Dr. Saul, for the American Academy of Pediatrics. Thank you so much. It's a real pleasure to be here. When I turned on the news this morning and saw the Today Show and the anchor from Dallas was trying to talk to Matt Lauer about what was going on, they said we all have. And I felt very much at home. It's a real pleasure to present some of the work from the American Academy. And I'm here really as a member of a team, an incredible team that's working on I think some very exciting stuff. So on behalf of the American Academy of Pediatrics, the Committee on Genetics and the Genetics and Primary Care Institute, let me get going here. The initiatives in genetics within the American Academy of Pediatrics are the Committee on Genetics, which is a policy reviewing and setting arm of the academy. There's a section on genetics and birth defects, which is really the advocacy. And what can we do to help Pediatric Geneticist Group? There's a division of children with special needs and it's set up the Genetics and Primary Care Institute, which I'll talk about in a minute. And the American Academy of Pediatrics is now embarked on a specific epigenetics training initiative that I'll mention also. The Genetics and Primary Care Institute is a cooperative agreement between the AAP and HRSA and Maternal Child Health Bureau, Genetic Services Branch. It's a three-year project started in 2011 and through May of 2014, so we're a little over halfway through it. The vision of this project was to improve primary care provider knowledge and provision of genetic medicine, recognizing that this is a significant hurdle. As we've already talked about today, we can talk about a variety of things, but how do we get this out to the field, out of academic centers, where people are providing primary care? And that's one of our primary goals. American Academy of Pediatrics has over 60,000 members nationwide. The three goals of the GPTI. One was to utilize quality improvement science to develop a change package for the improvement, excuse me, improved provision of genetic-related services. And this is, the American Academy of Pediatrics has this incredible network called QUIN Network, Quality Improvement Innovation Network. They have over 300 pediatric practices around the country that have told the academy, when something new and different is coming up that we think will make a difference in children's care, we want to be a part of it. So those practices then, as these projects then come down the pike, are solicited to participate in these projects. I happen to be a subject matter expert in one of those on the Act Sheets for the American College of Medical Genetics and Genomics, and we're now starting one for genetics and primary care. It's exciting to see what's happening with those people, and actually I'm going to give you some of the results of a survey that a good number of those QUIN providers participated in that I think will be useful for you to, in terms of trying to understand the obstacles that we deal with. Goal two was to set up a technical assistance center to address systems and policies, and one component of that was a colloquium on genetics, literacy and primary care, and I'm going to show you some of the results from that. And then goal three was the easy one to embed the practice of genetic medicine into the future primary care workforce. Obviously not the easy one, but it's the one that works now is just starting to get going after we've sort of got goals one and two off the ground, so we're going to be working hard on this one. And as I said, we have significant partners, not just within the Academy of Pediatrics, but we have significant partners in this room, in this endeavor. So we sent out a survey to the over the 80, excuse me, over 300 members of the QUIN project, and 88 respondents. So about 29%. We think that was pretty good. And we're going to be doing a periodic survey of AAP fellows in late 2013. The needs assessment in February of 2012 was really done because, okay, if we're going to be setting up this QUIN project in terms of what needs to be done in terms of getting genetics into primary care medicine, what's sort of established a baseline of what are the needs? This is a reasonably unscientific survey. It was sent out to a group of more motivated individuals, but I think still gives you useful information. So there were the 88 providers, 29%. It was an online 39%, excuse me, online 43 survey. Taking a family history is important, 100%. I gather a three generation family history, less than a third. How do you usually collect a family health history from your patients? I usually ask a question like, do any diseases run in your family? And you can see the other things. Some had a standard checklist. Some asked specific health questions about specific family members. And there was a couple who fessed up and said, I don't get a family history. When they did inquire about the health of family members, over 90% inquired about the siblings, parents, and grandparents. But only half asked about aunts or uncles, less than that about nieces and nephews, and around that, excuse me, less than a third about cousins. And the information that was least likely to be collected was about age of the family members in terms of the problems they were affected with, consanguinity, and ethnic background, things which we might consider important for certain disease problems that we're looking into. Now this is a very interesting slide, 86% order three or less genetic tests per year. And again, we consider this to be a fairly motivated group of pediatricians. 13% discuss with patients their risks, benefits, and limitations of the test in question. Less than five, excuse me, they refer less than five patients a year to a geneticist. But of that group, 90% have access to a genetic professional, and 75% have genetic professionals within 30 miles. Now you can look at that one way or the other. That says 25% don't have a genetic professional within 30 miles, and might consider that to be a geographic obstacle. 83% feel like they have a system in place for genetic referrals. That again, that's self... And there was moderate to low awareness of national resources, but overwhelmingly, they had not been utilized or perceived as useful. Excuse me, of the 12 national genetic resources that were asked on the survey, less than 50% were of the act sheets that were previously mentioned in terms of the newborn screening project. About half said that they felt competent in providing genetic medicine. Now, what's interesting is you might think, well, that was because they trained more recently, or the number of tests they ordered was somehow correlated, did not. 30, excuse me, of the 65%, of 63% of the respondents with an EHR, 65% reported ability to easily and efficiently capture the information as fair to poor. So two-thirds say, it ain't working. Now, a very interesting slide. What would you incentivize you to more effectively integrate genetic-based medicine into your practice? Increased understanding of genetics, which I think translates to education. CME in genetics. Reimbursement was up there. A more comprehensive medical home. And again, we're trying to integrate this whole concept of genetics in primary care medicine into a more aggressive medical home model within four pediatricians. Now, again, this was a select survey. One could argue these results are skewed since this group was more motivated and knowledgeable. Yet in general, they provided reported few interactions with genetic patients. At least those they referred or ordered testing on had wide variability and expressed some discomfort in genetic medicine. Acknowledging a need for the increased awareness, understanding, and the education sources that they need. Associated with that, just recently, we've looked at some stakeholder interviews. We've identified seven, we've conducted seven in-depth interviews with key project stakeholders and experts to look at, again, the barriers that need to be addressed. Again, this sampling was just our perception of folks who felt like we needed to talk to, so they were identified within the American Academy of Pediatrics. Extensive interviews over the phone, lasting close to an hour. Covering a wide variety of topics. What do these people think need to be done? What are the barriers? What can we do? And what are the actionable items going forward? The reports. PCPs lack knowledge and comfort with genetics. They lack a fundamental knowledge about what things mean and what to do. And uncertain of where to turn for for specialty help. As a pediatric geneticist, this is sort of disconcerting because I don't perceive this when I deal with other pediatric specialists. I don't perceive this when I deal with pediatric endocrinologists. I don't perceive this when I deal with pediatric nephrologists. Now, I might not feel as comfortable, because of this barrier with a moat and a drawbridge and a portcullis keeping me out of the castle. No time to incorporate into practice. Lack of education is a concern. Low accessibility of genetic counselors and specialties. Again, this is from the stakeholder interviews. Lack of involvement of PCPs in genetic projects and initiatives. Lack of knowledge of what is reimbursed. I don't know what tests are covered and which ones are not. Some of these tests run into the hundreds, even thousands of dollars. And I don't know what I should order and what I shouldn't, what it's going to cost the family and all that stuff. And again, as a pediatric geneticist I understand some of this and maybe it's because genetics has sort of evolved in my lifetime and some of the other specialties were already there. I don't know everything that's going to be covered but I don't feel that it's this standoffish. So what were the key competencies? Understanding of what tests are needed, understanding of when, understanding the significance, what to do when tests come back negative. That's always the big bugaboo. Just because they're normal doesn't mean that rules things out, which is what a lot of families think. Okay, we're good. That was negative. To refer how to communicate and how to coordinate this complex care. So what are they, what was from the stakeholders then what was suggested in terms of moving genetics in primary care forward, increasing provider education and training. And again, that gets much to the three goals of the Genetics in Primary Care Institute. Evidence to support genetics in primary care is important and does impact outcomes for families, better ways to collect and store family history, improve care coordination, increasing genetics information on board examinations, which we got into a little bit this morning in terms of certification and incorporating genetics into continuing medical education. The impact of low genetic literacy according to the stakeholders was that the problems with a good number of pediatricians prefer not to manage newborn screening issues and some of those are certainly very manageable in coordination with a genetic specialist where sometimes they would just rather take a hands off approach. Providers are not aware of their role in testing or treatment advances with regard to molecular genetic testing. Now what's interesting this slide is to remind me when I pulled my own pediatric genetic colleagues and say what do you think the barriers are this is my shorthand for basically saying they're the same things that the primary care providers say and they're not different but sometimes I think we look at the solutions differently and we have a tough time maintaining the context of what's out there in primary care. So one of the roles of the genetics in primary care institute was establishing a colloquium which was held in October of this past year was looking at genetic literacy in primary care and trying to look at how we can be looking at the knowledge base and awareness of genetic literacy in the medical home. We developed an overarching consensus statement which we have copies of here somewhere I think which can be distributed which you're going to but it is embargoed that I will go with you here. It will melt as soon as you walk out the door. We had speakers and content experts from around and some of the folks from this room and looking at the issues of family history looking at genomics, genetic literacy epigenetics in primary care and genetics and invited guests from a wide range of partners and to try to make sure we had a reasonable consensus about the issues that we were doing. This is a very lively discussion over a day and a half in tropical Chicago and we will spend a little bit of time going through this consensus statement with you because I think this is sort of a blueprint for us in terms of going forward blueprint for us I think maybe it's something that this group would like to look at also in terms of how we would recommend going forward in some of the ways. The purpose of that one and a half day meeting in Chicago was not to all get together and have all the answers. The purpose of that meeting was to try to set forth a blueprint going forward that we could recommend and we basically then had four things and let me just skip through here. One, define how pediatric primary care provider should use genetics and genomics in practice. Two, define, develop and provide the tools and resources then that are needed to integrate genetics and genomics into primary care. Three, integrate genetics and genomics into primary care training in all levels. And then four, provide an evidence base for optimal integration in genetics and genomics into primary care and the more research-oriented component of this. So let me go back through these then. In terms of primary care providers, recognizing that primary care providers are already using genetics and genomics in some ways maybe they don't even know it and so what's needed is an evolutionary process, not a revolutionary change. And this was a big, to me this was a big deal coming out of the meeting. We used the term genetic revolution and I think in many ways we've turned off our colleagues it's it sounds more than I can get my arms around. And so we're basically just asking them to evolve using a lot of things they're already doing. A lot of them are getting family history information. Maybe they're not getting that gold standard three-generation pedigree that we think they do but they are already getting it. Approach primary care using the framework of a medical home model that genetics and genomics can augment and strengthen this. It's not separate. It's all part of the same thing. And emphasize the development of competencies as Bruce was talking about. Not knowledge, but competencies that have, and many of which have already been incorporated into training, but just need to be tweaked. Okay and then looking at the tools and resources, emphasizing the relative values of targeted family histories. Oftentimes if a physician only has that 10-minute interview with somebody, he or she is not going to be able to get the three-generation pedigree but they can at least get targeted information that might be very pertinent to that child's care and potentially other family members. Providing the tools to do that. Encouraging the point of care support tools that are out there for genetics and genomics. Creating those tools for the use in interpretation. Providing patient and family education and support tools that are culturally sensitive and literacy and language appropriate. And then facilitating access for families to family support and advocacy. A strong component that needs to be integrated into primary care, not just what genetics geneticists provide when they see families. And in many ways pediatricians and primary care physicians are hard wired for a lot of this family support and advocacy and we should provide the appropriate tools to help them from a genetic standpoint. Integrate genetics and genomics into primary care training. This is the educational component then. Identifying the fundamental concepts that do need to be learned and integrated but then trying to incorporate genetics into genomics into the competencies. Recognizing the genetics and genomics educational efforts must span the entire educational curriculum and Bruce showed you the genetics vector from pre-professional to the CME and MOC. And I like the diagram that Tom Naska had earlier about going up except that seems to be a loop that I continually drop down to the bottom of and then need to work my way back up. And then looking at what we're going to do in a critical way developing the identifying the gaps filling some of those gaps looking at what we did did we really fill the gaps as we said we had hoped to and then look at what infrastructure is really needed to facilitate the filling the gaps and the research components for this. So that was the colloquium which we think was a reasonable blueprint and a lot of those things will be picked up by the genetics and primary care institute. This will be published the colloquium the papers and the consensus statement will hopefully be published within the next two to four months. We're working on the manuscripts now will be an electronic supplement to pediatrics we hope and we hope it will be of some benefit to the genetics community and the primary care community. One of the other things we're doing the genetics and primary care as I said they're setting up a technical assistance center the website will be up geneticsandprimarycare.org should be up within a week or two. We did have educational webinars we had a series of 10 and I think I'd address that in the next slide that we thought were quite good and were very helpful but we are going to be taking more information out of that and going forward looking at whatever vetted tools and strategies that are out there and trying to again use the strength of the American Academy of Pediatrics in terms of rolling this into the tools for primary care providers we have a significant partner with Nitchbeg in terms of developing a family history tool for pediatric providers that is sort of a next iteration of a similar tool that's been set up for prenatal care providers but it's different so we're excited about that and that's currently in development with a very short timeline and a lot of members around the table here are parts of that group and then looking at residency training initiatives. The educational webinars we had a series of 10 we didn't have thousands unfortunately meeting with us but we had they were well received done on a very short notice there were two to three hundred folks it was not CME we purposely set it up if you will without CME just a half hour and they are archived on the website right now if you're interested the organization for the 10 talks was developed from a manual which I'll show you in just a minute and fact sheets are now being developed from these webinars that will be posted to the genetics and primary care website that we hope again will be of some benefit to primary care providers that want more additional information could this be a template for collaborative efforts with other professional societies and other educational efforts I'd like to think so but time will tell again the AAP's newest strategic planning priority is genetics genomics and epigenetics AAP has what are called mega issues every usually every year but sometimes they will skip a year they've been on early brain and childhood development they've been on childhood obesity primary care the current one I think is going to be on the next one I think is going to be on anesthetic use in children so they identify what they consider to be a mega issue spend about 6 to 12 months reviewing the aspects and then putting the appropriate time energy and money and resources into figuring out how this can be brought to the next level of primary care in some way it was actually called just epigenetics we've argued that it really what you're really talking about is integrating more genetics more genomics and epigenetics into into primary care medicine there's a CME conference that's been funded called dive into the gene pool integrating genetics and genomics into your primary care practice and that will be in August a two day conference for primary care providers I just realized one slide was missing and let me just mention that briefly the as part of this as part of the instructions I was asked to look up what the certifying bodies are doing in terms of genetics and I looked up on the American Board of Pediatrics website and under the certifying examination what's asked for in terms of genetics and Roman numeral 7 tells me what needs to be done but it's basically the deficiency in my mind is it's knowledge it's specifically knowledge based and it's recognize dot dot dot dot dot or understand dot dot dot dot about list of about 40 or 50 different things I think we need to work much harder on that in terms of integrating trying to change that and if you look up the past RRC requirements for pediatrics in terms of genetics to my mind they are woefully inadequate and need a lot of help but as Mira said as everyone says if we put more genetics out in nephrology and this and that I think the point is it can be integrated without making it a false choice the committee on genetics is putting out a new manual medical genetics and pediatric practice which will hopefully be available in spring of 2013 I was hog tied to be the editor and those of you familiar with the red book in pediatrics for infectious disease please don't think this will be anything similar to that it's our first iteration it's our first shot at this and we hope it's of some benefit to primary care pediatrics which is our audience and a companion mobile app is also developing using a lot of the tables and algorithms from this book the committee on genetics is working on various policy statements or it's recently published various policy statements you see here Down syndrome, Fragilex, Prater-Willi and is working on policy statements on ethical issues for genetic testing which actually is I think is almost published that's a collaborative effort with the American College of Medical Genetics and Genomics which I should applaud both organizations it's unbelievable the machinations that had to go through for that but it looks like it's going to be a great statement that both organizations can share looking at the clinical genetic evaluation of child with intellectual disability or developmental delay, Marfan syndrome prenatal screening and diagnosis so we're always looking at things that we need to be adding the section on genetics and birth defects is the folks that are sort of self-identified geneticists within the AAP takes care of educational program at the AAP's annual conference in the fall looks at genetic related topics in the AAP newsletter supports genetics related content in a variety of AAP publications and also now has a listserv for sharing content and open forum discussion group which has really taken off substantially okay I think I it was a great talk Bob I just actually have one comment and one question the comment is that I heard now two talks in a row that people weren't giving CME for these webinars or these short things because it's too difficult I'm sorry that Murray left but full disclosure I said on the board of the ACCME so if people want to drop me an email about exactly why it's difficult I'm happy to pass that along because it really shouldn't be we need to from the ACCME side make this easier but the question for you Bob is the residency training initiatives that you had listed are those at specific programs is a template being developed or something that's all in our project advisory committee meeting in December we started discussing putting spaghetti on the wall we haven't sorted it into meatballs yet all right Heidi actually just drawing on Mira's comment you know I've observed that same comment about it being challenging to deal with CME you know administrative issues and I Harvard has had a program over the last few years to develop CME modules in genetics and genomics and I wrote one on cardiomyopathy a few years ago and it was reasonably straightforward and then the next one in hearing loss and Usher syndrome a lot more rules have been put into place before you could put one of these on and they came back to us and said you have to do this very extensive analysis of you know, practice gaps and basically the end result was it took two and a half years for me to get this module to do all of this sort of administrative work after we'd already written the CME module itself and you know I basically at the end of the process I'm never going to write another one of these things again but at the same time it's not to say that the work they asked us to do was not important you know identifying practice gaps is important as you think about implementing CME programs but I guess the question is what's the right combination of people to deal with these because I didn't feel like I was an expert in identifying practice gaps but maybe I was an expert in genetic basis of hearing loss and so how can we better support an infrastructure to get the expertise of individuals in specialties but support them in perhaps the research administrative process for dealing with identifying practice gaps and that sort of thing and I don't know if Mira can also comment on how to just make this easier because you know at that point I was done with those sorts of things to answer that I know it's difficult any new knowledge is an automatic gap you just have to be able to say that and verbalize that but new technology, new knowledge is an automatic practice gap so I think sometimes we get caught up with a lot of the logistics but it shouldn't be as hard as it is we can figure it out okay we have Bruce, Deborah, Mark and Gene, so Bruce Bob I wonder if a specific issue came up in your survey and that is that pediatricians for all of their professed lack of familiarity with genetics in fact have been using genetics as you pointed out but one of the pitfalls is that it has changed a lot in the past few years and for example many children they may follow who had genetics evaluations that did not result in a diagnosis or for that matter had a diagnosis that was untreatable now in fact may be faced with the possibility of either achieving a diagnosis or instituting a treatment that didn't exist a couple of years back but it's a moving target and I wonder if there was a cognizance of the paradigms they were used to no longer apply and some of the same children that had been the subject of evaluations actually should be the subject of repeat evaluations now that wasn't specifically asked in that survey I think that's something when we do the survey in the fall to the AAP membership definitely needs to be looked at and that's a significant point that we need to be sure we're integrating into our educational component of the GPCI you're right I mean people just say well they saw them three or five years ago they didn't say anything that was helpful let's forget it great Deborah so I there is one statement that you made which absolutely rang true with what happened in the College of American Pathologists is that genetics is not a revolution it's an evolution our knowledge and understanding of the information that can be applied to clinical practice is going to evolve over time and we found that to be a statement that we need to emphasize over and over and over again with pathologists so they don't just get scared and are like a deer in the headlight so that rang very true and we have this was sort of brought forward in the meeting because we have a very strong pediatrician who sort of is very involved with genetics but again he just practices pediatrics day in day out and he was quite offended with the term revolution he said we're already doing this let's make sure we understand what we're talking about here great we had Mark and Jean and Wolfgang did you have your hand up as well or no did you have your hand up as well yes okay and Wolfgang so Mark you're off already so obviously the GCPI has done a great job of doing a needs assessment as we've heard about I'm interested Bob if you can provide some perspective in terms of how you think AAP as a whole will take what was developed from the needs assessment and actually translate that into product beyond what the GCPI itself has done to really make sure that we close that a great question and the answer is I don't know they don't know but the I think the fact that they've identified the strategic planning initiative and something going that almost will essentially follow essentially 2013-2014 if GCPI goes away how it will be integrated into genetics I think would be something that they would take on because again in the strategic planning and issues that they do they devote a significant amount of resources that is people and money to keep these things going so it's really a question of sustainability then beyond the specific target right Gene thank you so much for sharing the resources that are coming available and I just wanted to share with all of you as you create these resources and have webinars or power points or even website links that those kind of things can be shared through outreach on G2C2 and have greater opportunity to reach out to various health care providers so take the opportunity to look at G2C2 and see if that might be something appropriate for your resources to list thank you and Gene for those who may not know what G2C2 is if there's anyone maybe just one sentence on what it is and where it's found yeah G2C2 is the genetics genomics competency center that Dr. Green referred to in his opening remarks and if you even just plug G2C2 into your browser it'll pop up it's a learning repository that's been created for primarily educators but also now the practicing discipline members so take the opportunity to look at that I'd be glad to talk about it more thank you I just wanted to re-emphasize the point you brought up about the gap of knowledge I think for those who are in the implementation and the teaching of genomics it is really also essential to bring this back otherwise information falls only one way I'm more coming from the functional genomics side and I know how much ambiguity is in the data and actually also how many results are false or later proven false so it's a very important function that I think everybody here should implement as well and you had it formalized there that the gap of knowledge should be identified for those who teach and implement and then bring it back to the community it's not a one way flow and one of the things again the pediatricians that we've talked to through this process have said pediatricians at least are used to dealing with ambiguous data and trying to help parents deal with that we just need to make them more comfortable from the genetic standpoint all right thank you very much so next


Hey guys, it's Monica. Thank you so much for joining me. I'm going to actually share with you in this video some products that I used on my recent vacation and then I'm also going to enclose some clips of the trip. Many of you know we went to Bar Harbor, Maine, and we camped by the ocean so it's my happy place. This trip was a little bit more difficult because of the recent passing in July of my father and I knew that when I was coming home I was going to be coming home and facing a memorial service where I had to write the eulogy and of course deliver it and I never in my wildest imagination ever thought that that would be something that I would have to do for my dad and I thought maybe while I was in Bar Harbor I would be inspired by the beauty of the area that I was in and I would be able to do put pen to paper so to speak and and talk about my dad but I just couldn't. I saw my dad everywhere around me. I would be looking at the beautiful flowers in downtown Bar Harbor and I would breast into tears because I just imagined my father how much he would have loved them and I envisioned him tending his and the same thing with the ocean in front of my campsite so it was just it was it was a wonderful trip in many many ways it was different because it was extremely low-key and it was a time of deep reflection for me so if you're interested that in the products I use for 10 days. Stay tuned guys thank you so much for joining me first off I tried not to pack a lot of makeup and I didn't want to spend time wearing a lot of makeup. I brought two wigs I bought a bunch of hair scrunchies one that I have in my hair and I have another one I love these scrunchies you know they've got the little they're like sort of like an invisible Bobby and you can put if you have really thick hair they're awesome if not you just kind of like double it and it works just as well and I usually put like a clip so I and then I just bought a little bit of makeup so so I'm going to stop by actually telling you about the the hair bubble I'm going to turn around so you can actually see it in my hair and you can see that I kind of like this is sort of like at the end of the day and this is sort of an everyday look for me I kind of twist it up and because I have really skimpy hair I usually have to double the I usually have to double around you know to get it to stay in or I squish it like this I do it the long way I pin it and then I just put a clip now the one that I got this was actually sent to me actually from hairdo and this is their pop this is their wavy wrap this was sent to me via the Octoly Network in Exchange for review I have this in butter toast I have this in butter toast I bought many of these over the course of time so I knew I would love this but what it was really interesting on this one is that it had less volume than some of my like this one has a whole lot of volume you know it had less volume and I thought this would be perfect for a really casual like no I don't know casual look so that's what I did you can see that the big clip takes up most of it my hair is super short so I have to put little combs on the side but I absolutely love love love my wavy's now you can get these in Alta I don't know you probably can get them in Sephora I'm not too sure where else but hairdo I got this by the Octoly Network you can get it on their website these things are just amazing and they are so easy to make a you know your hair look good you just twist it clip it and boom you're ready to go the other thing that it was super impressed with while it was up there was mercy handy had sent me via the Octoly Network three products to review and I took advantage of taking them with me one was their hand sanitizer they have a hand cream and then they have a deodorant I'll tell you I was deodorant every day I love it has a very very light fragrance not not heavy overwhelming this is actually a very light formula it says here it's designed we've designed the new generation of deodorants no alcohol no and I always butcher this a little aluminum aluminum aluminum aluminum and no paraben so this is a really really nice and say it's squeaky clean I would have to agree but it was also packed a powerful punch because I felt really good I felt fresh I was outside every day we were walking in the park we were on the ocean we were out and about I thought this did really well the other thing mercy handy sent me was their their hand sanitizer this has some cleansing this has like some cleansing bombs or gels and it just really really left my hands some hand sanitizers leave my hands feeling so super dry this did not I really liked it and the next thing was this amazing little cream that they sent flower power they've added small emollient pearls they say I like the screen this cream ended up being super super nice I used it probably every day while I was away so those three products sent to me complimentary from mercy handy I thought they were they were fantastic absolutely loved them the other thing I wanted to mention was that because I really didn't want to I didn't want to go away and carry a lot of stuff with me I had an unopened mascara it's superhero that I had bought probably quite a while ago and I figured you know I'm just gonna take one mascara I haven't used the it's superhero in quite a while because I've been using the essence and then I have a bunch of different miscaras that have been sent to me for review that I've been using so probably haven't touched the it's superhero probably in about four five months to be honest with you I took this with me and you know sometimes when you don't use something and then you go back to it after a while you remember why you loved it so much oh my gosh through tears through sun through 90 degrees through saltwater through waves this mascara held up and this is the one I brought with me used it every single day purchase this a number of times and I really really like the superhero the other thing was on my lips so I was sent two lipsticks from Becca one quite a while ago and this is the orchid orchid orchid but this is one of their lipsticks and I have talked about this for any for a dark lipstick this is about the only one that I really like I love this lipstick when put it on my hand so you can see it very natural looking even though it's a dark for me recently I received this from Becca by the Octaely Network and this is their plump and smooth new Hydra light up lip balm and it's like a pinky color but it's a very sheer pink and I've just been topping I've just been topping this and half the time I've been wearing this totally alone so these are the two lipsticks that came with me I did have a few others in the motorhome I had my remote number 45 and you know those but these are the two that I used this one actually every day sent to me complimentary from Becca via the Octaely Network in exchange review and I must tell you I love it I love it on my face the entire time on my face was my number seven I didn't bring any other foundation this was it boots number seven protect and perfect 50 SPF I you know when we first arrived up in Maine it was really really hot and sunny and even though I had a hat on I tried to really protect myself I felt super protected having this on I would put this on in the morning sometimes if I was going out again later on I might touch up wash up but in general I put this on in the morning it would stay put all day even after I added sunblock on top of it which I did I would have my Australian gold and I would just put it right on top of it it worked perfectly for me this I talked about before because this was also sent to me this is the billion dollar beauty this is the flash and filter highlighter and concealer I like this a lot so you've got a little bit of a highlighter not very super bright it's gonna look brighter on my hands you probably can see but I did around my eyes or little places that I just wanted to have like like on my non-existence cupid's cupid's butt oh whatever it is I really like this and the other side is the concealer and I'll show you this I can see the concealer I hope you can see that so you can see the lipsticks and the concealer this concealer was awesome that this is all I brought I didn't bring any other highlighter any other concealer this was just it I used this the entire time held up beautifully I thought it looked really beautiful and that's basically what I used for makeup my entire time now not counting eyeshadows that's me another story I did I did bring some eyeshadow but you know mostly it was really kind of low-key and we did we did a lot of hanging by the campground we went and explored a couple of places it was just beautiful so I'm gonna close some clips of when we arrived so you can see what our campsite is like and you can see some highlights of the 10 days we were there I hope you enjoy we arrived just gonna put up our screen protectors that's why the ladder is there but that's our front view this is our side view and the tide is out so when it comes in it goes right to the edge of our property line so we're setting up of course when you live in you know a camper for ten days it's a little bit more crowded but you know there's a little back stretcher blankets but this is not quite high tide tide's going out comes in just a little bit more but you can see our yard Jay's feet off by your pit and over the last 17 years this tree has come and gone a couple of times so Jane I opened Bahar Haber main and I was gonna do some vlogging while we were up here but then yesterday we went down to Bahar Haber proper the town and walked around there and I didn't take a darn picture at all so today Jay's golfing I don't know yet what we're gonna do this afternoon that hurricane is coming I guess up the I-95 corridor and it is going to probably affect us here later today and into tomorrow but we are like right on the water's edge the tide is actually I believe going out and when the tide is in all these rocks are buried right up to our campsite and it is just it's our favorite spot it just really is so I don't know you know I've been like really trying to take care of the first few days that we're here was super super hot I mean super hot and sunny and we we don't have a lot of shade on our campsite so I was really struggling to make sure I didn't burn I didn't want to get an instant image and I'm like okay you know so I I found myself using you know the same face products the same sunblock the entire time which was okay you know obviously but I'm gonna try to put together little bits and pieces of the trip into this vlog and also little bits and pieces of you know what I've been doing for my skin and all that I'm gonna turn around so you can see my motorhome behind me the edge of the rocks right here I don't think see where the grill is but the edge of the rocks on this side is where the tide actually high tide you can actually see the seaweed I think it goes right up into the rocks so it is pretty well when it's high tide none of these rocks are visible they're all covered it's pretty well a true waterfront site without a doubt the beautiful beautiful waterfront site so anyways I don't know what else I'll be adding to this but I'll add clips as the week progresses thanks so much for watching guys and this is me walking down the road in the campground heading towards my site you can see the water and you can see the green motorhome that is actually our motorhome sitting there and that's my car and kind of give you a perspective of what my campsite is like and I'll tell you every single day it looks a little bit different it's just a gorgeous gorgeous spot and like I say over and over again we just come as often as we can because we love it so I haven't shared much with you because we haven't that much it's been sort of more of a wedging wedging wedging out type of a trip and you know sometimes I think you just need to do that I think this is our either 18th or 19th year coming here so we're never in a rush to go see anything now because I think we've seen it all there's the motorhome behind me you can see how truly waterfront we are and as the tide comes in it's going to fill in right where I'm standing so it's really cool here we love it beautiful that's our favorite place even when we don't do anything and last night the hurricane came we got these storms from it but it wasn't bad it was just really windy heavy rain but it was nice it wasn't that I was really worried that it would be you know back Western Bay so we are at Scootick there's Jay on the rocks Vegean and it is beautiful it's it's the tide is going out so it is decidedly for sure undramatic but oh my gosh we've been here when the tide is coming in and the water just breaks over these rocks incredible over here to our three o'clock is a very beautiful yacht called KISSES it's not owned by the guys that owned their overseas I asked they told me no I think it's a huge missed opportunity personally but it is a $25 million yacht if anyone's curious so I told me that today and I was like well that's something I'll never afford no it was where the Richard Famous of the time would go and sit and have some drinks especially during this fun thing called prohibition well the very Richard Famous at the time said prohibition man it's not for us so they would go there and talk about the other manly isn't it the same thing 11 and after about an hour and a half of sailing out we made our way back towards Bar Harbor in time to watch the sunset over the western sky and oh my gosh it was so beautiful so beautiful to see that big big ball of Sun just kind of sink in the horizon all the times we've gone to bar harbor we've never gone out in the boat we've never taken a sunset cruise so this was the first for us and we'll definitely do it again the boat ride was fantastic it was affordable and it was so much fun they gave us a lovely tour of bar harbor from the water from my Acadia from the water it was gorgeous but look at the sunset isn't that amazing it was so so nice and after a while we just continued to make our way back into court where we docked our boat so we're heading to go get an ice cream you scream ice cream the ice cream so last day and we are going to be doing ice cream for lunch lobsters and steams for dinner here is the fruits of our labor thanks so much for joining me and please be sure if you have not already subscribed to the channel please subscribe please thumbs up the video leave me a comment below I appreciate every single one of you bye guys


Hello everyone, my name is Prevench R. I secured rank 523 in this year's UPSC Civil Services examination and I also scored 191 in my interview. I joined Shankar's interview guidance program. In fact, I gave my first mark at Shankar. The panel was very good and they also gave a lot of pointers on what areas I had to focus on and the changes that I had to make. The institute also afterwards sent a lot of study material including articles from different journals on important issues which helped a lot during my preparation. I would also like to make a special mention about Lena Ma'am. She supported me not just till my interview but even afterwards till the result came out. So thank you Shankar Ayesh and all the best to all the aspirants.


Good morning, this is Oswin Donraj one of the ACFLs at the War College today We're going to do a cardio and a lower body workout once you're all warmed up. Let's begin All right, so the first workout we're going to do is a sumo squat so essentially Get down your squat, but much much wider Stance and we're going to hold this for two minutes. We're going to do three sets of this Super set again two minutes hold sumo squat for three sets All right for the second workout, we're going to do planks Essentially, we're going to hold the plank as long as you can for three sets So get down on your elbows and have your body Perfectly parallel to the ground and your elbows should be directly beneath your shoulders Not wider or not too inward Now this is going to work out your core glutes and backs Hold it for two minutes Correction as long as you can hold and we're going to do three sets of this For the last workout, we're going to do a wall sit so anyone can do this at home. Essentially a squat Right up line up right against the wall and all the way down 90 degrees and hold it for as long as you can make sure you feel that burn Do a three sets of this You can do a one-minute rest let your thighs rest a little bit because we did other leg workouts Make sure you hold it as long as you can you want to stress your legs as much as possible So you can improve the cardio and endurance of your legs. That's again Against the wall and squat 90 degrees and hold it as long as you can Thank you all for tuning in for this workout. Once again, I'm Oswin Donraj. Stay healthy.  Thank you


So, now we come to the celebrated results of Brauer, namely Jordan Brauer, Jordan Brauer separation theorem and then using that we will prove the Jordan Brauer's invariance of domain also. I would like to tell you that in part one we had already proved the Jordan, sorry the Brauer's invariance of domain directly using cellular simplicial approximation theorem and Sperner lemma. But we could not prove Jordan Brauer separation theorem there, ok. So, here we are proving Jordan Brauer's separation theorem first and then using that we will prove the Jordan Brauer's invariance of domain. So, this has completely a different approach and historically the Brauer more or less came with these ideas of developing homology just to prove this invariance of domain theorem one might say. So, the idea, basic idea of the proof that we are going to present is more or less as in Brauer's original paper 1911. So, let me state them together because they go hand in hand in some sense though they are quite statements are quite different. So, Brauer Jordan Brauer separation theorem is an extension of Jordan's Jordan-Karu theorem for S1 containing S1 embedded inside in the complex plane R2, ok. So, such a thing is called a Jordan-Karu theorem or a Jordan loop which means 11 mapping of S1 and 11 continuous mapping of S1 into R2, ok. So, this theorem was a what can you say a sensation at that time because after defining what is the meaning of continuous function, lots of weird examples were constructed by many many mathematicians. Continuous functions like Antonis and you know what is called as pianos, pianos curves which were continuous functions from closed interval, but they were filling up the whole of space not only just you know I cross I, but I cross I cross I, I cross I cross I countably many times also and there are many other kinds of weird examples. Nowhere differentiable continuous functions and so on were there is by Brauer-Strauss. So, this came as a present surprise, but his own proof, Jordan's proof was rejected by people you know contemporary people. Later on it was Weblen who gave a proof that was accepted. After that several people have given several so called proofs, ok. Why actually so called? Most of them are wrong, but some of them are right, ok. There are different proofs of this one also. Some of them are right, ok. Here we are not proving that special case separately. We are going to prove directly, we are going to prove the n dimensional version of that namely an n minus 1 sphere embedded in an n sphere separates it into exactly two components. These two components have their common boundary as the embedded n minus 1 sphere. So, this is the statement. Jordan-Brauer that is Jordan-Brauer separation theorem. The Brauer invariance of domain says that if you have u and v are any two subspaces of r2 homomorphic to each other. If u is open, then v is also open. So, that is the meaning of invariance of domain, homomorphic invariance of domain. One is open, the other one must be open. They must be subspaces of the same rn, ok. So, towards the proof of this, we will state two lemmas which are themselves give you better picture of what is going on, ok. Sometimes the lemmas can be quoted and used elsewhere than the theorems. So, these are quite interesting lemmas. So, first lemma 4.6 says that take a subset of Sn which is homomorphic to a closed re-interval cross itself k times. Instead of the sphere, it is a disc. So, I am taking the square model here. So, you can take a disc model no problem. It is homomorphism. Homomorphic to ik where k is between 0 and n. Like you can take a point or you can take an arc k equal to 1 or you can take a square and so on. Any kind of homomorphic picture. So, it need not be in a rectangle even. It need not be twisted and so on, fine. Then the reduced homology groups of Sn minus a all vanish. You know that if you throw away one point from Sn, it is contractible. So, reduced homology vanishes, ok. So, this is a far-reaching generalization of that phenomena. Sn minus a, you do not know whether it is contractible or not. I can say that all the reduced homology groups are trivial. No matter what it is, a is homomorphic to ik is all that I need, ok. So, I would say that this lemma itself is quite useful, ok. So, the next thing is now suppose b is a subset of Sn, homomorphic to sk, ok, for some k between 0 and n minus 1. Then the reduced homology groups of Sn minus b, I mean you are throwing away b and what is left out. These are all 0 except in one single dimension. So, h to the power of n minus k minus 1 of Sn minus b is that, ok. So, this is also of importance in many or not theory problems and so on, all right. So, what we are going to do is first we prove these two lemmas, ok. So, first we assume these two lemmas and complete the proof of the these two theorems. Then we will prove this 4.7 first, ok, which is easier, though this is a little more complicated statement. The Kruskas matter, this one is the, this one will come later, the lemma 4.6 which is a very foundational result one would say, ok. So, that is the, that is the plan, all right. So, granting 4.6 and 4.7, we shall prove this 4.15 and 4.16 theorem, ok. So, 4.15 first, namely Jordan-Brower separation theorem.  We have to show that Sn minus b has exactly two components to begin with. And then those two components, components means what? Connected components, path connector whatever, u and v, call them boundary of u must be equal to boundary of v must be equal to b, this is what we have to show, ok. Now, look at the above lemma. What is this lemma? Lemma is what? b is homeomorphic to sk, where k is equal to n minus 1, right. So, put that h twiddle of n minus n minus 1 minus 1, ok. So, that will be h naught. H naught twiddle is isomorphic to z. H naught twiddle is isomorphic to z means h naught is isomorphic to z direction z, which is the same thing as saying, h naught, what is h naught is that I will use means what? That the space has exactly two connected components, ok. So, very easy proof. So, h naught twiddle of Sn minus b is z and this implies Sn minus b has precisely two components. Let us call them u and v. Now, elaborately, now you have to show that both u and v are opens of sets by definition boundary of u which is u bar minus interior of u, ok.  Similarly, boundary of v is v bar minus v, we have to show that boundary of v itself is boundary of u could be boundary of v. This is what we have to show, ok. So, v is open and disjoint from u, ok. u union v union b will be the whole space that is very clear. So, no point of v because v is open is in the closure of u because u is disjoint from v, ok. So, it take a point of v, v itself is a neighborhood, it does not intersect u. Therefore, it is not a boundary point. Therefore, boundary of u is contained inside v, ok. It is not inside u because by definition boundary of u is u bar minus u. So, there is a chance that it may be inside v. If it is not there also, the rest of thing is just boundary b because u, v and b together all the three things form our space s n, ok. It is a pure set theory. So, boundary of u is inside b, one way of it. So, now the point is we have to show that b is inside boundary of u. Every point of b is a closure point of u is what I would show. Then I am done. Once I show it is closure point, ok. It is not a point of u by the very definition. So, it must be inside b, inside a boundary, ok. So, b is contained inside boundary with the proof if you show that every point of b is a closure point of u. By symmetry, once I show it for u, it will be true for true for v also, ok. This is the same as showing that any arbitrary small neighborhood n of b, take a point b inside the boundary of b, ok. Intersects u bar. If it inter, every neighborhood intersects u bar, then you are done, ok. So, inside a neighborhood, whenever you have a neighborhood of a point, we can find a neighborhood n 1 of b in b, ok. What is b? b is homeomorphic to Sn minus 1, remember that. So, you can take a neighborhood and use the homeomorphism and come to Sn minus 1. So, there will be a neighborhood of Sn minus 1 going inside that neighborhood by continuity, right. So, you can find a neighborhood n 1 of b such that b is actually union of n 1 and n 2, ok. And both n i's are homeomorphic to i n minus 1. In other words, what I am doing is I am taking n 1 to be a small disc around this point, ok. The complement will be also a disc. Inside a sphere, you should take a small disc, the complement will be also homeomorphic to a disc, ok. So, b is a union of n 1 and n 2 and both n i's are homeomorphic to one dimensional over, sorry, is the same dimension is there Sn minus 1. So, it is i n minus, ok. i n minus 1 or a disc, d n minus 1 does not matter, ok. I am using the square model here, i n minus 1, ok. Here is a picture. So, this green thing could be the, so this picture is after all n equal to 1, n equal to 2. And b is a circle, b is the curve and we are working inside a sphere, ok. Same thing as working inside r 2, ok. This picture is for a curve inside r 2. So, this is the curve, all this along with this green part. And I have taken a point here, b on the, where? On the curve, on the b. This is b, right. On the curve, I want to show that every neighborhood of that will intersect u, intersect u bar. Of course, in picture it is obvious. So, that is the problem. You should not use a picture to conclude something, only what are the hypothesis so far. Keep, keep track of that, that is all. So, there is a neighborhood, there is a point b. I have to show that this neighborhood intersects u bar, ok. So, what I have chosen is, this n 1 is homeomorphic to i k minus 1. Its complement is also homeomorphic to i k minus 1, i n minus 1, k is n here, ok. So, now the previous lemma 4.6 says that s n minus n 2 is portion which is homeomorphic to a disc, ok. This is contractable. This has reduced homology or 0, ok. In particular, H naught of that is z or H twiddle, H naught twiddle is 0. So, that is connected. So, if you throw away only the, this part n 2 from s, from s n that will be still connected. That is the first lemma, ok. So, s n minus 2 is path connected because H naught twiddle is 0, ok. So, we take p, two points p belong to u and q belong to v, ok. One is in here, one is there, alright. Point is u and v and join them by a path. This path lying in s n minus n 2 because this p q are in s n minus n 2. What is n 2? n 2 is a part of v. So, I have taken points u and v outside this path and two as well as v itself, ok. They are inside u and v. Therefore, I can join them by p by s n minus n 2. So, that is path connected. But u and v are in different components of s n minus v. Therefore, you cannot join them in s n minus b. But this path is there, where it is? It is in s n minus n 2. Therefore, it must intersect n 1. The path whatever you have taken, omega must intersect n 1. So, let us say I have parameterized from p to q, ok. Omega 0 is p, omega 1 is this one. There will be a first time, the first t for which w t will be on this n 1, on this green part, ok. Which is the least element, ok, or whatever, t between 0 and 1 for which omega t will belong to n 1. That omega t, whatever the point is obviously in the closure of u. You will say that this must be in the closure of u, ok. What does that mean? My whatever n I have chosen, it will be inside n 1 by it, the whole n 1 is inside n, ok. This n intersects u bar. Every point, every point b has a neighborhood n which intersects u bar. That is what we have shown. So, that completes the proof of Jordan Brouwer separation theorem. Now, we come to Jordan Brouwer separation theorem, Brouwer's invariance of domain theorem. So, u and v are subspecies of R n. By taking a one point computation, we can work inside s n. There will be still open subsets of s n also or there subsets of s n. If one of them is open, I have to show the other one is open. The only assumption we have is that u and v are homeomorphism. So, let us fix a homeomorphism fee from u to v, ok. Now, we are assuming that they are inside s n, no problem, ok. Now, I have to show that v is open, right. So, take a point inside v which I can always write it as y equal to phi x where x itself is inside u, ok. What I have to do? I must produce an open subset in R n or c s n actually which is contained inside v and contains the point phi x. If this is true for every x, then why I have completed the proof that v is open, ok. We should produce an open subset of s n containing y and contained in v, ok. So, now you see the Jordan Brouwer separation theorem comes to help here. In a miraculous way, this great theorem will prove now, ok. So, let a be a neighborhood of x in s n because u is open, that is the assumption. So, take a neighborhood around x namely which is homeomorphic to a closed disk, ok and contained inside u, ok. That you know that that is possible for every open subset of s n as well as every open subset of R n whatever. Then its boundary, boundary of a is homeomorphic to s n minus 1. If we apply fee which is a homeomorphism from whole of u into v, ok, fee of boundary of a, ok, that will be write it as b, that will be a copy of s n minus 1 because it is homeomorphic to s n minus 1. And that is contained where? Contained inside s n. Of course, it is contained inside v also now, ok. By Jordan Brouwer separation theorem s n minus b has precisely two components and both components are obviously open subsets, ok. Look at a minus boundary of a, that is the inside of the disk. I have taken a to be a homeomorphic to a closed disk, right. a minus boundary of a, we say open disk, that is connected and that will not intersect fee of fee of this boundary of a, right, when you take fee of that. Therefore, fee minus a minus boundary of a, when we add this interior of that, ok, that must be a connected subset, ok, which is fee a minus b, fee a minus v b is connected. By lemma 4.6 s n minus fee a is connected because fee a is what? a is a disk. So, fee a is homeomorphic to a disk. The other lemma, the previous lemma 4.6 says s n minus fee a is connected, ok. So, far you have got the picture. On the other hand, s n minus b is s n minus fee a, b, remember b is fee of boundary of a, s n minus fee a union fee a minus b is a disjoint union because I have, this fee a I have thrown away here. So, here fee a is subset of fee a here. So, this s n minus b, I can write it like this, ok. So, disjoint union like this, ok. Fee a is closed, s n minus a is open, ok. This b is closed, of course, fee a minus b is semi closed. It is a, it is an open subset of a closed set, does not matter. It is disjoint, ok. Hence, these two sets must be the components of s n minus b. There are only two components here. This whole set and this is connected, this is connected, this is connected. The connected subsets when you have separate are contained in this one and there is a separation s n minus b, they must go to one of them and that is the whole thing, it is the whole of it. So, they must be the components, ok. So, this is an elementary topological result that I am proving. You have, you have subset which is disjoint, this is union of two connected components, ok. You have written it in terms in another way namely as disjoint union of two connected sets, ok. Then those two connected sets must be the components. There is nothing more than that here, ok. This is ordinary topology, ok. Hence, these two sets must be the components of s n minus b. But now components of s n minus b, we know that they are open subsets. In particular, it follows that this fee a minus b is an open subset of s n. So, this should have been obvious. If you think Jordan-Karuz theorem is obvious, but we have to prove it with all this elaborate way, ok. Fee a minus b is an open subset of s n. Also, it contains the point y because it contains fee x and it is a subset of fee, ok. Because fee whole fee is from u to v, ok. Thus, we have succeeded in producing an open subset, ok, around fee x actually containing contained in v. So, this proves that v is open. So, the two lemmas we will prove next time. So, using the two lemmas, we have completed the proof of two big theorems, ok. Thank you.


Felly, mae'r ystafell yw'r cyfnod yn ymddangos, ac mae'r ystafell yw'r ysgolwyr yn ymddangos yma, mae'r profesor Bob Ackroyd, ymdwybr yw'r frechurch yw Sgolwyr. Felly, mae'r ystafell yw'r ysgolwyr yn ymdwybr yw'r ysgolwyr. John C. Maxwell, ymddangos 21, ymddangos ymddangos yw'r ysgolwyr, ymddangos yw'r ysgolwyr, ymddangos yw'r ysgolwyr, ymddangos yw'r ysgolwyr. In 2024, every choice you make here makes you. Every choice you make makes our nation and impacts our people. 2,000 years ago, a large crowd was given a choice. There were two prisoners, Barabbas, a convicted murderer, and Jesus, a preacher and miracle worker. One could be released, the other would be crucified. The response was unanimous, not this man, but Barabbas. George Bernard Shaw once said, why not give Christianity a trial? The question seems a hopeless one after 2,000 years of resolute adherence to the old cry, not this man but Barabbas. Shaw's conclusion was striking, yet it's beginning to look as if Barabbas is a failure. The way of Barabbas is strangely contemporary. Like Frank Sinatra, Barabbas did life his way. The way of Jesus is completely different. He went around doing good by putting others first. He even gave his life as a ransom for many. The verdict then was not this man, has much changed. G.K. Chesterton once said, the Christian ideal has not been tried and found wanting. It has been found difficult and left untried. As 2024 commences, you confront many problems. Much wears us down and much weighs us down. This is true for you as legislators and true for your constituents. Jesus invites us personally. Come to me, all you who are weary and burdened, and I will give you rest. He bears our burdens. He is willing and able to help. Jesus gets us. For more than 20 years, I volunteered with Bethany Christian Trust and I currently serve as a chaplain at Socton Prison here in Edinburgh. I have seen Jesus meet people. He does take away their burdens and he does give rest. Jesus meets people exactly where they are, but he doesn't leave them where he finds them. The change is profound and lasting. Why not give Christianity a trial? Consider Jesus's life, consider his death, consider his resurrection from the dead. You can change your mind about Jesus.  Every choice you make makes you. Let me close with a benediction, the blessing of Aaron. May these words warm your hearts, enlighten your minds as you make choices with profound consequences. The Lord bless you and keep you.  The Lord lift up his countenance upon you and give you peace. May God bless you all. Thank you, Professor.


Hey, this is Brett, and this 2019 Ford F350 Supercab Chassis Cab Dual Rear Wheel is stock number 13335Z. I am here at Summit Automotive in Fond du Lac, Wisconsin, you're new and used heavy duty truck headquarters. This 2019 Ford F350 Supercab has the 6.7 liter Powerstroke diesel engine, it's paired up with the 6 speed automatic transmission. This truck has been fully safety and inspected by Elmer's service shop, has a fresh oil and filter change on the fluid tab and checked and topped off, and this truck is 100% ready to go. I'm going to go all the way around in this video, inside, underneath, start it up, take a look under the hood as well and just give you the most accurate representation of the vehicle that I can. Oxford white is the color, and I shoot all my videos in 4K, so if you have HD capabilities on your computer, tablet, smartphone, or television, I highly recommend turning them on right now because it is your best way to check out the quality condition options and cleanliness of the vehicle before seeing it in person. Obviously you can tell this one has ACM truck beds flatbed. This is a 9 foot 4 inch by 7 inch, I'm sorry, 7 foot 9 inch. So 7, 9 and 9, 4 are the dimensions on this flatbed, obviously 9, 4 long and 7 wide. So this one does have a gooseneck, which I'll hop up here and get you a look at. There's your gooseneck, there's also a 7 pin wiring there. The bed itself, it's got a little bit of light duty usage, but I mean, that's what flatbeds are for, right? You saw when I did the initial walk around, all the lights were working on the flatbed, and it's in really nice shape. It does come with a couple storage boxes on the side, they close like that. You can see the cab and the doors are all in really nice shape. It does come with the telescopic tow mirrors, and the front fenders in excellent condition as well. Now if you like this video, you can subscribe to my YouTube channel, which is youtube.com slash Summit Auto. Click the bell notification so you can update some of the videos I do each and every day here at Summit Automotive. Very clean down that side. Comes with the steel rims, and this one has Michelin LTX tires. These are LT24575R17s. In the front they have, I would say probably 60 to 70% of the tread left on them. You can see just how nice and clean that frame and underbody is. And that front fender is in excellent condition, headlight lenses are nice and clear. Front bumper, it's got a couple little dings, and the front valance does have a little crack right there, but other than that, there's a kind of a soft dent right there. You get the tow hooks on there, but it doesn't affect the performance of the truck at all. The grille is in nice shape, and the hood is absolutely perfect. Cab lights up top, passenger side front fender looks really good as well. And the passenger side rim, no scuffs or scrapes, looks really nice. Down the rest of this side of the truck, doors all look good. And this side of the box is in nice shape as well. I take these HD videos, so if you are far away, or even if you're close by, just cannot make the trip down, but you're still interested in purchasing the truck. You can see the truck here, the truck, and the confidence in the vehicle that you're looking at before you even get here. So when you do get here, there's no surprises, and you can make a smart and informed buying decision from wherever you're at. And if this video helps you make that buying decision, let your salesman know that you saw the video that was helpful in that brat's engine. You can see that the frame and underbody is exceptionally clean, and that it does have all the remaining factory exhaust. The back tires have just as much tread as the front tires. This one does have the camper package with the anti-sway bar right there, and you can see that these back rims are in excellent shape as well. We'll check out the interior next. In a second, we'll check out the interior. I did want to point out it does have a receiver hitch, and you get seven pin and four pin wiring back here as well. So you have the receiver hitch, you also have that gooseneck up there. All right, let's check out that interior. Inside the XL package gives you the gray heavy duty vinyl interior. You get the 40, 20, 40 split bench seating in the front here. Seats are in excellent shape, I didn't see any rips or tears on them. You get the heavy duty rubber floors. This one does have auto headlamps, tilt, telescopic steering wheel, power windows, power locks, power mirrors. The super cab here goes open like so, and you can get to the back seats, plenty of room back here. You do get latch child safety system, and this one has a fixed glass rear window. These seats do fold up just a little bit for extra storage, and you get a nice flat floor back here, which is great if you've got pets and whatnot. Bottoms of the doors all look really good, and this back window is also a power window. So, there is that. That door shuts nice and solidly. We'll hop inside and check out the miles, the radio, and everything that this truck has to offer, and then we'll start it up. You can see that this one has 26,395 miles. You do get a mileage to empty compass display on there as well. You get all your different trips and information there too. Steering wheel is in really nice shape. You get cruise controls and information center controls on the left, Bluetooth and audio controls on the right. Remember, this one does have the six-speed automatic transmission with the optional tap shift. This is your radio. You get AM, FM, and Bluetooth capabilities. This is also where your backup camera shows up. The truck's got to be running for that to work, so I'll show you that in a second. Turned out four-wheel drive, factory brake controller, climate controls, your heated mirror button, a USB and 12-volt power point. You also get two more 12-volt power points right there. Dual-glove boxes. This one has the owner's manual and all that good stuff. Passenger side floor and seat are in excellent shape, and the headliner is very nice and clean on this truck. Smells very clean. I don't think it's ever been smoked in, and you do get six auxiliary up-fit switches. We'll start it up, take a look at that backup camera, and then take a look under the hood. Right up, no check engine lights or anything like that. There is your backup camera, and that is working nicely. I would personally like to thank you for checking out the video today. Here is your VIN sticker, but I would personally like to thank you for checking out the video today, and hopefully from this HD video you've been able to verify the quality condition options and cleanliness of this truck all the way around. I think it's in really nice shape for an XL work truck flatbed. Under the hood we have a 6.7-liter power stroke diesel engine. Engine bay is very clean, runs very smooth. Once again, this truck has been fully safe and inspected by our service shop. Has a fresh oil and filter change, all the fluids have been checked and topped off, and this truck is 100% ready to go. There is your emissions sticker. I would highly recommend this truck for make quality and condition standpoint, and to see more pictures of this truck or one or other 550 new used cars, trucks, SUVs, minivans, wranglers, halftones, recoder tons, one-tons, flatbeds, dualies, you name it. We've got to go to that website right there, summitauto.com. Full pictures and descriptions of every single vehicle from two locations all at summitauto.com. If you'd like to check out more HD videos, you can go to youtube.com slash summitauto. Remember to like, subscribe, and share on this video and all the videos that you see there. Click the bell notifications. You'll get updates on the videos I do each and every day here at Summit Auto. In fact, in a second you'll see a link to a link to subscribe to my YouTube channel on the upper left. Link to more F350 videos like this one, the upper end link to this vehicle on our website on the lower left. Any link to one of our latest YouTube videos on the lower right, click those check us out. We're super excited to help you with this Ultra Clean 2019. Ford F350, SuperCab, Flatbed, Dualie, and XL in Oxford White. Thanks again for checking out the video. Remember to like, subscribe, and share on the YouTube channel. I really appreciate it. Thanks again.


I will show you how you can get the six Johto poker balls, the fast, friend, lure, level, heavy and moon balls, as well as the other two special balls in the game, the beast ball and the dream ball. But before we get into today's video, please subscribe to the channel, remember you can always unsubscribe later if you would like to. Firstly I'm going to show you the guaranteed way for you to get these eight special poker balls. So if you have played any Pokemon game in the past, you'll know the main tagline is always to catch them all. Well yeah, to get all of these special poker balls in your copy of Pokemon Scarlet or Violet, you are going to have to start to complete your Paldean Pokedex. As you hit certain milestones in the Pokedex with numbers of Pokemon you're collecting, you will start to receive gifts. These can range from revives to star pieces, nuggets and the other thing you're going to get at certain milestones is the special poker balls. The first one of the eight poker balls you will receive from this August challenge is when you have 240 recorded Pokemon in your Pokedex. At this point you will receive the fast ball, which is great to use against Pokemon who are quick to run away from battles. The next milestone is 260 entries. At this point you will receive the friend ball, which is good because when you use this on a Pokemon it automatically makes the friendship of that Pokemon even higher. So it's a really good option for those Pokemon who evolve through friendship. At 280 Pokedex entries you will receive the level ball, which is a great ball to use on a lower level Pokemon than the one you are battling it with. At 300 Pokedex entries you will get the lure ball, which is good for Pokemon we would normally fish for. But in Scarlet and Violet as they remove the fishing rod feature, we no longer have this. It's a nice looking ball though. At 320 Pokedex entries you will get the heavy ball, which is great to use on those heavy Pokemon. At 340 Pokedex entries you will receive the moon ball, which is good on those Pokemon who evolve using the moon stone. At 360 entries you will get the dream ball, which is good for Pokemon who are sleeping. And on 400 entries on completion of the Pokedex you will be rewarded the beast ball, which has the lowest catch rate of all Pokeballs in existence. Now you have one of all eight of these special Pokeballs. In these games there is a way to get more of all of these Pokeballs, although it's not going to be easy or cheap but technically you can get an unlimited amount of all of them. After you've completed the gym challenge for the water gym in Cascarafa city, you will have access to the auction house in Porto Maranada. There are four vendors that you can visit who will all have different items available to buy. The items they have for sale do change every single day and they range from battle items like the razor claw to sandwich fillings like the cloth sticks. But on very rare occasions these vendors will sell one of these eight special Pokeballs, although you will have to join the auction and beat two other NPC characters with the highest bid to get this item. If you do get lucky enough to find one of these, make sure you have a lot of Poke Dollars as these auctions will have a starting bid of a hundred thousand Poke Dollars and when I got lucky enough to find a friend ball it cost me a whopping two hundred and thirty thousand Poke Dollars. So get saving. I do honestly think it would be quicker to play through an entirely new game and complete the Pokedex again to get a guaranteed chance to receive these special Pokeballs rather than waiting on each of these special Pokeballs to show up at the vendors again. So when you decide to use one of these special Pokeballs make sure you to use it in a Terrorade where no matter what the ball is that you're using it'll have a hundred percent guaranteed catch rate and be sure it's on a Pokemon that's very special to you as well that's been worth in these unique Pokeballs. And with that you have all eight of the special Pokeballs in Pokemon Scarlet and Violet. Let me know in the comment section what your favorite is and what Pokemon you'd catch with that specific one. If you found this video helpful please drop a like and subscribe if you are new to the channel. Thanks for tuning in and I will see you all in the next one. So until next time.