Okay good let's continue with the applications and it's my great pleasure to introduce my closest colleague Oscar Cameras working together here with us in the group in the UPF and he has been working for years and years also on modeling and especially focusing on electrophysiological modeling with a big emphasis in trying to go towards the patients it's like not so much the modeling aspect as such but trying to create tools so that electrophysiologies in reality can try to both understand patient better look at data in a more integrated way and at some point try to use VPH technologies in order to improve or come up with new therapies please Oscar thank you Mark so don't worry just this talk and the next one you will be free so as Bart said Oscar camera I'm an associate professor here at UPF and I co-supervised together with Bart the pheasant group and I'm supposed to talk about cardiac electrophysiological modeling so let me explain you a bit the story behind it so a regular day in pheasants the two of us close together and then Bart explained some things about while I'm going to help Jerome to organize whatever summer school VPH and well I was really surprised like Bart is always with the rubbish and bullshit word especially with VPH things and I said no no it's a good idea because we need to organize whatever events for cardiac function and I was what cardiac what and and then while whatever I'm into complicated for you blood span is always same but we could have a catalan beer testing then that changed a lot of things and then say okay you want to help no way I mean no way I want to help but okay at least you need to give a talk okay well let's see no and then some weeks past and last week I was checking the program and I see cardiac electrophysiological modeling and I say what do I need to talk about cardiac electrophysiological model really in this program VPH no way I mean I'm an expert on cardiac electrophysiological model no way just ask anyone in the community it's a really interesting community basically meeting every one year and a half in the cardiac efficient events and you can ask anyone there and a lot of these names will come up big communities in France in Oxford in New Zealand in the US also etc and a lot of people here really nice people most of them then seriously I know most of them but we'll see why because I mean I had I mean one thing it was okay Bart is not really good organization thing so maybe he was wrong because I started in my background was on image processing my PhD I did it in Paris on image processing non-registeration in oncological applications between CT and nuclear medicine images and then I moved to London for modeling Alzheimer disease the effect of Alzheimer disease in brain structures but then why I've been in the cardiac fission conference during the last year I mean four of the last five in fact I was here in this picture also besides traveling I mean this is really nice places for traveling I think it reflects well how the community is changing over the years I wasn't the only one I wasn't the only one without a proper or a traditional EP modeling background in this conference people like Alistair Young Pablo Lamar Takao et cetera are often in these conferences and it's really related to what Blanca was explaining the other day that I like a lot he's more or less philosophical papers on this interplay between modeling and experiments on how you really need to think that modeling is not anymore just for modelers it needs to be an interdisciplinary effort and you need to start forgetting or the community needs to start forgetting like these people like say no we need to trust the data because the models are not good enough and the other one around I mean the modelers say the data is too noisy for the perfect models I haven't heard at some point some models saying okay I'm sorry we need to change the data because my model is right so these things don't lead anywhere so we need to change this over and over and this is one part and the other part in particular in cardiac electrophysiology is that a lot of people have been working for years and years in at the microscopic level but I like everything in nature in particular the human body it's a multi-scale problem and we have to deal with what is happening at the cellular level even at the protein level but also going to the different scales at tissue level and organ level and even systemic level and this is changing over the years sorry and this is changing over the years but it always eat everything started with Alice and Noble and these people working and developing in the 60s the first cardiac electrophysiological models at the cellular level and then also there were really very good initiatives led by Peter Hunter the children like to share these models also the kind of a standard model domain and by domain propagation tissue propagation models that this is quite particular to cardiac I mean being having working different fields like the neuro field you see that in this respect the brain modeling is far from having this knowledge in terms of standard models to use and also the problem is that most clinicians work at the macroscopic level I mean their measurements dealing with patients they are basically working at the macroscopic level why these people have not been working until recently at the organ level this is what I mean some ideas it's just the difficulty to get good data also having models and simulations at the organ scale and including the different scales it's very difficult and very time-consuming and as Bart was saying before I mean quite often you don't have the data for all patients so that's problematic and the problem is that historically all this cardiac EP modeling has been quite far from clinical clinical routine but this has evolved dramatically during the last let's say 10 years or so because there has been better and better imaging and signal acquisition systems in clinical routine not just in particular big hospitals research research hospitals also very helpful open source initiatives to share codes to share models and also the advent and the use of computational resources we saw in the talk of Mariano how now it's relatively easy to get access to high-performance computing that helps a lot to speed up things so with all this culture I was in London at some point and I met Maxim and the first thing the first day arrived to Casey and he showed me kind of a really nasty video on the acquisition of optical mapping of a dog heart in an open chest surgery it was so nasty that it was really nice so then after several beers and parties etc we decided okay maybe apart from beers we should we could start doing things together so I started to help him doing some image processing for the modeling projects he was working on basically I was doing a stupid affine registration he was doing the hard part on trying to construct a data assimilation pipeline in order to estimate different conductivities in the heart and this is already 10 years ago max so then I came back to Barcelona in 2007 and since then really I kind of forgot a bit the image processing side or just a couple this with a bit of the going to the clinic more and more often in particular locally to hospital clinic and work with electrophysiologist but also being involved in large European projects you hard and VP to HF so kind of my objective the objective of my research has just gone towards really trying to develop computational pipelines and really using the part of the data processing and also the modeling as well and and that's true I mean in the end the main goal is try to help the clinicians to better understand some particular clinical questions that's quite important to focus and to optimize some of the therapies and get them better tools for the to support them that the clinical decisions they need to make and a lot of them related to cardiac electrophysiology so in fact well Bart wasn't that wrong the problem is that I need to talk about this after Blanca really nice talk and after 150 slides of Maxim so and on top of this is the last day so everyone is super tired and he insists me you need to do it all kind of functions and use will present so this is what I'm doing but no equation just money con goes money Congress is just nice pictures and obviously Bart needed to pay for this so in the talk we see that so just a disclaimer so cardiac electrophysiological modeling but with a subtitle someone that is not really a modular image processing background and just trying to integrate this macroscopic patient data into models and use models not really develop them just talk to people that really are developing these models using different schemes on how we can go to image based cardiac models these days as always you really need to start from getting nice images and data from patients do image processing in order to stack patient specific representation in terms of mesh and then add the solvers and the model the mathematical models that replicates some of the physical phenomena in this case in the heart and then trying to what struct additional information that is not given by by the data the thing is nowadays we have a lot of information that you could you could input into the model and it's not very easy even for the clinicians for an expert to really handle or all these deluge of data and know how to interpret and even to communicate to other specialists or even to the patient and even if we just look at the at the at the imaging site we have I mean a lot of different imaging modalities nowadays they can provide very useful complementary information from echo to CT MR or different modalities of MR information about the structure and function but all this needs to be properly integrated if we want to make the models useful really at the at the organ level and models in terms of the different physical phenomena in the heart from the electrophysiology to the to the mechanics and to the flow so basically these three important steps not just the modeling but first extract the relevant biomarkers and indices from the data then integrate them in a proper way including uncertainty including what to do when you have contradictory information between different modalities etc so I'm going to start explaining some examples out of these three parts not really a lot on the data processing because this was the job of Matthew the other day so just to remember that in terms of the image processing once you get the raw data from an image of the patient you need to just recognize some structures the relevant structures in them different techniques at less base etc other things very importantly just to extract shape indices to start the formation indices in order to have a better overview of the patient's heart also we've been involved a lot in the signal processing with a group of Pablo Laguna and Pablo Martinez in Saragossa in order to better extract information a better process in this case electron atomical data that Max was mentioning before is quite used during interventions radio frequency ablations to guide the intervention and to be honest the commercial systems these days they mean the signal processing is very very basic so there is a lot of room for improvement in here to have better better data I won't go more in detail into this but we are now having a pattern on some of the techniques here that the clinicians are very happy about it so we need to construct what sometimes is called like a digital patient or patient avatar where we can integrate patient-specific information from images signals etc but ideally also population-based information information that can come from the clinical guidelines information that doesn't necessarily need to be in a nice image format but also everything related to reports and guidelines need to be to some extent integrated there I will just touch the integration of the imaging here but it needs to be considered so the first example this is the work mainly of David Soto that hopefully will defend his PhD in September and Maxim also has talked about VTs so I won't go into detail but obviously this is quite often related to heterogeneity of the scar in the left ventricle mainly and it's very important to extract or to get information about the heterogeneity of this scar in terms of core zone that is tissue that really doesn't conduct a lot anymore and border zone that is kind of a mix between healthy and and that tissue that is still conducts but allowed velocities and that are supposedly the reasons of their weakness so at the hospital clinic in the unit of arithmias in particular Antonio Berrezzo they've been during the last years developing optimized techniques for ablating these cases and rather than ablating the whole scar that it was kind of the standard procedure until not long ago just try to analyze the course at the border zone that I mean it's quite challenging you need to be really an expert on this to visualize this conduction channels of gray zone or border zone and then ablate just the entrances of these channels so that you kind of induce a short secret and then you stop the electrical reenters the problem is that yeah this is not a potato this is supposed to be a heart but it looks more a potato and then this is quite difficult to interpret in kind of research hospitals what they are using is just this image guided ablation vitian ablation where they acquire a preoperative MR image in the lane enhancement where they can get information about tissue properties really where is the scar and the heterogeneity of the scar but obviously we are talking about data that is acquired before the intervention and that it looks like a heart and data that is acquired during the intervention and it looks like a potato so in order to integrate this the clinician needs to do it a bit in his or her brain and it's quite complex so what David has been developing together with Costa in our lab during the last years is kind of an integration of these two types of data and it's basically based on a mapping of the 3d data into a 2d 2d disk where we can flatten the left ventricle with a laplacian conformal mapping so what we did was to really analyze and compare with a standard with a state of the art integration techniques on synthetic data we generated kind of simulated electron atomical maps and a real data so basically you can see here the process we did it for the endocardium and for the epicardium and you can see from the 3d you need to select some landmarks to guide this mapping and you go from the original 3d to flattening the structural anatomy of the left ventricle and here both ventricles into these maps and obviously you can do this with whatever that looks like kind of left ventricle even if it's more potato like shape you can see this animated that is a partner and you can see that while we need to do some readjustments in the end just to put the apex at the center but this process is quite nice because from the 2d disk you can get back to the 3d without losing a lot of information sorry we tested on on synthetic data and well we were quite happy because our methods kind of this landmark QCM work a lot better than the other standard techniques including rigid registration or even including no rigid registration based on currents because basically there were not constraints imposed on this non-rigid deformation so that was good for different scars so we were quite happy to have better overlap measures between the between the scars it was a synthetic scar in green the conduction channels imposed and not just the overall overlap but we developed a set of indices to analyze locally the conduction channels in terms of the position of the entrance and exit of the conduction channels and also the continuity of the conduction channels because some methods for instance these are the two more or less used now in clinical routine these days sometimes you lose the continuity of the conduction channel and this is not good we tested on several cases real cases and this is a lot more challenging to evaluate because of the noisy nature of the data but while we were quite happy to see this green dots come from the carto information carto data and are supposedly the places where you have double potential so candidates for being a channel and when we were applying our integration technique most of them were really onto what it was the conduction channel and depending on which technique you were using I mean points were going everywhere not really following the conduction channel so we were quite happy about these results but it's still very challenging to apply in routinely in the clinic we also applied similar techniques with experimental data here it's just some experiments that we were involved in hospital clinic for several years with pigs quite challenging to work with these pigs at some point they were free-relating and legs were just jumping etc here we have an electrophysiologist doing or acquiring electrophysiological data here we have an ecocardiographer acquiring mechanical data or deformation data the vet Gemma super scare here engineers and there was quite a set up and the nice thing is that we got a lot of data in fact to these pigs we had preoperative structural image and an MR but also we acquired when at baseline estate we acquired electrical and mechanical data of the peak then we induce an electrical problem and lbbb are left under branch block and then we again acquire these mechanical and electrophysiological data and then we implanted a CRT device kind of pacemaker to see which what was the effect of the electrical abnormality and to which is then this was corrected together with the mechanical abnormality with the device so that means a lot of data and David applied this kind of 2d conformal mapping to this data because we were having very heterogeneous data meaning a different time points with different resolution and we needed to integrate them in a common reference space so this to this was quite useful so we've got endo epi data basal lbbb with the device implanted we could just go for from this 2d to a kind of a 3d bullseye plot and then extract indices from these data and compare data different time points and even between different cases we could get kind of videos of the activation propagation at the different stages you see how the propagation at baseline is quite different from when you have a block of conduction and lbbb or when the CRT is implanted and we could also quantify kind of this interventricular and interventricular delays with kind of these histograms of isochromes so we are in the process of analyzing all this data that's quite challenging it's a lot of data and we have a lot of different markers and we are trying to analyze the relation between this pattern of electrical activation to where the leads of the CRT device were implanted because there are some some positions that are better than others we also had peaks with scar and without the scar so I mean we are analyzing these differences also together with Siemens with Tomaso Manzi they are using this data to validate their electromechanical simulations and they are trying to predict the CRT electrical activation patterns once the model is personalized either at baseline or at lbbb and results are quite promising it's kind of data simulation process with different parameters and we are trying different parameters to better have this data simulation done in addition not just the left ventricle and the right ventricle we are trying to apply kind of a similar strategy that we like to flatten things to the atrium as well and we have very preliminary results and to some extent it's a lot more challenging because of the pulmonary veins because of the left ventral appendage so we try to construct this kind of circular disc for the atria also but at the moment it's quite dependent on the registration phase between a given template we have and and the new atria we want to we want to analyze but we have one interesting results comparing carto preoperative let's say fibrosis after the ablation and the carto during the ablation more things to come in the next in the next month so this is a bit of the integration and once we have more or less the data in the same common reference space we need to build this reference space structurally for the for the models and I like it this is like that I stole from from Rafa Rafael Sebastian in Valencia because it was showing a bit of what it was some years ago and not even that long ago I remember conversations kind of 10 15 years ago with people using ellipsoid for us as the approximation of the of the of the anatomical instructor of the heart and for some questions it's okay but if you really want to go to very specific patient modeling it's a bit limited depending on the question now a days or more recently we get more and more information from the images and higher higher resolution data than this is reflected to better anatomical definition in the models once we have the anatomy we need to complement the whatever we extract from the image with information you cannot extract from the images that are more related to superstructural information or even with function so then we start from from the imaging we generate kind of a segmentation we generate a surface mesh but again we have a lot of limitations still you often see very very smooth left ventricles when this is not reality really this surface mesh more or less it's done in a standard way but with some kind of dilemmas we'll see in a minute and then you go to a volubetric machine and depending on how you do you can end up with very very expensive computationally meshes if you want to solve all your equations at every note of this of this mesh once you have the model construct you kind of add additional information based on experimental modes etc. like the pookinja system the fibers or the sky information and just starting by kind of this machine kind of machine dilemma it depends on the families kind of the French people like Salote to Edra whatever and the UK and kind of New Zealand they like a lot etc. well I mean it's always one week ago we were still discussing about this what is better so well I guess it depends on the application it depends on on what which properties you prefer of these meshes for the external meshes these are very very nice meshes to work with quite regular but they are they are very very difficult to construct with human organs it's not always easy to fit kind of these nice etc. into a real human anatomy and there are some people like André McCollum that they just push very hard the maths to really construct external meshes in complex structures like the atria but well the other family of people it just kind of building the general meshes where they are more flexible they need to be well they can be better fit to data but then they are less regular and in VP2HF European project we are working people from KCL they spent one year and a half just developing a pipeline a computational pipeline to construct these tetradial meshes automatically from from data and this was quite challenging really kind of more development work than research to some extent but really needed because this was one of the main bottlenecks to bring simulations into the clinic we'll see later these are some examples of these meshes generated by KCL people on really patient-specific data information from images and then quite important this super structural information to understand what's going on in the heart maybe a bit farther from clinical applications but still I was mentioning these smooth ventricles but reality is not like that I mean this is just some examples when you see the traviculations in the endocardial walls and when you simulate left ventricle anatomy smooth probably you will get errors when you simulate flow at some point mechanics at some point electrophysiology you need to be very cautious and on the assumptions you make while this is just some data from high-resolution MRI or synchrotron some people in our group generated and you really see how complex is this structure just imagine this full of blood and then with a catheter inside trying to touch a wall so that's quite challenging to to model so just commenting a bit on the fiber orientation Maxime has main comment this in terms of the acquisition these are some how relevant fiber orientation is for modeling for modeling electrophysiology and for modeling mechanics of the heart and while there are a lot of kind of histological data where you can see the different fiber orientations depending on where you are looking at in the cardio wall the cardio wall the left ventricle and the right ventricle etc. these are images from Damien Sanchez Quintana in Extremadura and there are some kind of data that some are believers some not based on MR DTI MRI ex vivo most of the time from canine hearts from human hearts there are also data in where people has been quite active in this field we are trying to get this information from higher resolution data from synchrotron also and then as Maxime was mentioning this pioneering work on in vivo DTI even if it's at some slices so there are some data there and and so we were trying to answer in one particular clinical question when we realized that we needed to look into fibers really properly and this clinical question was related to better understand the outflow track ventricular arithmias and try to generate a computational modeling pipeline to replicate what the clinicians see depending on the site of origin of the topic topic foresight of these arithmias and and in fact in these arithmias it can have a left ventricle origin or a right ventricle origin and based on the standard ECG data is not possible in a lot of cases to distinguish if it's coming from the left or from the right because the outflow tracks they are really close together physically so really you cannot distinguish properly in the ECG data and then it means that the radiofrequency ablation interventions can be very very long they go to the right they try to burn arithmias still is there they go to the left maybe sometimes that's nothing happened so it can be really really long procedures and quite painful so the idea is well let's try to do some EP modeling and owner whatever geometry one heart we had in the in the lab and just put different sites of origin and see how in the left ventricle and how this arrived to the outflow track of the right ventricle with a standard kind of detailed models tend to share etc and and then we show this to the clinicians they say exactly this is what I see in the data when we have the origin and the non-coronary cast while the propagation arrives around here a bit farther from the red farther from the outflow track when is the L cast it arrived from this exact site etc etc this it was even presented in a supposed to in a clinical conference so we were quite happy to get the clinicians believing in these simulations and then we kind of compare when qualitatively our results in terms of some parameters of these simulations with the literature and they were more or less agreeing to some extent in terms of the areas of the isochronous etc so we say okay let's go to process some real cases with these pathologies and we started with three cases that they were really awful in terms of the quality of the data the potatoes in Carter were really potatoes and data were really really noisy and then the first thing we realized is that we needed to segment the geometry well we set up kind of the whole pipeline like image process image generation parameter setting and simulations in comparison with the Carter data and then the first problem is that main segmentation techniques automatic segmentation techniques based on addresses they don't reach the outflow tracks so we needed to I mean a PhD in our group Ruben really very painfully manually with the help of some undergraduate students to segment all these outflow tracks etc we use a slicer for this and have money manual corrections and have good results but quite computationally expensive then to construct the mesh was also very painful because of the thin layer structural layer in the outflow tracks so a lot of kind of manual corrections with blender etc but in the end we got kind of nice meshes and then we needed to incorporate fibers and fibers okay well you can use standard rule-based methods like a streeter like buyer more recent one or fit whatever DTI data you may have the problem of these fiber models in fiber data that is that all of them they mostly look at the left vertical and we needed information good information of the fibers in the right ventricle in fact we talked with the kind of anatomist to get this kind of histological data and we saw that what the picardium kind of this is Twitter model rule-based models work fine together yeah we're fine but then when we were looking at the endocardial right ventricle something was wrong because these models are given kind of question conferential fibers where when I mean when we see a histological data fibers here are quite longitudinal and in fact it looks like we have two types of fibers one going from the apex to the pulmonary valve and one to the tricuspid valve so we said okay well let's change the fiber model to make it more realistic at the RV so we are trying to modify kind of the Bayer rule-based models defining kind of some directions or reference system with some directions by solving the Laplace equation with some kind of landmarks that all these kind of reference system in the hard fiber reference system they allow us to define some angles and to play with these angles to define the different fiber orientations and then we are kind of defined one direction going from the apex to the pulmonary and one to the tricuspid valve we are now in the process to compare these results qualitatively with histological data and also what we can see that we got we have imposed longitudinal direction here and we are comparing with all the data we may have a straighter Bayer DTI etc and I mean there are some some difference okay and then the next step is once you have this model try to see the influence of these models or these fiber models into the final simulations if a particular fiber model it's making simulations closer to the carto maps the issue these days is that these carto maps are not very good but we are seeing differences in terms of the electrical propagation obviously so now we are in the process we have better cases six new cases that we need to process these days and to really assess what is going on there in terms of the fiber models in the purkinje it's another very important super structural information quite often in modeling we have these fast electrical pathways not really modeled at the structural level and while we had some papers that showing that depending on the question you want to answer for some problems like CRT it may have an influence and that you need to consider really the structural purkinje so Rafa Sebastian he developed some techniques to generate these trees based on L-based systems or L systems the problem is that you could generate really nice images and figures and trees but I mean was this realistic or not who knows so he worked a lot we needed more control I mean this could grow in whatever way so we needed to really assimilate some data in order to control these models and to control some parameters of this model and that make simulations or the purkinje the structure of purkinje more realistic and we use this well we also look into this at the microscopic level in a collaboration with Fran Saxe in Utah and while we did some image processing to analyze this with graph theory measurements the purkinje network all this information was embedded in a way in a model in order to extract information of the purkinje tree directly from CARTA maps because this purkinje tree the problem is that you cannot really measure it in vivo so we were kind of analyzing these activation maps with kind of the gradients divergence to detect some critical points and then use geodesics to construct the purkinje tree we tried with simulated data and even with three cases of ventricular tachycardia fascicular ventricular car tachycardia related to abnormalities in in the purkinje system and we were quite really surprised to see that well I mean even with various parts conduction purkinje trees we were getting reasonable simulation results tissue characterization another point of important to take into account so this is not a kebab this is a heart of a human that was expanded because the heart was really bad in bad shape and we need to we want to use information at the astrological level to validate what is available at the in the MRI what we see in vivo in the MRI so we acquired an in vivo MRI before the expand the explained process and then we send this heart we're conservating from all it's it we send it to Damien such as Quintana and Extremadura that he did a bit of carpaccio with it with this microton system and then all these things that you see coming out it just very thin slices of the heart that goes through a kind of a staining process in order to get really nice astrological images a lot of 2d slices the really painful work we needed to do is to reconstruct all these slices back in 3d to compare with the MRI so David very fond on flattening things so he used this kind of flattening technique in order to build a common reference space for the astrology and for the 3d data and results are really really good really promising we can really compare point by point the in vivo MRI information with the astrology and this is being very helpful to determine a lot of parameters and how reliable is the information of the scar and the heterogeneity of this car in the MRI and we are in the process of doing this analysis so okay but what about really clinical routine so you have all the tools now or a lot of background to see okay is it being used in clinical routine in 2008 we had this you have project where one of the main goals or the main goal was really to do that to have computational techniques including modeling for all these big objectives large consortium a lot of money a lot of years hospitals companies etc. I mean very structure very well a structure project so what could possibly go wrong what happened after the end of the project 2012 in terms of computational techniques researchers we were very happy we had a lot of publications a lot of advanced technical advances and data processing in modeling and clinicians were superset why because everything was applied to a very limited amount of data in four years Maxime managed to have two patients and this was even in 2013 we got eight patients so clinicians were saying look guys I mean we cannot do clinical trials on the with this and I mean what happened what happened here so this is a say speculation but large consortiums are quite difficult to work with data wasn't good enough or it wasn't acquired for the purpose that we wanted for the modeling computational models weren't advanced enough we didn't have maybe fast enough computational techniques and competition limited computational resources even not very clear and concrete clinical questions and even clinicians they didn't know at all what the simulation was and maybe we beat oversold the product sorry but things are definitely improving when you see kind of people like these Japanese that some years ago nobody knew who they were and they even had they weren't publishing they didn't care at all to publish the website was in Japanese so it was impossible with nice pictures but you didn't know what happened there and oh animations are a bit destroyed here so I'm sorry the thing is these Japanese now they are publishing a lot they are even rejecting metronic metronic wants to work with them and they reject them like that they create their spin-offs and they publish even in media etc and the web is in English now young Hopkins our friend try and over she went from having publications in Hindaway to milestones nature communications this year this is a picture from these milestone nature communications when you can see that she has the fibers wrong in the right ventricle but it's a milestone paper and we see the BSC people our friends they went from having toothpaste our winning hearts nice videos but completely unrealistic to really being consulting doing consulting work to metronics so that's quite an improvement and as we went from you hard to VP2HF a lot of similar phases and but we passed from having eight retrospective patients in four years to now having one patient every two weeks done in a prospective study so that's quite an improvement the objective of VP2HF is quite similar but very important a unique and single clinical software platform and using a wise approach to decide where to use modeling or not we don't need to use modeling for all patients for easy patients we already have data enough to see if the patient is going to respond or not for instance CRT so the more resourcing resource intensive tools like modeling they will be used just when they will add real value and that's quite important we have set up this kind of decision trees in order to have kind of this hierarchical management of the patient and in reputable in case you'll people they have work a lot to have this workflow where the patient arrived to the hospital image data is acquired and then in two weeks they have a really nice well I will show you later well here wait here a really nice report where in this report the clinician can see the results of the simulation the results of different decision trees looking at different parameters and some recommendation in fact this first state here in terms of the decision trees it looks at the clinical guidelines it looks at more advanced imaging parameters and for cases that with data is not enough the system recommends go for modeling and then you do modeling and the modeling will give an answer so a lot of we've done a lot of kind of development work through the rocket app in order to integrate into a single platform all the different tools it was brilliant work of Carlos Agua developer in our lab together with in real people and together with clinicians so this is kind of one snapshot of this tool that the clinician can look around the whole database of images and data available for each patient okay okay I will just go quickly so take home messages so the field is improving a lot but really a lot clinicians really start to be interested on simulations they want to know what they are we have better data we have better computational resources I just I think I mean machine was stealing me the conclusions like trying to be integrative try to talk with different people or people with different profiles biologists clinicians computer scientists modulus is preventable is et cetera and do it before a certain anything whenever you have a clinical question try to design everything and start to talk with people and trying to go for a more systems biology multi-scale approach to solve clinical questions you really need it the other thing is that go simpler as simple as possible don't try to over complicate your tools because it's nice well this guy said a lot of things but some not and well just thanks a lot of the ganks we have around kind of license group and our brother group symbiosis that you will know a bit more now and the partners from European projects national project funding agencies clinicians and a lot of other colleagues nationally and internationally okay thank you very much thank you for your attention okay thank you very much Oscar for this elaborate overview extremely complementary to Maxime's while you said like I have nothing new to say one of the nice things also that I think is important one of the nice things that you said is important is okay keep it simple but not too simple neither because one of the things that you clearly showed is that okay mean you're not a model developer but you start to use models and then you see that at some point you want to answer clinical question and then you say like okay there's something strange so the question is then what do you do do you say like okay this clinical question I'm not gonna address it or do you say like no maybe we should go and look for the problem and then try to find a solution more deeply I think you need both things I mean it depends and that there is a lot of work for a lot of people so it's very useful people that don't do patient specific modeling to better understand how the models work I mean we know our BSc people have been doing this for years or other people doing more basic science and it just no one can do everything so I mean it's just a matter of just trying to to have complementary work and just put the things together and and just this work of kind of just evangelizing the clinicians well we know that is very hard and even papers like our friend Natalia to some extent is helping because this works even if some people don't believe fully on them they are showing simulation results to clinicians and they are kind of starting to be aware of it so I think you need both and not try to oversell everything and say that you have solved everything and some people do that and how do you go from you talk to a clinician and you say I have my model that will solve your problem and then at some point you do it capaceos in order to look at scars well this was an idea of a clinician indeed because they couldn't well they wanted to have proof that what they see microscopically you see similar things at the histological level and in fact it was very funny because the anatomist that he is all days looking at the astrology and the carpaccio the first time he saw the MR of the patient he said no this is not possible you are not guiding the ablation with this I mean you don't see anything here and it has been after some time doing the 3D reconstruction of the histological data and put it together with the individual data that he starts to believe that what is not too too bad the in vivo MR data but you really need to work a lot on how to present things to kind of the different specialists and how do you talk with them so again like Maxime said is you need to couple different people from different backgrounds and a lot of cases as kind of a VPH researcher you have to be in between and try to find the right resources in order to get it on some other questions for Oscar well thank you Oscar for the great presentation I wanted to ask you do you find it really relevant to I mean the the scar information you obtain from Carter or do you think there may be some other better predictors let's say for certain or with me as for example well for for VT is crucial because I mean there are kind of heterogeneities or conduction channels that are too small to be seen at the resolution of the imaging and the clinicians electrophysiologist until very recently what they've done all their lives is to look at one of the signals and in fact this is what they they used to detect this kind of double potentials or fractured fractionated electrograms and this is done with the carto data it's not even the 3d reconstruction this map but to look at every acquired point the signal the one this signal that's why it's very very important to have better signal processing and these days is awful they just detect the maximum peak at every point and this is completely nonsense there is huge room for improvement there and then how to couple this together with the imaging information I mean you can imagine a really nice system where the preoperative information is going to guide you the acquisition of the different carto points and doing together in an integrated way the signal processing and just to detect inconsistencies between all the MR data and all the carto data as well I think you need to have both and with the new electron atomical systems where you can have thousands of points you really need to go for advanced signal processing and how to couple with another question is AF and the ATREA where fibrosis in the ATREA well no no no no it's well partially related to that also I think one really important thing is by the fact that you work with all these different people and you have your way of presenting something or modeling something you always have to translate it into a way that people are used to work with that means that if you show electrophysiological modeling to an electrophysiologist make sure you put one these signals next to it because they're not necessarily gonna understand the things that you like because they've never been used to working with it so I think that's important is do these translations not only talking the same language but also showing the same data even if you're not convinced that's the best way of doing it but they've so much experience in it and pattern recognition is still the thing that people are the best at at this moment. A very stupid example of this some weeks ago that it's quite hard to believe we were showing results of the outflow track of the red ventricle simulations to the electrophysiologist and Ruben put some views of the 3D model and they didn't know where was the red ventricle and the left outflow track and is this the outer and they were asking to us because this wasn't the standard views where they they have to look at the data and they were we are going to stop working with you if you don't put us the 3D model in the right orientation. Okay thank you very much


All right, here we are Proverbs You know, I haven't taught the book of Proverbs since 1999 Yeah, I was 20 years old don't laugh so hard So We'll look at this together. I'm gonna give you an introduction I'm gonna first I'm gonna read verses one through one through five actually one through six. I'll read one through six I'm gonna give you an introduction to give you some background and information that is important for the understanding of the book And then we're gonna go into chapter one. So we're gonna look at chapter one today so beginning at Proverbs chapter one verse one reading to verse six The Proverbs of Solomon the son of David king of Israel to know wisdom and instruction to perceive the words of Understanding to receive the instruction of wisdom justice judgment and equity to give prudence to the simple to the young man knowledge and discretion a wise man will hear and increase learning and A man of understanding will attain wise counsel to understand a proverb and an enigma the words of the wise and their riddles Okay, let's give you an introduction So we have a backdrop and then we'll move into the verse by verse approach to to the book of Proverbs So notice how it begins by simply saying the Proverbs of Solomon the son of David king of Israel so we see that this book was written primarily by Solomon and Solomon was the son of king David and a woman We all know in scripture by the name of Bathsheba Solomon is the main contributor, which is why it's referred to as the Proverbs of Solomon Now when you look in the history of Israel, you see that King Solomon reigned from 971 BC to 931 BC and when you read the Bible you'll discover that three books are attributed to him You have the song of Solomon the book of Proverbs and Ecclesiastes it's been said though. I don't know how Scholastic this really is But it's been said that the song of Solomon was written when he was a younger man because when you read the song of Solomon It's a song that's filled with passion So it's been said that the song of Solomon was written when he was a younger man that Proverbs was written when he was in his middle age and That Ecclesiastes the third book that he wrote was written in his older age Well, no man was better qualified to write this book because he's regarded as the wisest man You see remember how that? God had spoken to Solomon and said ask anything of me as high as the heavens make your request and Solomon made his request he asked for wisdom and It says in 1st Kings 4 29 and 30 that God gave Solomon wisdom and exceedingly great understanding and Largeness of heart like the sand on the seashore Thus Solomon's wisdom excelled the wisdom of all the men of the east and all the wisdom of Egypt In 1st Kings 4 34 it says and men of all nations from all the kings of the earth Who had heard of his wisdom came to hear the wisdom of Solomon? Now he was quite a prolific writer He was a a man who spoke according to 1st Kings 432 3000 Proverbs and he wrote a thousand and five songs Only around eight of them 800 of his Proverbs are recorded in the book of Proverbs now Just to give you some more background Chapters 25 through 29 were assembled during the reign of another king by the name of Hezekiah Hezekiah ruled from 715 to 686 BC and They collected it in order that Hezekiah could benefit the people with God's word There are other contributors that are mentioned Proverbs 22 17 all the way to 24 34 Consists of the words of the wise These are the sages they had sayings that Solomon may have collected and edited in chapter 30 Chapter 30 is written by an unknown writer by the name of Agar and chapter 31. We'll see was by King Lemuel There's no biblical information on either of these two men But as you look at Proverbs the question has to be asked Why would we study it and the reason we study the book of Proverbs is it imparts wisdom The word wisdom when you speak of wisdom speaks very basically of the ability to live life skillfully So this is one of the few biblical books that it declares its own purpose. It's in order to impart wisdom So Solomon declares in the first chapter that he intends to impart wisdom instruction understanding prudence knowledge and discretion to the one who will hear and So that's what we're going to be looking at as we go through the book of Proverbs This is a book that is written that's intended to impart wisdom But the caveat is that you want to hear that you want wisdom We're going to look at that in some detail as we go through our introduction in just a moment But let's begin again in verse one the Proverbs of Solomon the son of David the king of Israel The word proverb is the same It's a saying of ethical wisdom It's a lesson that uses comparisons to reveal truth a Proverb has a purpose to keep somebody from choosing the wrong course of action And so a proverb is intended to give proper information so that we can make right choices And so it's spoken of as the Proverbs of Solomon the son of David king of Israel And then he goes on in verse two to say to know wisdom and instruction to perceive the words of understanding To receive the instruction of wisdom justice judgment and equity To give prudence to the simple to the young man knowledge and discretion And then he says a wise man will hear and increase learning a man of understanding will attain wise counsel and so he says to know wisdom instruction into peace perceive words of understanding to receive Instruction Solomon desires us to know the word know speaks of attaining He wants us to attain wisdom and again. He wants us to grow intellectually and experientially He speaks of wisdom and again I mentioned that wisdom is the art of skillful living in verse two He speaks of instruction because that's what he wants to receive for us to to know wisdom and instruction in verse three to receive Instruction of wisdom the word instruction speaks of mental and spiritual discipline. It's the training of the moral nature Which accompanies the gaining of wisdom It's gaining that which is worth having because a lot of people have a lot of information. That's not worth having a Lot of us have things in our heads that we don't even need to know anymore And I still have something I just it comes to mind see I'm telling you kind of rabbling around and I'll say hey Why don't you tell him this? Stanley Stanley Stanley Chevrolet two blocks off the Santana freeway One one nine eight always Firestone Stanley Chevrolet. Why do I know that? I don't know, but I've known it for 50 or 60 years and I can't get it out of my head There's stuff that we know that we don't need to know That's an example. I could give you more. You don't want any more but so wisdom and instruction and and Understanding it. This is all something that speaks of value And he wants to impart to us those things that matter to teach us to live skillfully To have a mental and spiritual discipline to gain discernment that we're understanding in verse two to gain discernment by comparing Two things and then choosing what is better That's what he wants us to have in verse four. He speaks of prudence. We don't use that word prudence Very much have had all anymore. It speaks of that which is circumspect and what is circumspect? Speaks of walking with an awareness of your surroundings being aware of where you're at is prudence It's it speaks of shrewdness actually and the word discretion Speaks of being on the alert in order to escape evil in order that you might find good So I want to give you wisdom. He says I want to give you instruction. I want you to have understanding I want you to have prudence and I want you to have discretion And that's the reason why he's writing the Proverbs of Solomon You see in pursuing the wisdom of the Lord Your life will be skillfully lived spiritually and mentally disciplined You will be able to compare things Make the best decisions And live in such a way That you are pleasing to those you live amongst Do you want that? I do And how do you gain that? We'll be studying the book of Proverbs And that's how you gain it Notice how he says in verse five a wise man will hear an increased learning and a man of understanding Will attain wise counsel The evidence of a man being wise Is revealed by his desire to increase his learning You see anybody can have godly wisdom But they need to diligently Apply themselves to the gaining of it And wisdom is something very often that is gained over a lifetime We know that God gives wisdom Because as mentioned earlier God gave wisdom to Solomon And according to Proverbs two verse six The Lord gives wisdom From his mouth comes knowledge and understanding So we know that God gives wisdom But we also know that it comes in other ways It comes for example by being taught to us Our parents as we grew up Those of influence have given to us the ability to gain wisdom In Proverbs four verse 11 It reads I have taught you in the way of wisdom I have led you in right paths So God gives wisdom And he imparts it very often through teachers Who teach us the proper way to live and to gain this wisdom We're going to see as we study Proverbs How to gain wisdom We know that wisdom is something that is to be valued. It's something that we're supposed to be pursuing Because according to Proverbs 16 verse 16 How much better to get wisdom than gold? Think about that for a minute How much better to get wisdom than gold? And get understanding to get understanding is to be chosen Rather than silver Now the average person today maybe even amongst believers would say I haven't paid my bills with wisdom lately Nice I could use some gold to pay my bills And wisdom would reply well if you had me you wouldn't be paying that much now would you? And so How much better to get wisdom than gold and to get understanding is to be chosen rather than silver It is to be pursued Proverbs two verse two Incline your ear to wisdom apply your heart to understanding Proverbs four verse seven wisdom is the principal thing therefore get wisdom And in all your getting Get understanding Wisdom is something you purply seek James one verse 15 if any of you lacks wisdom Let him ask of god who gives to all liberally and without reproach it will be given to him And wisdom is something that can actually increase with age when the person is living for the lord I had spoken to my pastor chuck on one occasion and I asked him pastor When does the minister retire out of ministry? And he said to me when I stop enjoying what I'm doing. It's time for me to get out As long as I love what I'm doing He says I should remain and then he said this he said, you know one of the things about ministry is this he said Dave he said The longer you live and the longer you walk with the lord the more you have to give to somebody else He says it's the one thing that you actually gain through life Over time more experience with god more knowledge of his word more experience with his his spirit and all And so a long life that is lived for the lord very often is a life that is filled with with wisdom in job 12 verse 12 It says wisdom is with age admin and with length of days understanding Wisdom has a fruit that it produces James 3 17 says the wisdom that is from above is first pure Then peaceable gentle Willing to yield full of mercy and good fruits without partiality and without hypocrisy Wisdom results from the fear of the lord you see then in verse 7 where it says the fear of the lord is the beginning of knowledge Fools despise wisdom and instruction And in job 28 verse 28 it says to man he said behold the fear of the lord that is wisdom And to depart from evil is understanding And the new testament makes it clear and you'll see this later on as we study through proverbs that this wisdom is bound up in jesus christ Colossians 2 verse 3 says concerning jesus in whom are hidden all the treasures of wisdom and knowledge and so Solomon's desire is for us to know the lord to understand his ways To perceive the words of understanding he says to receive the instruction of wisdom justice judgment and equity He goes on in verse 6 to say to understand a proverb and an enigma the words of the wise and their riddles To understand a proverb proverb and an enigma in other words you need to apply yourself to understand mysteries And perplexing questions the word enigma is a word that is used that speaks of a mystery when it speaks of riddles that talks about Difficult or perplexing questions So to understand a proverb it means that you apply yourself to understand Some things take mental discipline.   It doesn't work that way at all You act actually apply yourself You apply yourself to the gaining of wisdom. We'll see that in chapter 2 next week when we gather And we see especially in the first six verses how that works But you apply yourself to the gaining of wisdom It's like what paul said as we've been studying through first timothy out paul said in first timothy 4 15 and 16 Meditate on these things give yourselves entirely to them That your progress may be evident to all Take heed to yourself and to the doctrine Continue in them for in doing this you will save both yourself and those who hear you So there's a pursuit if you want to grow in your understanding if you want to grow into wisdom It's got to be the chief desire of your heart.  It has to be Something that just causes you to be willing to to No longer do some things in order to pursue that which matters It doesn't happen overnight. It happens over time. It comes through prayer It comes to seek in the lord It it comes to spending time in the word of god it comes through a variety of means But it's all distributed to you through the lord and by his holy spirit But he's going to satisfy your your hungry heart for this if that's what you desire Whereas it begin verse seven the fear of the lord is the beginning of knowledge but fools despise wisdom and instruction This is the principal part of knowledge A reverential submission to god Interestingly enough This is unique the fear of the lord. This is unique in all wisdom literature You see for unbelievers Wisdom doesn't believe begin with god It does not begin with god When you read the writings of some of those who are are spoken up as profound writers the greek thinkers of An earlier day in all Even modern writers that are perceived as being Very deep The overwhelming majority have no fear of god at all Many of them that are looked at today as being profound are atheists They have absolutely no foundation of the fear of the lord at all So when when Solomon begins by saying that all of this actually begins with the fear of the lord Which is the beginning he says of knowledge and wisdom and instruction. That's unique Because the other writers through the ages would not have pointed you to the fear of the lord But he says that's where it actually begins You see an unbeliever doesn't have the fear of the lord Psalm 36 verses 1 through 4 says there is no fear of god before his eyes For in his own eyes.  He has ceased to be wise and to do good Even on his bed. He plots evil He commits himself to a sinful course And does not reject what is wrong and that's true All you need to do is watch the news and watch some of the debates that you're going on right now Concerning a variety of things and you're going to see that there are always There's always been sinners and intellectuals who defend the sin always And they will come up with the most interesting interesting things to to justify evil And a lot of it to me it reminds me of children on playgrounds You know what i'm saying when I say one says you did this and the other says, uh, you did too That's kind of how they debate today You know, you did evil. You did evil. You did worse evil. No, you did your mama did evil I mean that's kind of where it's at today It's crazy But it's true So with the proverbs you'll see this listen wisdom begins in the fear of god That's where it begins It is the root of all wisdom To know and understand his ways and to realize the power That he has his majesty how awesome he is And when you have this right sense of reverential awe of god, it drives your life To do that which is pleasing to him But when you don't have that Then you will be driven to do what pleases yourself. That's what you'll do You will please yourself To the hurt of others And so solomon begins the man who is the wisest man Says this is where it begins It's the principal part of knowledge And that's something that he never ceased recognizing Even in his darkest days when you read the book of ecclesiastes It's one of those books that You go through 12 chapters And he tells you all the things that he did He in his kingdom when you read concerning the life of king solomon in in his day Gold was like dust. I mean it was like the dirt I mean he lived in an opulence He lived in a lifestyle That even the richest people who've ever lived have never compared to how solomon lived There his his lifestyle was beyond He had his spill of every desire that man could have Every entertainment He experienced it He even went to the folly of alcohol. He drank He had as many women as he wanted He had everything and he read ecclesiastes, you know, tell you and then he'll he'll he'll say what he had done And then he'll say and I discovered everything under the sun is vanity And I did this and I did that and I did this and then I discovered it was vain And then I did this and I did and he does that for 12 chapters And you see this man speaking of all that he did read ecclesiastes See what I mean All that he did all that he had All the fame that he had people would travel, you know, the very famous queen of sheba She came to see him. She said I've heard wonderful things of you, but I didn't hear half of the truth of it She said and she blew her mind when she visited him. This is a man that had Everything that an individual could want Everything that a man could want and he said at the end ecclesiastes 12 13 and 14 Let us hear the conclusion of the whole matter Fear god Keep his commandments For this is man's all For god will bring every work into judgment Including every secret thing Whether good or evil One of the things that's interesting scripture Reveals to us is there's no secret thing god knows it all He says it all We don't think that sometimes we think we can hide things from him. We even try to hide our thoughts from him But he tells us in psalm 139 he said I already know your thoughts before they're formed I already know the words before they're on your tongue I know it all you can't hide a thing from me And uh Solomon said no He said we need to realize that this is the conclusion of all things fear the lord So Solomon knew fearing god had benefits Both in this life and in the life to come and It is revealed in a righteous life And it adds years of life into blessing In proverbs 19 23 it says the fear of the lord leads to life And he who has it will abide in satisfaction He will not be visited with evil When you have the fear of the lord it keeps you from doing an awful lot of things that would end up with you paying a price later on So he speaks concerning how the fear of the lord is the beginning of knowledge But he says fools despise wisdom and instruction verse eight my son Hear the instruction of your father Do not forsake the law of your mother For they will be graceful be a graceful ornament on your head And chains about your neck So a practical outworking of the fear of the lord Will be the teaching of god's word To your children He says the fear of the lord Is the beginning of knowledge and then he commands in verse eight hear the instruction of your father When you give the word of god To your family if you're a parent here today When you give the word of god to your children The word of god produces the moral foundation by which choices will be made in the future They're given to them a moral grid When you pour into your children When you instruct them in the ways of the lord They will have A backdrop by which they're going to be able to judge what is right and what is wrong That doesn't mean they will always do what is right Because if they have their mother's nature, they'll be bad No, if of course i'm teasing we received the adamic nature came from adam But i love to tease that way No, they're gonna do with what sinners do But one of the things that i learned over time raising up My children who are all adults now, but Marie and i learned this if we poured into them The word of god When they sinned as they did They sinned against the light They knew right from wrong They knew right from wrong I could actually speak to them and I could say you know that's wrong You know that's wrong And you could get that they could get this little attitude, you know this little stiff back thing that they do And I just would stay there. I just say no, you know, it's wrong Yeah, that's wrong. Yeah It's wrong There are times when we were talking as a father to a child and I they would want to argue And I would say I think you've made mistake What do you mean? I think you think we're having a conversation We're not I'm telling you And it comes from this direction This is what i'm telling you. We're not conversing this It's not your opinion versus mine and one of them's right when i'm wrong. You're wrong And the reason you're wrong is because this is what god's word says and this is how we line up See, so that's how I would speak to my children from the time they were old enough to want to argue When they're younger, they would just kind of smile when they got older. They thought they had brains And they did But they also needed their thoughts to be brought in line with god's word And that's what he's saying here the instruction of your father Do not forsake the law of your mother The instruction law We have imparted to you Hold fast to these things These are the things that are creating within you that foundation Because choices will be built on the foundation of your early days And again, that's the single responsibility of the child to the family by the way When you read scripture obedience is that one requirement to the family See god's word is simple to the children and The fact is the bible teaches them To obey and to honor god in exodus 20 verse 12 It reads honor your father and your mother that your days may be long upon the land Which the lord your god has given you Ephesians repeats that in chapter six verses one and two children obey your parents and the lord This is right honor your father and mother, which is the first commandment with promise So the bible teaches us as parents to raise their children and their responsibility is to obey The father and mother as they give the word of god and the result verse nine They will be a graceful ornament on your head and chains about your neck In other words obedience to the parents results in children developing an attractive life Speaks of graceful ornaments When it speaks of these graceful ornaments, those are beautiful charming qualities qualities that develop It's a result of practicing what they're being taught He said this is what it's going to be like. It'll be a beautiful character Then he goes on to warn verse 10 my son if sinners entice you Do not consent If they say come with us. Let us lie and wait to shed blood Let us lurk secretly for the innocent without cause.  We shall find all kinds of precious possessions. We shall fill our houses with spoil Cast in your lot among us. Let us all have one purse My son Do not walk in the way with them. Keep your foot from their path For their feet run to evil They make haste to shed blood Surely in vain the net is spread in the sight Of any bird, but they wait they lie and wait for their own blood They lurk secretly for their own lives. So are the ways of everyone who is greedy for gain It takes away the life of its owners And so if sinners entice you do not consent even if they say come with us What is this? This is an exhortation and notice it begins in the first chapter. It's an exhortation To stay away from bad company interestingly enough If you look at this and i want you to see this you may think i'm teasing you and i'm really not Notice what it says in verse 10 11 if sinners entice you do not consent If they say come with us let us lie and wait to shed blood Let us lurk secretly for the innocent without cause goes on You know what you're saying here? Stay away from gangs Isn't that interesting? That's what he's saying Stay away from gangs. That's what was just described to you. You may not even noticed it as I was reading it to you But that's what he's saying son.  Isn't that interesting? But that's what he's describing right now He says he says if gangsters are persuading you if they allure or seduce you to join their gang Don't do it In verses 11 and 12, you notice he says they lie and wait to ambush They're waiting to to assault To seduce maybe even to kill and they boast that they're so tough That they can take even the most powerful person as surely and as swiftly as death swallows its victims It gives promises in verse 13 and 14 They're saying we'll find all kinds of precious possessions We're going to fill our houses with all of this stuff In other words after robbing people our houses are going to be filled with their possessions And then they entice in verse 14 and they say cast in your lot among us. We'll have one purse In other words, we're going to have easy and quick wealth and we're going to give to you a share of whatever it is We get so they're enticing you and what is his command verse 15?  For their feet run to evil And they make haste to shed blood They live for evil They hurry to perform it And they're willing to injure the innocent To get what they want I'm watching the news just yesterday Some guy Is running away from the police. Perhaps you saw it on the news Drives into an underground parking structure Smashes into a car Gets up tries to run They'll they'll injure innocent people A mother and a child will be driving and And somebody's trying to evade the police after robbing Somebody smashes into the car kills the child They they don't think and that's what Solomon's saying They're going to do anything they can to get away And they're going to do anything they can to the innocent if it gets them what they want So he's saying son don't do it Their feet run to evil and they make haste to shed blood In verse 17 surely in vain the net is spread in the side of any bird Even birds are wiser than these evil people A bird will avoid a trap, but they don't At least be as wise as a bird that avoids a trap that ultimately ends up killing them So he's saying you know a bird knows to stay away from that which is dangerous son. You ought to know the same He goes on and he says in verse 18, but they lie and wait for their own blood They lurk secretly for their own lives. So are the ways of everyone who's greedy for gain. It takes away the life of its owners So the blind folly of greedy people results in their own destruction. It takes away the life of its owner In other words, they're not going to get away with it. Sometimes it appears that they are But they don't you don't get away with it. You end up paying the price He says and they're gonna it's gonna they will reap what they have been sowing He goes on in verse 20 wisdom calls aloud outside She raises her voice in the open square.  I will make my words known to you Because I've called you I've called and you have refused.  Well, that's the picture of wisdom wisdom standing in in like a mall or a plaza At a thoroughfare at a place where a lot of people are gathering and he's picturing wisdom standing there crying out to people And saying come and receive from me But notice no one stops to listen. Why? Because nobody really Really cares And it says in verse 22 how long you simple ones will you love simplicity for scorners delight in their scorning fools hate knowledge And that you can almost hear a tear in the voice there He speaks concerning the whiz the the simple the word simple there speaks of people who are naive These are those who are satisfied with life as it is They really don't need much more than food and drink a place to live Something to watch on tv They have no desire for anything deeper than that So he refers to them as the simple ones in verse 22 in verse 22. He speaks of the scorners The scorners are interesting you've gotten like two categories on the one you've got the person who's Happy watching the game drinking a beer and that's as far as he wants to go That's that's life for him But then you have the scorners The scorners are the cynical They're the defiant ones They have no shame.  They're scorning us And that's what they do And there are many people who do that and you have friends and you have relatives who do that You have people that you go to work with you have people that if you're in school who are in school your professors Many of them are scorners when I was in college, you know for a number of years I had a number of professors who made it there Their um their chore it was there. It's like their mission to undermine your faith They they would say things I I had one professor in particular comes to mind through the very first day of class said to you how Said to us how many of you are christians? How many of you are born again? and I was in a sociology class in Cal Poly and how many of you are uh believers in Christians born againers So a handful of us raised their hand out about 25 or 30 students There may have been three or four of us who raised their hand and the first thing he said in the very first day of classes I feel sorry for you That was the first thing that was the opening introduction. That was our opening lecture I feel sorry for you Is what he told us because you believe the words of that little black books begin of the bible You believe those words and I feel sorry for you. He says i'm a scientist and I believe in facts And I believe in verifiable scientific evidence and you don't you walk around just believing But I have to believe in facts interestingly enough this man who believed in facts in one of the Lectures he gave to us told us how people say that There is a correlation between smoking cigarettes and lung cancer He said I've got a lot of studies that prove that that's not true He says I smoke I've been smoking for years He says and I've got a lot of studies scientific studies that demonstrate that that is not true. That's fallacious He died of lung cancer That's the truth He died of lung cancer The man who pitied me The man who pitied my beliefs The man who trusted in his science not that science is bad.  They have no conscience.  They want nothing to do with it They are people who try to not be made uncomfortable at any cost and and a lot of us have people it's christmas season and Every one of us has a relative or two That is exactly like that. Don't say anything to me about god, please I mean, let's just celebrate the real reason for christmas, which is drinking and eating You know and giving presents and trying to feel good one day out of the week and they have their own philosophy Pertaining to that But they're very insensitive more only so we speaking about that here and what does he say in verse 23 He says turn at my rebuke surely.  I will make my words known to you turn Turn at my rebuke wisdom speaking, but it also can be a picture of god who is wisdom In joel chapter 2 verse 28 in the old testament god says i will pour out my spirit upon all people in john 7 38 and 39 jesus said he who believes in me as the scripture said From his innermost being will flow rivers of living water But this he spoke of the spirit Whom those who believed in him were to receive for the spirit was not yet given because jesus was not yet glorified So as wisdom is speaking wisdom is saying i will pour my spirit on you And he also wisdom also says i will make my words known to you Well in john 14 26 Jesus said the helper the holy spirit whom the father will send in my name He will teach you all things and bring to your remembrance all things that i said to you Listen when you turn to the lord and you say god i i want your wisdom and i want to understand your ways He says i'll i'll make myself known to you guys understand that today Understand that you haven't been left in the dark. You haven't been left alone You haven't been left without wisdom. You haven't been left without understanding god says i will give it to you But you do pursue him You wake up in the morning. You see today is the day the lord is made. I will be glad i'll rejoice in it lord I'm gonna pursue you. I will seek you with all my heart today. I'm gonna pursue you. I'm a believer I'm gonna follow you today lord You're gonna give me a lot of opportunities today to be a witness for you and there are gonna be a lot of Opportunities to stumble god. I need your help And i want to start out right with you today and even as it says Turn out my rebuke.  I will make my words known to you and so you say lord I'm gonna read your word. I'm gonna pray. I'm gonna seek you. I'm gonna serve you today You have promised that you would do this for me and I know you will In verse 24. I have called you refused. I have stretched out my hand.  You would not receive correction Therefore Because you refused all of this I will leave you to reap the consequences You see when things are going well for you You mocked me When things are going good you rejected my counsel You didn't need me. You had no time for me. You had no desire for me. You didn't need me That's that's the interesting thing.  Where is God? Where is your God? Well, wait a minute.  You tell me where he is Because you're the one who told him to leave That's a fact And the Lord here look what he's saying I called you refused I stretched out my hand no one regarded You disdained my counsel you would have none of my rebuke So you're reaping what you're sowing I'll laugh at your calamity I'm mock when your terror comes when your terror comes like storm Your destruction comes like a whirlwind when distressed and anguished come upon you You're gonna call That I want answer You're gonna have trouble But no resource to deal with them And the tragedy will leave you devastated Because you were not prepared to deal with it He says in verse 28 They will call on me I will not answer They will seek me diligently they will not find me Because they hated knowledge Did not choose the fear of the Lord They would have none of my counsel despised my every rebuke Therefore they shall eat the fruit of their own way be filled to the full with their own fancies For the turning away of the simple will slay them And the complacency of fools will destroy them Isn't that cherry you refused God you refused my word You refused to seek me You refused to communicate through prayer And then your terror hits you And you wonder where I am But you refused to seek me you didn't search for me And now you will have no help You've come to me too late In John 7 33 and 34 Jesus said the this to some who were questioning him Jesus said to them I shall be with you a little while longer and then I go to him who sent me You will seek me and not find me where I am you cannot come When I was present with you you had every availability To have relationship with me, but you never availed yourself of that And the day is going to come When there is no relationship between you and me That's why it's important for us to rise up early and seek him That's why it's important for us as believers to actually understand what it means to be a believer To be serious, you know, I'm believing that we're in a time right now Where it's easier for us to be known for what we believe now It has been said and think rightly so that the fifties in the fifties somebody once said and there's some truth to this In the fifties more people went to hell than pretty much any time in the United States And I thought that was very interesting But the point that we're making was the United States in the fifties here and you know in some people's history and some people's Memories even in the fifties In the United States Coming after World War II and and being on top of the world with this what was called the greatest generation There were there was a lot of morality in the United States the United States at one time As a nation was was really regarded as as the city on a hill It really was the United States at one time was regarded very highly because of its moral strength We were as a nation a very a very moral nation there were there were strong requirements for citizenship there were There were laws on the book books that were enforced such as Ordinances against public profanity What is common in language today when you're in a store and somebody's wearing a t-shirt with some Expletive on it Or you hear a mom speaking swear words to her kid some of you've heard that I have swearing at them like I mean horribly, you know and That you could be fine. You could get a ticket for using language that was improper Um, there were so many things I grew up in That today's world is so different than Even when I grew up It's difficult sometimes for me to adjust because Things are accepted today That were never accepted before The parades and and the programs on tv Um, it's it's profane I mean and and and and I'm not trying to sound like an old buddy duddy, but I am explaining that word shows you I'm a buddy duddy, but An old goat But some of you don't know this You know, do you know that they didn't even have toilets that were seen in in in sitcoms in the 60s and 70s? You did that one of the first the first time a toilet was ever flushed on tv was on archie bunker All in the family and that they called groundbreaking Because nobody even you never acknowledged you even had a toilet in your house It was always amazing to me that lucy and ricky had a kid Because they slept in two different beds You know, there was no swearing. There was no there was no profanity. There was nothing like that at all And what has happened to the younger generation? Is the younger generation that's coming up now that we have such a burden for the younger generation? Does not have a moral code that they live by I don't know what that is What is that are we on fire? I'll see you later I don't know what that is Oh, that's an amber alert.  Oh, I get it. We didn't have iPhones Instant communication isn't that interesting? See so we live in a different time my illustration perfect In a different time Telephones used to be used to talk on So we we we as a society have become hardened And so you'll have people who argue and say Keep your religion to yourself And then a hurricane hits And then a fire hits Then a flood hits And the church responds The church sends teams The church cleans out people's houses The church prays with a hurt woman cares for her children. The church does that church always has done that But see the world will say we don't need you God we can do it ourselves God But god says i'm going to leave you to yourself And that's what he's saying you would have none of my counsel you despise my every rebuke Therefore they shall eat the fruit of their own way and be filled with full of their own fancy For the turning away of the simple will slay them And the complacency of fools will destroy them But whoever listens to me Will dwell safely and will be secure without fear of evil because You follow the way of wisdom You will not enter into the path of an evil life And the result of avoiding evil Is that you will have peace in isaate 26 3 You will keep him in perfect peace whose mind has stayed on you Because he trusts in you if i can give you anything as a closing thought about this i can tell you this i've been walking with the lord for a long time now And i can tell you What he just what i just read out of isaate 26 god keeps you in perfect peace you know why Because my god does not fail My god does not fail My god does not fail god has always been right on time god has always done What he promised he always has He always has and i can i can tell you that i've been walking with the lord this month 47 years 47 years And i can tell you my god has always been on time now when i was young i wondered if you was going to show up I did Are you Can you not hear me groaning Can you not see what i'm going through god you see my tears you hear my cry i've been there done that We all do and then the lord says i'm always on time Not a second too soon and not a second too late I am always right on time He always is So i've learned to wait patiently on the lord Because he will arrive at the right moment and my heart can be in peace And i am telling you i have been the person who has struggled wondering god And i've gotten to the place now in my walk with the lord where i say you know what My god is good My god will show up my god does take care of me my god has never forsaken me my god will never leave me My god loves me my god is here because he promised he will keep his word I will trust him and that's what the lord is simply saying They had nothing to do with me They don't have me But if you follow me i'll be with you I will be with you Wisdom we're gonna have a good time going through problems