Welcome to this session on competitiveness. My name is David Schlesinger. I run a China in media consultancy. I'm the former editor and chief of Reuters News globally and the former chairman of Thomson Reuters China. Before we begin this afternoon's discussion, the forum has prepared a short video to introduce the subject. So let's run the video now. Uncertainty has eclipsed the world economy for a long time. The overshadowing sovereign debt crisis in Europe, the risk of a weak recovery in the United States, combined with the slowdown of economic growth in China and other emerging economies, has cast a cloud of doubt over the global economy. Within such uncertain times, a high level of competitiveness is the best strategy to ensure resilience and sustained prosperity. The Global Competitiveness Report seeks to explore and define the common factors and policies that create sustainable prosperity for economies. In other words, we're looking at their productive potential. The considered factors range from the basic to the more complex, political institutions and governance, infrastructure, macroeconomic stability, as well as the quality of human resources are all taken into account. The country's labor market efficiency is examined, as well as financial and goods markets, and how well these factors are allocated within the economy. Innovation and the development of new technologies are also critical for more advanced economies, looking at the capacity to develop new products, improve business models, and enhance productivity. Switzerland remains highly competitive, topping the rankings for the fourth year running, with the Nordic and the Asian Tigers also performing strongly. Some Western European countries, like the Netherlands and Germany, also feature in the top 10. But Southern European countries such as Spain, Portugal, Italy, and particularly Greece continue to struggle. The United States continues to lead the way in innovation. However, a number of weaknesses are chipping away at its competitiveness. The U.S. fiscal imbalances and continuing political deadlock over resolving these challenges means that the country falls two more places to seven. Its fourth year in decline. Russia and India have also weakened in recent years, while China and Brazil have emerged the stronger leaders among the BRICS, fortifying their rising importance in the global economy. For more than three decades, the Forum has identified competitiveness as a key issue and indicator for future prosperity. And we've stayed in tune with the latest developments in thinking. In order to ensure rising prosperity in an uncertain future, we aim to integrate the concept of sustainability more comprehensively into our broader competitiveness research, capturing the extent to which countries are addressing social and environmental concerns. Sustainable competitiveness is a new concept and a potential solution to the ongoing global economic challenges we face. And that innovative thinking is detailed in this year's report. The Global Competitiveness Report is one of the leading tools for benchmarking competitiveness, both now and for the future. So what that video shows is a very balanced scorecard approach for looking at competitiveness and a very sophisticated approach, but one that in the end still leaves developed economies very much dominating the top and the ranking of the top ten. I think its Switzerland, Singapore, Finland, Sweden, Netherlands, Germany, United States, United Kingdom, Hong Kong and Japan. So what we want to talk about this afternoon is what countries and companies can do to become more competitive, what makes a winner, what you can train for, what you can develop, how you can develop your people and your institutions to actually have much more long lasting, sustainable competitive advantage. Joining me on the stage, Huang Mengfu, the chairman of the All China Federation of Industry and Commerce from China. Prime Minister Helle Thorne-Schmidt and Prime Minister Helle Ramey of Rwanda. Marie Gabrielle Inaykin, State Secretary of Economic Affairs of Switzerland, Mustafa Muhammad of Malaysia and Gordon Orr of McKinsey, who studies companies and helps companies become more competitive for a living. Welcome all. Huang Mengfu, let me start with you please as the host nation and one that is rising up the rankings of competitiveness, in the top ten. What is your vision of what Chinese companies can do and must do as part of the national development to become more competitive? Although Chinese overall speaking generally speaking Chinese companies are not the best of most competitive but some of the Chinese companies I think they are improving their competitiveness. They already have this kind of global influence and I think this kind of for example the number of patents they registered and they owned and the total number of the patents created by Chinese company ranked third globally. So I think if we look at corporate competitiveness the innovation capacity is the key. It is very innovative and they can always adapt themselves to grasp to see opportunities in the market and then they will be very successful. So I think the Chinese companies are now very much paying a lot of attention to investing in science and technologies especially innovation. This is a very important foundation for future innovation. Secondly is investing in human capital. Human capital is the very key for innovation so to attract most of the best talents into companies and corporations will be another successful factor for behind competitiveness and thirdly in order to be more competitive you need to be global. So you need to be globalized and you need to compete in the global market so in order to be competitive you need to be very competitive in the global market that means you can have the access to the global capital market you can have access to the global human capital market and also you can better tap on the global resources to develop your own companies I think such kind of globalized strategy will help you out. Prime Minister Krebs, you could talk about some of the developed economies of the West, Nord economies in particular do you think there are particular lessons that can be brought from their competitiveness in the future? Yes I do because I think what this video is showing as well and what the World Economic Forum assessments of competitors have generally shown is that competitiveness is a very complex issue that might have been a time where we thought that low taxes, low regulation was the best path to become highly competitive but I think what we are understanding more and more is that that is perhaps not as simple as that and that being competitive is about people, institutions equal opportunities not wasting talent in your society women of course as well which is a waste of talent in many countries because you don't have equal opportunities so that is what competitiveness is about and an example I think is interesting Denmark is not on the top 10 this year we are number 12, we will improve that for next year but what I do think is interesting is that you still see the Nordic countries as some of the most competitive in the world and the Nordic countries are of course different countries but we still have a common denominator which is that we are countries with fairly high taxation a lot of regulation in terms of environment and health and safety in the workplace but also a fairly large state and from a traditional point of view you would perhaps say how can that be competitive the fact is as you have shown yourself during the years that the forum has shown itself that it is actually competitive and I would actually argue that the countries that have had a strong state high regulation and of course good economies are the countries that have come through the crisis in a better way than so many other countries and when I say that we need a strong state and a strong welfare state of course I mean in a healthy way in a way that is sustainable from year to year a system that can be paid for year to year and I think there is a very strong point particularly after the crisis or at the when we are on the edge of exiting the crisis to argue that some of the countries that have had regulation in terms of environment in terms of strong state that can provide for equal opportunities investment in education and investment in infrastructure those are the countries that have come that are exiting the crisis best and those are the countries that have the future in them in terms of competitiveness Interesting thank you President Kagame from a position of a country that is trying to rise up the competitive league table still in the 60s how do you view the role of the state and what can you do to actually help Rwanda and what can similar countries do to become more competitive Thank you competitiveness first of all builds on a number of things builds on activities on conditions on efficiencies thereof but it also builds for a purpose it's competitiveness for the purpose of growth where it is or farms it's about growth how do they grow with the nation it is how that growth trickles down and impacts on people's lives does it make the difference and that's why I agree with the point that has just been made competitiveness builds also on the compact between the top and the broad bottom meaning the people what is the how do the two interact to make sure that there is overall growth and therefore that growth also leads to the difference for each individual in that government has the role to make sure that it acts in a partnership with the private sector to make sure that the vision that has been articulated within which they work serves both and both serve the vision so there has to be a clear connection and responsibilities where the government should be investing in creating conditions where the private sector operates and thrives in which case therefore it comes back to the same point made again by others earlier it's about building institutions it's about infrastructure it's also about playing by the rules which is regulation how is therefore you have to look at appropriate ways of regulating these activities to make sure that there is always and on which innovation and entrepreneurship will thrive and affect and touch every life of the nation so government has responsibility to play its part in that in playing its responsibility with the people and not doing things for people but rather making sure that they allow people and there is always the potential any people wherever you go thank you when you look at Switzerland and Switzerland's long standing position at the top of the league tables what is it that is particular about Switzerland and what is it that can be put into a playbook that could be distributed more widely that others could copy well I think probably the most important thing is the general framework conditions that we have and have had for many years many things have been already mentioned rule of law, institutions that work I think that has been the main issue not deviating from those and strengthening those if possible the second very important issue is the issue of human capital and education we have a dual system of vocational training and academic and I think we have been very well served although even the forum says there is more enrollment in academia we think it's not what we need what we need is more enrollment in technical like engineers and mathematicians and people like that but you can study this in Switzerland without going to university and the third thing is of course innovation and when I look back to the 90's even beginning of year 2000 we were not so good at innovation we became better also with the help of many good people the skills we needed and we didn't have in Switzerland and which helped also during the last years to make a very robust economy so I think innovation and the unique cooperation between industry and academia the government remains a little bit in the back we have some we can give some help but business has always to participate so it's never for free it's never subsidization and it is our firm believe that industrial policy is not what we should do last year when it was very difficult with a very strong Swiss franc and suddenly people came and said we can't cope anymore because even very competitive export industries were feeling that they were losing margins and losing out markets even then we said it's not the right thing to do so then the national bank did the right thing and we continued just to ensure that the general framework conditions were good and that's how I think we could keep the good position we had I hope it continues it's difficult in difficult times and with a world demand going still growing but growing less fast it's difficult for a country so heavily dependent on foreign trade that's why another important thing is open markets and open trade I think that leads me to my question for the emerging Asian economies have certainly had a roller coaster ride over over the last several decades what are the specific lessons about what you must do during the bad times to prepare to keep the country's competitive 97, 98 of course those are very difficult years and some of the East Asian economies have been able to reform and transform and in general those countries which have been able to enhance the role of institutions macroeconomic stability implement measures which improve talent for example these countries have done well I'm talking about my own country Malaysia for example we learnt lots of lessons during the 97, 98 crisis governance was improved the banking system was strengthened and this has enabled us to do rather well in the rankings and some lessons we learnt and of course we had a recent European-American crisis American subprime crisis and that is still well behind us but now we are settled with another set of challenges so if you are competitive we will be in a better position to overcome these challenges having said that I just want to relate the correlation between countries and the level of competitiveness there is not a direct relationship but there is a very strong relationship between the level of incomes with level of competitiveness you look at the top five countries Switzerland, Singapore Sweden, Denmark and Norway and all these countries and at the bottom you have Burundi, Sierra Leone and there is to me there is a big difference between how competitive you are and the level incomes and that has got to do with other panellists have said in the last few moments when you have high incomes you can have good social protection you can have good institutions you have education science and technology innovation so in our own situation talking about where I come from in Asia and Malaysia this is a challenge for us having lots of resources to move up the ladder is so important to improve the quality of human talent education innovation S&T for as long as we do not improve on those funds it is going to be very difficult for us to move up the chain the index finally a few words on the role of government we believe governments play a very important role not only in terms of setting rules and regulations following the rules and regulations but also in terms of taking the lead and in our case as far as East Asia is concerned and ASEAN is concerned we believe government which is pro-business governments which understand the challenges being faced by business this is key to ensuring that companies in our part of the world are competitive so those are some thoughts I would like to share with you at this point in time thank you Gordon or you spend your life looking at companies and trying to help them become more competitive are there things that you see in common companies that they do wrong and things that they in common that they really should do better first thing I'd observe from spending 20 years in North Asia is just how quickly the competitiveness of a country can change and how effective governance really within a decade can transform the business environment and its attractiveness I think you we looked at a couple of things from a business point of view key enablers where we see broadly defined public-private partnership let me talk about talent development first and then maybe harnessing innovation to go with that so I think in enabling the right talent development and mobility to become more competitive highlight four things first just to echo what you said ensuring you're maximizing gender diversity in the workplace just to take a couple of comparisons entry-level white collar in China is 55% women in India is 29% at mid-level executives in China is 21% which isn't great but it's an awful lot better than the 9% in India making sure we have the policies and to capitalize on the talent pool the second is to capitalize on international talent to fill the gaps making sure we have policies that make it easy for companies to bring the required skills whether it's on a temporary or permanent basis as individuals and also for their families creating the right ecosystem of allowing international schools the contrast between say a Shanghai where there's a multiplicity of international schools and a Seoul where there's very few makes people's choice very easy in many instances when they're deciding where to live the third point that I would pick up on is support in the education system for developing an innovation mindset and critical thinking particularly when we're emerging from an education system that emphasizes a lot of rote learning creating not a complete institution but perhaps something in parallel that allows and the experiment in Shenzhen of launching one of the first Chinese private universities outside of the national is an example of that right now and then finally, I think it's important not to forget when we talk about talent development and mobility looking after second and third tier cities it's very easy for policies to end up sucking all of the talents into the Beijing's and Shanghai's to take a particular challenge that China has today yes, you can put incentives out there to help encourage multinationals to invest in the second and third tier cities but in some ways the big challenge today is keeping the private Chinese companies. I spent time this weekend with the leadership of a multi-billion dollar private Chinese company that's headquartered in a top five city and the subject of conversation is do we have to move our headquarters to Shanghai to keep the talent and that's bad for China, it's bad for the city and I'm not sure it's actually great for Shanghai if everyone gets sucked in there as well so maybe I'll just stop there at this point, thank you. What I'd like to ask the group is whether it actually continues to make sense when we think about competitiveness in terms of individual countries or are we moving to a time when we have to think much more about competitive regions and much more cooperation between neighboring countries to create an environment that is more conducive to business. Any thoughts on that? Where I come from again, ASEAN we are 600 million people GDP of one trillion growing middle class and every income every GDP growth of five, six, seven percent we have been talking more and more in terms of a group and I think this is a very important point although it takes a while for us to graduate because we have to promote our own countries which is very important we all come from different countries and the number one priority will be our own country but where we come from we're beginning to think in ASEAN terms if ASEAN is becoming a more competitive region and by the year 2015 when we achieve what we call the ASEAN economic community we're going to be even more competitive and what's interesting is that we're beginning to attract attention of two sets of countries and also companies on one hand countries like China and America and Russia and those powers and world they're dealing with us because they're dealing with us because they're dealing with us because they're dealing with us because they're dealing with us because this is a force to be reckoned with so countries so to speak knocking in our doors to engage with ASEAN so this is a manifestation of how relevant regional groupings has become in the last few years secondly of course companies in the country but now they are looking more and more in terms of 600 million people growing middle class and also bigger GDP so it is certainly relevant where in our part of the world regional groupings we're beginning to think more and more in terms of regional groupings the challenge of course is to make sure that we get there in 2015 we are going to create this ASEAN economic community but we are all committed all of us in ASEAN I am trade Minister Malaysia for example we meet on a very regular basis and we do monitor progress in terms of achieving the goal of creating an ASEAN economic community therefore I would agree with you that in the part of the world I come from this is becoming more and more important and more relevant we've been recognised by countries and also by companies how much you can benefit from your region also being competitive and there's absolutely no doubt that if you're part of a competitive region like Denmark is part of the EU you can become more competitive and I think there's a number of reasons for that but one interesting reason is of course that there's also a peer pressure to be amongst the most competitive in the world I mean I shouldn't bore you with a relationship between Denmark and Sweden for example but one always want to be better than our neighbour so it's a very high pressure and a good pressure as well to have that competition within countries we measure ourselves in terms of the competitiveness in Germany, in Sweden in the UK and this is important to us but one thing I'd like to say because it's so fashionable in Europe right now to blame everything on the euro as such and I think one lesson that we have learned from this euro crisis and the European crisis is that countries matter and what you do in a country in terms of structural reforms tightening your budgets becoming more competitive it does matter so one thing we have learned is that we can't blame the crisis on anyone else we have to take responsibility responsibility ourselves so by saying that I'm also saying that even in a region like the EU you see vast differences in our competitiveness because we have realised that what you do within each country actually matters I think it makes a lot of sense in many ways for integration to take place in the part of the world I come from in East Africa the African community comprising of five countries coming together with a corporation of 140 million people we have found that this is a very interesting relationship however complex it is more beneficial in terms of real economies of scale where there is even depending on the level we have started from each individual country within that region together we can overcome certain challenges by being together rather than by each handling our challenges individually or separately and this does not take away responsibility for each country to work on its competitiveness but it's also the aggregate of that that makes the region competitive we have found that coming together, working together makes it easier for example to build infrastructure that serves the whole region we resolve many of these challenges together as we maintain and keep building the competitiveness for the region we also work on the competitiveness of each nation as a constituent part of this larger area so we have found I think this is the best way to go and also that's how companies work across this region and beyond even in terms of trade and other activities we found having made it easy for people to operate within this integrated space it makes it easy for everyone and very beneficial several of you mentioned creativity is being important in the competitiveness challenge but how do you actually stimulate that or does it just have to happen spontaneously are there specific measures you can take to make a place a region, a country more innovative and creative maybe you could start by giving one example from this part of the world that I think a lot of people look to if we go to Taiwan and we talk about this we have a new science park which is now home not just to two of the world's greatest semiconductor companies but 400 or 500 additional companies that cluster around it this came out of a public-private partnership to create an innovation hub in Taiwan in technology where the government set up ITRI and ITRI went out and imported not just engineers and talents it went out and bought intellectual property and brought it into the country and made it available to those startups and then yes it provided some incentives but I think most importantly it provides a completely transparent and efficient business operating environment one stop government access with it within the park quality location and facilities close to the airport and then it just created this domino effect of clustering over time wrapped around it clearly a respect for intellectual property as a prerequisite for encouraging people to shift from being dependent on the government providing the intellectual property to companies and individuals creating their own just one example but clearly I think there are multiple in the region that have worked one challenge we have in developing countries is to improve collaboration between universities and industry and this is where the Swiss and some European models have been very useful and as a matter of fact we're using that as a benchmark this is something that we've not done too well and we believe by improving this collaboration between universities and industry and in the process also encouraging entrepreneurship this will be very important to encourage innovation innovation we believe is central to this whole issue of competitiveness in fact it is probably the most critical element and it's got to do with the mindsets it's got to be culture of learning in schools and it's got to start from young from preschool and schools and universities so that that's a challenge for all of us and in our view rankings have been very useful we follow these rankings very closely it affects the debate in my country as to what needs to be done what further reforms will be done but I just want to share with the panel that in our view this is critical innovation is critical and the need to improve collaboration between universities and research institutes and also companies that's something that we can emulate from some of the countries in Europe maybe as I was as Switzerland specifically mentioned I think probably the most important thing is actually the whole schooling system and the good university and then specialized school system as we have for technological issues this has been attracted a lot of foreign years coming the best actually coming to Switzerland and then staying there also for a few years and continuing to work in the country the second is of course the good cooperation between academia and industry and this has been working very well it is also a little bit supported by the government because we support projects we have a commission supporting projects done by both and the business which is the cooperating part just pays part of the contributes to the cost of the project but it works very well and last year we had a lot of new projects in the middle of the crisis people said we have to do something otherwise and it was very the objective was very strong to be strong in that the other one is also that we tend to see government as doing basic research but applied research is done by the company so we have a clear cut there and finally big firms and SMEs cooperating together big firms usually have the money but small or very small firms usually and this is you know 98% of companies in Switzerland are working with big firms and they have a lot of big companies and they have a lot of big enterprises there usually a lot of creativity is in these companies and so the cooperation of both works very well and is also what we think one of the strengths of the Swiss innovation I would like to go to the audience now to see what questions you have there are mics please wait for the mic and keep your questions two questions one first of all admiration for Switzerland and Denmark in spite of high taxation they have proved to be so competitive and both the ladies gave very valid reasons if you keep the question short question is you said that in Denmark you are targeting to take it from well to top 10 so what are the one or two things you will do so that other countries the question is for president Kaga a very simple question a landlocked country may have challenges in manufacturing will the right competitive strategy be to focus on services like IT just a thought I will have your view thanks very much that's an excellent question I think we are moving from 12 to 10 I became the leader of my government a year ago I think one of the things that you get measured on in Europe these days is your capacity to take decisions and in terms of structural reforms of your economy and what we have spent the last year doing is taking decisions on structural reforms we have made a tax reform we have made an early retirement reform we have adopted many reforms that will change the economy one of the things that will put some Europeans countries apart is their capacity to take decisions and then they will move into a different league and I think with some of the decisions that we have taken this year we are moving up there for next year landlocked countries and IT yes it's true our country is landlocked so we have had to make certain choices in terms of developing in investing in high value products but also focused on IT and services thereof in fact that's what explains the area point that was being discussed of the value of bringing together academia private sector companies and government we have around this for example established special zones where to give you a feel of that we have a partnership between one of the outstanding universities in the United States coming to Rwanda operating in that zone developing our people to have certain capacities and along that we have been able to attract certain companies to come and work around that high institution it is with Rwanda specifically targeting IT and other areas of technology and we found companies are coming in to invest with that and the government has had its role in facilitating that to happen so that is all to meet the challenges of landlockedness thank you it's still in the back thank you Mr. Chair my question is for Mr. Huang last year if we look at top 100 the profit margin is slowed down so we would like to get your opinions on some development trends Mr. Huang I think I think private companies in China they are suffering from a smaller and smaller profit margin this is a general trend all companies in China if we compare Chinese companies with other similar companies their profit margin is actually the jobs in the profit margin is actually not that big and last year we have experienced we were experiencing some problems some financial institutions they have a super high profit margin some financial institutions on the balance sheet 50% of the profit margin of private companies are actually earned by financial companies so and also some monopolized sector they also enjoy a very high profit margin but other private companies had really difficult time last year so I think in the future we are going to see a few couple of changes so things will be different perhaps abnormally high levels of profitability for many Chinese institutions in the last few years and the financial speculation that many private companies have undertaken boosted their profits but underneath the surface their profits were lower and they were benefiting from a super normal period of growth when capacity in many industries was lagging behind demand and now it's getting into reverse it's payback time I want to ask my question is for Mr. Huang two questions first one now we have more and more multinationals to relocate their manufacturing center to other countries in East Asia they believe that Chinese is China is now losing its manufacturing center and some of our scholars believe that this is a necessary process for economic transformation what would be your view on this second the policy paper used by Central Government to encourage investment in SMEs or private companies by Central Government why this policy paper is not that effective first thing first question I think if we look at national competitiveness in the globalized world each country needs to locate precisely its unique strength to improve its competitiveness if you fail to identify your own unique strength and that you probably will not will fail in the global market so over the past 20 years China made a China identify its unique strength and now China is becoming a manufacturing center for the whole world so for those low profit market manufacturing sectors they are going to shift their centers to other countries this is a very normal phenomenal process but I believe China is a big manufacturing center we still maintain its unique strength in the long run although we have a certain working labor cost but over the years China managed to accumulate a very comprehensive sophisticated manufacturing system and supportive environment so China still has its unique strength maybe in Vietnam you have a cheaper labor cost but maybe in developing in Vietnam they don't have our supportive systems for manufacturing activities of course in the future China is transforming its economy focus on labor intensive and labor intensive to shift on to other sectors so I think in the next 10 to 20 years China is going to build more pillar industries in Chinese economy because every year we have 6 to 7 million college graduates and we have more than 50 million researchers and scholars so I think with this kind of help we are going to successfully transform our economy Thank you, I'm David Cameron Member of European Parliament East of England including Cambridge I wanted to ask the panel about the impact over regulation I'm a great respecter of Denmark and it's good to see the Prime Minister here but the EU as a whole I believe is wholly over regulated the commissioner responsible So let's go to the question about the importance of government can there be too much government So we start with Denmark I think it's hard to argue that you have too much I mean of course there can be too much regulation but if you look at my own country you have a tremendous amount of regulation in terms of health and safety in terms of environmental standards and other legal framework and I would actually argue that during the times where we have had high regulations in terms of environment what the Danish companies have done and I see some of them present here today what the Danish companies have done is to invest in research and development so that they can live up to those high standards in terms of environment and energy efficiency and the situation today is because they had to live up to high standards they are highly competitive at the global market today and I think this is a very interesting story where you regulate and actually push the companies in a positive way so they become more competitive at the global market you could say the same for food safety we have a very high regulation in terms of food safety and there's no chance that now we have agricultural producers and agricultural experts in food safety operating here in China because this is exactly the type of product and the type of knowledge that they're interested in now so I think you shouldn't be too scared of regulation I think some good things can come of it because you can create you can be cutting edge in your business and use that as a business opportunity Yes, really what some of us meant by regulation was nothing to hinder good progress in terms of innovation or entrepreneurship or doing business it's a regulation in terms of enhancing high standard and quality and also setting the ground to the point that when people come to do business in a place where they don't know what to expect and what one expects is what the other expects but in terms of doing business they are as free to do that and definitely they will benefit more from how they have done where in terms of what they needed to do but regulation did not mean in any way hindrance or an obstacle to freedom to operate but it's just simply to enhance quality and standards and create predictability in the area you are operating in Thank you I'm Annette Nays from the China-European Business School, CIBS I have a question on the change in the competitive rules of the game because the economies are transforming and the new economies who are fast growing have a different balance between the state and the market so there might be a different business environment in a decade from now how do you see that and who are better placed, are at the western or the new champions in this new business environment with a different state and market balance That was going to be my final question for the panel but thank you for asking it now looking at the crystal ball how has the landscape put a change in 10 years? It is a very dynamic process the balance between state and regulation and deregulation but moving forward we have to move on this journey of less regulation of course as mentioned earlier there is this regulation which has a positive impact but having said that I think let me comment on the regulation which results in imposition of non-tariff barriers and which will be protectionist in nature that will hinder trade those are not the kind of regulation we are talking about back to this balance between state and the market in our view this journey towards deregulation and more freedom of the market is something which is unstoppable therefore although there will be ups and downs role to stay rebalancing all this trying to do some physical repair here and there but in longer term in our view it is almost inevitable that to be comparative we got to allow market forces to dominate the scene and the governments get out of business and be less and less involved in business activities that's the way forward this what we see now in other words is a temporary aberration is a dynamic is a result of some political and other factors but in longer term we have to move firmly in the direction of less state intervention other views into the crystal ball how will the competitive landscape look 10 years from now I would like to say a few words I think market and regulation should be different in different countries for China for example we're having this market economy but we didn't have too much experience on that so now our major task is to fully use the market for also the government's interference to be gradually faded away and market economy has already been existing for many years the government is going to interfere the economy so you can see these are two different trends so we cannot just generalize that whether the government interferes or not it depends on the real situation of a certain country and the level of interference would be very different in different countries but anyway general speaking market should play a very important role dominant role one thing is for sure you can't take the state up with the equation to talk about competitivity one of some of the things we've discussed here today is that competitiveness is created by investing in people it is having an efficient society with a legal framework that works by investing in infrastructure by investing in equal opportunity and having investing in innovation which is based on what you do at home but also a global outlook and listing all these things I think it is clear that you cannot achieve all these things if you have a completely passive state you need a good combination I think the market should work as it does best but you have to have an active state that invest in all these things because these are the things that we have to compete on in the years to come well I would absolutely agree but I think the of course the path is towards more and more market economies everywhere in the world we need a state which gives the rules of the game because even a market economy can go out of hand so I think this is what actually the role of the state is is to do enough regulation not too much but the right one and what for instance we do is when we have a new regulation we look at the cost for SMEs and in every proposal to the parliament we have to explain why the cost is what it is and why it is necessary and why it is more cost then they become less competitive which makes the whole country less competitive so it is always a little bit a balance but in the end I'm sure that every country has to find its own balance between both I'm from China's economic weekly I would like to ask Mr. Hong what they are not do you think because they own economies reform will be good for the market economy and will become a major critical factor for the economic recovery of the world state owned companies reform is the major reform and China's economy can develop to today because we have done a lot of work for the state-owned economy and non-state-owned economy in the same process but now the SOEs are faced with some new challenges because we are transitioning or transitioning our economy not only for the non-SOEs but also for the state-owned economy to a large degree the SOEs should utilize its competitive advantages in order to better transform so I think there should be a certain potential for state-owned businesses on the business in China but in some of the areas China's state-owned economies should be privatized so my thinking is the state-owned companies should be capitalized and the government should control the capital we only have a couple of minutes left so I'd like to end by asking everyone on the panel to really think about the future and how long will it take for those 10 years 15 years for some of the developing Asian and African nations to break into the top 10 or top 15 ranking of competitiveness how long will it take before China or some of the other Asian neighbors really moves up the ranking or some of the African nations how long will it take your view it's hard to say I cannot China by 2020 China will become a later country as an innovative country it has to be at least approaching top 10 in terms of the ranking if not to top 10 already it's all decided by the transformation of China if in the future 10 years we can successfully transform our development pattern our economic and our economy I think we can achieve that but for a lot of other developing countries I think it's very difficult for us to catch up with the western developed countries especially for the large economies well I don't need a crystal ball because if the Chinese are saying that China will be in top 10 in 10 years I'm sure that this is true and I'm sure that will happen because this is how things happen the Chinese get to where they want that's how I see it but I do think a lot of things will change one of the most interesting moments in this debate was when someone asked from the floor is it not horrendous that manufacturing jobs are leaving China where they have lower salaries and lower regulation and the reason why I think that is interesting is that exactly the same discussion that we have at home where one is saying isn't it terrible that jobs are going to China and we are losing the manufacturing jobs I think that is something in this for all of us and I think the globalised economy if we manage to reform ourselves and be at the edge of where we should be we could all strive in the new competition also some of the countries that have a longer way to go thank you and your view about Africa Africa has a chance but we need to work very hard towards that there is no doubt about it because if you look at even the recently put made report by World Economic Forum the case of Rwanda I am sure many countries can do it even better Rwanda which was at 70 in terms of positions moving forward 7 places to 63 now out of the 140 countries that were surveyed now if we we work harder we can keep moving closer to that point but I imagine and in Africa for example this year as you know three top countries one was South Africa evidently the other was Mauritius the third was Rwanda so the other countries are working on competitiveness as well and it's a question of focusing and working hard to achieve that so I think in 10 years it's not exaggeration that some of the countries will reach in the next 10 years very high levels the question is who they put them back again if everybody becomes more competitive it might not be so terrible to be only number 15 but of course this will depend on that the race to be at the top of the table is going to be more and more intense I think it's good for the world countries are going to be more efficient more productive they're going to be more innovative they're going to be more prosperous so it's good for the world and as far as ASEAN and Malaysia is concerned we have a goal to be top 10 and to do that we have to reform our education we've got to be innovative we've got to engage in entrepreneurship and we've got to create all working hard in the next 70 years to be there we talked about talent being the key enabler on the piece of rankings of how countries do an education China in bracket Shanghai came out number one last year and I suspect perhaps if you did China bracket Shanghai on competitiveness as we've been talking about today it might be in the top 10 today but with that emphasis on talent I'm pretty confident that in the next 10 years yet China and maybe some other Asian countries will reach the top 10 fantastic thank you all very much thank you for a great audience


What is up guys? What is up? It's me. It's Jacob I'm sunburned But I'm also here to thank each and every one of you guys old and new near and far For subscribing to this very YouTube channel I'm gonna say I went full-time on this YouTube channel 12 months ago. I quit my full-time job Well, actually if you want to know the full story A long story cut very very short. I actually got terminated because of my YouTube channel So we've gone full circle.  So I came home to New Zealand and for the last 12 months straight That's exactly what I've done today Well actually well no it was today it was overnight we have hit 140,000 YouTube subscribers on this YouTube channel and for that all I can say is How grateful I am You guys and the success of this YouTube channel be it You know small in comparison to a lot of other channels, but for me personally, you know, it's been very very successful Even though there's been months that I've put out a video if can you believe this in 2020? There's been a couple of months where I've put out a video every single day Yet I've still lost subscribers at the end of that month and it's in those months That you really get tested that your mental fortitude your your staying power Staying in the game. You know what I mean even in the face of adversity is tested And that's where you build your character and if you can continue to to Make content I'm not gonna say strive or anything epic like that. It's making contents making content Whatever that may be For me, it's it's a mixture of content as you guys know, but you know It wasn't the content that was gonna go viral But it was the content that meant something to me and as long as I stayed true to my heart Everything was gonna be fine now these last I mean look You do it. I do it. We all do it. We all look at some of our favorite youtubers Subscribe account and and You know you track it you can track it and You can track it by the thousand on my YouTube channel. I can see it I Can see the individual number, but you guys can't so Overnight we've we've finally ticked over from 139,000 to 140,000. It looks it looks absolutely amazing to be honest It's a clean number. It's a it's another 10,000 it's another level up in my opinion and to be honest that do you know what really really excites me to Reach a hundred and fifty thousand now that is a real milestone. This is awesome. Every single milestone has been fantastic But you know to reach hundred and fifty thousand would be would be would be something else and I firmly believe that if I stay true to myself and I can stay in a positive mindset and I can have a balanced life Which includes my children in it and you guys this YouTube channel, which means the world to me Then then there is no reason why I Can't continue to be creative and continue to bring the content that interests me and hopefully interests you guys You know, I'm never ever going to be pigeonholed into any niche This channel is always just going to be following me and whatever. I'm interested in clearly football has been a massive interest for many many years Now I'm going to say almost three This YouTube channel has so much potential a Lot of you guys see it a lot of you guys tell me about it. I see it We are in Pandemic times worldwide at the moment so any content creation outside of wherever I'm living at the time is going to be tough But not impossible. So guys just stay tuned. There is so many There is a lot of content to come. I've got at least You know 10 videos created As well as the final five or the final four sorry videos in the top 100 series So we've just had a hundred forty thousand subscribers. I wanted to jump on quickly I wanted to test out my new microphone and I wanted to even though I'm sunburnt to an absolute crisp I wanted to come on create this video upload it as soon as possible You know literally as soon as possible and this is going to be the easiest upload I've ever done because I'm recording it through OBS. So not only do I have the audio being recorded. I've also got The video being recorded. It's not gonna be look Believe it or not. I'm actually not that shiny. I think there's been moments in this This video where my skin It actually looks as if it's it's shining like aluminum or aluminum But it's not for some reason using this video and recording it through the software is is is decreasing the quality Somewhat or maybe I'm just imagining things. I'm not sure. This really really feels like a podcast now I mean Jake's wide world of sports is my second YouTube channel It's gonna be where I do begin my first ever podcast So if you do want to follow that, please do we're almost at a thousand subscribers and it's absolutely Incredible, so thank you so much for your support on this channel and that one once again It's Jake's wide world of sports. We are at 830 subscribers if we can get it to a thousand overnight. I mean that would be That would be something else So guys, I'll leave it to you like the video if you are a subscriber that still enjoys this content Please let us know where you're tuning in from.  There's so much content on this channel I've made over 1800 videos and and in the last 30 days the reason why Okay, the reason why This has happened the reason why we're at a hundred and forty thousand subscribers, which is absolutely Mind-blowing is because I've put the work in I have published whether it be a live stream or normal video 90 videos in the last 30 days 90 Now that's some hassle. I've enjoyed absolutely every single one which is the most important thing or else I'd be completely and utterly burnt out right now. I am gonna take a break from YouTube I'm gonna go visit my two kids for at least a month. That's happening on the 12th of February I urge you to come back to the channel for the Super Bowl. I'm gonna be reacting to it. It's gonna be a lot of fun I can't wait. I'm gonna be here probably a good two or three hours before the game So come and chill. I'm gonna be having a few drinks with you guys and the audio quality I'm hoping is gonna be sick. You know even Going around like this. I literally feel like I'm a rap star. I mean, I don't know how cringe-worthy that is but That's the truth. That's how I feel. I could be spitting some bars right now like Harry Mack By the way, if you don't know who Harry Mack is, please go and check him out He is officially my favorite youtuber and with that being said I want to wish you guys a fantastic day And peace out. Thank you so much for all your support 140,000 let's get to 150 and I might call it a day. Who knows?


Hey everyone! Welcome to my vlog of me seeing a lunch for the first time! I'm shooting this on Friday afternoon. It's about 6.30. And I am getting ready to drive up to Vandenberg, or to the area around Vandenberg, to see the Insight launch at somewhere between 4 o'clock and 6.30 in the morning. I'm a little bit nervous because I made the very, very good decision to go see the descendants last night. But it did mean that I got to bed at about 2, and I did have to get up at 7.30 to work because I had some deadlines today and stuff, so I've taken one nap today. Only one. It was about 25 minutes because it was to an episode of Seinfeld, the one with the astronaut pen, fittingly enough. And yeah, I'm gonna continue to try to rest a little bit and take another nap before getting on the road at about 11 o'clock. So I will be vlogging the whole thing and bringing you guys along with me. I have never seen a launch. A lot of people are amazed by that. But I've never been able to take the time or afford to put myself in a hotel in Florida for a week, hoping something goes. So now living in California, I can actually drive up the night of. So I'm gonna go do it, and I'm super excited. I really, really hope it goes. And I'm gonna bring... Oh, Pete says hi. I'm gonna bring you guys along for the ride. This is my life with a cat. Just smashing his little face into mine all the time. It's pretty much the best, whatever. All right, it's midnight-ish, a little before midnight. I have a triple espresso with me because I'm not nor... This is normally me passed out time. I'm not quite the one that goes out at midnight. I've never been that person. So I'm not sure how the next two and a half hours are gonna go.  But I'm hoping that the, like, excitement and adrenaline of the launch wakes me up when we actually get out to Vandenberg. So, yeah, driving through the desert at midnight, I'm excited. Launch nights. So after driving two and a half hours, made it out to the church near Vandenberg. And I was kind of curious as to what it was gonna be like meeting sort of off-site. Again, I've never been to a launch. So I'm kind of amazed. I keep looking over this way, this way, because I will turn around and show you guys. Let's try to do this without getting shadows all over me. You can, no, you can't see it at all. But right behind these trees over here, I'm pointing at it, but you can't see it. I got to the NASA social spot. Or at least I feel like half the town is also here, but we're in a church. And there's a lot of people here to watch the launch. So right now there's just a lot of drinking coffee and mingling. All right, guys, there is a serious lack of light, because, you know, they want people to be able to actually see the launch. But we are, we just came out of the four minute hold. It is 4 o' one and a bit in the morning. We just came out of the hold. So we're about ready to launch. So I am going to do some vague attempt to actually show you guys the launch. So as we get down to the final countdown here, it's kind of exciting. For those of you who don't know, by now, if you're watching this video, you do know that this is the first ever interplanetary launch from the West Coast, which is super exciting. And pretty interesting. Insight is taking a very odd trajectory. Well, not odd.  So this is pretty exciting, pretty interesting. There's a fair bit of fog covering the launch site. So you can't totally see it. There's maybe 100 people a bit of a distance away. Oh, there's a car. So yeah, there's a lot of people gathered and you can't totally see it, but I'm going to attempt to show you guys at least the streak in the sky or I'll probably just splice in NASA's footage. But I'm going to go up and watch a launch because I have never seen a launch before. So this is really exciting. So let's go watch a launch. All right, we're about 25 seconds from launch. Doesn't look like much from where we are, but yeah, it's that vague dot. Oh, you can hear a little bit of a rumble, a little bit of a rumble. Oh, wow. It's so much bigger than I thought it would be. It sounds like it's so far away. Oh, don't tell me it's totally going to be in fog. I'll put the NASA stream back on and see what's going on. Heard a little bit of a rumble. I tried to get as much audio as I could for you guys. Heard a bit of a rumble and then less of a rumble and then actually asked some people around to turn on the NASA live feed because it was not obvious whether or not anything actually happened. It kind of sounded like it started and then it didn't go. The like the four inch flight kind of deal saw absolutely nothing and heard almost nothing. I kind of hate to say that like owing to the fog and you can't actually see anything. I tried to get a picture of it, but it's too dark. Obviously it's four o' seven in the morning.  Sigh. Well, I can say I did it. Okay. Well, I'm going to go drive home for two and a half hours.


Asking for information. What is this? This is a table. What is this? This is a table. What is that? That is a chair. What is that? That is a chair. What's this? It's a pen. What's this? It's a pen. What's that? It's an apple. What's that? It's an apple. What are these? These are pencils. What are these? These are pencils. What are those? Those are books. What are those? Those are books. Where is Mr. King? He is over there. Where is Mr. King? He is over there. Where is Ms. Knight? She's right here. Where is Ms. Knight? She's right here. Where's Johnny? He's in the house. Where's Johnny? He's in the house. When's the movie? It's at nine o'clock. When's the movie? It's at nine o'clock. When's lunch? Lunch is at noon. When's lunch? Lunch is at noon. How is the food? It's delicious. How is the food? It's delicious.


And Aaron, in that moment, what's on your mind? What's going through your head plate?  Man, it was just good at bats all around.  I was just trying to, you know, get something out of the plate and just wanted for the team. Did you envision your first walk-off being a walk-off? Yeah, legitimate walk-off. Uh, not really, but, uh, we'll take it.  You know, we'll take it any way we can against him. We go next to Justin Shackle. Hey, Aaron, what's the biggest takeaway from completing a sweep against a team like the White Sox? Wow, biggest takeaway. Just, we got some good pitchers, you know, that's what I go back to is our pitching defense is on top of it right now. Just the double plays we turned, you know, I know DJ made a nice sliding grab out there, you know, kind of short right field today. Just the pitchers, like, I don't know, like the shutdown of a team like that is pretty impressive. You know, they're one of the powerhouses in the AL, you know, they drive a lot of home runs, they get on base, they got good speed.


I'm going to move on to Dr. Byrd. All right. I'm going to be presenting a case today that I saw while I was on the pediatric rotation. All right, so this is a case of a six-year-old female who initially presented to clinic with a complaint. Well, her parents' chief complaint was an abnormal head position. And this was July 2015, but her parents and teachers have noticed kind of her starting to turn her head around October of 2014. So it had been going on for quite a while. And really the only other thing they had noted was some frequent tripping, which they weren't sure if that was just because of this head turn or really what was going on. But otherwise, she was healthy, no other past medical history. She had, because of this head turn, and she saw an outside optometrist who thought that she had some amblyopia and Dwayne syndrome and referred her to the pediatric ophthalmology clinic. So when she was seen, her visual acuity was 2060. Hers to business exam was significant for a large left head turn. She had impaired abduction in the right eye and impaired abduction in the left eye, so kind of a left conjugate gaze palsy. But the rest of her extracurricular motility was full. She was ortho and primary gaze. No large refractive error. And the remainder of her dilated exam and slant-lamp exam was normal. So I'm just going to talk a little bit about a horizontal conjugate gaze palsy and what kind of go over some anatomy and differential. So it can localize to a few different locations. A lesion in the contralateral frontal eye fields can cause it. An ipsilateral peramine, pontine, reticular formation lesion, or an ipsilateral abducens nucleus lesion. So if we review the abducens nerve nucleus, we can remember that the nucleus not only innervates the ips lateral rectus, but it also sends neurons to the medial rectus of the contralateral eye. So if you get a lesion of the nucleus, you do get a conjugate gaze palsy. And then just kind of similarly, or a few things that are related to this anatomy, we can remember that the seventh cranial nerve in the facial nerve here is in close proximity. And so a lot of times, we do see lesions that can cause a conjugate gaze palsy or a cranial nerve sixth palsy in association with a cranial nerve seventh palsy. And then also, just as a reminder, that one and a half syndrome is another thing you can get with lesions in this area, where you have damage to abducens nucleus and the ipsilateral MLF, which can cause essentially you have a conjugate gaze palsy and an ips lateral I&O, where you have only preserved contralateral abduction. So that's just something to keep in mind. So if we think about a differential diagnosis for a conjugate gaze palsy, I wanted to break it down into adult and pediatric differentials, but realizing that you can have these in the pediatric population. So we can think about brainstem ischemia, infiltration, trauma, inflammation, compression, demyelination, or any key Corsipov syndrome, which is a reminder is metabolic insult. And it can insult the cranial nerve sixth nucleus. We can see it in a lot of different things, including pancreatitis, anything where you have kind of abnormal electrolytes, but also most commonly in alcoholism, and then ALS. There are rare complications of listeria meningoencephalitis, where you can get cranial nerve palsies, so infectious causes as well. In the pediatric population, we have more congenital problems that are on the differential. That I'll kind of review some of these that are a little more rare. And we probably haven't gone over too much before. But a brainstem AV malformation could certainly cause a conjugate gaze palsy. Neoplasms, such as a pontine glioma, is on the differential. And we'll go through the rest of these. And in this patient, this is a new onset, kind of a cute presentation. So these don't necessarily all fit with her, but we'll go over them. So if you have a bilateral Duane's retraction syndrome, it could have some characteristics that look like a horizontal gaze palsy. But you wouldn't really see a unilateral gaze palsy. This and Duane's retraction syndrome is really a disinheritation syndrome, where you have varying degrees of abduction, abduction, or both deficits in one eye. But the classic hallmark of the disease is this co-contraction in the eye, where it is the medial rectus and the lateral rectus are firing at the same time. And you have this contraction, which causes the palphebral fissure narrowing that we see. These images are of an ipsilateral or unilateral Duane's. But if you had a bilateral Duane's, it could be, I guess you could think that it was a horizontal gaze palsy. But you do see other potential abnormalities with the eyes in up-shoot and down-shoot changes, or up-shoot in certain gazes. So that is probably not really what, you know, in our patient, she doesn't really fit that criteria. There's another disease called Wildervanx cervical ocular acoustic syndrome, which is a triad of Duane's retraction syndrome, Clipple fiel anomaly, where you have congenital fusion of your cervical vertebrae and sensory neural deafness. These are pretty rare. Another disease that's in the spectrum of the disinherbation syndrome is the Mobius syndrome, that we also know as congenital bulbar paralysis. These patients can have an abduction or absent horizontal gaze bilaterally. So they can basically no horizontal gaze. But they do have, or they can have preserved vertical gaze. These are congenital problems with the cranial nerve nuclei, so they have cranial nerve seven palsy. So these kind of masked faces, no facial expressions. And multiple cranial nerves can be involved. So this is image demonstrating an atrophic tongue. And on their pathologic findings, they've found atrophy and necrosis of cranial nerve nuclei. One theory for this is potential vascular insult in the prenatal period, but it's not completely clear. Another rare disease that could, congenital disease, that could present with the horizontal gaze palsy is this congenital horizontal gaze palsy with progressive scoliosis. It's again in the spectrum of a cranial disinherbation syndrome. And these kids can have horizontal gaze palsy. They don't have a horizontal vestibular ocular reflex. They can have esotropia, but they usually have preservation in their convergence, normal vertical gaze.  And then goucher disease is in the metabolic spectrum. So you don't have glucosuribrosidease, so you can't break down your glucosuribroside. And these, they could have just a horizontal gaze palsy, but they can also just have ocular motory proxy and anything that falls into the super nuclear gaze palsy. They have a lot of other systemic problems and varying. There's different types, so they might not present. There's some infantile types that are more kind of severe. And there's other types that present later in life and are more mild. And there's Leigh syndrome, which is basically an infantile or neurodegenerative condition. You can get a thumb oplegia with this. And again, kind of super nuclear problems could be horizontal gaze palsy and that, but they have a lot of other neurologic problems that are kind of degenerative over time. So with our patients, I mean, we have an acute onset of a new gaze palsy. Looking at the differential, really the concerning things are a neoplasm. So she did get an MRI. And unfortunately, these are the results. So this is a T1 image. And you can see this large hypo intense lesion here. We see it again on T2 imaging and hyper intense here, kind of heterogeneous. And then again here. And you can notice that it's really isolated to the ponds and you have this distinction between the ponds medullary junction. This is, this imaging is characteristic of a diffuse intrinsic pontine glioma. And if we go back, we can also see that this lesion is causing mass effect in obstructive hydrocephalus as well. So unfortunately, this is a really kind of sad diagnosis and a hard one to give patients. I think in this case, I was around when she got the MRI. And it kind of reminds you that as ophthalmologists, we do sometimes have to deliver really bad news and hard news. I think you don't have that experience a lot. But when you do, it's a good learning experience. So this is the, this neoplasm is usually diagnosed between five and nine. So it presents in childhood that it can be diagnosed at other ages. But many times the first symptom is a cranial nerve palsy. And typically, you see six cranial nerve palsy as the presenting sign. You can have facial paralysis so patients may come in or parents may come in and say they have, you know, they noted their child has an asymmetric smile. And then clumsiness, difficulty walking, loss of balance, weakness are all things that can be presenting signs. So our patient had some, you know, tripping that was noted. It's unclear if that was, you know, I think the parents maybe thought that was from the head turn, but a lot of patients, about a third of patients that diagnosis do have symptoms and increased intracranial pressure because a lot of times these lesions do cause a obstructive hydrocephalus, just given their location. And it's a really rapidly progressing disease. So usually once the patient starts having symptoms it's diagnosed within three months and the symptoms progress pretty rapidly. The prognosis is quite poor, and it's the main cause of brain tumor-related deaths in children at this time. Without radiation the median survival is about four months. Overall survival is 30% at one year, less than 10% at two years. There's rare cases where the patients have had longer-term survival, but these have been associated with atypical features clinically and in the imaging. So at the moment, the treatment that we have is radiation, it's not curative, it only prolongs survival by a mean of three months. A lot of times patients are started on steroids just to try to help some edema, but again, nothing curative. There's, of course, research being done into alternative treatment methods and they've identified this mutant histone K27M in about 80% of cases that is a potential target, but they're starting some clinical trials, nothing that's imminently gonna be available. And then immunotherapy as well as another kind of target. There are a few clinical trials with some vaccines against various, or targeted against the Ponting glioma, but again, nothing that's imminently gonna be out. So going back to our patient, she was seen again in clinic. This is kind of a month or a few weeks after her MRI.  When she got the MRI, she did get admitted, had oncology, see her, they did more imaging, did a spine imaging, and got hooked in. So she ended up getting radiation therapy. Prior to getting, starting her radiation therapy, again, no disc edema was seen. She still had her left gaze paralysis and her left face turn. In a few months later, she progressed and had left facial paralysis and leg ophthalmos. And then in this timeframe, she started getting radiation therapy and she did have some improvement on her imaging of the brain stem glioma. When she was seen again in February, she actually had improved abduction of the right eye. So really kind of more of a picture of a isolated left cranial nerve six palsy and now in clinical esotropia. And she still had a really, really significant head turn that was difficult for her. So the decision was made to do surgery and she was taken to the operating room because of basically no function and forced sections in the OR. Vertical rectus transposition with a foster suture modification was done and a Botox and Melachmedial rectus. Or sorry, oh yeah, that's correct. And the foster modification is basically doing a fixation suture to attach the transposed superior rectus and the transposed inferior rectus to the lateral rectus to try to give it more power. And on her five week follow-up, she did have an improved face turn and a little bit of near-intermen-hypertropia and a little bit of exotropia in primary position but overall they were very, you know, her parents felt like this was a great improvement. But unfortunately, around February, she did have increased tumor size on her MRI and then she was put on hospice and then couldn't pass away. So she, you know, it's a really sad case. I think for me the things that stood out for the case is just kind of the, first of all, delivering really hard news more than just, you know, you won't be seeing again but that this is kind of a lethal malignancy in a child. And then also, you know, it is hard to do at times a pediatric eye exam but knowing that this is the potential when you have to know that that's an option before you call something a Dwayne's or a Mobius or saying it's a congenital thing because these do need to be picked up and where some, you know, many times the ophthalmologist might be the first person seeing it and the doctor that has to actually order the MRI and diagnose it before it, you know, before time goes on. So that is my case. Does anyone have any questions or comments? Dr. Kapps? So not to cast any esperses of why operate on a little girl whose life expectancy is less than? Well, I'm, I don't, yeah, I, it's a quality of life thing. And so I think just based on the difficulty and the parents feeling like the head turn was a, you know, was a problem that that was enough of a thing. And in February, her, I mean, her scan had gotten better and then it got worse. So I don't think, I mean, the life expectancy thing we know overall of the statistics, but I don't think for her at that time, you know, if the parents, yeah, you never know. And it was basically quality of life operation. I think, and it's Dr. Dries's, I mean, if you have anything, I think that was the rationale, which is very reasonable.  Yeah. That's a great presentation. Do you, you know, we're now treating a lot of other gliomas with carbonyl flat and other chemotherapy aids. Did you find anything? Because we've got actually in comparative when we use radiation treatment for, you know, visual pathway, for optic pathway gliomas in NF1. Yeah. And even the non-NF1 tumors, they respond wonderfully. Yeah. They're causing troubles. It's, I mean, these appear to grow much more rapidly, more aggressively, exactly. They've done studies and they hadn't shown, you know, in the studies that they did with other chemotherapy agents, there wasn't any improvement and just kind of caused more toxicity. So there had, I mean, at this point, the focus is really on kind of the more novel mechanisms, but the chemotherapy agents that are tried haven't worked. And I think, you know, the location and the rapidly, the rapid progression, I think just put it in a little bit of a different category. But yeah. Dr. Werner. I think the other thing with optic pathway gliomas is that they're such a different tumor. Some people even wonder if, there was a huge debate at NANOS the other year about, are they really gliomas or are they just tomatomas? And should they be treated with chemotherapy ever? Sometimes, not at all, because there's a pretty high spontaneous regression, right? Even with vision and with imaging. So I think it's been very difficult to show unequivocally that whatever we do to treat optic pathway gliomas is actually better than the natural history, which is so good anyway in children. Right. That's a relief. Whereas these guys, these diffuse pontine gliomas are just so uniformly fatal. Yes. I think that might even argue for ongoing and more aggressive trials of chemotherapy. That's cute, right? Like you don't have very much to lose, whereas in a tumor that's going to potentially regret on its own, then you have to be pretty sure you're actually doing something beneficial. That it's also going to grow and cause harm. But the kids have worked for you. I mean, what this reminds me of, as far as the collateral damage of radiation that we induce in kids with the optic pathway gliomas for that F1. Right, yeah. It's for friends. Yeah, yeah. And it's such a night and day difference. So it'd be very cool if they could find something that would go up.  But that's kind of like the option we have and they're using, there's a lot of clinical trials and I mean, hopefully there are things that as they're setting genetics in more of the mutations, but down the line, yeah. Yeah, there wasn't, you know, it looks like there had been some studies done and nothing really panned out. And now the focus is more on the kind of alternative newer methods of treatment from what I've seen.


English vocabulary with pictures, problems and defects. Number one, scratched. This CD is scratched. Another way to say it is there are scratches on the CD. Scratches are marks on the surface. Number two, cracked. The CD and the windshield are cracked. Number three, smashed. The guitar is smashed. Smashed means completely broken into many pieces. Number four, torn. Ripped. The jeans are torn or ripped. Torn and ripped are usually used for fabric or paper. Number five, crumpled. The paper is crumpled. This word is typically used only with paper. Number six, stained. The shirt is stained. Another way to say it is there is an ink stain on the shirt. Number seven, chipped. The mug is chipped. This means there is a small piece missing. Number eight, dented. The car door is dented. This word is used when a piece of metal goes in. Number nine, bent. The key is bent. The word bent is used when something that should be straight is not straight. Number ten, burnt. The bread is burnt. The word burnt is used when something was heated too much and turned black. Thanks for watching English Tips from Espresso English. If you liked this video, please share it.