatments, many of these pharmaceuticals are actually not covered by insurance, at least in the US, prior to menopause, because they're considered for people with osteoporosis who are often postmenopausal. And finally, most of the participants in our survey talked about having to self advocate and coordinate their own care, which was of course terribly stressful while they were undergoing pain and having difficulty with just the most basic activities of daily living. We hope that bringing attention to this rare but significantly disabling condition will guide midwives and other clinicians in their approach to working on teams and to communication, and of course importantly to unicorns. So these are our references, and we are ready for your questions. Wow. Thank you so much, Madeline and Susan Rachel. Thank you so much for that beautiful presentation. Thank God for VIDM. That's how I got to learn about this condition for the first time. Like I've never heard it before. I don't know if any other person has that kind of experience. So thank you so much. I don't know if we have questions. We can put it in the chat box. We still have some few minutes to take questions. If you have questions, please, let's put it in the chat box. And let's also love up on our speakers. Let's show them some love for bringing us this beautiful presentation. Thank you so much. But I have a question for you. I've not seen any question yet, but when I see it, I will read it out for you. So, but I have a question because this is a midwives conference, or we expect that a lot of our participants are midwives. So what steps can midwives take to help identify people at risk for PLO, whether they're in pregnancy or after pregnancy? You know, for some like me, even I'm a midwife, I've never even heard about it or something. So, but how can midwives help to identify these cases? I think one of the most important things is to really pay attention to the history taking because there are going to be things in someone's history. It reminds me a little bit about something like the symptoms of a thyroid disorder. There are things that don't seem like they would have anything to do with each other, and yet they might. So if you have someone who reports that they were bulimic as a teenager, and then they were on depoprovera when they were in college, and maybe they have not the greatest diet, or they have difficulty processing gluten, or maybe that they have had minimal trauma fractures. So when you're taking a history kind of stringing together those things that ordinarily you wouldn't necessarily think of, but being aware of things like that that can contribute to going into pregnancy with lower bone density than you might expect for a healthy young person. Other things, you know, one of the things in the research that they found was that, you know, being athletic as a child, or as a young person versus being sedentary, someone who's very slender, just thinking of things that again ordinarily you wouldn't think of as going together. Madeline, do you want to add anything to that? I think you covered it well. I think it's also noteworthy, you know, we covered a little bit some of the medications. So medications that people sometimes take for MS, steroids, long-term steroid use correct, that can be something that can cause lower bone density. And then, you know, yeah, so that's great for prevention. And then I think also just taking back pain seriously really early on when it's reported, whether it's in pregnancy or postpartum, really looking at things like ADLs and how the back pain is impacting ADLs. Because I think, I mean, from my own experience having fractures, the impaired mobility was more severe than it would have been with a muscular issue. And paying attention to what I could or couldn't do and how I could or couldn't move could probably indicate that it was greater than a muscular issue. Yeah, I think the thing that you really heard from our respondents was if someone comes to you, forget about the predisposing factors, if someone comes to you soon after birth or late in pregnancy and says, I'm having a sudden onset of excruciating pain, you have to take that seriously and don't refer them to a chiropractor, get some imaging. Very, very important. And we do have a question from Dr. Pitter, which is a really interesting question. Dr. Pitter is asking if there are any particular race, racial groups or ethnicities who are at greater risk. And honestly, I would say we don't really know because there's so little research and when when I was doing my literature review for the write up of this study. One of the things that really was impressive was that there were many articles that would just have one case or there'd be an article with two cases. And, you know, there wasn't much, although several of them were out of Asia with an Asian population, but I think that's random. I think that the presentation of just a few cases can really inform us about that. I think it would be other lifestyle factors and previous health conditions. But that's the guess we don't really know. Thank you once again Susan, Rachel and Madeline for this beautiful presentation. We have comments and people are sharing feedbacks in the comment section saying that thank you for sharing the light on this very important topic and we still need a lot of research in this area. Thank you so much.


Legion, Freedom of Russia and Red Army of Ukraine, drove tanks to the Kursk and Belgorod regions. After the demilitarization of two oil depots, it became known that the Freedom of Russia Legion, Red Army of Ukraine and the Siberian Battalion entered the Kursk and Belgorod regions of the Russian Federation as part of a joint operation. As reported by Russian opposition leader Ilya Ponomarev, the border town of Lazova-Rudka in the Belgorod region is completely under the control of the Liberation Forces. Representative of the main intelligence directorate of Ukraine, Andrey Yusov, in a commentary to Channel 24 commented on the entry of the Freedom of Russia Legion, the Red Army of Ukraine and the Siberian Battalion into Russian territory. The Legion, Freedom of Russia, the Red Army of Ukraine and the Siberian Battalion on the territory of the Russian Federation act as independent units since they consist of citizens of the Russian Federation. They, after all, are at home, Yusov noted. He confirmed that a joint operation of these units is probably now taking place on the territory of the Russian Federation. Returning to the armed assault inside the Russian region of Belgorod earlier this week, Major General Rupert Jones says that while there is still a degree of confusion about the incursion, it poses different challenges for Russia, Ukraine and Western allies. He told Sky News, from a Russian perspective it points to an internal security problem, it's humiliating for them, it's an attack on their own soil. He adds that from a Western perspective it will cause some concern over what degree Ukraine is supportive of that incursion. When we're giving weapons, we're concerned about those weapons being used into Russia so there will be some diplomatic concerns. Russia says more than 70 attackers were killed in the Belgorod region and the remnants of their units were pushed back into Ukrainian territory after two days of fighting. Moscow has blamed Ukrainian militants but Kiev portrayed the alleged incursion as an uprising by Russian partisans. Supporting that, the Russian Volunteer Corps and freedom of Russia Legion who back Ukraine in the war have both said they were responsible. Medvedev insults US President.  US President Joe Biden's recent blunder in which he mixed up Ukraine and the Middle East sums up his poor mental state. Former Russian leader Dmitry Medvedev has claimed, Biden's gaffe came in an interview with MSNBC as he discussed the Israeli military campaign in Gaza with host Jonathan Capehart. The US leader said West Jerusalem should not repeat the mistakes that Washington made following the September 2001 terrorist attack. America made a mistake. We went after Osama bin Laden until we got him but we shouldn't have gone into Ukraine, Biden stated. He then corrected himself saying he meant the whole thing in Iraq and Afghanistan referring to the US invasions and occupation of the two Middle Eastern nations. Confusing places and people has been a recurring issue for the 81-year-old president.  Some Russian officials have suggested that Biden's slip of the tongue was Freudian. He didn't mix it up. He can no longer keep to himself what everyone understands. The US has disgraced itself in the bloodiest manner with the whole Ukrainian project. Foreign ministry spokeswoman Maria Zakharova said, Moscow perceives the Ukraine conflict as a US-led proxy war against Russia, in which Ukrainian soldiers serve as cannon fodder. In the nine-minute interview with MSNBC, Biden mentioned Ukraine wants calling out former President Donald Trump for his skeptical attitude towards NATO. The incumbent leader described the organization as critical to our national defence. Moscow has cited the expansion of the military bloc in Europe as a key cause of the hostilities with Ukraine.


Okay guys, this is the Mecha webcam. It's currently crowdfunding on Indiegogo so you can go ahead and back it to get an early price deal. This is a 3-in-1 webcam and I'm pretty excited to showcase to you guys the capabilities of this. Now by first looking at this you'll realize that this doesn't actually look like a webcam and there's a reason why. This is actually a large studio light and there's a button on here on the left to change the light to three different colors. It can go to warm white, natural white and cool white. On the fourth press it turns off. The top right you can turn the microphone that's inbuilt into this on and off as well if you wanted to use this as a mic. And the third thing is obviously the webcam and you're probably wondering where that is and that's right here at the bottom and it pulls out. I'll showcase in a second how to use this, how it functions and how it looks when you're on a remote video call. Basically show you what else is in the box. You get yourself the quick start guide with the user manual to get you up and running. You also have a USB to USB-C adapter in case you have maybe a MacBook Pro or a laptop that only has USB-C ports then you can use that to connect with the USB cable at the end of the webcam and it's literally plug and play no adapters required. Last but not least you have 10 little circle sticky pads double sided. This is going to be to connect the webcam to your actual laptop or monitor screen in case you can't get it to stick by itself or using the magnet. I'm going to talk about this in a second but let me dive in to setting up this webcam and show you how it actually works. Okay so you have a very strong clip at the back here and you just click this onto the monitor screen. There we go. So now I'm just going to plug this into my laptop and now I will be ready to use this. So the power is feeding in directly from the USB so let me show you the lights. This is the cool white then you have the warm white which is more of a yellow glow and then you have a natural white which is a balance halfway between both of the previous ones the fourth time you press it it turns off. The webcam itself is a pull webcam that sits on a string and this is a 2 megapixel 1080p 30 frame per second webcam. It's not the strongest so it's not a 4k webcam or anything like that but nonetheless it should do a good enough job. And then at the back of this this is where I will show you those little circular sticky pads. If you have trouble connecting this to your monitor or your laptop screen then you can stick one of those pads here and then it will be in place for as long as you need to and then you can very easily remove it but you'll also have to remove any smudge marks on your screen. So to connect this I'll just clip the light on there I will turn the light on I prefer a warm light and I will actually pull this down to the middle of the screen. If you struggle to have it connect this will shoot back up and it won't connect and it will swing so you can either do one or two things you can use those sticky pads to really connect it to the screen but I generally like to avoid using anything sticky on my screens. The preferred option is using a magnet so on the right hand side of the webcam you have this pull out magnet which is pretty strong. This will sit behind your laptop screen and I'll showcase how this works so I'll connect this back on there and just turn the light off for a second. You pull the camera out again and then you connect this magnet to the back of your laptop in the position of where you would like the webcam to sit and there you go it is a very strong magnet so if I move this around the screen it will also move the magnet to the back of the laptop screen. Let me just show you what it looks like on the back as well. Ok so now you can see the magnet at the back if I reposition this make it lower down you'll see it works pretty well but if you take a look if I move just the camera the magnet is strong enough to move along with it so you can really reposition it accordingly to your eye level. Most of the people that would be buying something like this would suit people that generally need to have eye-to-eye contact with all of the people on their video calls and I think it makes a big difference especially if you do things like job interviews this is going to be very handy and it allows you to really keep staring at the people that you're talking to whilst meanwhile having maybe some documents around with some notes to cover all of your talking points. So now let's go ahead and open a zoom call and test out the video quality the audio quality and with the light on and off and see how it overall performs. Alright guys so let's test this out and do a comparison with the inbuilt camera and microphone of my MacBook Pro compared to the Mecha webcam so right now this is the FaceTime HD cam on my Apple MacBook Pro it's pretty blurry I have closed the shutters a little bit just so that it's a bit darker so it's not super bright and I wanted to showcase to you guys the difference between switching the video from my inbuilt camera with the Mecha webcam. Let me go ahead and do that now and I will move the camera to the center you twist it to make it straight make sure you get it aligned and there we go the difference with this is I can look directly into the webcam and still see most of the frames on my screen whether I have notes up on the left or the side this will be perfect for that and if I do a job interview and I want to make sure I have eye to eye contact this is going to be perfect as well just to make those notes appear on one side of the screen and it doesn't seem like you're looking all over the place so there's many different benefits to having a camera like this of course for a lot of people and I know you guys will comment this you might not get used to very quickly the wire and the camera being in the middle of the screen because you might have things on the screen that you want to see and read very easily you might have a PowerPoint presentation that you're presenting and you want that to display fully so you can also remember that not necessarily the camera has to be in the middle you can also just as equally move it back to the top and just have it there until you're ready to move it back to the middle so you're quite flexible with that which is great now in terms of the video quality yes it is a lot better than the inbuilt webcam on my laptop and I'm pretty confident it's going to be better than pretty much all of the inbuilt webcams in most laptops these days but it is 2 megapixel which is quite a low resolution so that's one thing to remember but it is a budget friendly webcam overall but it's not to say that they will have a 4k version of this webcam out in the near future so keep an eye out on their website and on their crowdfunding pages now let's go ahead and test out the studio light that's on this webcam so right now it's off I'll turn this on and as you can see it does brighten my face if you feel like it might be a little bit overexposed then you can cycle through the different ones this gives more of a yellow tint so this is the warm light and if you are working in the evenings I always prefer having a warmer white light than a cooler one but let's take a look at the natural one this is kind of imitating daylight coming through the windows and it does make it a little bit clearer and a little bit more natural but there is a bit of a yellow haze to it but overall I think studio lights are very key especially when you are working in very darkened rooms just as a comparison I'm going to completely darken out this room here close all my shutters and showcase how much difference this light actually makes so let me turn this off for now okay pitch dark you can't really see anything I would never have a video call like this let's turn on this light and there you go you can see I'm the core subject that's been brightened up I'll just cycle through this is the warm light and finally this is the natural light for me personally I think the natural light works best it makes things a little bit clearer and a little bit more realistic and not overexposed or the tint of the video is not swaying towards a little bit more yellow but I would still recommend if you can get more of a natural light source then that would be the way to go and for most people you'd hardly use this studio light in built into this unless it was absolutely necessary and you're working really late at night time or you are somewhere where you can't turn the lights on maybe in a different building for example but nonetheless it is an option for most people okay and the final test I want to do is for the in-built microphone right now the microphone is being used by my MacBook Pro and I'm now going to switch it over to the mecha microphone before I do that I need to turn it on by pressing the microphone button on the top of the unit you'll see a white light just on the microphone icon at the top right hand side that will show up in your zoom or video calling settings now the audio that you're hearing is directly coming from the mecha microphone I have tested a lot of in-built microphones on webcams in the past and a lot of them have been underwhelming they've not been great and I wouldn't recommend any of them however with the denoising microphone that's inbuilt into this one I have to say it's a lot better than pretty much all of the ones that I've tried in the past if I was really in a situation where I have to use the microphone in this because maybe the one of my laptop is not working and I don't have any other external one then this one will be doing a decent enough job for me to be comfortable to use this on video calls and of course this isn't a very high-end premium microphone by any means but it will do a decent enough job if you are on the go and you are looking to get some audio input whereby you don't have a headset you don't have a working internal laptop microphone this is going to do a good enough job for everyone on the call to hear you clearly so hopefully you found that review useful guys and to be honest I think they've done a lot of research in terms of what would be working for a certain audience that would require something like this the fact that you can turn the microphone on and off manually I don't think I've seen that in any other webcam before I think having the integrated light especially one that's as strong as this would also be very useful for people that work in very low lighting environments and if you are going to require to keep eye-to-eye contact depending on whatever purpose you're having video calls for then this pull-down microphone is quite a nice way to do it the camera itself extends to a maximum of 20 centimeters to get it back in you just pull slightly and it springs back in place and it locks just underneath there and although it is quite a large webcam kit I think this would suit someone that wants to mount it on top of a monitor and have it there in more of a permanent position rather than a very portable one that you just put on top of your laptop wherever you go but if you did want to take it with you then it does come with this nice carry case that you can just put it in and put it in your backpack and really use it wherever you take your laptop check out the link in the description below it's currently crowdfunding on Indiegogo you can get super early bird pricing for it but it is starting to ship this month in august 2022 so keep an eye out for the public release and check out the latest pricing information check out all of the latest specifications customer reviews everything you can to make a decision on this webcam but if you guys have any questions about this then always drop a comment down below new videos out every week new gadgets are of you plenty of things like webcams and laptop accessories and so many more make sure to subscribe so you don't miss any of those ones and I will catch you guys at the next one take care