Hello everyone, this is Dr. Mang Shivastra. We are to the department of radio diagnosis from Jawaharlal Nehru Medical College, Aligarh Muslim University. Today I am presenting the role of renal Doppler in diagnosis of co-op patient of Avota, a case report. Renal Doppler is indicated in hypertension, especially if there is significant suspicion of renal vascular hypertension, suspected vascular pathology like aneurysm, pseudoaneurysm, malformation or AV fistula, vascular murmur in epigastium or to identify the cause of renal failure in patient at risk of renal vascular disease. Herein we are presenting a child who was diagnosed with co-optation of Avota using renal Doppler during workup for secondary hypertension. Now introduction, co-optation of Avota accounts for nearly 5-8% of all congenital heart defects. It is more common in male and male is to female ratio is 2 to 3 is to 1. It can be associated with other congenital anomalies like bicuspid valve, which is the most common association, which is seen in 75-80% cases. VST, TGA, Parachute-Mittal valve, Petenductis-RTOS, Belly aneurysm, Spinalis scoliosis. There is also syndromic association for example, Sean syndrome, Face syndrome, Ternum syndrome, etc. The diagnosis of co-optation of Avota can be delayed and can be present only when there is serious complications such as congestive heart failure, which is seen usually in infants or hypertension, which is commonly seen in older children. On clinical examination, it is suspected whenever there is discrepancy between arm and leg systemic blood pressure or hypertension raised into medical treatment. Because of its high efficacy for detection of secondary hypertension, renal Doppler is simply being paid attention to. Herein, we presented a 15-year-old male with secondary hypertension who was finally diagnosed to be caused by co-optation of Avota using renal Doppler sonography. Co-optation of Avota can be primarily divided into two types. The infantile, which is also called as pre-ductal form, which is characterized by diffuse hypotasia or narrowing of the Avota just distilled to the brachiochiphalate, proximal to the ductus arteosis. And the second one is adult type, which is also called as juxtaductal, post-ductal or middle aortic type, which is characterized by a short segment abrupt stenosis of post-ductal Avota. Now, the case history. A 15-year-old male, patient presented with complaint of occipital headache on and off for three months. There is no family history of known this factor for hypertension. On general examination, patient was found to be hypertensive and BP measured in upper limb was 170 by 100. The systemic examination appears unremarkable, no cardiac murmur or bruise was detected. The lab investigation were with a normal limit and patient was advised renal Doppler to screen for secondary cause of renal hypertension, that is renal aortic stenosis. On renal Doppler, the bilateral male renal arteries and intra-renal arteries shows increased acceleration time, spectral broadening and perverse stardust flow. There was reduced monophagic flow in abdominal Avota by lateral lower limb arteries. However, upper limb arteries shows normal multiphasic flow. On the basis of these findings, proximal flow limiting pathology, likely in Avota is suspected and CT angiography was advised. On C2 angiography, a focal constrictive narrowing in the descending thoracic Avota is noted, distal to the origin of left sub-clebian artery with proximal dilatation of ascending thoracic Avota and distal normal appearing descending thoracic Avota. Also noted, multiple dilated perivartibral and mediashtinal colactals enhanced motting pre and post stenotic segment. Now the final diagnosis, the patient was diagnosed as a case of co-optation of Avota post ductile type and referred to higher center for further management on patient's request. Now the discussion. Many experts believe that the suspicion of stenosis in Avota raised during Doppler ultrasound is more reliable sign for possible co-optation of Avota than basic physical examination. Considerable differences in flow characteristics is in the descending Avota is a major hallmark in those patients having co-optation of Avota. However, it should be kept in mind that in some patients normal flow velocities are recorded in spite of existence of clinical sign of co-optation of Avota and in fact the findings of normal flow velocities does not exclude the presence of an obstructive lesion. Now the conclusion. The main differential diagnosis for co-optation of Avota is bilateral renal RT stenosis. The main color Doppler findings which favors co-optation of Avota is started as far as flow in bilateral renal RTs and segmental RTs sought with pattern wave in abdominal Avota and normal flow pattern in upper limb RTs. Reinal Doppler is a non-invasive affordable and cost effective skinning pool in detection of congenital RTs and normalities and general workup for secondary hypertension. So it should be recommended as a part of general workup before proceeding to CT and geography. These are the references. Thank you.


I've got two now, do I do a putty? So I was told that we have 20 minutes and the talk starts in what, 10 minutes? No? So can I grab the extra 10 minutes as well? Okay, I will try my best to keep it 20 minutes then. Is it projecting? No. Okay, now? Ah, okay. Okay. Yeah, I've got quite a few. Okay. Let me just... Who is the worst? Is there any way for me to see the screen from... I will do it live. Yeah, no worries. Okay. Okay, ready? Okay, so don't tell Michael that I got 197 slides. Okay. And I also need a little bit of time to do a demo. Okay, all of this in 20 minutes. Okay? Hopefully we're going to keep this secret. Okay, so who am I? I've got a really long name. So as long as you can be done, I'm happy with that. I work for a company called Learn Kubernetes. And basically what we do is we teach to other people Kubernetes. Jessica has got this logo. So what am I here to talk about today? I'm a little bit... I'm here to talk about, you know, why do we use these Kubernetes being... Why is it so popular? Why is everyone, you know, so interested about deploying containers or using containers for, you know, machine learning or web applications? So, but before we dive into that, let's have a look at a little bit of a background, right? What do we do when we deploy applications? Well, back in the days, right, we used to have large applications, right? And we used to build these large applications. But, you know, in the recent past, what happened is we basically decided that it was a much better idea to just, you know, break these large applications to smaller components than each component would have, like, you know, a single focus. We would have an API, a front-end, and each of those would be independent, right? And we thought it was a good idea because we could have quicker deployments, right? Everything would be separated and we could be released independently. We said, you know, each team could work on a single feature, so that's a good idea. And it's also overall less risky, right? Because if a component goes down, it's just that component. It doesn't take down the entire system. And, you know, as developers, we said, this is a great idea. We should keep doing it as much as we can. However, there is something else going on, right? So, there is, you know, some of us who are perhaps more into the infrastructure side of things are seeing these kind of things and thinking, well, it is great, but when I have a single application that I could just bring that single application and put it inside a box and that would just run, okay? But now we don't have a single entity anymore. We have, you know, these individual components. So we should run each individual component in its own box, right? What we call virtual machines, for example. But the reality is that as developers, we like, you know, we don't just break things in four. We tend to be, you know, a little bit more. You know, we take things to the extreme sometimes. And we end up with a lot of applications. So a lot of applications actually introduce quite a lot of challenges on the infrastructure side of things. And if we look at some of the challenges, the first challenge that we can think about is, you know, when we had this virtual, when we had these computers, right, these computing units, then those tend to be like quite large computers that could run a lot of things, right? And if you look at the alteration of things that were using the operating system and in a space which was usable for you for running the application, it was a tiny bit using... The operating system was using a tiny bit. The rest you could use yourself. Now, if you had only a few applications, then, you know, you would have this split. And overall, the memory and CPU used by your operating system would be a tiny bit, right? So if you think about it, 2 to 3% to run the operating system, it's okay, right? It's very small. But when we switch to something like, you know, smaller components and a lot of them, what happens is we tend to run smaller applications and smaller rich machines. And the ratio between what is used by the operating system and what's used by your application, your web application changes quite a lot, right? So we're seeing some shifts from 2 to 3% to more than double from 6 to 10%. And if you think about it, if you have a bill on GCP, for example, of $1,000, then you're spending $100 in running operating system. So some money that you will never see back, right? It just lost. The other challenge is usually when we build this application, we used to put this application inside these boxes and everything will be fine, right? We will have another box and another box and if the application was smaller then there would be just a little bit of gap, right? Which we couldn't utilize. And it was still okay. But now with this application that we're building, which are much smaller, much more focused, right? Compared to what we had before, we have, you know, all different shape and sizes. So if we deploy them in these boxes, then there is a lot of wide space, right? Which we didn't have before and now we do. Which is kind of a problem. And the last sort of issue that we get that we inherited from this sort of development that we now we do is that, yes, all these microservices, we like to pick languages, do we? Okay. But it turns out that we really, really like them.  Okay. But in general, more in general, is we have a lot of applications, right? Different languages. But even if you are in one of these companies, really rigid saying, we do just Java. Okay. Really serious. They still have the same problem, right? Because they have different run times. It's never just matches the same. So even if they pretend to be better, they are not. Okay. So what can you do? That's one solution. Okay. But let's take a step back, right? So we talked about, so all of these, some of these problems were originated by ourselves, right? So we pick these boxes, we call them version machines, and we place stuff inside. But what if we change the story, right? What if instead of starting with version machine, we start with something else? So it turns out that in the meantime, there were some features in the Linux kernel that they were quite interesting. One of these was control groups, which is basically when you launch an application, you can define how much memory and how much CPU that process is going to use. Okay. And then you can limit things like memory and CPU. And then the other things you can do is you can launch a process like your web application or your binary, and you can also set isolation. So what a process can see. Can you see other processes? Can you see network packets from other processes as well? So we just, you know, designing boundaries around our application. What kind of things you can see and how much memory can you use? It turns out that this sort of stuff is quite interesting, and someone said, what if I combine three things? You know, these control groups, name spaces, and a little bit of magic, okay? And they came up with this, right? What we call dockers, what we call containers. So just a way to launch a process, which has got some extra memory and some extra name spaces just to set isolation and groups. So generally, we don't say this, but let's say for the sake of the point we are trying to make, but docker containers look like lighter virtual machines, like lighter boxes that we've seen before. So before we had this, right, so we had the server and several virtual machines, several boxes inside. Now we basically, if we'd run containers, then we don't have these boxes anymore, and then we can run the infrastructure much more packed, right? So everything is neatly organized together, which is good. And the other benefit of these containers is that because these are just processes where we set limits, right, it's not as slow as a virtual machine. I mean, you must have run virtual box and waited, you know, for a copy and come back and still there booting, and there is no hardware emulation. This is just launching a process in the same way you launch your IDE, right? So that's the same thing. The docker container is the same thing. And then the best part is that when you launch a virtual machine, it's going to pre-allocate some memory, right, and CPU. When you launch a process, it's just going to use the memory dynamically. So these docker containers are basically just double-clicking on your IDE. And then the first part, which is also quite interesting, is that these docker containers, at the end of the day, what they are, are just archive, like zip archive. And what they contain is not just the code that you run, but all the dependencies. And dependencies, if you're running, for example, a JVM, it's going to be the runtime. If you're running Node.js, it's going to be in Node.js binary. If you're running Ruby, it's going to be the MRI. If you're running Go, well, you don't need any of that. It is just a binary. So we combine your runtime or your files all together with any other dependency you've got, and we just wrap them up in a zip file. And we call that zip file container. Okay? So that's the magic of containers and how they work. But the powerful thing is that if you think about it in the past, right, if you had to deploy anything like a Ruby on Rails application or Node.js, you would need to go to someone else and say, hey, can I have a box? Can you go inside? Can you go inside? Install a couple of binaries, blah, blah, blah. And if it was just one, that was fine. But when you had several applications, it becomes really, really complex, right? This server needs to have Node.js and Ruby and so on and so forth. But with Docker containers, we don't need any of that. Because we wrap everything inside a container, we don't care what they look like from the outside because they are just containers, and we can just deploy them as containers. So containers are great. I hope you share the same feeling. But the thing is if we have a lot of virtual machines and we switch to containers, we still have a lot of containers. Okay? We haven't solved the problem on how do we use these containers? So it's Christmas time. Okay? So I have a couple of wishes. You know, I'm going to have a wish list with some things I want to solve this problem of containers. So the first wish I had, what if it could be something that could manage all of these containers? And it could be something that ideally, I don't need to go there and manage the servers. It's just going to take everything, it's just going to take care of everything for me. So it's going to basically look at all of the things I've got and just make a single bundle. Okay? So I don't need to worry about where these applications that I built are going to end up. And then ideally, I want to also make sure that this is something that I can program because I'm a developer and I like to write code. Okay? And you might have used some of these tools in the past. So it turns out that this technology that managed several containers and have got these properties are called container orchestrators and the market has got a bunch of them. Okay? So you might have heard of these ones, but another example is if you're using AWS, it's called AWS ECS, which is the container orchestrator. And it's not a fair fight. Okay? So Kubernetes is de-factor, de-container orchestrator. Okay? So this is a fairly old graph, but the trajectory is, you can see the trajectory of Kubernetes. And so why this Kubernetes? Why is it so popular? Well, one of the reasons why it is so popular is because you don't need to think about your servers. You don't need to think about this computer that you have to deploy your applications. What Kubernetes does is you install it on one of those. The other nodes inside your infrastructure will join the master node. And what happens is the cluster is just going to absorb memory and CPU of all the nodes. Okay? And it's going to become like a massive computer, just a single one, which is much easier for us. We only deal with one single computer. The other interesting thing is about Kubernetes is that it's quite clever, but clever is not the right word. It's quite a nice Tetris player. So if you think that these boxes that we created, they come all different shape and sizes, right? Kubernetes, what it does is usually play Tetris with your infrastructure. As more containers come in, Kubernetes will just find the best slot to place your containers, right? Until the end, you get something like this, which is great if you like Tetris. And it's also great if you like efficiency, because as you can see here, we're trying to maximize the space that we can get out of our servers. And then the last one, again, I'm a developer by trace, so I like to program things and change things. So everything you're doing in Kubernetes is just an API call. So you've probably seen, this is a cool request, and I can query the API, and I can query the application that I deployed. And then there is also documentation, so I can just read the documentation and create more endpoints. So if I want to create an application, I can just say, curl, create an application. Curl, create an under node. Curl, provision, load balancer. So everything in Kubernetes is just an API call, and that's quite so cool. So do you believe me? I just made up everything. It's demo time. So before we do the demo though, just a quick description of what we're trying to do. So ideally, this is what we want to build. We want to build the red pages that people visit. That's what we do all day. However, sometimes these red pages, they become super popular, so we need two copies instead of one. So what do we do to distribute the traffic between the two? I hear a lot balancer from the crowd. Very well. Now, we might have more than one application because hopefully, you know, where we work, they don't have like a single product or a single microservice, they probably have more than one, like this. What if I want to route the traffic to both microservices? How do I distribute the traffic? I hear a lot balancer from the crowd. Not really, but that's the thing. Okay. So actually, we have two layers of load balancers when we want to distribute the traffic between several services in our infrastructure. So we have an external load balancer and an internal load balancer and then the applications. So in Kubernetes, we do exactly the same thing. We just like to call everything with different names. Okay. So instead of calling the internal load balancer internal load balancer, we call them services because you know in computer science that's a very specific term, the service. And then instead of calling the external load balancer, the load balancer, we call it the ingress. Okay. This is a little bit more specific, thankfully. And why calling the application or container? Container is where you can call them pods. So that's how we call them. Okay. So that's basically how we deploy application in Kubernetes. So let's have a look. So we discussed about three different things. We discussed about the ingress, the service, and then our pods. So the way it works is first of all, we create a container. Yes. Correct me. So a container, what it is, we usually create container from a list of instructions. So the list of instructions is usually called a dockerfile. And this contains basically, it's like a glorified ISO in VisualBox, right? You say, I want to start with Ubuntu. I want to start a couple of things and install my application. That's the same thing we do in containers. In this particular case, I built a hello world app in Go and just packaged inside the container. Then I can build a container with docker build, dash t for the name. I can call it hello. And then hopefully it will not let me down. Okay. So this is going to take ages, and we can move on. So what we do when we have this container, then we just define how we want to deploy it. Now, everything we do in Kubernetes, we actually write this very nice YAML file. So just to configure a description of what we want the end product to look like. And what the end product will look like is a single application. What's the name? Hello world. Oops. And what's the name of a container? Okay. It's called demo. I built the wrong one. But you get the idea. We're basically just describing what that should look like. Then we have the service, which is the internal load banser and the ingress. If you think it's a lot of YAML, yes. It is a lot of YAML. Kubernetes engineers are usually called also YAML engineers, because that's what we do all day. Okay. So once we have those, then I have a cluster running locally. Oh, by the way, this is just created a container. It's local. So when we have these resources locally, then what we do is we have a cluster, a Kubernetes cluster. In this particular case, I'm running a local cluster called Minicube, which is running on my machine, because I was afraid that the internet would not work. And usually what we do is we send these YAML files to the cluster. The cluster would read it and then create the resources on our behalf. Now to send these instructions, we use a command line called kubectl, which everyone pronounces with a different name, kubectl, kubectl, I say kubectl.  And we just send the resources. You can see that when we create these resources, then the created resources, we submit the request, but it doesn't wait, right? It's just going to return immediately. But in the background, what happens is Kubernetes will go and create these resources for us. I can see hello word here and then the ingress. So I can see that it created all of the resources. Can I see my application? Hopefully it's going to work. Yes, I can. I can see the application. So you can see CKFGD. What is that? CKFGD. OK. Well, good. Now, the good thing about Kubernetes is that we generally have a single application, but that's, you know, we like things to scale. So generally what we do is we scale the number of replicas and scale the number of instances of our application. And the way to do that is by writing what we call a deployment, which is what I just showed you. Generally, the reason why we use deployments is because in Kubernetes, when you create a deployment, then the deployment looks after your pods, right? Looks after your application.  OK? So let's have a look at this one quickly. So what I can do, I can go in my deployment and I can change the number of replicas, which is the instances of my app from one to five. And I can see there are five new applications running now. So what if I go and delete this one? Then I do a get pause. There are still five running again. OK? This is because as one is deleted, Kubernetes will replace it with a new one. OK? So it's doing a lot of stuff for three for us. OK? But one of the things that we do very, very frequently when we deploy application is we deploy an application and then we have a better version. OK? We deploy version one and then, you know, a couple of days later, we just find a way and redeploy it again. Now, Kubernetes is quite interesting on this space because it automatically does what we call a rolling update. It's going to do an upgrade of your application with zero downtime. So how do you do that? Well, if you look at this particular deployment, we have three applications with a red page. So when you say I want to upgrade from version one to version two, this is what happens. Kubernetes will create a new version of the application. OK? And we'll replace it with the old one. Create a new one, replace it, create a new one, replace it. OK? Because it's doing it one at a time, then the traffic never goes down. Right? We never had downtime. So let's have a look at that as well. So what I should show you before we start is that the application exposes a version. OK? This is version one. So what we can do, hopefully this is going to work, nope. I'm pretending this is normal, but it's actually not. So bear in mind with me. I've got version one. You can see version one running. OK? So what I do next, I'm going to go and change this from version one to version two. What would you expect to see now? Is this is going to continue to be one all the time? What's your guess? Is it going to go to two? Yes, hopefully. I guess. Hopefully it works. So the way we check that is we do a kubectl apply dash f. OK? And then switch back to the slip. And we see what happens. Oh! More two. One and two, two, two. OK. Eventually it's going to switch to two, right? You can see now the whole traffic is going into version two. So we just did a rolling update, but just changing the version of the application in the specification. And that's basically, Kubernetes did a rolling update for us. What is my mouse? OK. So that's basically why everyone is so excited about containers and Kubernetes. It's quite easy to create deployments. It's quite easy to do rolling updates. And because everything is encapsulated, it's very easy to scale to several servers as well. So who is using this and why? So I think a good example of who is using Kubernetes for the sort of large-scale processing is this company called OpenAI. So what I do is back, I think two years ago now, they used to train machine learning models on Kubernetes and they had like this what we call now medium size. At the time, it was really large size. We have 2,500 nodes. OK. And what kind of things they did, they installed basically something designed to scale the system, right? So when the application needs to train more models, then it will just create more instances of this model and will just, you know, process more jobs. And then that was combined with another thing in GKE, which is the cluster auto-scaler. So when you run out of space, like in this case, it will just create more nodes and then keep doing this training of models. So it turns out that they were building a model to play Dota, which is quite cool. And I don't know if you've heard the news, but I think this year in July, they also managed to compete with pro players as well. They run, for competing with pro players, they run much larger cluster. We're talking about more than 5,000 nodes per cluster. So it's very cutting edge stuff. But at the time, the reason why I'm mentioning this is because at the time, they basically shared what kind of configuration they had for their own cluster. And this was the configuration for the 2,500 nodes. So you can see that they used 250 sites P10, P100, which I think are TPUs, and a bunch of various TPUs. This is everything in Google Cloud, everything on GKE. Can you guess how much money is this per hour? No? Well, it turns out that it's not a lot. I mean, it is a lot. Objectively, it is a lot. So we're talking about US dollars here. So it's probably 1,600, close to 2,000 dollars. But if you think about it, you're right.  But if you're a small research center, you have access to so much power, which normally would be just for large corporation or large companies. Now you can go in GKE, click on two buttons, provision a 500 node, 5,000 node cluster, pay 2,000 dollars for an hour and just take it down. This is unprecedented. We never had such ability to create things so quickly and destroy them. Even if you're sitting in your room, you're back home just mining bitcoins or training models. So I think this is pretty exciting for me. So that's everything I wanted to show you today. I hope it was 20 minutes, more or less. So we talked about microservices, how things have changed since from where we started, from these monoliths. We talked about these containers as lighter VMs, so just processes that have got memory and CPU limits. And we talked about Kubernetes as one of these container orchestrators. So that's everything I wanted to show you today. I think we usually run workshops on this kind of stuff. We have one coming up, the 27th of November. But the reality is that we're going to do a repeat of the zero to Kubernetes course, which we have done in September. And we're going to do it in December. What we're going to do in this session is we're going to do the same three hours. We're going to go through building an application in Kubernetes and deploying it. So last time was quite popular. I'm not sure about this time, but yeah. I think if you're interested in these sort of days, it's on the 7th of December. I think it's on a Saturday. So join me. And I hope you enjoyed it. Thank you very much for listening to me.


So, one of the issues that people have come to me is, Eric, I'm just starting out and I have a small business but the government says there's a requirement for the percent of work that I need to perform. Yes, that is correct. So, the good news about today's video is we're going to discuss the new changes that came out in December of 2018 and how the rule on subcontracting and the percent in which you can subcontract has just been modified and updated as of December of 2018. So, we're going to discuss that in today's video. Stay tuned and watch right now. All right, so listen for all of you guys out there who are concerned about your ability to be able to meet the requirement on performance in terms of hiring subcontractors, how many subcontractors can you hire, what percentage of the work that you have to perform. This is the video we're talking about today. So, I created a little chart that we're going to show on the screen right now and what the chart is discussing is the new rule just came out and was released in December and it's called the limitations on subcontracting for small businesses, class deviation O as an Oscar 0003. Forget about the name of it but just know that this rule just was just released so it may or may not have taken effect where you're working at but I want all of you out there to what? Govcom better. So, in order to do that you've got to have all the information available to you. If the rule has probably taken effect maybe the contracting officer or contracting officials don't know this rule. Remember guys, when I was doing Govcom a lot of times the contracting people would come to me and ask me how to do things because they weren't up to speed on all the new training. If they haven't gone through a training recently or they just or if they were certified or recently became a new contracting official it's quite possible that they're not even aware of these rules. So, guess what?  So, let's talk about the new rule today and how it affects people out there like yourself. So, first and foremost the main deviation of this rule from the previous rule on subcontracting was that if you had a business and you were doing like say supplies or services you were supposed to perform 50% of the work and you cannot contract out more than 50% of the work. So, you ABC business had to do 50% and then the subcontractors could do 50%. The new rule in terms of deviation allows for what they call a similarly um similarly situated entity. I had to review that again myself similarly situated entity. So, that means that uh an entity that let's say you if you were awarded this contract as a hub zone if you've got another hub zone business that's also a small business you guys can now work together to meet your 50% requirement. If it's an 8A contract and you've got another 8A firm that you can work with you guys can work together to meet your 50% requirement. So, now it's not just it doesn't it allows more flexibility in terms of not only do you're not the only person or the only entity that has to meet that requirement it allows you to bring on another entity that's similar in terms of size you know I mean in terms of small business size. So, if you're a million and they're 2 million that's similar in terms of the government's eyes. Remember we're talking about the federal government here. So, when we say similar we mean as long as they are the same certification that was issued under this particular contract if it's small business and their general small business if it's hub zone, tub zone 888 and they fall under the umbrella of the small business arena then they can help you meet your percent requirement for supplies services or construction. So, the same thing on the construction arena what they talk about is now your entity can bring in a similarly situated entity to help you meet your 25% requirement. So, you can technically subcontract out 75% of the work as long as you can bring in someone alongside of you that small business that's in construction and that's under the same type of small business category that the contract was awarded in they can help you meet your 25% requirement. So, this is great news for small business out there because why a lot of times people are just getting started and you may not have everything that you need to get the wheels turning. So, the government I'm telling you ladies don't listen the fellow arena they're the bomb. The government is creating rules policies to allow small businesses to really embark on this journey. So, they're making it more favorable for the little guys to get started and to start growing their business. So, listen take advantage of the new rule also I'm going to have a link to it below in the show notes description. As always, GovCon better. Thank you for watching. Aaron from Score Contracts. We'll see you next time.


Hey friends, today I am in Epcot and I have dining reservations at Licellier, the steakhouse and restaurant underneath the Canadian Pavilion here in Epcot's World Showcase. I am so excited. I haven't been here for years and I could really go for a good steak. So, let's go do this. We have a couple minutes before our reservation, so it gives us time to walk around and explore the Canadian Pavilion a little bit. It is so beautiful, especially the garden area down here. It's so fun to be exploring all the restaurants at Epcot again. It's 2021 now and because of the pandemic that we're in, it's giving us a new perspective on all these restaurants. That's why if you notice I've done the beer garden, I've done Tepanito, I'm doing Licellier today and I'll do all the other sit-down restaurants that are in World Showcase. That's my goal, to get them all done just so we can start off the year right. Look how beautiful it is down here. It's amazing, isn't it? I absolutely love it. I love the flowers and just the whole entire garden. There is so many things I want to show you in the Canadian Pavilion. So, if I don't get to it now, we'll show you after we have dinner, but this is just amazing. I always like going back this way because they do Canada far and wide and I like the little bridge area. Look at this. So fancy.  Look at it. Everyone's getting misted. Maybe we'll actually go back that way and do Canada far and away after dinner itself, but it is getting time for the reservation so we better get on over there. Here is the restaurant itself. I am so excited. It does get a little dark in there, but it's so amazing. Like most of the restaurants in 2021, all of the menus are actually a QR code so you scan and check. They do have menus posted on the outside, but I don't know if they're accurate because the menus have changed in almost every single restaurant, but I'll show you just in case. Right here is that menu that I was talking about outside. Oh, actually you might not be able to see much, but there's the entrees. We got a prime rib eye steak, the New York strip, the filet, some Asian impossible dumplings, a sustainable fish. This stuff is so amazing. I am pumped. I am so excited. I'm checked in, so I'm going to see if maybe they have a reading area inside. And our table is ready, so we're going to move down into Le Celier. Told you it gets really dark in here. Now that I'm at my table, I can take my mask off. It is so awesome down here. Actually, I like the lighting. It is like the perfect dining lighting. Like it really sets the mood. All the tables have candle lights, and they can see all the light fixtures are actual maple leaves. It's very cool in here. I also like the carpet. Obviously, this being a steakhouse, we're going to be getting some steak, but because we are in the Canadian pavilion, I think I need to get myself a good Canadian beer. They have Lafay de Monde, which actually means end of the world. That's what my waiter just told me. And then, of course, Moose Head and Molson and LaBat Blue. I think I might actually get this because it's on draft. Yeah, I think we're going to get an end of the world draft. I believe last time I dined here, I had the filet, but this time I might actually explore and get a different steak. I do know the prime rib eye actually looks phenomenal. I might actually go in that direction. I know that's a shocker because everyone always says if you're going to come here, get the filet, get the filet, but I don't know. The prime rib eye is calling my name. It actually looks like the filet is still more expensive. It's $59. The filet comes with the mushroom risotto, and then the prime rib actually comes with fingerling potato salad, bacon, and then wilted spinach capers. That's going to be a tough one. I can also get some enhancements. Ooh, I might actually want to get the maple wispy glazed Brussels sprouts. That sounds amazing. I also just stumbled upon the fact that they have a Licellié signature poutine down here. Here is the Le Pen du Monde, the end of the world beer. Cheers. Oh, that is amazing. Oh, wow. I love it. Wow, that is so good. I decided on getting the prime rib eye steak. The reason why is because I've had the filet before. The filet is only seven ounces, and the rib eye is 16 ounces. So I went with that, and I'm going Pittsburgh style. And then instead of getting Brussels sprouts, I'm going to get the actual Licellié beef poutine, which I'm excited to try, and I subbed out the mashed potatoes for the fingerling potato salad. So this is going to be a good meal. I am excited.  They actually have a bread service here, and it's a special bread service. Look at this bread service. We have a pretzel roll, sourdough, multigrain, and then it comes with a maple brown sugar butter. That is amazing. First, I'm going to try the pretzel roll, and I don't think I need the brown sugar butter for that. So that is amazing. And now I got to try this brown sugar. I do. The brown sugar butter is amazing, but the pretzel roll is the best so far. I do want to kind of try the pretzel with the brown sugar butter. I think we're going to do it. Maple brown sugar butter. Oh yeah. This is going to be super sweet, but I'm so excited. While I was snacking on my bread, the poutine has arrived. Look at that. I am so excited to dive into this. It looks so amazing, doesn't it? I'm going all in here. Oh my lord. This is absolutely amazing. The french fries have the perfect crunch to them. I absolutely love it. Wow. I'm hooked now. I am 100% hooked. Look at this. The only issue I have is if you're dining by yourself, which a lot of people don't buy, dine by themselves.  It's too much food.  I want to, but like I don't want to get full on bread and fries before the steak comes. But I want to keep eating it because the french fries are still crispy. And if I wait, then they're going to get soggy. So like I'm really torn because delicious steak, crunchy fries. Which one? I don't know. But that is absolutely amazing. Absolutely. Now I'm just going to wait for the steak to come.  That's what I came for. That's the main course. And here it is. Look at that baby. I am so excited. We are going to dive right in here. Oh, perfect. This looks perfect. Cooked just the way I like it. I asked for it Pittsburgh style, charcoal on the outside, a little bit rare on the inside. I'm going to eat it without the mashed potatoes first. But usually I like to dip my steak in the mashed potatoes. I know a lot of people like to do that, but you got to taste the steak on its own first. So first bite. It is so beautiful. Look at this char. Oh, I can't believe how amazing this is. It's perfect. Perfect. Now we got to add a little mashed potatoes to the steak. Once you get down to this small portion of the steak, you don't want it to end. So you start making your bites a little bit smaller each time.  But like I don't want it to end. So I'm going to keep making it tinier and tinier just to make it last longer. I am very happy I decided to go with the ribeye instead of the filet. I probably would have been done with the filet already. This is cooked perfectly. The char is amazing. And it's just overall such an amazing steak. I love this whole entire atmosphere down here. It really sets the mood and it makes it 10 times better. But all things come to an end. I miss it. That first bite though, it reminded me of Ron Swanson from Parks and Recreation. Like I feel like I could have probably taken a Polaroid picture and kept it in an album. So amazing. But now I think I'm done. I do want to give you like a tour around the dining room a little bit before I head out. It's actually a very tiny dining room. It's got a nice little fireplace. I like the doors and I just love all of the different maple leaves and all of the like just pretty Canadian woodwork. And then as we make our way out, you see all the different artwork and it gets like super super bright. But like I said, it's dark down there. Look at that on the outside. But wow coming out of there, I feel so full. Definitely going to have the meat sweats. But we're going to walk around the Canadian Pavilion a little bit. Maybe check out Canada Far and Wide, which is basically their show over here and just enjoy. It's such a beautiful day out. This is where the show is at back here. And we're going to get a little misted here as we walk past the waterfall. I'm already prepared for this. Looks like we're just in time. Zero minute wait. Hello. Hello. It's so funny the last time I was in this theater, they weren't actually doing the show. They were using it to house I think an apple orchid. It's like a festival booth where they sold different ciders and stuff. I remember that. It says the word Canada comes from Kanata, the Huron-Iroquo word for village. And although those early villages have grown into our modern provinces, Canada has remained a cultural mosaic, a place where you can keep and nurture your language and traditions while embracing the future. An official language spoken here. It is one of North America's oldest metropolises, a perfect blending of old world meets new. Neighbor Montreal blends over 350 years of multicultural heritage with stunning architecture. And I'd be remiss if I didn't acknowledge our deep love of a heart. For many Canadians, it's a way of life. And a way of life for our dentists too. That's just a glimpse of our Canada, far and wide. We hope you know now why we love it so much. Not just for the natural beauty, but for the people who make it so special. And the best way to really know this country is to experience it yourself. So come visit our Canada. It was actually really beautiful. I want to go to Canada so bad now. It looks so amazing there. And also I learned a little bit because I remember watching The Office and Michael Scott went to Canada and he was calling it Kanata. And I'm sure it was like just like a goofy way that Michael Scott speaks, but he was actually kind of pronouncing the word that it was actually derived from. Kanata. And I thought that was really funny because he's like, how you say Kanata? How you say? Wow, it's so beautiful up here, isn't it? All of the shops are actually closed down, but I just like being up here. There's nothing open. Like this is not open. That side's not open. So there's not a lot of people up here. I like it though. I am really enjoying all these restaurant excursions and the different countries at World Showcase. It's so fun because we get to eat at the restaurants, embrace their culture and culture and food, and then also just kind of enjoy all of the different pavilions. It's really entertaining and it actually enhances the experience a little bit. I feel like it. I don't know what do you guys think? I feel like you get like the total package when you dine at one of the sit-down restaurants at Epcot's World Showcase. The trading post is still closed over here. I remember coming in here and actually getting maple syrup, hard candies. Also, I want to keep in tradition where I show you guys one of the cool hidden Mickey's that's actually in whatever pavilion we're dining at. So I want to show you a cool hidden Mickey here. I'm not going to tell you exactly where it's at.  We are looking at the different totem poles actually and if you can see the hidden Mickey, I know it's a little bit dark but I'm looking at some of the totem poles here in the Canada pavilion. If you can see the hidden Mickey, let me know. I'm going to zoom back out so you can see exactly where we're standing. I hope you guys are enjoying these videos. If you want me to do more videos like this, let me know. Maybe you can help me decide which one I'm going to do next, like which country or which restaurant I'm going to go to or world showcase. I've already done the beer garden in Germany, Tepanito here in Japan and it would be nice to see what you guys say. So leave me a comment below and if you haven't checked out those videos, check out those videos. It was just like this one. But now I want to move along and I ran into my friend. Who? Where? Jackie, super enthused. Hey Nate. I like your shirt. Thank you. I like your shirt. Yeah. We didn't dress to match. We actually, we had two separate plans today. So you came from Hollywood Studios and now I'm here and we both were Epcot Spirit jerseys. Except for yours is nicer. It is. It's nicer. Mine's newer. Yeah. I need to get a new one. I recently got it. I've got blue paint on mine. It's a memory. It is a memory. Making memories. Taking pictures. Now we're going to move along because I want to head over to the Mexico Pavilion. I heard a rumor that all of the Cabaneros are missing. So we want to ride the Grand Fiesta tour to see if that's true. Is it true that everyone left? They're all gone. Espedar. ¿Dónde estás los caballeros? All gone. We know Donald is already missing and they replaced him with just a sombrero. But Jose and Panchito are supposedly gone missing too. So we gotta find out. We have to find out. We have to get in line. Yeah. We have to come back today. You're not enjoying the Mexico Pavilion unless you're dancing as you're walking in. The question is, is if all three Caballeros are gone, will there still be a concert tonight? Looks like we're coming up on a fiesta. Look at that. They are. They're cardboard cutouts. No animatronics. It was fun to ride the Grand Fiesta tour and we talked to a cast member and they were just down doing some refurbishment and maintenance on the animatronics. I don't know about Donald because he's been missing for a couple weeks now. A fiesta with a sunset. Look at that. Beautiful, isn't it? I ran into some more friends, Beth and Mike, villains and vice and we're actually gonna head on over to France because I hear that the Ratatouille merchandise is actually out and I'm fogging up. Look at me. I look like Odin. Oh wow. It's like a magic trick. But yeah, as I was saying before my glasses started fogging up, we're gonna head over to France and check out all the new merchandise and also probably get some more drinks and something else to eat. It's just a beautiful night. It's a nice night for a walk. Mind if I join you? It went from like a beautiful sunset to complete darkness already but we are in the France Pavilion and first I want to find the Ratatouille merchandise. I don't know if there's anything I would buy myself but it'd be nice to show you guys. I did see a little bit of it. It's really cute and it's all themed around Ratatouille's adventure so we'll see what they got. Look at how fancy this is. They have a little chef set that is amazing and then Remy's Ratatouille adventure ears. They're actually little rat ears. I like this a lot. These are really cute then they also got some shirts here, a dress, a hoodie, a chef's coat. They even have some magnets and phone cases with Remy in France, like well in the France Pavilion, not actual France.  I think it spins. I don't want to touch it. Oh yeah, it does spin. At first I thought wow maybe these won't be that popular but it looks like they are popular. They're about to sell out on the shelf and people are lining up to actually cash out. They all have Remy ears. Even Jackie's getting on board and she's buying some Remy ears but look they're almost all empty there and the line to actually cash out is going up and then inside the exit way of the theater and then back down to come all the way over here but nobody wants chip. I have chip actually but that is much too long of a line for me and I think I'm actually going to go and try to get myself the chocolate croissant that I keep on missing because that's always a long line. The line this time is actually going pretty quickly. If you remember last time I was here I wanted to get the truffle croissant because it looked really good but the line was going all the way up on the bridge so I decided to pass. Now I got back in line to do the same thing but my friend Beth is telling me that the truffle croissant is basically like a mushroom. That is not what I had in mind. I was about to make that mistake but the fun thing is I think I'm still going to make the mistake. I have to try it now even though I know it's bad. I don't know though. I don't know. I thought it was a dessert.  Honestly I have to say I really thought it was going to be like a sweet croissant but now it's more of a savory croissant and I just need to know. Like now it's like more about just knowing. So here is the croissant right here and I decided to get the frozen french martini just in case I don't like the croissant. I need something to wash it down with but don't you think this sounds like a like a dessert croissant kind of? Oh looks like we're getting the martini. They assemble the martini glasses to order. Very fancy. At least you know you're getting a fresh glass. At least you know you're getting a fresh glass. I like it. What's the fancieness happening on top of mine? I like it. That may look pretty for you. Thank you. There you go. Here it is. The croissant truffle noir. I'm excited to try it. I really thought this was like more of a chocolate which I don't understand why I thought that. Maybe it's the way it looks. Maybe it looks like a chocolate. Yeah it does look like a but it has no chocolate in at all. It has no chocolate but we're gonna try it. I'm so excited. Beth is like laughing. She was thinking how funny. I can't wait to see this. Oh boy. It's not bad right? What are we eating? Hey got that croissant croissant. Just a few reminders. Face coverings are fully covered in oils and dye. I don't taste anything bad. It's just not chocolate. It looks like chocolate. So all I taste it was croissant at first but then when it gets to the middle I don't like it that much. I mean it's kind of like deceiving but I'm going to eat this whole thing. Not going to waste it. I mean I'm going to eat it. That's a really long one. Sante? We're going to try to cheers our French martinis. I need to wash down the truffle from the middle of that croissant. Sante. Oh that's sweet. It's like a creamy. This is delicious. Yeah I like this a lot. You can take a look at the inside. This is where all of the truffle actually is. You can see it in there. It's kind of strange but like I said it's going down.  Hopefully I don't drop my croissant. No you almost made me drop my croissant. I'm so sorry. I'm sorry. I can't do it. I tried. Hold on. I tried. I'm sorry. It was good. Some people like it. It's just not my bag. I knew what I was getting myself into. Beth gave me the warning and it's not like it's a bad thing. It's just something that I know I probably won't like. A lot of people always ask like how do you always like things? It's because I tend to steer away from things that I don't like but I just wanted to be adventurous there. You know what I mean? I was really fooled thinking that it was chocolate. Yeah like I really believed it was like a chocolate croissant. I have no idea why it does not say chocolate anywhere but I really thought that just a couple seconds before I order it and then my friend Beth told me and I was like you know what you're going to try it anyway. So at least I know. But at least I can say the frozen french martini top notch. Thank you. But with that we are closing down Epcot. What an amazing night. It was so fun just hanging out with friends, having some drinks, seeing the missing three Cabaneros and just enjoying Festival of the Arts. I hope you enjoyed the video. I enjoyed making it. We'll see you next time. Bye.


Well, hello everybody, I'm Mel Hauser. I use she, they pronouns and I'm executive director of all brains belong. Welcome to Brain Club. Tonight we'll be talking about access needs in healthcare. We'll be hearing from a panel of community members discussing their experiences attempting to access healthcare and as you'll hear, it doesn't go well often. Brain Club, of course, for those who are joining us for the first time, this is our weekly community conversation about everyday brain life. It's, so we've been doing this for a little over a year and a half now for purposes of educating community about neurodiversity and related topics of inclusive community. This is not a support group. This is not for medical or mental health device. This is for education purposes only. All forms of participation are okay here at Brain Club. As many of you have figured out, you can have your video on or off and even if it's on, we don't expect anything of you. We certainly don't need you to look at the camera or sit still or anything. So feel free to walk, move, fidget, stim, eat, like whatever, whatever needs doing. And everyone is welcome here at Brain Club and all formats of communication are welcome. You can unmute and use mouth words. You can type in the chat. There'll be about a 24 minute video that we'll play shortly. So during that time, we'll have only chat box going, but then we'll have plenty of time for discussion to follow if you'd like. In addition to affirming all aspects of identity, it's really important to us to respect and protect the group's collective access needs and give everyone a chance to participate. However, they are most comfortable. Observation is a completely valid form of participation, but in order to give space for folks with a wide variety of communication access needs, wanna just give space for folks to join in if they want to. So if you've shared out loud, maybe wanna keep sharing in the chat to give space for others. All right, so closed captioning is enabled. You just have to toggle it on if you'd like to use it. So depending on your version of Zoom, you might see the lab transcript closed captioning icon. And if not, try more dot, dot, dot, and choose show subtitles. You can do the same and choose hide subtitles if you'd like to turn them off. And that's my visual support to open the chat box. So I'll actually see it if anybody would like to use it. And by the way, direct messaging is enabled. So if you'd like to, if you're uncomfortable for any reason, you're welcome to send a private chat message. Okay, so as I said, we're continuing our conversation about access needs. So here we go. Before that though, I wanna recap why this matters. The status quo of neurodivergent health is not good. We know from the literature that there are extensive barriers to healthcare access darty at all in a study of autistic adults found that barriers to healthcare cluster in these three buckets. One is environment related, so related to interactions with the environment. The provider, so autistic adults perceive widely that medical providers have insufficient knowledge and skills and unhelpful attitudes that interfere with the provision of healthcare. And lastly, the system. There are so many defaults in the healthcare system that are a mismatch for patients needs. You must pick up the phone to make an appointment. You must fill out the 20-page packet to become a new patient. And remembering that anytime you have a default, anyone whose brain does something different is othered. And so those defaults contribute greatly to barriers to access. And the healthcare culture, which starts really early. There's a hidden curriculum for medical trainees and I know many of you have heard me share this before. Like in my medical training, it was very common that a supervisor, usually a burnt out resident, would make some comment like, up, there's a patient with a list. As though there were anything wrong with organizing your thoughts and writing. This is what goes on and patients feel it and it's real. Knowledge also relates to failure, to recognize autistic people and help people provide, like help people acquire a lens to understand their lives. And what we know from Zerbo et al in 2015, study out of Kaiser, less than 10% of primary care physicians would suspect their patient is autistic. If the patient volunteers information, shows interesting people, discusses emotions and can see the whole picture, despite the latter literally being one of the key strengths of autistic cognitive systems. Anyway, so this is reflective of the stereotypes that are part of medical education and are barriers to access. And as we talked about a few weeks ago at our all the things webinar, that there is often a widespread lack of knowledge about the physiology of autistic people. When you zoom way out and you think about how all of the, many of the medical problems that are commonly experienced by autistic and ADHD adults, this is a whole body neuroimmune constellation. Hey, Lizzie, are you around that you can pop the link to the all the things project in the chat? Checked. Thank you. So are everything's connected to everything project that Lizzie's gonna link in the chat. It takes a look at the patterns of medical conditions commonly experienced by autistic and ADHD adults and almost all of the autistic and ADHD adults in our medical practice, for example, that the standard medical management actually doesn't work for our community because all these medical conditions are intertwined. And when you fragment all the body parts and you fragment you treat these conditions as distinct and separate, as opposed to intertwined with the others that often results in patients not getting better. And lastly before we listen to our panelists experiences, last month, our theme was that of the double empathy problem. Double empathy problem is a term coined by Dr. Damian Milton, an autistic social scientist in the UK that Dr. Milton shown in this has been reproduced many, many times that it is the mismatch of communication styles, world views that results in miscommunication. It's not that there's one set of normal communication skills and then there's autistic people over there. It's that it's both sides. It's non-autistic people having a very difficult time perspective taking and misunderstanding autistic people. And as we covered last month in our double empathy and healthcare brain club about the double empathy problem between healthcare providers and patients is also a huge barrier. All right. And so with that, let's hear from our panel. You have to let me share a screen, I think. Brian, see if it works. Oh, okay. Now what do I do? Oh, okay. So I pulled it up. Thank you so much. You pulled it up. And then if you see the share screen arrow thing when you click it, there should be a little checkbox at the bottom that says share sound. It makes you select it and then you can. Oh, I see that. I just do like, I share my entire screen because I get confused, but you can, you're welcome to choose whatever you'd like to share. But how do I get the, how do I, so I shared sound. How do I get the- The video? Yeah. Do you see the direct message with the link in the chat? I clicked that. Yep. Cool. So if you just start playing YouTube. Oh, did I give you like a wrong link? Does that not photo or video? It goes to a video trying to access help. But when I, sorry, everyone, I hit share screen. I see the, do I hit desktop one? Yeah, yeah. Try that. You're doing great, Amy. You're doing amazing. Yeah. The motor planning of share screen is absolutely the worst thing I do all day. Does anyone see it? Not yet. Do you have two monitors?  So I have shared screen. A screen comes up and it says basic advanced file apps. And then it's like desktop whiteboard. There's no- How about the upper left corner? Does it just say screen? Is that a choice? Under basic? Under basic. No, it just says desktop one and there's an exclamation point. How curious. Mel, does the video have that background sound or is it like, can you mute and have it on? I think you can mute and have it on. I'm happy to try it too, while Amy's trying it too. I tend to have to use that. Thank you. I have the video pulled up like on my Chrome web browser. But when I hit share screen, it just, it doesn't, there's just like all these boxes. And none of them say screen or video details or Google Chrome. One says Google Chrome, it says unknown. I wonder. Mel, I would just need the link. I don't know if you're sharing your Sierra or Sarah. Thank you. There you go. Sorry. No, thank you so much. And so in the culture of interdependence, we've got it done. Oh, I guess you can't hit mute. I think it's not letting you mute yourself and still, oh, you might just have to hit the share sound button when you hit, when you, yeah, if you unshare. Okay. And then click the little button in the corner. I always forget about that one. Oh yeah. I don't think I've ever had to do that. It's tricky. You should be able to mute. That was not, I forgot about that part. Yeah, our house is chaos. What comes to mind? It's very hard to access health care. I think it's hard in general. I think our system is broken for pretty much everyone. But the amount of additional layers that come when you have, you know, in a way, any type of disability, just, it makes it truly a monumental problem. When you think about your experience trying to access health care, what comes to mind? This is going to be kind of a bummer of a conversation. So here's a content warning because I don't have a whole lot of really great health care experiences. I have medical PTSD. So when I think of the health care experiences that I've had, a lot of them have been very challenging, particularly from, I don't know, have been very challenging, particularly from communications perspectives, trying to make myself understood to the doctor and being understood. What comes to mind is a doctor or physician, or the nurse, you know, willing to understand that this individual is different than all the others. And how can he or she adapt to that individual needs? But with me, it's more about, you know, will this doctor, nurse position accept me for who I am, not what I am? Obviously been autistic my whole life, but I didn't know I was autistic. So I didn't ever knew what the challenge was. And I think about myself even as like a little child and someone had to put attention on me or had to touch me in any way. I think I had a real fear response that I'm just starting to really start recognizing. And I didn't always felt like I was asked permission. And that I realized in retrospect is huge. So I kind of didn't access healthcare or access that very, very minimally. Even in emergency rooms, like not being able to tolerate the environment and being, you know, potentially written down as an uncooperative patient because I had to leave before they were done with their stuff because I just couldn't tolerate it. What are some challenges that you faced in accessing healthcare? The challenges that are faced accessing healthcare is the accessibility formats, documentations that they give you new patients or existing patients, you know, forms that you had to fill out per meeting or pre-form meetings when you get there for your doctor appointment that day, which, as you know, is not accessible. It was very anxiety producing for me. The thing I think is like what I've recognized even in like a basic wellness exam, there wasn't a connection, I didn't have a connection to my body and I didn't have a connection to understanding why the question was being asked. So if I went to a wellness exam and they're like, tell me about your teeth and I would just be like, I don't know, I don't know how. And I, because I'd be so anxious, I don't think I had access like to my fully functioning like speaking. I just wouldn't know what to say. Nobody believes you. And then there are different levels of that in, you know, well, you look at it wrong or you couldn't possibly know yourself because you're this subgroup or that subgroup. And then there are the ones where, well, everybody looks fine, so it has to be fine. And I found out a lot as a parent that I would know something was wrong, but my kids didn't look disabled. They looked cute and perfect and just the right amount of chubby. But no, no, I'm just one of those moms. Yes, the difficulty healthcare system for me was the physicians of trying to understand my complexity of my learning knowledge and how I learn and how can they adapt to my learning? For me, it's more about, you know, not only speaking to them on that same level, which is very, very tricky, but also complexity of the healthcare system in itself because they're running on the medical terminology of the healthcare college insight. And when they use those or explain those to patients, sometimes patients like myself with disabilities cannot get it because it's, you know, it's like you're teaching a seminar at a university, but you're doing it with a patient. Well, she has staring spells. Well, she can walk a straight line and touch her nose so there couldn't possibly be any neurological difficulties.  You start to wonder, where is the problem? I have spent a lot of time not getting a lot of things and part of it was, well, maybe this is just something I'm not, maybe I am wrong. You know, maybe there's this big cosmic thing that 95% of the populace gets and I don't get because I'm me and I don't get it and I didn't know why I didn't get it then, but I just knew I didn't get it. But no, it wasn't me this time. A lot of different symptoms show up in the different symptoms of the body that were fundamentally neurologically related. On COVID, you know, and other, you know, medical issues like asthma, it's, you know, it's very common, but it also seems that shouldn't ever be ignored in a medical profession field because those could complicate, you know, the lifespan of an autistic adult or a child. Even though I talked with them about the other symptoms of the autism, my symptoms were brushed off as PTSD. And I can just feel when I walk in, I don't know if it's a safe space for me. And I don't know that it's like a safe space for me, like being neurodivergent, but I also don't know if it's a safe space because of the way that I'm gonna be treated and disregarded in terms of like, just go lose weight. I'm terrified to go.  And so like if I go get my blood pressure checked or something like that, there's this like quality of, oh, I can't believe that you have normal blood pressure. Like just like the things that people are saying to me, you know, I just recently had a routine mammogram and like what was said to me during that appointment was incredibly inappropriate. When I came to Vermont and, you know, I moved here so you had to get a new medical home, this old country doctor, nice man otherwise, took a look at me, weighed me and signed me up for like the entire list of every health test you could possibly have. And I'm like, I don't really want to pay for all these, but okay. And then I was like, no, we don't need to do the cholesterol. At least I know that one is fine because I'd had it done recently and I inherited low cholesterol from my dad. And he wouldn't believe me. So we ran the test.  And I said, well, should we worry because it's gone up six points in a year that's the most it's ever gone up. And he told me to be quiet. And I was like, okay. I couldn't really voice anything back for me because we're trained not to do that. How was your menstrual cycle? And I was like, fine, great. Well, when was your last cycle or whatever? And it was like, I have no idea. And I immediately like was yelled at. And what they said to me was it's my, I think of, and I started crying. And they said to me that it's my job. Like I always think it's a good sign when people are crying because it's my job to make sure. And if I have to yell at people to make sure that they're taking care of their health. Going through that time period was super frustrating. Trying to like get attention and going to like all these different specialists and not getting a whole lot of answers. So many of these experiences are me advocating for what I need. It took me five years to get a diagnosis for my autism. My healthcare provider said, well, we can't say you're autistic. Or like, you know, like my chiropractic care was like, no, there's just no way. Like just like not asking me, not curious at all. Like not saying what makes you think that you're autistic or how could we find you an autistic specialist to figure out or- To give you some idea how powerful it was. Number one, learning that I was autistic was like a kaleidoscope coming into focus for my entire life that made everything make sense. And I was also diabetic at the time. My blood sugars literally dropped 20 points overnight and stayed down with a self diagnosis of autism. I find that hypocrisy bothers me a great deal in general. And, you know, we're supposedly, you know, a society where we're supposed to take care of ourselves and be informed and make decisions and be self actualized and everything. And even if you're all those things and in many ways, if you are those things, healthcare isn't designed to work for you.  And if you actually are like, no, that doesn't actually affect me. This over here affects me. Nobody quite knows what to do with you. Doctors I don't think are really taught how to work with patients who don't fit the expectations of, you know, what the profile is. They're trained to make decisions in a very specific way. They need to in order to be really good with their time. Because nobody else lives in your body, but you. Right. Right. So you think after a certain amount of time you would become an expert in it. Yeah. I mean, that's kind of how I look at mine. Yeah. Thanks. Knowing that just because somebody shows up in front of you and may appear normalish enough, but there needs to be given some amount of space or grace to allow for the fact that maybe this person has other things going on that you don't know about. I try very hard to communicate, but then when I get frustrated I become very blunt. And the new doctor I have at least can deal with that. But a lot of people in healthcare are still sort of trained in that, you know, I am in charge and you are here at my whim sort of thing. And, you know, we must be respectful. There's so many different layers of those nuances that I'm like, no, I had to wait 45 minutes for you. I could never go back. So in that one moment, and I went to therapy and we're starting to get all these strategies of how do I go back? And that's when I found ABB. Really, basically I was going through another round of low mood and fatigue and sort of growing hopelessness about the possibility of having a future. And I had pretty much exhausted mainstream healthcare options or at least the mainstream healthcare options I was willing to try. And I heard this, I was sitting with this friend with Overcoffee who was the director of the Vermont Disability Council and she was raving about this new doctor in Montpelier who was out as autistic and starting a medical practice. What do you wish healthcare providers knew about neurodiversity and neurodivergence? It's really like, I want them to know about ABB. I want them to know what Mel has figured out. I want them to know this connection between all of the things that I wasn't waking up in the middle of the night with panic attacks. I was waking up because I wasn't breathing because I needed a sleep study. I was waking up because I have dysautonomia because my autonomic nervous system doesn't work correctly. Everyone was putting this on me that like my thoughts were causing these panic attacks. Like I don't know who has panic attack. I wasn't having a thought in the middle of the night. And the way in which Mel has reframed that it's my fault that I'm not doing something correctly that I'm broken, which is, I feel like what the healthcare would say like you're not doing enough. And what I hear Mel saying is no, the medical system isn't doing enough for you. And so that's what I would love to say is that if the medical care system didn't blame people who have difference that instead was curious about that. And we have made some, not enough, but some progress over the last 40 years. Learning to accept people a little bit, to give people a little bit more grace, a little bit more space to be themselves when we can tell they need it.  And if the cranky people are the people that we're relying on to give us the referral, to actually listen, to think about what we're saying and try and put the pieces together in the areas that we aren't knowledge about because nobody can know all of this stuff. And if they're just grumpy because we don't fit what they think, no. For me, I see that process of the healthcare industry is starting to come around and understand neurodivergent individuals and neurodiversity. Having curiosity around my experience, like asking me, do I understand where the question is coming from? Providing a space that I can feel comfortable in and safe in helping me make connections back to myself, not making presumptions about my body but asking me if that makes sense. Finding ABB, he's just like, I've said this to Mal, I've said this to a lot of other people, but it's like, I just know I'm gonna live longer. I can't imagine being yelled at. I can't imagine not being cared for. I think the whole first wellness visit that I had with Sierra, I think I bawled the entire. Like, I just remember my sure being all wet because I just couldn't believe the care that I was getting and I couldn't believe the access and I didn't even know what I needed. I had zero idea and that there was all these different options and so it's just so radically different for me. The idea that we can just say this is my access need and if we can take that step to say, okay, we're gonna actually look at this problem. What is the actual problem with access? What is the actual problem with communication? What is the actual problem with coverage?  So I think that's what we need. What I want providers to do across remote state life is to understand the individual needs. If we can understand your needs, we need to be respected in the same way. And for me, it's more about having that work individual participant relationship. Basically, you want the doctor to get to know you better vice versa, the patient should get to know the doctor better. What helps move things along quicker and make the process more easy for both parties? The doctor, the nurse and the physician at large. Plus the individual patient would get to know you better would feel at ease coming back to those services. So I did the intake, which invited me and then that invited me to share like among other things, what I care about and also offer to have a provider spend time discussing things I cared about which really impressed me and among other things like the possibility of sort of like how do you structure an appointment in a way that it's comfortable to you when you feel comfortable? And I thought, and things I had never thought about is even possibilities of sitting in a doctor's chair with a comfortable blanket or pillows or something like that. So that was like, oh, I could, and so that it was just nice that people thought about things like that. And then I was sitting, when I was sitting in the waiting room for my first appointment, there was this a short, a really short book written for kids and it basically told my life story of losing it. I remember reading it waiting for my first appointment. So sort of losing it and having these public meltdowns that I was so ashamed of and it explained those things in terms of the flight, the fight flight response which I was totally on board with already. So, and then there was also something on the wall in the office about polyvagal theory which I was also totally on board with already and thought that I was impressed that ABB knew about and was thinking about. So at that point I thought, wow, it looks like these people speak my language. And what I wanna see for it is, you know, that says a belonging within the healthcare field industry but also understand everybody's access needs is different. We're all different, we're not the same. And for me, it's more about trying to connect I had a universal connection between each industry or each systems and try to make it a collaborative system where it's cost effective and more efficient because everybody wins that way and it's more collective than having these barriers or what you call silos that are preventing us from providing those services in the first place. And then this is like a sincere attempt, a really sincere attempt. The most serious attempt I've ever seen in a medical practice to meet people where they are at to serve everybody well and to leave nobody behind. It's an incredible effort to make groups and meetings and medical care accessible and interpersonally, practically, financially. And I love that the practice is really developed in consultation with patients and like we're in these advisory groups and invited to join them and that what happens in the practice after that is informed, how the practice develops is informed and driven by what we say in those meanings and basically informed and driven by patient needs. I just didn't know that I would make it.  It's not only do I live a longer life because I have the healthcare but now I have community and making friends. I feel understood. I feel like all of the things that seemed so isolated in the issues with my health are now understood with very simple medications. You know, it's like, it's just changed my relationship to being able to get up in the morning, like limited my limbic response so that I actually can be here right now speaking to you. All of these things that ABB are providing for me and then it's like the other patients are just, I've learned so much. This is just like so amazing to me. There are these amazing group medical visits where Mel and Sierra offer this cutting edge information but they also allow lots of time for questions and in-depth discussion around the areas that concern us. And beyond that, and there's more because there's also an opportunity to meet others in the community who are going through the same or similar things which then gives us the opportunity to learn from each other's experiences and to really value and feel valued by each other and feel a lot less alone and a lot more hopeful. So I mean, the first thing I just wanna say is to thank our panelists, Sarah, Matthew, Amy, Linda, Zeph. As Sarah said in the chat, we are so grateful that you are willing to make yourselves vulnerable and share your experiences so authentically. And I think like the power of your stories and like there's like a million me too is in the chat. It's like all the people who think they're the only ones. So when we think about access needs, there's so much here. So first off, if folks are not, I mean, like most of us didn't grow up thinking through a lens of access needs. I'm like, what are my access needs in a given situation?  And even if you did, you don't know what you're allowed to ask for. And that's one of the reasons that in our medical practice, we focus on universal design principles where we're trying to offer things in multiple different ways and giving people freedom and choice to pick what works for them. Because I think Amy actually said this in their remarks that like you don't know what to ask for. Hi. One thing I've been thinking about with access needs and expressing my access needs. Well, first off, I don't know what they are. I don't know what I need. That really resonated when Sarah said that. I really don't know what I need. And then I'm thinking in situations where my access needs are not being met, my nervous system amps up, the stress response. My response is flight. I run away. And that response triggers, it turns off the Broca Center in the brain which is the language center. So when I'm overwhelmed, I actually physiologically cannot speak. And I think others probably experience this as well. So to express my access needs in the moment is near and impossible. I've made a couple of cue cards. I've laminated a couple of cue cards that I share with people. I practice with people who are safe, who I feel comfortable and safe with that I can say I don't need a whole lot of context when I say no to them or when I express my access needs. So even if my access needs are being fully met and acknowledged in a situation, I still express them with those people because it helps me to tone my nervous system.  I've been here before. I remember I did this. Let's give it a try again. And so I'm slowly, I feel in this whole autistic experience of mine, I feel like a fern. I feel like I'm unfurling. I feel like I've been clenched really tightly for about 57 years. And I'm just starting to unfurl. And I'm really kind of, well, I'm terrified, but I'm also really very excited and hopeful to see what blossoms, what this next phase of my life could be now that I have this new knowledge and understanding of who I am. Thanks, that was a lot. That was amazing.  So anyway, thank you for sharing that. And I think you're modeling, practicing this lens and this framework around safe people when you have access to your cortex, including the ability to communicate intentionally. Yeah, thank you for sharing. There's lots of support in the chat for you, Moonie. I don't wanna take up too much space because I was already on the video so much tonight, but I just wanted to say that watching that, because I haven't seen that in so long, it's like that almost feels like in such a distance pass for me, that my whole relationship and my connection with Sierra and Mel and other patients and it almost felt like, oh, it's like such a different person now. And I went through a really hard time this summer that almost felt like past experience I would have had if I didn't have ABB. And what maybe like would have taken four years to figure out in the past was like six weeks. I mean, it was just like, and it was just like, I felt like so many people in the community rallied around me and so I just, the thing that was ringing in my ear was just like congratulations, you're autistic. Like that's what I received eventually. Like that's what I got was congratulations, you're autistic, which is everything I needed to hear because I'm really proud to be who I am in this community. So thanks for listening and all your comments and everything. Amazing. I just wanted to share something really quickly. Also, hi everyone, I'm Nora. This is my first call. Just at the beginning when we were having some technical difficulties, seeing how well everyone like cooperated and just like lifted each other up. I don't think I've ever been on a call where there's been technical difficulties and it wasn't like, it didn't feel like there was some kind of vibe of somebody getting blamed for it. That was just so wonderful to see and to be with. It's amazing. And thank you for sharing that, Nora. And I think that like one of the other things that really stands out to me, anytime someone notices something that seems so basic, it's humbling, right? Like it's humbling that that stands out. Why does that stand out? Why is it that like most people in many other environments see something else when really it's not that hard? And I think like part of what I think is happening here is that we are bringing people together who, I'm like losing the ability to speak. It's like that our people coming together who like can reimagine something else, can reimagine a world where the Zoom doesn't work and the team comes together and people jump in and chime in and support one another and figure out how to support and compliment one another's access needs. Like that's how it can be. All, that's how it can be. And so it's my hope that the more times we see it and we experience it, then we know what's possible. And then what follows is we come to expect it and demand it everywhere. Laura. I feel like Mel, you've introduced so many of us to that term, the culture of interdependence. And I feel like this community has helped me feel motivated to use that in other areas of my life and to try and normalize that we all have different needs and that we can support each other instead of blaming each other or feeling bad for what our needs are. And I feel like that's trickled into my family life and my work life in different ways. And I'm just really appreciative for this community for always role modeling to me how to be a community. Amazing, thank you. Getting in the chat, Michelle says, I think you all have deliberately made the ABB and Brain Club a socially connected community and each of you is part of the community, right? This is more than a nonprofit organization offering services. It's the culture of interdependence. Everything is connected. Well, I want to slip that sink in. Yes, right, it's we're living and breathing it. As Amy says, being provided some braces and access need, it seems to be easier to find around ABB. Thank you, Amy. Erin. Hi, this is my first call. I just, I don't know, I'm kind of blown away by you guys. I just never experienced such safety in a group, especially on Zoom. It's just, I don't know, I'm quite touched. So I just wanted to share that it's just really beautiful, the way you guys communicate. And it's so, it should be so normal. And it should be so, I shouldn't feel so blown away, if that makes sense, and simultaneously I really am. So I'm just glad I came across you all. And yeah, cool. So amazing, I'm so glad you're here. Yeah, I think that, I mean, what we did and we're, you know, we're a new organization, we'll be two years old in November, but I think what we just started doing was showing up. We should have showing up authentically and being like, hey, you want to show up authentically? And then people are like, I don't know how to do that, but okay, I'll try. And that's, yeah. As we wrap up tonight, I think that I again, more really want to thank our panelists for sharing their experiences. And I really appreciate all of you for being part of this discussion. Thanks everyone, see you next week.