ain any other obligations undergoing statutory um and we may have views as to whether that's a good idea or not we're not quite sure what however we're going to get loaded up with so um starting off whether ridiculously small budget is is fine we discussed that certainly when i was being grilled on whether i should be honest or not to expand as things expanded that's to be expected and i guess we can take a shot at what numbers those might be there's a little premature at the moment so we don't actually know how much it's going to expand i imagine it will become set wise in fact finally because things will get added on the track yes in one sense that's when i was saying using a word like settling in i mean that the problem is that the probably over the next few years there are going to be quite a lot of changes in your remit it's not going to it's not going to come in one every year because i mean one area for example in our previous report we'd looked talked about did you have a remit for long-term investment commitments and the whole area of like prudential borrowing and so on and i mean at the moment the government says that i think you don't have a remit within that and in your response that i think you say this is a point for future consideration as it's well beyond the expectations of the sfc for today which is fair enough i guess that's still the position but potentially that's something that if it did come on board that would require other resources i think we have plenty of views on that but it may not be at the quite the point of which we discussed them but i think you're probably right to say that they're going to have to be discussed and and and either taken on board or not and they has resource implications of course but also just to be fair we were told from the beginning we had a budget of 20 000 and if we needed more during this year perhaps for research or for projects or for anything that we could ask for that so it's not as if the purse was closed had we needed it but for what we've done so far we haven't needed to ask for more but that isn't an ideal situation to be in you're absolutely right we should have our own budget okay appreciate your frankness on that i mean the other main point i wanted to just touch on was a i mean as i understand it your remit is to comment on the reasonableness of the forecasts and we've already talked about a little bit about is it at the higher end of reasonableness or the lower end of reasonableness i mean as an accountant i like numbers i mean would it be fair to say that you know would it be possible to mark reasonableness out of 10 and something is nine out of 10 or two out of 10 or is that being far too mathematical there's huge range of errors associated with these forecasts so there's a kind of you know if you look at the fan charts of the bank of england or the robustness that the obr do you're changing assumption the forecast will go in a different direction so there's quite a range of of single point estimates that would be reasonable i think what we're what we tend to assess as much as that point estimate is the methods that have been used to produce it so we're we're very concerned about so what assumptions have been made in this modelling work how detailed it is what effects are they accounting for what are they failing to account for and so it's the kind of the robustness of the approach that's been followed is essentially what gives it the score of reasonable yes i suppose that just you know raises a few questions in my mind like your process could be quite reasonable apparently all along the way but then the result you know is the actual result reasonable or not are you saying basically you're not commenting on that well no it's not it's an iterative approach if you see that the the approach that's being followed is going to lead to a kind of wild forecast that has no credibility at all then there's something wrong with that that approach fundamentally so and you feel then that the comment you give it it's you've got the scope to be kind of nuanced or whatever the word is as to this is very reasonable this is quite reasonable this is a little bit reasonable i mean how do you how do you see that happening or is that just something that's evolving well i think that's something that kind of evolves and then it comes it comes into our report i mean we've already kind of used language to indicate where in the range of reasonableness that particular forecast happened to be and you're happy with that basically uh yeah given given given that we are not responsible for the forecast uh this this is the way to do it i think but but i think the language i mean as campbell has already said had an impact where we said we thought the the actual number the end the end number was optimistic um there was a change in what was put into the draft budget as a result of that comment so we think that has been effective right so that's probably something again we need to keep watching over time as to how the language you use feeds into what actually happened yeah we also add we had a quote earlier from um Greenspan who was well known for being opaque and uh the problem with this is if you use language you have to establish what the words actually mean absolutely yes um scoring one out of ten is is um inviting disagreement but uh it's easier if it's the same as Campbell said with the fan charts it's basically what you're saying is it's reasonable to this degree of probability or something um but that's hard to write in a report for for everybody i mean i know what i mean when i'm saying that and you might as well but not everybody else does so it's a bit awkward um what i think we do do is having said something is reasonable then there's some qualifications further than the language which is not in you know it's reasonable we're not very reasonable it's reasonable but here's some things which need to be improved or something this is giving a a qualification to it and sometimes we say it's reasonable without any further comment which means this is probably as good as you're going to get we may find that we i'm not sure all of us will be here but um we may find later on uh that when we've got a bit of a track record of the forecasts and the actual out turns we've got a better handle on um how reasonable is reasonable you know we've discovered that these ones are not terribly sensitive so they tend to stay within a certain reasonable excuse me band around the the central forecast other ones are much more volatile yeah so i mean in the obr papers we saw things statements like you know there's a 65 probability of such and such or this is a probability of over 50 well a probability of over 50 doesn't reassure me very much i mean do you think you would get down that way as language or would you prefer just to stay to the words i would prefer to stick to the words i don't find 50 probability that all that bad compared to it might be 30 percent it's all right it's a judgmental fact of ultimately even how you interpret it and so on so i'd rather not get too fancy um but try and establish um a way in which you and everybody else understands what we mean when we use certain language okay thanks so much so i just to move up before i let Mark in just an issue of reasonable surely that's not so much about whether it's reasonable or it's whether there's an issue of political influence is that not one of the concerns that there may be yeah maybe i can i was listening to this kind of little discussion here i was thinking maybe rather than think about in terms of reasonableness it's whether or not we've been convinced that the way this forecast has been produced and the number that's been produced as a result of it is convincing and obviously if it was subject to political interference it wouldn't be convincing okay so it's it's as much of that of the Scottish government forecast of saying look here's our methods here's our models these are good solid ways of doing it or and we critically evaluate those and say well no i'm not convinced by that let's do that a different way maybe do that a different way until they've produced enough kind of supporting evidence for their forecast to be able to convince us okay thank you mark thank thank you convener to the deputy convener has given the the image of the forecasting being scored by the physical commission as if it were an episode of strictly come dancing but uh i'll i'll just leave that one out there um i would not dream of doing so um in terms of the uh looking ahead to the workload that you anticipate or or potential workload that you anticipate obviously the there will be legislation being brought forward in relation to the fiscal commission i would anticipate will probably be this committee that will look at will certainly look at the financial memorandum i would anticipate we will probably be the ones who will be allocated the legislation but looking at the costs that will be associated with that you've mentioned today for example the the requirement for somebody to be essentially your eyes and ears um out there um there are probably also going to be administrative requirements that sit behind that and then you've spoken about potential further requirements depending upon the outcome of the um the process of further devolution and where that leads so i'm just wondering in terms of the discussions you'll be having with Scottish Government as that legislation is developed and in terms of the costings that are developed are you going to be feeding that information in terms of what you anticipate your requirements to be so that they can build a sort of accurate picture of the likely budget that that will that will need to be attached to the fiscal commission the short answer is yes and we have been doing that okay okay so that's building in a number of scenarios as well um because obviously um that we don't yet know what the final outcome of the of the devolution process is going to be we've got a we've got a rough idea based on the command paper but obviously what happens in in in just just over a month's time may alter that significantly it may alter it slightly it may not alter it at all so there needs to be some cognisance i guess of where that process is going and that might lead in a number of different directions in terms of for example you were speaking about the possibility of requiring another economist it may require you to have additional staffing beyond the one individual that you've you've spoken about or potentially admin support that may be attached to that so are you building in a number of different scenarios that's all that's all correct and that we've identified some of those same potential needs but we have not built scenarios in the in the formal sense saying if this happens then then we need exactly that but what i've already mentioned is our eyes and ears we think we need that now i mean i absolutely convinced we need that now that there are some more powers coming almost no matter what but we don't know what went and to what extent hence we have already put a line in the sand about the real possibility of another economist but probably sometime during the year i personally don't believe that you you build up staff you don't build an empire until you know or an army of soldiers until you need to to deploy them in a sense but that's that's you know that's on the ground and also the fact that we would need more just more support in general as you say more admin support of one sort or another research support but we haven't done it in the sense of a formal scenario you know with the capitalist but we've put all of those on the table as potentials okay if it's helpful at all in comparing to other fiscal councils elsewhere for example the Irish one has five commissions like us and they don't do any forecasting they do of course have more things to consider because it's not a question of devolution that happened a hundred years ago but you know these are markers of the kind of resources you need manpower you need to deal with these things they have a number of other people and i can't remember without my notes all here forgotten how many other people i have going through the numbers and checking as it were what their what their view is so that's just a bit of a marker as to what might be coming down the road okay disrespect one of the crucial things is as you give us more tasks it's the nature of those tasks do they require us to scrutinise work that's done by the Scottish Government forecasters or do they require us to do our own analysis on top of that and as soon as we're asked to do additional analysis produce our own forecasts then there's an exponential rise in the resources that we need i think the position that the Scottish Government has taken certainly the one that doesn't expect the fiscal commission to be producing its own forecasts at present so we'll be operating i imagine within that envelope at present i mean there was this question which came up and i'm not sure if it's still live or not as to whether we should look at and provide the word reason what it's the affordability of the investment projects if we were required to do that and i don't think we were in a position to do that but if we were that would be a huge increase in the workload and hence the resources needed because you get ready into some details Andrews referring to these long-term commitments the long-term investment at the moment i think it's probably off the agenda but i'm not entirely sure about that but if it were to come on the agenda so it depends what we're asked to analyse sure i appreciate that and obviously there have been you know others out there have made their own calls around what they believe needs to happen and there perhaps would you suggest hasn't been a cognisance within some of those calls of the the level of budget that would be required in order to deliver what is being requested by some exactly i mean you know this is a process and and there will i assume be a discussion about what we become over time and that has to be costed and someone has to make a decision in the parliament about where the value of money sits okay thanks hey thank you um there are people who know further questions from committee oh jean sorry you could have let me know a minute earlier i suppose it's just just a point lady rice that you you've said that you're working two days a week and professor he's had it and and camelese are working approximately one day a week is that a workload that you expected um i'll turn to my colleagues to be to be very honest we expected a fairly intense period in the late summer in the build up to the draft budget in our report then i'm not sure any of us but my colleagues may disagree expected it to continue with the pace it has this isn't every single week but some weeks are much more um so we're a little quieter in november but otherwise it's been all ago absolutely it's lumpy and as susan says the lumpiness is smoothing out within the in the wrong direction as far as workload is concerned um i i would reckon i would have reckoned on on a day a week on average across the year i reckon about camel but i'm getting towards two you know because other things happen sometimes they happen with very short notice which is also difficult because if we got other lives and we have to have other lives in order to have food on the table um you i'm planning out the year ahead and to be told on friday that by Tuesday would you comment on this please uh sometimes doesn't fit so you know i'd be known to do it in an airport or something it's it's it's difficult to regulate in that sense but this is all part of the settling in i guess and then in the second year we'll be much better at forecasting around around yes rather than the economy with more success yeah i think well like the other commissioners it has proved to be quite demanding in terms of time given i have a full-time job to do outside of the fiscal commission work in fact in relation to the budget one of the things that might help going forward is is if the the budget put provision to buy out time for commissioners from their employers so that that would free up time to develop to fiscal commission work as i think you should get paid and i mean your workload's only going to increase surely so i mean it would have one would have thought it was reasonable to be paid for us i mean i know it's a kind of prestigious position but even so i mean i mean okay robert does it for free but i doesn't mean anyone else to do that okay gee that was a good question actually it was a good question um i just a couple questions to to to kind of finish off really you know and one of it one is really um in terms of your role in evaluating scottish government figures in relation to out turn figures you've said in your response to finance committee report on the draft budget you've said and i quote it it is indeed our intention to compare forecast to actual out turn figures once you have figures for the outcomes that match the forecast made on the count techniques in the moment we haven't been given sufficient data on matching pairs i'm not really sure what you mean by that what are these matching pairs that's on the actual out turn all right okay in a specific okay i wasn't familiar with the lingo so that's fair enough it's okay i just wonder if there's something exotic in there i should maybe know about that having said that i think my view is that's the next thing the next most important thing for us to do the problem is we need to actually have the data on the out that was clear from the quote on the out turns and not a sample of one so otherwise it's going to be a period of time before we can do that properly and do you have access to hmrc data at all no no and won't get it i don't think right okay that's interesting right well i didn't i thought that was the case and just one other question are you i understand you've had discussions with the sweden and the public of island in terms of the official fiscal commissions but have you are aware of any other subnational fiscal commissions and if so have you had any discussions with any of them that's a very good question interesting scotland is one of the very tiny number on terrio i believe has a new one it's at ontario kind of Australia thought maybe yeah um campbell and i are going to a meeting of fiscal and budget officers um it that the oecd is is hosting and um and i actually asked uh the lisa van trop who runs that piece of the oecd about other subnational bodies and the answer was very few the hope there is that we actually meet whoever is there and can have some conversations understand some of you know how they've developed if they've preceded us at all but to some extent this is breaking your ground okay i think um as far as i know uh the subnational ones are ontario california i asked last time i was in virginia because i was told there was one there but there's something else but there isn't uh there isn't something there and there may be others um but the other place is to look actually one place to look would be in belgium for very obvious reasons um so there's a little bit of this and it's particularly important for us because the difficulty we have difficulties due to the fact we're subnational rather than national um which other councils don't have so other people's experience will be interesting the only question is whether they've got more experience than we have and i mean they may not i can i can follow up on some of that but they may well be there in Vienna yeah we're hoping to meet some of them if they exist okay well thank you very much are there any other points you wish to make to committee before we wind up the session i don't have any other except to others except to thank you for you know inviting us in i don't know about my colleagues no thank you very much um your responses to your questions i'm much appreciated um that being the end of the public session of the committee i'd now like to just have a one minute break while allow our witnesses and um public and official report to leaf


Studying Romeo and Juliet, let's look at the main quotes to remember when both Romeo and Juliet discover that they are children of the opposing households. Romeo overhears the nurse speaking and he asks, is she a Capulet? This rhetorical question shows his devastation at learning that she is a Capulet whilst he is a Montague. Also, the exclamatory sentence, Odeo account, shows his deep heartbreak at realising this. The repetition of the pronouns my show that he feels like he owes his life to his enemies. Bear in mind that he speaks here in iambic pentameter. Similarly, when Juliet discovers he's a Montague, she is in mourning. Bear in mind, everything she says here is an iambic pentameter. She mentions love, hate, early, late and she speaks in oxymorons here showing her conflicting feelings. She also speaks in rhyming couplets showing her deep love for Romeo. Bear in mind, these first two sentences are written in exclamatory sentences, showing Juliet's deep grief that she's fallen in love with the foe. Yet the alliteration here shows she's resolved to love Romeo.


You know, it was kind of nice to be king. You get to build summer palaces and winter palaces and, you know, places to hang out. So this is the nice little, you know, summer palace. It's probably got, I don't know, 130 rooms in it. But once the French figured out how to build Versailles, everybody wanted to copy it. So this is kind of a scale down copy of Versailles, basically. And there's some, you know, tourists there looking at the place. You guys say there's never any. You can see the weather in Vienna is always lovely. It's September and it's like, you know, 40 degrees. So these are the gardens in the back. And they've got, again, it's a direct copy of Versailles. You've got these gorgeous gardens in the back. They've got a fountain in the middle. And then you've got this kind of quasi, you know, Prussian Nazi columns with eagles on them in the back. And so that was added later. Obviously that's not from the 16th century. But here's the fountains. You've got Neptune in the middle. You've got various, you know, gods around there and huge fountains.  And then, again, there you can see this that was added with a Germanic eagle on top. So this is at the top of a hill. You can zigzag back and forth. You can climb straight up to it if you want to see it. So if we're going to talk about Iowels, we have to go back to Mr. Harold Ridley. And he did his first Iowel surgery at St. Thomas' Hospital in London. And the interesting thing about it is there was supposedly a plaque there. So when Alan and I were at the ESCRS in London, our mission was to find the Ridley plaque. And so it took us a good half hour of going through back hallways and down in basements through St. Thomas' Hospital. And nobody had any clue what we were talking about. Nobody who works there had any idea. But sure enough, we finally found it. Here's the plaque talking about the first intraocular lens implanted by Mr. Harold Ridley. And so there you see it. Now, there are people who swear that date is wrong, that they found the original records and that that date is wrong. But in any event, Mr. Ridley is known to be the first person in the world to put in an intraocular lens. And so here's Mr. Ridley. After he retired, he went out to his country home and he was a fisherman. And when Mr. Ridley got this idea, it was very interesting. He was a surgeon in England during World War II, during the Blitz, when the Germans were bombing London. And the RAF fighter pilots were going up to try to shoot down the bombers. And when they were being hit by machine gun fire, the cockpits were shattering. And pieces of the cockpit were getting into these pilot's eyes. And so Mr. Ridley was treating them at the hospital at St. Thomas's. And basically it turns out, fortuitously, that the cockpits were made out of PMMA, Plexiglas, which is what it was called. And Mr. Ridley was smart enough to say, gee, this material is inert inside the patient's eye. And so as he was looking at patients who at that time they were doing surgery, they were removing the crystalline lens and you were giving them glasses that were aphakic. So if you can imagine a plus 10 glass, I mean, they're hugely thick. You've got all kinds of problems. You get a prismatic effect around the edges where light is bent around the edge and then you don't even see it. So these poor patients would have what we call the jack-in-the-box effect, which means there's a blind spot right here. So you'd be driving down the street and then a car would pop into the next lane out of nowhere because they were in your blind spot. And of course it would magnify everything 25%. And so these people really had a difficult time. And so legend has it that a student was asking Ridley during surgery, well, you're taking out the cataract, aren't you gonna put in another lens? I don't know if that's true or not. But Ridley's idea was interesting in that he was doing crude extra caps. This was the time when everybody was doing intercaps where you were removing the entire lens. And so as a result, his first lens was designed to go in the posterior chamber, which is very interesting. So that's what Ridley's first lens looks like. And he was also fortuitous in that company Rainer in London, which still exists, still makes IOLs, was the one who made the IOL for him. So it was a disc, it was a very thick disc made of this PMMA, polymethymethacrylate or plexiglass. You know, the problem is, is these were just kind of hand polished. So they were very rough, it was very difficult. But this is an eye that was donated to our lab many years ago. And this is one of the original Ridley lenses, which was inside the lens capsule and lasted for about 30 years. So if it stayed in the capsule, this lens actually did okay. But the problem is, is this was the edge of the lens. And so you can imagine that stripping against UVL tissue, you know, you didn't have capsillotomies then. And so this is what the lens looked like. And so as a result, they ran into a lot of problems. A lot of chronic UVIS, chronic UGG syndrome, pigmentary glaucoma, dislocated lenses, a lot of problems. What I'd like to do now with maybe Becca's help here is I want to show you one of Ridley's original videos. So this was, this was copied from a 16 millimeter tape. So this is one of his original videos. Sorry, our mouse is not working. And so I don't know how to work these without. There you go. Yeah. Is it the keyboard? All right. Let's make that bigger now. Oh, I don't know if I can do that. Sorry. All right, so here's Mr. Ridley. Let's see if you can see that. That's a graphing eye. Controller. You go into the eye and you saw all the way across it. What? Yep, yep, this is done under loops. There's no microscope.  I swear, this is how you guys do capsillotomies sometimes, tear it. Then you go in and you mash on the lens and push it out. Now look what that's doing to the endothelium. About 10,000 endothelial cells are dying but he pushes it out.  Just flush it out. So this is again, all done with loops. Now here's his, here's his lens. Push it in into the posterior chamber. And then you close it. Oh, I'm sorry, they didn't show how you close it. You close it with four oh silk sutures. And so you put two four oh silk sutures and you tie it under loops and you tie a big loop on there. And then when the patients come back to clinic, you actually just cut out the sutures and take them out. So this is how surgery was in, you know, 1951. And so pretty amazing how, you know, surgery has come in greater than 60 years. And so that's pretty phenomenal. So the one that made me cringe was the grafie knife. You'd go limbus to limbus, then you just go, just saw the cornea in half.  Which is why people wouldn't do cataracts until the cataract was mature. I mean, patients had to be at least 2,400 before you would dare do a cataract surgery. So it's come a long way. So that was Mr. Ridley surgery. So because of the complications and because people weren't used to doing extra capsular surgery, most people were doing intracaps, meaning you remove the cataract with the capsule bag in text. There's nothing to support it. So people started working at anterior chamber eye welds. And so putting an implant in the anterior chamber in front of the iris. And so these went through various designs. Now, one of Mr. Ridley's residents, Mr. Peter Choice, was one of the designers of the anterior chamber eye welds. And so this was the original choice lens. Again, made of PMMA. So it's a big piece of plastic that goes inside the eye. And he went through nine different iterations. So this was the Mach 1. And so this was the time people were trying to fly planes faster than the speed of sound. And so Mach sounded really modern. And so this was the Mach 1. And he went through various iterations. And this was the Mach 8. So this was the one, this was even in use when I was starting training. And so you see it's got the foot plates on there. It's got PMMAs, we had to make a big incision. But again, you're doing a big incision surgery anyway. You're doing an intercap. So you're putting it in there. We used to joke that these came in two sizes. Too big and too small. And so it's very difficult because we didn't have anterior segment ultrasound and OCT to measure it. And so you had to kind of do a caliper and you'd measure limbus to limbus and then subtract a millimeter. And that would be roughly your size of the anterior chamber. It's a very crude estimate. So this is Mr. Choice's lens. This was the Choice Mach 9. This was the last one that he made. All right, so again, we say, what are some of the problems with these lenses? Well, this is a Choice lens. You can see it there in the anterior chamber. And what these would do is they would scrape on the iris. And as they scraped on the iris, what do you get? You get microhyphemis. So you can see this little hyphae here. And so that was the problem with these lenses is if they were too small, they would propeller around the anterior chamber of the eye. If they were too big, they would tuck the iris and pinch it off. And so you would get chronic low-grade hyphaemus. You'd get ovelling of the pupil. This is a donated eye, cornea cutoff. You can see it's got this ovelling of the pupil. And you always had to do a perfiliridectomy with these because you'd get a pupillary block in these. And so you can see that the ovelling of the pupil. And this is where an actual foot plate of the IOL has tucked that iris posterior to the ciliary body. So they didn't have OVD when they were putting this in. There was no heel on. They were just kind of putting these in. Sometimes they put air in the anterior chamber. Sometimes they just shove them in. And again, you're doing this with loops. You're not doing this with a microscope. And so oftentimes the iris would get tucked posteriorly and look how thin that iris is. You get this thin-day trophic iris. But look at the top. Trubacular meshwork, something you're going to learn about next week. And you see that there's pigment, all this clogging the trubacular meshwork. So you get pigment dispersion from these anterior chamber one-piece plate type lenses, the choice lens. The other problem is this is the edge of a choice lens. And so again, the finish was you just took it and kind of rubbed it and it made it smoother. And so this was actually the edge of a lens that was removed. And just for fun, I wish I had this picture. When I was a fellow many years ago, we took a Coca-Cola bottle, broke it on the curb, and then took an EM of the Coke bottle and it looked just like that. So you can imagine what this is going to do in the anterior chambers, the pupils moving in and out. And so you could really get significant problems. And in fact, as these lenses were coming out, there was actually a surgeon in South Dakota who coined the term UGG, UV-Irosclochroma-hyfemosyndrome. And he never, I never met the guy. He never came into meetings. His name was Ellingson and it was called the UGG syndrome and it stuck. And so we use that to this day, UV-Irosclochroma-hyfemosyndrome. And that was chronic inflammation and hyfemos caused by poorly finished choice lenses. Now, choice was the first one to defend him. I was an innocent Dave Apple fellow speaking on my first Askers meeting. And of course, Mr. Choice was on the podium while I was talking, you know, he immediately stopped me and said, these were unlicensed rip-off copies by American companies of his lens. So these were not his lens inside. We're finally apologized to him. So these were Choice rip-offs, but companies were starting to make IOLs at this time, even in the U.S. and this was one of the U.S. made choice lenses. So because of the difficulties with one piece plate lenses, people said, well, why don't we make a lens instead of being one solid piece of plastic, a lens that has loops on it? And therefore, you can put this into the anterior chamber a lot more easily. It's less bulky, easier to finish. And so this was the first one. And those people who were inventing these, they put their name on it. So this was the Azar lens. It was called the Azar 911Z. They had come up with a way to make plastic loops out of polypropylene. And for those of you who were in the lab with me last week, we actually saw a pair of polypropylene loops, which underwent some surface degradation. And so these had clear polypropylene loops. And again, a PMMA optic, these were very easy to put in the eye. You just slide them in, they're very easy. And these eyes did great for about six months until they started running into problems. And so this was the Azar 911Z, but there were other ones, Larry Lyske male lens. This was the Lyske lens. All he did was he squared off the polypropylene and that's what that looked like. And some of them even made solid loops, various different ideas on the same thing. But the idea is you have these loops, these closed loops around there. That's right. Sir. What material of those optics are those? That was actually, this was all PMMA. So this was a whole lens out of PMMA. And then this was one, this was the ultimate one. This one had, look at all those little wires coming out. And so this was very popular in the early 80s here in Utah. And so they put a whole bunch of these in and boy, Randy and Alan could tell you, when you remove these because of UGG syndrome, these were a nightmare to remove because there's eight little individual loops that would go into the angle and then get cocoons of fibrosis around them. And so removing these was just awful. Trying not to cause irritodialysis and you'd have to cut them in two different places and back the loops out. These are really tough to remove. But again, they would cause just that chronic UGG syndrome. This is what an UGG syndrome looks like. This was another one. This was the Hesburgh lens.  But if you look at this with the slit lamp, it's got corneal edema. The eye is extremely red and irritated from the chronic UVitis. So this is chronic UGG syndrome from these. And this was one of the side effects. This, believe it or not, is a cornea cut in half. And so it was interesting when the A's are 911Z came out, the company was touting this as safe, as a wonderful lens. Everybody should be using it. There was a high volume surgeon in town who had founded the Eye Institute who would advertise on TV and give people roses and send a limo to pick them up so that he could do their surgery and all. He was the first high volume guy. He was giving talks saying, I put these in and they're fantastic. I've never taken one out.  And so you don't ever see a lot of your complications. So this lens, the A's are 911Z led to corneal edema, chronic ux syndrome. This is actually a cornea from one of those original ones. Why? Well, what happens is when you've got these small round closed loops as they go into the angle, which is what we're looking at here. They actually dig into the peripheral iris and the iris forms little cocoons over them. And so what happens is, is you get chronic irritation of the iris, but the other thing is when people rub their eye, which unfortunately people do after surgery, there's nowhere for that force to go. And so what was happening is these closed loops, as you push in would cause the optic to vault forward. And we did a bunch of studies in the lab where we literally put a bunch of them in there and squeezed them and saw what happened and they would vault forward. And so not only would these dig into the iris tissue and cause chronic irritation there, but they would bang forward and bang on the endothelium. And so you would end up with chronic corneal edema. And this just shows you, this is an IOL loop in the anterior chamber angle as it dug into the tissue. So this is what these closed loop anterior chamber IOLs would do. This was again one of the lenses I told you about the eight different little haptics. Look how they're digging into the angle there. This is an anterior view of a cadaver, a corneal remove so you can see it. And those loops are digging into the angle. So really, really difficult to remove once that happened. This was the lens we saw in clinic last week. This is a Dubrov lens. And so this guy Dubrov said, well, if the closed loops are a problem, why don't we make open loops? So he designed his IOL with three broad loops that would go around like propeller. The problem is is those loops would go into the angle and would totally close it off with, you know, synechia on top of them. And so you would literally shut off two thirds of the angle with this lens. And it was very sharp. The edges were very sharp. You can see where it's kind of scraped on the iris up above. So these turned out to be quite a disaster. And here again, here's an eye with just chronic UG syndrome with corneal edema. So eventually when you get corneal edema, they even called that UG plus. So you'd get corneal edema and your chronic UG syndrome. What is this? Bowie, all right. So there's a cornea. There's a Bowie blister with chronic corneal edema. What is this? We haven't done this this year yet. Exactly, so we are now in the macula and you see, exudate here in the outer plexiform layer, the layer of Henleys. So we're going to talk about that when we talk about retina in a couple of weeks. So that you would get chronic cystoid macular edema from all the inflammation. Well, Kelman, who was the man who invented the ultrasound. I mean the same Kelman. Charlie Kelman said, If the problem is with closed loops, then why don't we make an open loop by a well? So his first one, it was made out of PMMA. We used to call this the pregnant seven. And so you can see it looks like a pregnant seven, literally. This was a very stiff one piece PMMA. And so this didn't work very well. He immediately went away from this and made an open loop with again a tripod. And so Kelman's argument, he used to give these at talks, is that if you go to a bar and the floor is uneven, if you have a four legged stool, what happens? It wobbles. But if you have a three legged stool, it's sturdier and it doesn't wobble. So that was his argument. This didn't work well either. And so he, you know, he's, Kelman was smart. He about six months later said, okay, forget that argument. And he designed his Kelman lens. Now, does this look familiar? And this is our anterior chamber, Iowa, to this day. And Kelman designed this in the early eighties. And so this was a design that worked. It's open looped. So if you squeeze that, much like leaf springs on a truck, it will take up, you know, the pressure that you're squeezing it and that optic would not vault. So this was very good in that situation. Also, those little haptics were flatter. They weren't round. And so they didn't dig into the angle. And as you can see, he put a little kind of an anti-curve on it. So it would only kind of touch the angle in two places instead of along the whole arc. So this turned out to be a very good design. And as I say, we use it to this day. So this is our present day anterior chamber, one piece PMMA IOL. So that's kind of the evolution. Just to go back to Kelman's idea of the FACO, I thought this was a great idea. Kelman was a brilliant guy. He was a real showman. He played saxophone and was like on the Johnny Carson show. And his office was in the Empire State Building, seriously, in New York. And he did very well doing his surgery there. And so one day he decided he'd never played Carnegie Hall. So he rented Carnegie Hall and invited all of his patients that he'd operated on and did a concert for him.  And so he did that.  So when Kelman was thinking about ways to get out of cataract, you know, because we were doing surgery with large incisions that were taking out the lens as whole, he said, God, we gotta have a better way to do it. He is at the dentist's office. And the hygienist is sitting there with the ultrasound cleaning the plaque off his teeth. And he's asking the hygienist, what is that thing? He said, well, it's an ultrasound. It grinds up the plaque. And so he had the aha moment. And then immediately went back and started working on using ultrasound to break up a lens to remove it. And that's, again, what we use this day. So Kelman was the one, that was his aha moment was at the dentist getting his teeth cleaned. So I always think of that when I was at the dentist last week and the hygienist is doing what she calls her deep clean where she takes the ultrasound and kind of goes into your mandible, take off the plaque and goes, oh, does that hurt? Oh, not really. Ah! So that's how Kelman got the idea. And that's how we ended up with fake emosification. Okay, so this is the original apple core. So I don't know who the guy is with the swarmy mustache, but this is how Dave Apple did things. You'd go to the corner of the cafeteria because we didn't have enough space in the lab yet then. You take up the whole corner, you'd spread out all these EM pictures that we did and then he'd take his dictaphone and he would just randomly dictate and then the secretary would try to put it into sentences and do it all. So this was all the original apple core we called it and we would sit there and go over the pictures and then dictate them all. So this is how papers were done in that era. All right, so while people were looking at anterior chamber, and again there were issues with anterior chamber, people in Europe said, why don't we come up with a way to clip the IOL to the iris? Now again, we're still doing intercaps, still not having any capsular support. So they said, okay, why don't we clip it to the iris? So this was Cornelius Binkors lens. And what he did is he said, okay, we'll put two loops in front of the iris, two loops behind the iris and we'll clip it on there. So this was the original Binkors lens. Now, because minor detail, if you like dilated the pupil widely to look at the peripheral retina, sometimes the IOL would just fall out. And so minor detail, so Jan Worst said, well, we've gotta find a way to fixate this IOL to the iris better, so it doesn't fall out. So he did a couple of things. He put two molds in here so that you could suture it to the iris, but he also put this little peg on there so it would hold it to the iris more firmly. We used to joke that this was the worst lens because it would cause horrible UGG syndrome. And you can imagine that suture going through there and then this pin on there. So these really caused horrible problems. The other thing is the haptics were made out of polypropylene. And this again, we saw one of these literally last week in the clinic, they're still out there. This is a polypropylene haptic. And as it gets in touch with UVL tissue, i.e. the iris, the angle, even the solar body, it would undergo what we call this mudflap cracking. So when it rains out in the desert and then the rain dries, you get this mudflap cracking on the road. That's all surface degradation of polypropylene. So you can see that. So it was fun because this was at a time when people were just kind of taking out lenses and there was no center in the world to study them. So Dave Appel was smart enough to start an IOL center. When I was his fellow, we would just do EMs on hundreds of these lenses. And every day you look at them and go, wow, what is that? And then try to figure out what it is. And so we were the first ones to really report degradation of polypropylene. Why is that important now? We're suturing an IOL to the ciliary sulcus or to the iris. What suture do you use? You use proline sutures, polypropylene. And so if you use a 10-ohl polypropylene and you suture an IOL to the iris or to the ciliary body, that can break down just like that. And eventually that suture can break down enough that it will literally break. So we use 9-ohl because 9-ohl, believe it or not, much bigger than 10-ohl. It doesn't seem that way, but it is. It's much bigger and so it lasts longer. This is interesting. What do you think this material is? It's titanium. So people said, wow, titanium never breaks down. Why don't we put that on there? Yeah, okay, so this is an iris fixated lens with titanium. The only problem is that titanium, even though you don't think of it as being really heavy, in an IOL it was pretty heavy with titanium and they had trouble polishing it really well. So it would, plus it was expensive. So titanium lasted for about a millisecond in the market. But enough so we saw one. So this was actually a titanium loop. So this was a worst lens. And as we joked about it, look at the irregularity of the pupil. The suture that goes through, I'm sorry, my pointer must be out of the battery, but there's a little suture coming up to suture that to the iris. There's a peg holding it there. So look at the iris atrophy all the way around. And so you get chronic Ugg syndrome, chronic pigment dispersion, glaucoma, all kinds of further problems. And this is an EM of one of these lenses that the loop that was behind the iris, and you can see all of the material stuck to that loop. So this was the two loop mink course. Of course, this is now when people are starting to do extra caps now, finally. And so you can see there's still a little bit of a caps that are back there. And so what they decided is they said, well, if we've got a caps that are back back there, we don't need to put four sets of loops. We can only do two sets of loops. And so eventually they made loops that would go back toward the caps or back. So what's funny is at this time, IOLs, they're going all kinds of designs, all kinds of advertising. This was an ad from the journal Copeland, was a company that made these propeller shaped IOLs. Two tabs in front of the iris, two tabs behind. And here's the Copeland elves making IOLs for Christmas. So this was actually an ad from journal ophthalmology. There's the Copeland elves that are making that. This was an interesting IOL because you'd get a square pupil.  So you'd get a square pupil, again, chronic pigment dispersion, chronic UGG syndrome, all kinds of problems with these. This is what one of those Copeland lenses looked like. Corneal edema, UGG syndrome, pigment dispersion. And so these could cause really serious issues. My favorite is this one. This was one of these irritable capsular lenses. Look at it, proven, safe and effective. Discontinued. And so this was pulled off the market. And it was actually, a lot of these were pulled off the market by work that was done here. Dr. Olson and Dave Appel would literally go back to Washington and testify before the FDA. And so these were lenses that eventually were pulled off the market because they really weren't successful. All right, so now let's see something familiar. So again, people went the whole route. The original Ridley lens was made for the posterior chamber because he was doing crude extra caps. Well, everybody started doing intro caps for many, many years. Eventually people started getting back saying, wait a minute, if we can leave that capsular bag intact, not only are there advantages of vitrious not coming forward at all, but we can also consider putting an implant in there again. So Steve Shearing in Las Vegas was the first one to come up with a posterior chamber IOL, years later after Ridley. And so he came up with this J shape. And you can see it's got that J shape on there. And the idea is you put it in the posterior chamber and with capsular support. There was a great idea. So ophthalmologists are an innovative bunch. Once somebody saw this, he said, wow, what a great idea. And so immediately within like six months, there were a couple of variations of this coming out. And so guys were literally drawing IOLs on cocktail napkins, you know, at Academy meetings, and well, I shouldn't say Academy Academy, it was totally against IOLs and FACO from the first. They should say early Oscars meetings. And then companies would go back and literally make these. And so they were coming out. And so if you look at this, it's got this stiff J coming out from the middle. So if you think about it in the capsular bag, that would really ovalize the bag and it wouldn't fit well. So a guy named Simcoe in Oklahoma said, why don't we make these loops C shaped? So, you know, they'll more adequately fill that round shape. So he came out with these really big C shaped loops. Now, what are these things? They're actually positioning holes, we call them. And so, you know, we again didn't have OVDs then. And so you would literally shove these things behind there and you'd put a hook in there and move them around. And so this is how they would get in. And then this was the lens that I trained on. This is Bob Sinski's lens. And so he came up with what we call a modified J-loop. So he moved the J more to the periphery, angled a little better so it would fit inside the bag. And it went to two positioning holes. And so this was the Sinski modified J-loop lens. And this was the lens in the mid 80s that was the lens. I mean, this was the lens. And it really nicely done. ILab was one of the first U.S. companies to make implants in Southern California. You can see they literally wrote their name on it and they had the power on there. Turned out later on, we realized that you don't want raised letters on there, because again, they could scrape on things and cause nitices to form on there. So they eventually got rid of that. But this was the Sinski lens. And Sinski invented a hook to put it in, which you guys, we use to this day. So, and Sinski just passed away last year. I mean, he lived until his mid 80s. Life was good when you were one of the first IOL people. He bought a huge winery and Napa and it's called Sinski. And the label of his wine bottles, if you look carefully, he's got the little IOLs on it. And so his family now runs it, but still they make a wonderful Pinot Noir. So you can even get it in Salt Lake, it's funny, we found a restaurant here in Salt Lake, you could order a Sinski Pinot Noir, but so life was good in those days. All right, so then the argument became, where should you put an IOL? Should you put it in the capsular bag or should you put it in the soak us? And so at this time, we hadn't invented a capsule rexus yet. So we were making capsule atomies with a sharp Cystitone. The idea is you'd make a dozen punctures around the anterior capsule with this sharp instrument and then you tear off the capsule. And so you do an extra capsule, you take the nucleus out whole and that would split the capsule in a bunch of places. So people said, well, you really can't get that in the bag, we should just put it in the sulcus. You're arguing just put it in the sulcus and that was safer that way. And so we did some studies on IOLs that were in the sulcus and so this is actually a view from the back, a Miyaki view where there was an IOL in here, but look right here, look at that pigment broken up. And where was that? That's right where the haptics scrape on the posterior iris. And so Dave Appel and all of his fellows, myself included, argued very forcefully to put it in the bag. And so there was an argument back and forth with the people of Wilmer. And because it's Hopkins, Wilmer, they were obviously correct because Dick Green can never be wrong and so, but eventually you're not putting it in the sulcus anymore. So you know how that argument went. So this is an IOL that was put into the sulcus. That's the iris. First of all, notice that the anterior chamber, which we can measure is back here. So that iris is totally pushed forward and adhered to the cornea. Look at that loop. That loop is down here in the ciliary body. And so that loop dug in here. And again, so you've got synechia, you've got chronic glaucoma. This just shows how bad our surgery was. This is a huge summering drink in the capsular bag. But I would be bad as a weatherman and I keep getting in the way here. Going this and you watch the weather on TV. So finally, we got the ways to do a capsulotomy where you could have an intact anterior capsule, you could put an implant in the bag and sure enough, there's a Sinsky lens in the bag. Apple may I'll give you a look how beautiful that looks. And again, that's where we are now. I mean, it's all different kinds of IOLs but that's where we are now putting it in the bag. And here you can see, here's the iris to the front, there's the capsular bag, there's the loop of the IOL in the bag. And you see no UGG syndrome, no pigment dispersion, beautifully fixated within the capsular bag. And again, that's where we are today. Now, as technology was improving, polishing improved too. And so when we had these, this is an original one-piece PMMA lens and originally those were hand polished. It was funny because when you'd go to the IOL manufacturers, they were all in Southern California at that time and so there was rows of tables just like this, only sterile. And there was all these little Hispanic ladies with hairnets and makeup light polishing IOLs. I mean, literally tables of them just like this and that's how they fixed them. So people finally figured out a way to tumble polish these. And tumble polishing is you put little beads coated with polishing material and you tumble them in a cylinder. So those of you as kids, did you ever polish rocks? So remember you put those rocks in there and you'd churn them for like a week and then they come out all polished. Well, that's what you do with IOLs basically. It's a glorified rock polish. So you put some little beads in there and some polishing compound and you tumble them for a long time and look how beautiful this looks though.  So you can't talk about IOLs without talking about evolution of cataract surgery. And they really went hand in hand. And so as cataract surgery got better than IOLs would change to match it. And so again, initially we were doing intra caps. And so how did you do an intra cap? You would make this huge incision stem to stem, I mean, limbus to limbus. Now we would put a couple of stay sutures in there because if you got an expulsive hemorrhage, you want to be able to tie that down really quick. And so then you would have a little tag of conjunctile on the cornea.  You'd put in some alpha chymotrypsin which would digest the zonules. You'd leave it there for 30 seconds and then you take this cryo probe and you'd put it on the anterior capsule. Push the pedal down equal. This ice ball would form on there and then you'd yank that entire lens and capsular bag out in one piece. Just, it would come out. And then you'd put an implant either in the anterior chamber or put to the iris and then you'd tie down all those sutures that you had. And so, you know, this is an 11 millimeter incision. It's a huge incision. There's no capsular support. So people started doing extra caps. And with an extra cap, what that means is you'd leave the capsular bag intact. You would go in much like Mr. Ridley did originally. Now you can see our wounds got a little bit smaller. We even made a little corneal sclera tunnel. You'd do your capsulotomy and then you'd go in there and you'd either use fluid or counter motion and motion. You'd pop the edge of the nucleus up. Then you'd go in there with a loop and you'd grab that nucleus and pull it out.  It was interesting because you would pull back on a syringe. And so you could generate anywhere from zero to 400 millimeters of mercury pulling manually. And so when you wanted, you'd go in there and then you'd start pulling back, pulling back and start grabbing cortex and then you'd strip the cortex and yank it back and it'll gobble up the cortex and you'd squirt in a little more fluid. So that's how you did extra caps.  And so he invented the ultrasound. So the idea now to this day again is we use the ultrasound to fragment the hard nucleus so we don't have to bring it out whole. So as a result, we can break it up into tiny pieces. You can suction it out. This will allow smaller incisions. And you have better control. Yes. Was it true that someone was at the dentist's office like listening to the ultrasound? It was Kelman. It was. Yes, I'm sorry. You missed that story when you were answering your page but absolutely, it was Kelman and the hygienist was working on his teeth with an ultrasound. Absolutely, that's absolutely true. So the second thing that this allowed is it allowed us to modify our wounds. And so initially with those extra capture, making just a big incision right at the limb bus and putting lots of sutures in, you'd get a stigmatism and all. So as people started saying, hey, wait a minute, we can use an ultrasound, make smaller incisions, we started making these stepped incisions. So you'd go back about a millimeter back, you'd go down partially into the square and then you tunnel forward and then eventually enter the clear cornea. And so that was this shelved incision that you'd make. Well, Howard Fine in Eugene said, wait a minute, you know, if we're doing these smaller and smaller incisions now, why do we even have to go through the sclera? Why can't we just go through the clear cornea? And so he was really the one who pushed these clear cornea incisions that we did now. Now that did a couple of things. First of all, you didn't have to go back in the sclera where it bled, you could do clear cornea. But second of all, we could now do surgery with topical anesthesians that are retroboar block. You know, if you're digging through the sclera at all and taking down conjunctiva, you can't do that with topical anesthesia. You need a retroboar block. And so this allowed us to start doing topical anesthesia. And the other thing people figured out is we used to operate superiorly. You tilt the eye down, you'd sit at the head and you'd work that way. People said, wait a minute, if we're doing a clear cornea incision, we don't have to be superior. What we worry about, you know, the lid covering overware incision is we could move temporal. And so that allowed us to sit comfortably, gain access to the eye without it turning down so it's interesting how technologies are all interspersed. And so we were able to, with this incision, to jump to topical anesthesia and sit temporarily, which is what we all do to this day. And so, again, better access to the eye. You didn't have to tell. We used to do with our extra caps. We would grab the patient's superior rectus muscle up above through the conge. You'd pinch it and you'd put a big 6-0 suture through it. Then you'd pull that out and you'd clip that to the drapes and then the eye would be tilted downward and that way you could gain access. Then you'd take down the conge, you'd make your big incision in the sclera, into the cornea, and then you'd do your extra cap. Well, again, you didn't have a reflex. You didn't have good depth perception there, but so all of these were intertwined. And so the clear corneal incision allows topical anesthesia, allows temporal removal of a cataract. Well, this was all good. People are making smaller incisions or doing fecal, except you'd have an IOL made of PMMA. So you say, wait a minute, we're doing this great surgery. Now we have to expand the incision to six to put in an IOL. Well, that doesn't make sense. So again, it went back to the IOL manufacturers. And so Tom Misako in Southern California said, well, why don't we make an IOL out of something foldable? So he went to one of the companies and they made the first silicone plate lens. And it was smart because he came up with a way to put it in an injector. And so when you see this, it comes out. It kind of looks like a softshell taco. So we call this the Misako taco. And so this was his Misako. And I just had a ball when I was at Ascrus. I was giving what was called the Binkorch taco. It's a really big talk. And you get to sit in the green room behind the stage like Johnny Carson, you know? And so you're there and we were honoring one of the old giants of the field who was like 94 and Tom Misako was introducing him. So I was sitting in the green room. You know, this was my research, right? These guys were gods when I was a fellow. And so talking to them for 20 minutes, asking them about what it was like in the old days. It was great because these guys were just, they just loved somebody who actually, you know, knew about their work and knew who they were and all.  And so it was really neat. And so Tom Misako was telling me about how they worked with the companies and what they did. And then the other doctor was talking about how he was doing Faco and all. And it was very interesting because I got to tell you my one story. It turns out that, you know, because of this disasters with Harris fixated lenses and early anterior chamber lenses, Ralph Nader, you know, you've heard that name, Ralph Nader and Nader's Raiders, you know, talking about all these unsaved products. He jumped on the bandwagon and said, these things are dangerous, they're blinding people. And so they did hearings in front of Congress to ban IOLs. And so there were some serious hearings going on and Nader's Raiders were talking about banning IOLs. And so the doctor from Southern California, one of his patients was a guy who played a TV character called Marcus Welby MD. So you have to remember now, this was the time of three networks. No cable, no internet, three networks. And so every week, you know, 80 million Americans would watch Marcus Welby MD and he was, Robert Young was his name. He was this actor and he was a general practitioner. He would see, you know, one patient a day. I mean, he would take care of him in the hospital and drive to his house and he was America's doctor. I mean, he was like the second most trusted man in America. And so he had cataract surgery with an IOL. And so they brought him to the congressional hearing and he said, this device saved my career. And then afterward, you know, there was cameras and flashes and pictures and all. And so the Congress congressional committee voted to not ban them, but to do a quote FDA study. And so it was good cause it didn't ban them but then, you know, all these devices had to be studied under FDA auspices. And in fact, this was the device arm of the FDA. This was what caused the FDA to form a device arm. But because of, you know, the doctor taking his patient back to Washington in testify, it was great having him tell the story. He said, yeah, we came out in the hallway and there was cameras and lights and everybody and nobody was paying attention to Nader. And so as a result of that, the IOLs did not get banned but they went into an FDA study. And so it was interesting when I was a resident, you had to be a quote investigator for each company. And at that time there were probably 15 IOL companies. So first thing you did during your resident orientation is you'd fill out like 15 IOL investigator forms. And then after each surgery, you had to fill out these check boxes on the investigator forms. But because of, you know, Dr. Marcus Welby, the second most trusted man in America saying this saved his career, that saved IOLs. All right, so this was the original mozaco taco silicone. And so we figured out that silicone may not be the best material. And so people started working on this new material, hydrophobic acrylic, does that sound familiar? Because it has a high refractive index, you can make it thinner, you can make it three pieces or one piece and sure enough, these are some of the different materials. This is a hydrophilic acrylic inside the capsule or bag. And of course this was our latest hydrophobic acrylic. And I'm stopping here because, you know, you guys, we get all kinds of lectures from, you know, Alan Crandall and from everybody about how we do surgery now and how we do IOLs. But nobody ever tells you the history about what happened and why it happened and how we got here. I think it's just fun to know that. So we'll stop here and go back to the Shonbrun Palace. Now, next week you do have an assignment. Is it glaucoma? I believe, I'm not sure, but check and see. I think it's glaucoma because we did lens last week. Okay, so glaucoma next week, right another week after that. So please study your glaucoma. We're going to talk about anterior chamber anatomy. We're going to talk about various diseases that affect glaucoma. So study that and I won't talk so much. You guys are going to talk again. Questions?


We can say that's just a little metaphor from perception. It kind of points to that the Father, the Son, the Holy Ghost, and the Trinity really is one in spirit. But in terms of teaching purposes, God is just a word that's used for creator. Christ is a word used for creation. And the Holy Spirit is like a bridge for the sleeping Christ to make it back and remember the true Christ, the real Christ. So because the Holy Spirit is a bridge, there seems to be form that is involved with the Holy Spirit. For example, in the chorus, the Holy Spirit is called the voice for God. It's not even the voice of God. God doesn't have a voice. It's so cool. God is just business. Not even a voice. But the voice for God, meaning the voice that speaks and represents God to the illusion. And that voice is an illusion because that voice will cease to seem to exist when it is no longer necessary. So it would be great when you reach this state and you say, I no longer have to listen to guidance anymore. Why? Because I am. That's the goal. So when you say that Jesus speaks to you or that you are the Holy Spirit and the Holy Spirit told you this, does the illusion, does the voice, the solution? Yeah, in the end, that voice is just a time device. It's a device that's being used with time.  And those will get used a lot. In fact, part of it is going to just get comfortable with that and not misuse that. The ego could be sitting back there and be saying, oh, I kind of like this guidance thing. I could just do about anything, any well thing I please doing. I'll just call it guidance.  I was not guided to take the garbage out. And then the other part he says, I'm not guided to take the garbage out either. You see, this is where you gotta watch this ego. It's very clever. My Holy Spirit told me. Well, actually my Holy Spirit told me. And you can tell when there's conflicting guidance from the Holy Spirit and you start hearing this word, my, coming out. This is part of the ego's trick. Remember how I said the ego could quote scripture? The ego could take any concept and say, oh, I think I'm gonna take over this concept to preserve itself. So this is where it's very sneaky. And you actually have to come down to an experience we were talking about yesterday, how you feel. You're feeling happy, light, peaceful, joyful. You know, that's when the guidance is coming and you're listening and following. If you listen to guidance and follow guidance and don't feel joy, then you've got a discernment lesson going on there because the Holy Spirit inspires joy.


This lecture is part of Berkeley Math 115, an introductory undergraduate course on number theory, and will be about the prime number theorem. So this is the fundamental theorem of analytic number theory. And what it says is the number of primes less than x, which is usually done by pi of x, is asymptotic to x over log of x. So this is the number of primes less than x. And asymptotic means the ratio tends to one as x tends to infinity. So if x is very large, say about a billion or so, it means the number of primes less than a billion is going to be very close to a billion over log of a billion, which means if you pick a random number between one and a billion, the chance of it being prime is about one over log of a billion. The prime number theorem was first proved in about 1896 by Ademar and de la Ballet-Poussa. They gave independent proofs of it, and they both used ideas originated by Bernard Riemann. And what I'm going to do in this lecture and the next one is give a sort of rough sketch of the main ideas behind that proof. There are several technical complications involving complex analysis that I'm not going to go through in detail. Requires more complex analysis than this course really covers. In particular, in the more than a century since that proof was found, there've been several improvements in particular. There were some improvements found by Neumann and Don Zagie, which I'm going to incorporate. There are several other proofs of this. So Ademar and de la Ballet-Poussa's theorem used complex analysis. And if you're a number theorist, this is kind of annoying because results in number theory really should be proved just using number theory, not using complex numbers. And for many years, it was an open question whether you could find an elementary proof. And in 1948, Selberg actually found an elementary proof of the prime number theorem. His proof uses Selberg's identity, which is the sort of variation of what I call Selberg's identity in the previous lecture. Unfortunately, Selberg's proof was marred by a rather unfortunate priority dispute with Erdisch. What seems to have happened is that Selberg was giving some lectures on his work on finding an elementary proof just before he had, I mean, after he'd found Selberg's identity, but just before he'd figured out how to use this to prove the prime number theorem. And someone in the audience passed notes of Selberg's lecture onto Erdisch, who an Erdisch and Selberg both noticed that you could then use Selberg's identity to prove the prime number theorem. So my feeling about this is that Selberg found a proof of the prime number theorem and Erdisch found a rather minor variation of it using Selberg's ideas. So my own feeling is that Selberg is that person who should be credited with the proof. Anyway, so in the first two lectures of this course, I mentioned you could find some easy opera and lower bounds for Pi of X. So we have an upper bound. You can find an upper bound for Pi of X using the fact that the product over the primes between N and 2N is at most the binomial coefficient, which is at most 2 to the 2N. So this gives you an upper bound for Pi of X, which if you work out the details, it looks like something like Pi of X is at most about two times X over log of X. On the other hand, you can find a lower bound. Again, here use the product over all prime powers that are less than or equal to 2N or P is at least this binomial coefficient. And using this, you can find a lower bound on the number of primes and you get a lower bound of the one Pi X is greater than or equal to about a half times X over log of X. So if you look at these, it's quite easy to get the prime number theorem up to a factor of about two. And with a bit more effort, you can get this two down to a number slightly bigger than one and you can get this half up to a number slightly less than one. So however, it turns out to be very difficult to get this, to show that you can make this constant as close to one as you like and the same for this constant, which is what the prime number theorem says. So what I'll do is I'll recall the proof of the prime number theorem, sketch the proof of the prime number theorem. So this uses the Riemann-Zeta function, a zeta of S, which is one over one to the S plus one over two to the S and so on. And it was Riemann who discovered you could use the Riemann-Zeta function to estimate the number of primes less than X. Actually, you don't really use the Riemann-Zeta function. What you do is you use the log, you take the log of the Riemann-Zeta function and then take the derivative of that, which is called the logarithmic derivative of the Riemann-Zeta function and it's this function here. And as I mentioned in the previous lecture, this can be written as lambda one over one to the S plus lambda two over two to the S and so on, where lambda of P to the N is equal to the logarithm of P for all prime powers and lambda N is zero otherwise. So you can see that this lambda function is very nearly counting primes. It's counting primes except that you are not quite counting primes, you're counting prime powers and you're also weighting things by a factor of log of P. And the idea is you can estimate the following function. You define psi of N to be lambda one plus lambda two and so on all the way up to plus lambda of N. And so for example, if we take psi of 10, this is equal to log of two plus log of three plus log of two, again this comes because four is two squared plus log of five plus log of seven plus log of two again coming from two cubed plus log of three coming from three squared. And if I worked this out right, this number is about 7.83 and if you look at psi of 20, then you have to take this and you have to add log of 11 plus log of 13 plus log of two again, that comes from two to the four plus log of 17 plus log of 19. And if I work this out, this is about 19. And the idea is to show that psi of N is roughly equal to N more precisely, the ratio of psi of N and N should tend to one as N tends to infinity. And this would turn out to be more or less equivalent to the prime number theorem. So here are the steps of the proof of the prime number theorem. So step one, zeta of S, first you show that zeta of S has no zeros with the real part of S greater than or equal to one. So this is the key step. So you remember I mentioned every proof as a sort of key step plus a lot of routine details. And this is the key step. And once you've done that, well, calling the details routine is a, they're rather more difficult than being completely routine, but this is really the central step of the prime number theorem. So why should this be important? Well, Riemann showed that you can write pi of X as a sum over zeros of the Riemann zeta function. Actually, it didn't really sum over zeros of the Riemann zeta function. What he summed over was poles of zeta prime S over zeta of S. But obviously a zero zeta of S is a pole of zeta prime of S over S. So if you look at his proof, he was actually using the logarithmic derivative of the zeta function. And there's a pole at S equals one, which gives you the main term, which is roughly X over log of X. Actually, it's really something more complicated called the logarithm, the integral of X, but we won't worry about that X over log of X is good enough. So, and then you get plus other terms coming from the other poles of zeta prime over zeta. And suppose, so these come from numbers S such that the zeta of S is equal to zero. And suppose S is equal to sigma plus IT, where this is real and this is imaginary. This is sort of traditional notation. Why people use sigma plus IT? I don't know, but all number theorists do so. So this is the real part and the size of the error depends on the size of sigma. The T sort of gives you a sort of oscillating contribution, which doesn't really matter too much. Now, if sigma was greater than one, this, these terms would be much bigger than X over log of X. So things would break down completely. Fortunately, it's easy to show the Riemann zeta function as no zeros bigger than S equals one. If sigma is equal to one, the terms are about equal to X over log of X in size very roughly. And the trouble is if you are having other error terms that were the same size as X over log of X, this would kind of mess up the idea that pi of X is approximately equal to X over log of X. So zeros with real part one, if there were any, then the error terms would be as large as the main estimate for pi of X and you wouldn't be able to give an asymptotic formula in the prime number theorem. And it turns out that zeros with sigma less than one are giving you smaller error terms and there's a bit of a complication because there might be an infinite number of terms with sigma slightly less than one, but that's a complication that we're going to kind of brush over. So this obviously is the question, where exactly are the zeros? And the most notorious open question in mathematics is the Riemann hypothesis, which says that all the non-trivial zeros should have real part sigma actually equal to a half, which is in some sense the best possible. And this would give us the best possible estimates on the number of primes less than X. So that's the key step. The second step is something called Neumann's Talberian theorem. Now, this is a theorem from complex analysis, which says that if you've got a reasonably nice function and the integral from one to infinity of f of X, X to the minus S, the X converges for the real part of S greater than one, and if you can extend it through a function that is holomorphic for the real part of S equal to one, then the integral converges for S equals one. So Talberian theorems are kind of theorems that tell you that something actually does converge when you hope it will converge. This theorem I'm going to skip the proof of because it involves some slight, well, involves some ideas from complex analysis. I'll try and put a link in the video description to a short proof of this by Zagia, if you want to see the details. And then step three is we use Neumann's theorem to show the integral from one to infinity of psi of X minus X over X squared, dx, we show this converges. And we're going to show it converges by using Neumann's Talberian theorem and in order to use Newton's Talberian theorem, we need to know that something is actually holomorphic for the real part of S equal to one. And this is where we use the fact that the Riemann Zeta functions know zeros with real part one because if it had zeros then the function Zeta prime over Zeta would not be holomorphic for this condition. So this is where we use step one. So once we've proved this, the remaining steps are rather easy. So step four, we deduce from step three that psi of X is asymptotic to X. So, and going from step four to step five, so step five shows that pi of X is then asymptotic to X over log of X. So going from step three to step four and step four to step five are really rather easy. And the hard parts of this proof are steps one and steps two. So I just recall some facts about Dirichlet series. If we've got a Dirichlet series A one over one to the S plus A two over two to the S and so on then we can ask, where does it converge? Well, if it converges for S equals S naught, some real number, then it also converges for S is greater than S zero. And more generally, it converges whenever the real part of S is greater than the real part of S zero. So what this means is that in the complex plane, we can find some vertical line here such that the series converges in this region here and it does not converge to the left of this line. We might also get extreme cases where it converges for all complex numbers or doesn't converge for all complex numbers. But except in those cases, there's always some line such that the series converges whenever the real part is for the right of this line. In other words, larger than this number, the real part of S zero diverges to the left of it. You notice this is actually sort of similar to power series. You remember that if you've got power series say centered at the origin, then there is, you can find some circle such that the power series converges inside the circle and diverges outside the circle. And when you're on the circle, maybe it converges and maybe it doesn't, it's kind of hard to tell. And again, the circle may be degenerate. It may be a single point in the power series might converge nowhere or it might be sort of an infinite circle and the power series converges everywhere. So convergence of Dirichlet series is rather like convergence of power series except that instead of converging inside a circle, it converges in a half plane. By the way, if a power series, if a power, the place where a power series converges in a circle is the circle of convergence is much the same as the circle of absolute convergence. In other words, if a power series is absolutely convergence in an open disk, then it's actually convergent in the unit disk. For Dirichlet series, things are slightly more complicated. For instance, if you take the series one over one to the S minus one over two to the S plus one over three to the S and so on, it converges provided the real part of S is greater than zero. But if you take the absolute value of its coefficients, you get one over one to the S plus one over two to the S and so on. And this converges whenever the real part of S is greater than one. So the half plane of convergence is no longer the same as the half plane of absolute convergence. The proof of these statements about convergence are not that difficult, but I'm going to skip them on grounds they're complex analysis rather than number theory. Next, we need to know where are the zeros of the Riemann-Zeta function? So the Riemann-Zeta function is one over one to the S plus one over two to the S plus one over three to the S and so on. And you remember this can be written as an Euler product, product over all primes of one over one minus P to the minus S. And now we notice that Zeta of S is none zero if, first of all, all factors are none zero. And secondly, the product converges through a none zero value. So obviously it's rather difficult to tell if you've got a function written as a sum of things it's pretty hard to tell when it's zero. But if it's written as a product of things, this is a lot easier because this is obviously going to be something to do with where the zeros of the product are. Well, provided the product converges, so you can get a product of things like one times a half times a third and so on and all the terms of this product are none zero, but if you take the product of all these, you're obviously going to get something zero. So it's not enough to check that the product converges, you've got to check that it converges to something none zero. And an easy way to do this is to take its logarithm. So we look at the logarithm of the product over all primes of one minus P to the minus S. Since we're taking logs, they turn reciprocals into taking minus signs. So if this converges, so if this converges, well, so we can write this as a sum of logarithms of one minus P to the minus S. And if this sum converges to something, then the product is none zero because if the sum converges to something finite then the product will be X of that finite thing and X was something finite is none zero. So what we want to do is to study the convergence of this sum here. And we know that logarithm of one minus P to the minus S is approximately P to the minus S in absolute value. So you remember log of one minus X minus log of one minus X is X plus X squared over two plus X cubed over three and if X is small this will be approximately X. So we want to know, so we want to know if the sum of P to the minus S converges. And this converges if the real part of S is greater than one. You can see that fairly easily because here this is a sum over all primes but if you take a sum over all integers, sum over N of one over N to the S this converges if the real part of S is greater than one. So if the sum over all integers converges the sum over all primes converges. So what we conclude from this is that the Riemann Zeta function is none zero for S is greater than one because of the Euler product. And what we want is to know that Zeta of S is none zero for, so it should be the real part of S greater than one for the real part of S equals one. So you can see this is right on the boundary of the region where we can prove it's none zero. So what's going on is, so we've got a complex plane here. Here we've got the Riemann Zeta function and here we've got the line with the real part of S is equal to one. And in this region here, there are no zeros because the product converges. And what we want to know is, are there zeros here? So there are no zeros in this half plane, but we want to know whether or not there are zeros on the boundary. And this turns out to be sort of very tricky to prove. Anyway, the other zeros, by the way, are in this line here. So this is called the critical line. So this is the line with real part of half. And it's known that definitely are some zeros on this line. And there are also a few zeros of the Riemann Zeta function at minus two and minus four. And so they're called the trivial zeros and everybody mostly ignores them. So we would also like to know that the Riemann Zeta function is actually defined for all complex numbers because the series for it only converges in this region. So it's not even clear that it's defined for the real part being equal to one. So how do we define the Riemann Zeta function in this region here? So what we can do, there's an easy way to do this. What we can do is we can look at the series one over one to the s minus one over two to the s plus one over three to the s and so on. And now this converges for the real part of s is greater than zero. If s is real, you can see it converges because it's just an alternating series. If s is complex, it takes a little bit more work to show that it converges. But again, I'm going to skip that. And what you notice is that this is equal one over one to the s plus one over two to the s plus one over three to the s and so on, which is minus two over times one over two to the s plus one over four to the s plus one over six to the s and so on, which is equal to Zeta of s minus, minus two Zeta of s over two to the s. So we find that one minus two over two to the s times Zeta of s is given by this series here, one over one to the s minus one over two to the s and so on. So this is defined for the real part of s is greater than zero. So this almost gives us a definition of the Riemann-Zeta function for s greater than zero, provided this thing here is non-zero. Well, this does actually have zeros. It has zeros whenever two to the s minus one is equal to one. And there are some points with real part s equals one where this holds. So this doesn't quite define Zeta of s for all numbers with real part equal to one because of the problem with this. But then we can do a different trick. We can look at Zeta of s minus three over three to the s times Zeta of s and do the same trick and show that this is also defined for real part of s greater than zero. And now we just use the fact that two to the s minus one equals one and two and three to the s minus one equal one, the only common solution is s equals one. So the first definition shows that Zeta of s is defined whenever two to the s minus one is not equal to one and real part of s is greater than zero. And this variation using three instead of two gives the same value for that. And altogether this shows that Zeta of s is defined for all numbers with real part s greater than zero except for s equals one. For s equals one, Zeta of s really does become infinite. So that gives the analytic continuation of Zeta of s to real part of s greater than zero. By extending this argument, you can actually show that Zeta of s can be defined for all complex s except for s equals one, but we don't actually need that. So I'm going to omit it. So that's a summary of the basic background for the proof of the prime number theorem. So what I'm going to do next lecture is to go through steps one to five in a little bit more detail and actually sort of sketch the proof of the prime number theorem.


Inorganic membranes have become increasingly popular in the water treatment and desalination industries due to their unique properties such as high chemical stability, long lifetime, and autoclaveability. These membranes can also withstand harsh conditions such as high temperatures and chemicals, making them ideal for use in industrial settings. Synthesis methods for inorganic membranes include liquid membranes, dynamic membranes, ceramic membranes, carbon-based membranes, silica membranes, and zeolite membranes. Each method has its own advantages and disadvantages, but all have shown promise in terms of performance and efficiency. Inorganic membranes have been successfully applied in a variety of water treatment processes including reverse osmosis, nanofiltration, ultrafiltration, and electrodialysis. This article was authored by Ahmad Kevani Fard, Gordon McKay, Anita Beaconhout, and others.


Hi everyone, Joe for jasmiescasebrakes.com. This is a good one for a Saturday night 2020 Panini flawless football two box Pick your team number 17 a very big. Thank you to all of these people right here for getting in on the action Thanks for buying your team straight up And thanks for spending a bit of your Saturday night with us Now we pulled some teams out for those R&Bs for those number blocks So Daniel Lyman you ended up being last-bought mojo with the New York football Giants Now those number blocks So those are done in separate videos. So this is the number block just for those teams and just for pick your team 17 We'll set that one over here. I guess All right, and then we just kind of a quick little two team number block featuring a couple big teams right there chargers and the Packers again, just a serial number break Applies only to those teams and only for pick your team 17 just right there I'll set this one over here All right, here it is 2020 flawless football good luck Okay, can music request from Justin too You know I should do a break where Where I randomize everybody's names at the end and the winner can request a song for the next jaspy's case breaks playlist Curated by yours truly Maybe we'll do that All right, we'll do that second briefcase in a second. Here's the first one both briefcases go bigger go home Right good luck everyone. I got the sounds of the Dodgers at Braves in the background Dodgers going to the top of the ninth Only down two runs. Can they pull off a? Win I know we'll see I'm trying not to look at the encased cards Let's do the cards in the slider box first There's the blockchain and it's gonna be Jalen Hertz flawless rookie signatures the digital card going to Going to the Philadelphia number block So that's gonna go to PJ with number zero set that over there. All right When we got Kenneth Murray three color patch seven out of ten for the chargers chargers, of course are a number of block team so Chargers seven that's gonna be PJ with Chargers seven we got some chiefs 12 out of 15 Clyde Edwards E. Lair Patrick Mahomes in the middle and Miquel Hardman jr. On the right side Kansas City is a number block team. So if you're not familiar with these number blocks right here We go by that digit right there. So if it's 12, it'll go to the number two So two we'll get two out of whatever 12 out of whatever 22 32 42 52 Two is Andrew Chris Carson 19 out of 20 Seahawks that See that'll be for Paul Paul Norden got the Seahawks straight up 11 out of 15 one two three color dual relic an autograph 11 out of 15 Sam Darnold and That'll be for Daniel and the Jets last spot mojo Daniel and the Jets Five out of 15 two color dual relic former Raider Omari Cooper Dallas Dallas is a number block team So that'll go to Dallas five and that is for Paul Norden with Dallas five Eight out of ten diamond auto Deandre Swift Nice this quick hit going to Aaron Salinas and his Lions nice Will Smith versus Will Smith Nice diamond there Aaron. There you go. Thanks for getting in. Thanks for getting your team straight up another cowboy 17 out of 20 CD lamb Nice three color Dual relic and autograph got more of a little bit of a navy blue on the right side here So Dallas seven Will be for Daniel. There you go Daniel. Yeah, that was a nice hit darksiders He's pretty good As a sleeper and draft kings All right Left right and center and then we'll do another briefcase. Good luck. We got oh no a Randomizer career colors Peyton Manning Colts edition Peyton Manning Broncos edition four out of five Kurt has the Broncos and the Colts are a number block team. So Colts for Travis you're in on it One happy person one sad person one person with a train whistle. All right on the right side. We've got Adrienne Peterson lions edition two out of ten sapphire Matches the color of the team Aaron Salinas Detroit Lions nice sapphire in there and the card in the middle Is a quarterback two color patch one out of two It's the original TB 12 Terry Bradshaw And that looks like that's a 12 right there to raking. That's a 12 one out of two Pittsburgh Steelers picked up straight up by Patrick Evans. There you go Pat Out of fives and under get the train whistle all aboard the big hit express So these are naturally mine not lab grown Cases close on this one. We got one more to go. That's it for the Dodgers today. I'll be down to their final out Justin Turner Keep it alive Justin. All right Slider box first then left right and center Not gonna look Try not trying up to peak. I want to be as surprised as you when we pull out those encased cards Quad relic chase clay pool 10 out of 15 Another one for Patrick Evans and the Steelers got the Steelers straight up 5 out of 15 a trio of Ravens Lamar Jackson Mark Andrews Mark East Brown That's Daniel Lyman with the purple birds. I think we got the entire Cowboys wide receiving core right we had a Mari Cooper CD lamb Michael Gallup right here now 6 out of 15 with a point on the star 6 out of 15. So Dallas 6 Gonna go to PJ someone should have gotten the Cowboys straight up they wouldn't gotten that trio of receivers 4 out of 10 we got Heinz Ward jersey and autograph and that will be for Patrick and the Steelers Dodgers down to the last strike Any rings rings them up Ruby Otto Jacob Eason 2 out of 20 blue horseshoes Are a number block team so Colts to Andrew Roth AR We got dual relic and autograph Mark Andrew 16 out of 20 another one for the purple birds Daniel They're saying that and that that's a catch, right? Look at that hands right out in front Looking the ball right into his hands. That's that's good. It's good right there They're saying that Lamar Jackson taking Working on taking a lot more snaps under center Which he barely does so that could be an interesting evolution to his game. All right, there you go, Daniel And from Daniel to Daniel Jones 9 out of 15 two-color patch and autograph They've added some some players to the Giants Right some new coaching on the Giants a healthy say quan this year This could be a good step forward for Daniel Jones mark B picked up the Giants straight up left right center left side legends Ruby eight out of 20 Brett Favre part of that Chargers Packers number block and letter 8 PJ with Packers 8 on this side. We've got More Cowboys Cowboys Sapphire 5 out of 10 Ezekiel Elliott Nice color match there Cowboys 5 is gonna go to Paul Norton. There you go Paul and the last hit out of here It's gonna be For a number block team. It's Jalen Hertz Really nice patches dual relic Three color pack for maybe and autograph. He's got a nice auto 20 out of 25 and it's gonna be 25 out of 25 Philadelphia is a number block team on this side Philadelphia 5 Paul Norton Congrats, that's some nice dual relics right there He's your QB one out in Philadelphia. He's got Devonta Smith to throw to It's gonna be pretty nice. Congrats to Paul Norton. Thanks everyone for getting in I'm Joe for jashby's case breaks calm. We got a randomizer to do We're gonna have to make one person happy and one person sad with this dual relic Peyton Manning And someone's gonna win a train whistle too. So let's go back to some fresh Some new list fresh dice new list We got Colts edition, which is a number block and we got Denver edition, which was picked up straight up Let's roll it. Let's randomize it Full 12 times. We're really gonna make you sweat it out team on top after 12 one two three four five six seven eight nine ten Eleven and 12th and final time after 12 goes to Denver and That's Kurt Kurt disser with the Denver Broncos picked up the Broncos straight up Apologies to Travis who had We had Indianapolis for but congrats to Kurt you get the Multicolor right one two three four five five color dual relic Four out of five Peyton Manning career colors dual relic and of course out of fives and under get the train whistle All aboard the big hit express That's it everybody what a great break 2020 Panini flawless football two box pick your team 17 in the books Keep your eye out for more flawless that may end up on the side We may dig up some more immaculate some more NT so keep your out on jaspys case breaks calm I'm Joe and I'll see you next time for the next break. Bye. Bye You