From around the globe, it's theCUBE with digital coverage of AWS re-invent Executive Summit 2020 sponsored by Accenture and AWS. Okay, welcome back to theCUBE's coverage of AWS re-invent 2020 virtual Accenture Executive Summit. The two great guests here to break down the analysis of the relationship with cloud and Accenture. Brian Bohan, director, head of Accenture, AWS business group at Amazon Web Services and Andy Tay, AABG. The Accenture Amazon business group lead, managing director at Accenture. I'm sure you're super busy, Andy, with all the action. Brian, great to see you. Thanks for coming on. I'm sorry, thank you. You guys, Accenture's been in the spotlight this week and all through the conference around this whole digital transformation. Accenture's business group is celebrating its fifth anniversary. What's new? Obviously, the emphasis of next gen, post-COVID generation, highly accelerated digital transformation, a lot happening. You got your five-year anniversary, what's new? Yeah, so if you look back, it's exciting. So it was five years ago, it was actually in October where we launched the Accenture AWS business group. And if we think back five years, I think we were still at the point where a lot of customers were making that transition from, should I move to cloud to, how do I move to cloud? And so that was one of the reasons why we launched the business group. Since then, certainly we've seen that transition, right? Our conversations today are very much around how do I move to cloud? Help me figure out the business case and then pull together all the different pieces so I can move more quickly with less risk and really achieve my business outcomes. And I would say one of the things too that's really changed over the five years and what we're seeing now is when we started, right, we were focused on migration, data and IoT as the big three pillars that we launched with. And those are still incredibly important to us, but just the breadth of capability and frankly, the breadth of need that we're seeing from customers. And obviously as AWS has matured over the years and launched our new capabilities, we're able with Accenture and in the business group, we've broadened our capabilities and deepened our capabilities over the last five years as well. For instance, this year with COVID, especially, it's really forced our customers to think differently about their own customers or their citizens and how do they service those citizens? So we've seen a huge acceleration around customer engagement, right? And we've powered that with Accenture customer engagement platform powered by Amazon Connect. And so that's been a really big trend this year. And then that broadens our capability from just a technical discussion to one where we're now really reaching out and helping transform and modernize that customer and citizen experience as well, which has been exciting to see. Yeah, Andy, I want to get your thoughts here. We've been reporting and covering Accenture for years. It's not like it's new to you guys. I mean, five years is a great anniversary. You know, check is good relationship, but you guys have been doing the work. You've been on the trend line and then this hits. And Andy said on his keynote, and I thought he said it beautifully and he even said it to me in my one-on-one interview with them was it's on full display right now, the whole digital transformation. Everything about it is on full display and you're either were prepared for it or you kind of worked. And you can see who's there. You guys have been prepared. This is not new. So give us the update from your perspective, how you're taking advantage of this massive shift, highly accelerated digital transformation. Well, I think you can be prepared, but you've also got to be prepared to always sort of it. And I think what we're seeing in recent times and particularly in 2020, what is it? I think today there are 4% of the enterprise work loads sit at the cloud, you know, that leaves 96% out there on-prem and I think over the next four to five years, we're going to see that sort of acceleration to the cloud pick up. This year as Andy touched on, I think on Tuesday in his, I think the pandemic is a forcing function for companies to really pause and think about everything from how they manage their technology, their infrastructure to security, to where their data sits, to what insights and intelligence they're getting from that data. And then eventually even to the talent, the talent they have in the organization and how they can be competitive, their culture, their culture of innovation, of invention and reinvention. And so I think when you think of companies out there faced with these challenges, it forces us, it forces AWS, it forces AABG to come together and think through how can we help create value for them? How can we help them move from sort of just pausing and rethinking to having real plans in action and then taking them into implementation? And so that's what we're working on. I think over the next five years, we're looking to just continue to come together and help these companies get to the cloud and get the value from the cloud. Because it's beyond just getting to the cloud, it's actually then living in the cloud and getting the value from it. It's interesting, Andy was saying, don't just put your toe in the water, you got to go beyond the toe in the water kind of approach. I want to get to that large scale, because that's the big pickup this week that I kind of walked away with was it's large scale acceleration. It's not just toe in the water experimentation. Can you guys share what's causing this large scale end to end enterprise transformation? And what are some of the success and the criteria have you seen for the folks who have done that? Yeah, I'll start and maybe Andy can pile on. So it's interesting if I look back a year ago at re-invent and when I did the CUBE interview then, we were talking about the ABG, we were starting to see this shift of customers. We've been working with customers for years on kind of single, what I call single threaded programs. We can do a migration, we can do SAP, we can do the data program. And then even last year, we were really starting to see customers ask the question is like, what kind of synergies and what kind of economies of scale do I get when I start bringing these different threads together? And also realizing that it's to innovate for the business and build new applications, new capabilities. Well, that then is going to inform what data you need to hydrate those applications, right? Which then informs your data strategy. Well, a lot of that data is then and also embedded in your underlying applications that sit on premises. So you should be thinking through how do you get those applications into the cloud? So you need to draw that line through all of those layers. And that was already starting last year. And so last year we launched the joint transformation program with AEBG. And then so we were ready when this year happened and then it was just an acceleration. So things have been happening faster than we anticipated, but we knew this was going to be happening. And luckily we've been in a really good position to help some of our customers really think through all those different layers of kind of the pyramid as we've been calling it, along with the talent and change pieces, which are also so important as you make this transformation to cloud. Andy, what's the success factors? Andy, Jassy came on stage during the partner day, surprise fireside chat with Doug Hume, talking about this is really an opportunity for partners to change the business landscape with enablement from Amazon. You guys are in a pole position to do that in the marketplace. What's the success factors that you see? Really from three fronts, I'd say, one is the people. And again, I think Andy touched on sort of eight success factors early in the week. And for me, it's these three areas that sort of boils down to these three areas. One is that the people from the leaders, it's really important to set those big bold visions, point the way and then, you know, set top-down goals at how we're going to measure you. Because you almost do get what you measure. To, you know, beyond the leaders, to the right people in the right position across the company. We're finding a key success factor for these end-to-end transformations is not just the leaders, but who you have imposed across the company working in a collaborative shared success model and people who are not afraid to invent and fail. And so that takes me to perhaps the second point, which is the culture. It's important we're finding for the right conditions to be set in the company that enable people to move at pace, move at speed, be able to fail fast, keeping things very, very simple and just keep iterating. And that sort of culture of iteration and improvement versus seeking perfection is super important for success. And then the third part I'll maybe touch on is partners. I think, you know, as we move forward over the next five years, we're going to see an increasing number of players in the ecosystem, in the enterprise and state. You're going to see more and more SaaS providers. And so it's important for companies and our joint clients out there to pick partners like AWS or Accenture or others, but to pick partners who have all worked together and have built solutions together. And that allows them to get speed to value quicker. It allows them to bring in preassembled solutions and really just drive that transformation in a quicker, iterative manner. Yeah, that's a great point worth calling out. Having that partnership model that's additive and has synergy in the cloud, because one of the things that came out of this week, this year's reinvent is there's new things going on in the public cloud, even though hybrid is an operating model with outpost and super relevant, there are benefits for being in the cloud and you've got partners, APIs, for instance, and have microservices working together. This is all new, but I got to ask that on that thread, Andy, where do you see your customers going? Because I think as you work backwards from the customers you guys do, what's their needs, how do you see them? Where's the puck going? Where can they skate to where the puck's going? Because you can almost look forward and say, okay, I got to build modern apps. I got to do the digital transformation. Everything is a service, I get that. But what are they, what solutions are you building for them right now to get there? Yeah, and of course with industries blurring and multiple companies, it's always hard to boil down to the exact solutions, but you can probably look at it from a sort of thematic lens and what we're seeing is as the cloud transformation journey picks up, from our perspective, we've seen a material shift in the solutions and problems that we're trying to address with clients that they are asking for us to help address. It's no longer just the back office where you're sort of looking at cost and efficiency and driving gains from that perspective. It's beyond that. It's now materially the top line. It's how do you get them driving to speed to insights? How do you get them decomposing their application set in order to derive those insights? How do you get them to sort of adopt leading edge industry solutions that give them that jumpstart and that accelerant to winning the customers, winning the eyeballs? And then how do you help drive the customer experience? We're seeing a lot of push from clients or ask for help on how do I optimize my customer experience in order to retain my eyeballs? And then how do I make sure I've got a sort of self-learning ecosystem at play where it's not just a static experience that I can sort of keep learning and iterating how I treat my customers. And a lot of that, that's still self-learning that comes from putting in intelligence into your systems, getting AI and ML in there. And so as a result of that, we're seeing a lot of push and a lot of what we're doing is pouring investment into those areas. And then finally, maybe beyond the bottom line in the top line is how do you harden that and protect that with security and resilience services? So I'll probably say those are the three areas, John. Brian, on the business model side, obviously the enablement is what Amazon has. We see things like SaaS factory coming on board in the partner network. Obviously Accenture is a big, huge partner of you guys. The business model is there. You got IaaS is doing great with chips. You have this data modeling, this data opportunity to enable these modern apps. You have to worry about the partner strategy from Andy. Talk to them just now about how partners within even Accenture. What's the business model side on your side that you're enabling this? Can you just share your thoughts on that? Yeah, yeah, and so it's interesting. I think I'm going to build a little bit on some of the things that Andy really talked about there, right? And that we, if you think about from the partnership, we are absolutely helping our customers with kind of that IT modernization piece and we're investing a lot. There's hard work that needs to get done there and we're investing a lot as a partnership around the tools, the assets and the methodology. So when AWS and Accenture show up together as AABG, we are executing off a single blueprint with a single set of assets so we can move fast. So we're going to continue to do that with all the hybrid announcements from this past week. Those get baked into that migration modernization theme. But the other really important piece here as we go up the stack, Andy mentioned it, right? The data piece, like so much of what we're talking about here is around data and insights, right? I did a CUBE interview last week with Carl Hick, who's the CDIO from Takeda. And if you hear Christophe Weber from Takeda talk, he talks about Takeda being a data company, data and insights company. So how do we as a partnership again, build the capabilities and the platforms like with Accenture's applied insights platform so that we can bootstrap and really accelerate our clients journey. And then finally on the innovation on the business front and Andy was touching on some of these, we are investing in industry solutions and accelerators, right? Because we know that at the end of the day, a lot of these are very similar. We're talking about ingesting data, using machine learning to provide insights and then taking action. So for instance, the cognitive insurance platform that we're working together on with Accenture, you think about property and casualty claims and think about how do we enable touchless claims using machine learning and computer vision that can assess based on an image damage and then be able to triage that and process it accordingly, right? Using all the latest machine learning capabilities from AWS with that deep AI machine learning data science capability from Accenture, who knows all those algorithms that need to get built and build that library. By doing that, we can really help these insurance companies accelerate their transformation around how they think about claims and how they can speed those claims on behalf of their policy holder. So that's just an example of a kind of a bottom to top view of what we're doing in the partnership to address these new needs. That's awesome. Andy, I want to get back to your point about culture. You mentioned it twice now. Talent is a big part of the game here. Andy Jassy referenced Lambda. Next generation developers will be using Lambda. He talked about CIO stories around they didn't move fast enough. They lost three years, the new person came in and made it go faster. This is a new, this is a time for a certain kind of professional and individual to be part of this next generation. What's the talent strategy? You guys have to attract and attain the best and retain the best people. How do you do it? You know, it's an interesting one. It's oftentimes, it's a significant point and often overlooked. People really matter getting the right people in, you know, not just in AWS or in our customers is super important. We often find that much of our discussions with our clients is centered around that. And it's really a key ingredient as you touched on. You need people who are willing to embrace change but also people who are willing to create new, to invent new, to reinvent and to keep it very simple. We're seeing increasingly that you need people who have a sort of deep learning and a deep, or deep desire to keep learning and to be very curious as they go along. Most of all though, I find that having people who are not willing or not afraid to fail is critical, absolutely critical. And I think that that's a necessary ingredient that we're seeing our clients needing more of because if you can't start and you can't iterate for fear of failure, you're in trouble. And I think Andy touched on that, you know, where that CIO that you referred to lost three years. And so you really do need people who are willing to start, not afraid to start and not afraid to lead. Yeah, it takes a gut check there. I just said, you guys have a great team over there. Everyone at Ascension, I've interviewed strong, talented and not afraid to lean in and into the trends. I got to ask on that front, Cloud First was something that was a big strategic focus for a century. How does that fit into your business group that says Amazon focus, obviously they're cloud and now hybrid in everywhere, as I say. How's that all working out? We're super excited about our Cloud First initiative. And I think it fits it really perfectly. It's what we needed. It's another accelerant. If you think of Cloud First, what we're doing is we're putting together a capability set that will help enable end-to-end transformations as Brian touched on, help companies move from just migrating to modernizing, to driving insights, to bringing in change and helping on that talent side. So that sort of component number one is how does Accenture bring the best end-to-end transformation capabilities to our clients? Number two is perhaps, how do we bring together pre-assembled, as Brian touched on, pre-assembled industry offerings to help as an accelerant for our customers? Three, as we touched on earlier, is that sort of partnership with the ecosystem. We're going to see an increasing number of SaaS providers in an estate, in the enterprise estates out there. And so part of our Cloud First and our AABG strategy is to increase our touchpoints and our integrations and our solutions and our offerings with the ecosystem partners out there, the ISV partners out there and the SaaS providers out there. And then number four is really about, how do we extend the definition of the Cloud? I think oftentimes people thought of the Cloud just as sort of on-prem and prem. But as Andy touched on earlier this week, you've got this concept of hybrid Cloud and that in itself is being redefined as well. You've got the intelligent edge and you've got various forms of the edge. So that's a fourth part of our Cloud First strategy. And for us, we're super excited because all of that is highly relevant for AABG. As we look to build those capabilities as industry solutions and others, and as we look to enable our customers, but also as we look to extend how we go to market and sort of couple up our joint IPs in our respective SKUs and products. Well, what's clear now is that people now realize that if you contain that complexity, the upside is massive and that's a great opportunity for you guys. We got to get to the final question for you guys to weigh in on as we wrap up. Next five years, Brian and Andy weigh in. How do you see that playing out? What do you see that's exciting for the partnership and the Cloud First, Cloud Everywhere, Cloud Opportunities share some perspective. Yeah, I think just kind of building on that Cloud First, right, with Cloud First, and we were super excited when Cloud First was announced and I think it signals to the market and what we're seeing in our customers, which is Cloud really permeates everything that we're doing now. And so all aspects of the business will get infused with Cloud and in some ways, it touches on all pieces. And I think what we're going to see is just a continued acceleration and getting much more efficient about pulling together the disparate, what had been disparate pieces of these transformations and then using automation, using machine learning to go faster, right? And so as we started thinking about the stack, right, well, we're going to get, I know we are as a partnership as we're already investing there and getting better and more efficient every day is the migration pieces and the moving assets, the cloud are just going to continue to get more automated, more efficient and those will become the economic engines that allow us to fund the differentiated, innovative activities of the stack. So I'm excited to see us kind of invest to make those bits accelerated for customers so we can free up capital and resources to invest where it's going to drive the most outcome for their end customers. And I think that's going to be a big focus and that's going to have the industry focus. It's going to be making sure that we can consume the latest and greatest of AWS's capabilities and in the areas of machine learning and analytics. But then Andy's also touched on it, bringing in ecosystem partners, right? I mean, one of the most exciting wins we had this year in this year of COVID is looking at Massachusetts, the COVID track and trace solution that we put in place is a partnership between Accenture, AWS and Salesforce, right? And bringing together three really leading partners who can deliver value for our customers. I think we're going to see a lot more of that as customers look to partnerships like this to help them figure out how to bring together the best of the ecosystem to drive solutions. So I think we're going to see more of that as well. All right, Andy, final word, your take. Thanks for innovation is picking up, things are just going faster and faster. I'm just super excited and looking forward to the next five years as the technology invention comes out and continues to sort of set new standards from AWS and as we as Accenture bring in our industry capabilities, we marry the two and we go and help our customers. Super exciting times. Well, congratulations on the partnership. I want to say thank you to you guys because I've reported a few times from stories around real successes around this COVID pandemic that you guys worked together on with Amazon that really changed people's lives. So congratulations on that too as well. I want to call that out. Thanks for coming on. Thank you. We're super proud. Thanks for coming on. Okay, this is theCUBE's coverage, Accenture, AWS partnership part of Accenture's executive summit at AWS re-invent 2020. I'm John Furrier, your host. Thanks for watching.


Dr. Rashmi, we can't hear you, sorry. You'll have to unmute yourself. Can you hear me now? Yeah. Yeah, thank you so much. Yeah, thank you so much, Dr. Gauri and the organizing committee for giving me opportunity to be here, especially Dr. Shilpa Ladd, who invited me for this talk. So I'm going to speak on ultrasound guided breast intervention. So breast intervention is equally important as diagnostic tool, like we are encouraging breast screening program for early detection of breast cancer. So unless you are able to prove them in the form of tissue diagnosis, there is no use. So I request everyone who is attending here to start doing some kind of breast intervention so that you're able to give the tissue diagnosis to the treating clinician. So it's very important. You can learn from your seniors if you don't have in your own hospital, you can learn from area who are doing major number of biopsies and affinities. It is very simple. And I'm sure the more you do, you will have better experience and definitely you can master in this. So, slant, okay. Now ultrasound is the most preferred method for breast intervention. The most important cause because it does not have radiation compared to the mammography CT scan and other tools. So every clinician, they are very concerned about this. So definitely ultrasound, if the legion is seen on ultrasound, it's always better to do an ultrasound guidance. It is widely available in every corner of the country. It is real time imaging. So you can always position the patient according to your convenience. And it is more cost effective compared to the mammography and tomosynthesis. We can do FNAC or fine needle aspiration biopsy. We can do core biopsy. We can place the clip under ultrasound guidance. We can also put via localization of the mass. And the most recent one is the vacuum-assisted breast biopsy or vacuum-assisted breast lump excision. Both are very important nowadays because everyone wants accurate diagnosis and more sample for the diagnosis. So coming to the fine needle aspiration, cytology and biopsy, it is the simplest technology to do breast intervention. The most common cause for this that the patient presents with painful lump which is cystic. FNSA is required for symptomatic relief. It has several disadvantage that there is no patient preparation required. There is less complication compared to the biopsy. And sensitivity and specificity of picking up malignancy is very high, 83 to 90%. So you are able to tell whether patient has got mass which is having malignant cells or not. But you're not able to give them the histological diagnosis or the molecular diagnosis. Again, for the microbiological assessment, you need fluid for aspirated fluid for the gram stain and AB stain or any other microbiological analysis. So again, fine needle aspiration is very important for the microbiological assessment. So indication, as I told you, symptomatic cysts very important to do FNSA. A patient has got abscess for the microbiological analysis. Post-operative seruma patient has undergone surgery and she has developed some collection which is causing her problem. Again, you can do ultrasound guided aspiration from the seruma. Lymph node, most of the time you will have to find needle aspiration just to say whether they have got malignant cells or not. But sometimes you may have to do biopsy as well. And sometimes if you are not able to perform the biopsy, then clinicians may ask you to do FNSA from the suspicious solid lesion. So again, FNSA is very important whether the mass has got malignant cells or not. It is very simple technology. You just need a syringe. If the mass is superficial, you can get away with the syringe with the attached needle. But if the mass is deep, you have to use the spinal needle. The pathologists recommend either you use 22-gauge needle or 23-gauge needle. But sometimes if the collection is thick, you may use 20-gauge or 21-gauge needle. Once you get the aspirin, you have to transfer this through the slide. You can make this smear yourself. Most of the time you won't have pathologists accompanying you to prepare the slides. So this is the bottom one which has got the aspirate on the slide. And this is another slide you have to use to make the smear. You can go perpendicular to this or along the smear. So like how you are comfortable, you can make it yourself. After making the smear, you have to transfer it to the fixating agent. What fixation is used is the ethanol that is 95% ethanol ethyl alcohol. You also have to have five to six dry slides so that if pathologists want some other stain, they can prepare from that. Or if they want some microbiological assessment, they can prepare from that like gram stain, gene wheels and stain. For AB stains, they can make from it. So you have to send at least five to six wet slides in the ethanol and five to six dry slides so that if pathologists or microbiologists, they want to make another stain, they can make from the dry slides. So finally, aspiration is not sufficient for the histological diagnosis. If you want to grade the tumor, again, it is not sufficient. If you want to have molecular analysis like ERPR, HER2 or K67 status, again, you need to do biopsy. FNAC for the benign also, many times you won't get the diagnosis. You can just say there is malignant cells or not. Most of the time you need to do biopsy to get the complete diagnosis of the benign pathology as well. So along with malignancy and benign pathology, if you want to get the histological diagnosis, you have to go ahead and do the core biopsy. Now the core needle biopsy, it is just like FNAC, but you are going to use thicker needle. You can see this is the automatic gun which is supplied by the bar. You can see this is the 14 gauge gun. So in breast commonly, this is recommended. This is the 14 gauge green one. Many times you will, you can get away with the 16 gauge itself. If the mass is hard, better to use the 14 gauge needles. But if it is firm to soft, you can use 16 gauge itself. Now it is an outpatient procedure. You have to do on the local anesthesia because you're going to cut some amount of tissue. So it's better to give local anesthesia. Where do we perform this core needle biopsy? If the patient has got biopsy four or five months, definitely you are going to do the core biopsy because diagnostic yield is very high for almost 98 to 99% time. You will be correct in diagnosing the disease. Byreds three sometimes you have to decide depending on the patient's anxiety. Many times in byreds three, there is 2% chance of malignancy for a few patients that may not be sufficient to give them relax. They want to relieve their tension. So if patient wants or the clinician wants or if you think that patient cannot come for the short term follow up after six months in that condition also for byreds three lesion, you can go ahead and do the biopsy. And patient for the mutation analysis or molecular testing or ISC examination, again, you have to perform the core biopsy. So byreds four and five must, you have to do core biopsy. Byreds three, depending on the condition of the patient whether they want or clinician wants from you, if their clinical suspicion is high, still you have given byreds three, clinician may ask you to go ahead with the core biopsy. Do we prepare the patient? So make sure that you explain the biopsy procedure in detail to the patient, get the written informed consent because it is a minimally invasive technology. There is chances of some complications, we have to explain to the patient that there is chances of minimal bleeding after the procedure, which will subside in few days. So like all the pros and cons you have to explain to the patient. You check whether patient is on any blood thinner or not. If patient is on blood thinner like a clopidogrel you have to stop for four to seven days prior to the biopsy or you can check the INR, it should be less than 1.5. And if you are checking the platelet counts it should be above 50,000. Now this is the equipment you need. You need ultrasound with high resolution linear probe. This is the dressing set, you need this. This is the sterile gloves, betadine. This is the sterile cloths just to make that area sterile so that it doesn't get contaminated. You need the 16 gauge or 18 gauge or 14 gauge gun to get the tissue. And along with this, you need 2% of xylokene because this is going to cut some amount of tissue. You have to give some local anesthesia. So we use xylokene 2%. And then along with this you are going to transfer the sample to the 10% buffered for formalin. So this is very important. You have to have this by side so that you can transfer the sample immediately to the formalin where it is taken to the pathology. Now how we perform. So once you have identified the mass on the ultrasound you give the local along the track how you're going to introduce the needle to the mass. So most of the time you will end up doing needle. It should go parallel to the chest wall or parallel to the skin or parallel to the mass so that you get the longest length of the mass for the biopsy. You should not go perpendicular. Perpendicular if you go, you may hit the chest wall or pectoralis muscle which may be very painful. So you give the local anesthesia, make a small nick and the needle track should be parallel to the skin or the chest wall. You can get four to six scores. You transfer all the course to the 10% buffered for formalin. And then it hand over to the pathologist. So this is how you do.  The needle should be at the edge of the mass so that it can travel through the mass. Once you shoot, it has to go further two centimeters. Now after doing the biopsy, you apply a good manual compression for five to six minutes. You have to do entire procedure under asepsis so that it doesn't get infected. Apply a good compression and then you apply a good compression bandage which can be kept for 24 to 48 hours. Instruct the patient about the post biopsy sequelae about a pain and bruise which will subside in few days. And then avoid any intense physical exertion after doing the biopsy. If patient still feels some pain, you can prescribe some NSAIDs or any painkillers for few days. If you have done this procedure in the asepsis condition, you don't need to prescribe any antibiotic. Sometimes they may need painkiller, that's all. Now next investigation is the tissue market placement or clip placement. So what we place, there is the ultra clip here. This is the ribbon shape which is easily available and this clip is inserted within this pen-like needle. So this is inbuilt inside this needle's tip and there is a push button. So once you identify the mask, you have to introduce the needle in the center of the mask and once you are in the correct position, you just press this push button and the clip inside, this is the ultra clip which is inside, it will get detached from the needle tip and it will remain there. Once you see that it has been detached, you can withdraw this needle and what remains, this is the clip inside. This is very useful, patient who are going for the new adjuvant chemotherapy. Now diagnosed cases of breast cancer, many patients, they want to go for precise treatment like breast cancer or minimal surgery and the oncologist, they want to place the clip because they want to start the patient on new adjuvant chemotherapy. After giving the new adjuvant chemotherapy, many patients, they are having good response, the tumor may completely resolve what you will see at the end of the new adjuvant chemotherapy clip remains and the entire mask gets completely resolved. So in that case, just before the surgery, because they want to excise the tumor bed, they will ask you to mark the clip where it is and based on that, surgeon will take two centimeter of margin and they'll do the breast-conservative surgery. So nowadays it is very important that you should know how to put the clip, where to put the clip so that oncologists, they don't have to send the case anywhere else and the patient gets the more precise surgery. Another procedure which can be done in adjuvant guidance is the hook wire localization. This is again, there is a needle-like cannula. Inside this cannula, this is the hook wire which is inserted inside, it comes in a set. So you introduce this cannula at the center of the mask or just at the outer edge of the mask. Once you are at the correct site, what you do, this is the hook wire which remains inside this cannula.  So this is like sheath like cannula, it comes out and what remains after placing this hook wire, this is the only wire remains and the wire part of the wire will be hanging outside. You can stick this to the skin so that it doesn't get displaced. So along the wire surgeon goes and they do the very small surgery so it will hardly cause any dysmorphism to the breast. So it is very important nowadays to know all these procedures because everybody is for personalized and precise treatment. After doing the surgery, now the surgeon wants to confirm whether the entire tumor has come out or not. So they will send for the sample mammography or sample ultrasound. You can see here after doing the surgery, the mask and the wire completely has come out so there is nothing remaining inside. So this precise surgery can be done only if you know how to place the hook wire. Now next, which is the last one and this is the most recent entry to the breast intervention. This is the vacuum assisted breast biopsy or where vacuum assisted breast lump excision. This is diagnostic as well as therapeutic investigation where you can provide to the pathologist more amount of tissue for the diagnosis and you can have more diagnostic, better diagnostic yield. So it is again a minimally invasive technique which is more efficient than the core needle biopsy but less invasive than the open surgical biopsy. It can be done under mammography as Shilpa has already shown you that 2D or 3D guided vacuum assisted breast biopsy. It can be done an ultrasound guidance or MR guidance. Now I'm going to talk about ultrasound guided vacuum assisted breast biopsy. So the difference between the core biopsy and the vacuum assisted breast biopsy is the breast biopsy needle size is larger than the core biopsy. It comes into like 10 gauge, 11 gauge and 7 gauge. If you're only using for the diagnostic purpose means you want small amount of tissue you can use 10 gauge or 11 gauge but if you're using for the therapeutic purpose you can use a thicker needle like 7 gauge. So the difference in placement of the needle tip is that in core biopsy you keep in the center like you keep here at the edge so that you can go you can shoot through this center of the mass but in vacuum assisted breast biopsy you keep the needle trough just under the mass or posterior to the mass. So when you start sampling this is the needle this is the trough and this has got a blade here. So once you start sampling this blade keeps cutting and at the same time under vacuum this mass keeps falling under gravity to the trough. So cutting and vacuum collection happening simultaneously like you can see cutting and then simultaneously mass also is falling into the trough and it gets further aspirated under vacuum to the vacuum chamber. So this is the set. This is the vacuum generator. This is monitor which guides you which clock to do the sampling. Sorry to bother you ma'am could you please go to slideshow? I think it's yeah, it's fine. Okay, sorry. Yeah, so you can see here this is the vacuum generator and this is the disposable needle probe set. So entire thing is disposable. It comes in disposable set for each patient you have to use one. For one patient this needle can be used for two, three masses as long as it is cutting and but the same should not be used for the different patients. So this is the disposable needle set here. This is the needle tip you can see it shows up and this is the trough with the cutting needle. This the length is same as for biopsy this is two centimeters. So up to two centimeter it can easily cut and it can be collected in the vacuum chamber and this at the back of the needle probe you can see this is the vacuum chamber where the sample gets aspirated and collected. Okay, so this is the entire set. Now, where we perform we can use this as a diagnostic investigation when the legion is very small like five to 10 mm then many times if you do four biopsy or FNAC it may give you false negative results. So in small cases again it is very important to use the vacuum because this will not only give you diagnostic if it is benign it gives you therapeutic benefits as well and you're going to provide the sample in total so pathologist also will be happy the diagnostic yield will be almost 100%. So small lesion if you have vacuum better to go ahead with the vacuum assisted breast biopsy. In cases where patient has already undergone with the core needle biopsy but there is radiological pathological discordance again if you want to have better diagnosis you can go ahead with the vacuum because this will give you better diagnostic yield. And then again in B3 masses the pathologist have reported as high risk lesions or indeterminate lesion which has got indeterminate malignant potential like ADH, radial scar, atrial lesions again they can have associated DCIS or malignant pokai. So these cases again, Vav is very important because you're going to provide the entire mass for the diagnosis. So chances of missing any underlying malignance is very less. So for small lesions, sub-centimeter lesion B3 masses or high-risk lesions again vacuum assisted breast biopsy scores over the core needle biopsy. Now coming to the therapeutic again it is used for the if it is proven case or very typical of benign lesions like fibroidinomas and papillomas you can use Vav directly for the excision for the biopsy as well as for the therapeutic purpose again, the patient has got wrist abscess which has got very thick collection difficult to aspirate the entire pus then in that case also you can use Vav and you can provide entire abscess for the diagnostic as well as for the therapeutic. Now, how do we do? So same as you do for the core needle biopsy you take the informed patient consent patient position in supine or lateral oblique depending on your convenience and the patient convenience make sure that patient is comfortable position because it is little longer procedure compared to the core needle biopsy and then you give local anesthesia here you give local anesthesia 2% xylokin with the diluted adrenaline, okay? So this is very important because we add little bit of adrenaline because it stops the bleeding now you are going to do continuous cutting so chances of bleeding is more so if you're going to do Vav you add diluted adrenaline 1 ml it is sufficient to the 2% xylokin you give 15 to 20 ml of local anesthesia at the site of biopsy along the needle track and around the mass so that it doesn't bleed much you give a small skin incision because needle size is thicker than the core needle biopsy size of skin incision little bigger 3 to 5 mm if the mass is deep the incision the skin incision you make little away from the probe so that you can get more horizontal approach I'll show you how it is done so needle should be placed just under the mass push it to the mass so that needle and the mass falls automatically into the trough then you start sampling after doing the sampling you apply compression once you remove the needle make sure that there is no mass left there is no collection if there is any collection you can vacuum that collection that area should be completely clean once you have assessed that then you can apply the compression with the pump for 5 to 10 minutes and then you apply a tight compression bandage and then of the specimen if you think there is calcification you can go ahead and do the sample specimen mammography so that you can be sure that calcifications are out and then you can do the unilateral mammogram just to confirm if you are placing clips sometimes entire mass will be out and the patient wants to be sure that that area has been completely clean for medical legal purpose in benign condition also you should place a clip after doing the procedure and for malignancy again if there is no residual tumor left in that area better to place a clip though it increases a little bit of cost but it's it's much better if you place a clip so that later on for follow up it is very useful so this is the mass which has been identified on the ultrasound this is typical fibroidinoma if you have core biopsy before doing the lab well and good but it is so typical that it can't be anything else you can do FNSE just to make an entry that you're doing for the benign lesion and then you give a local anesthesia at the site of the needle track you can see the needle track is going to be under the mass so you have to give local anesthesia how you're going to enter behind the mass so this is the local anesthesia needle track you can see it is going just push it to that and then you give a small skin trick two through three mm or three to five and depending on the needle size and then you introduce your needle through the skin entry and then make sure that your needle tip is just under the mass it is entering it is posted to the mass and then you can start cutting you can see here this is very small video just I have done yesterday so like just I asked sister to send that quality is not that good but you can see this is the mass and you can see this is needle that this truck is just posted to the mass okay and you can see as it is being cut it is falling on the truck right you can see here so this is just posted to the mass and as you keep doing the mass keeps falling on the truck till it gets completely excised okay so and after getting this sampling done under vacuum the entire sample gets collected in the vacuum chamber you can see here this is done and then these samples same like core needle biopsy sample you can transfer this to the 10% formalin and hand over to the pathology another patient quality is not that good of the video low resolution so you can see here again you have this is very important to place the needle just posted to the mass once you're in the correct position the procedure is very simple you can see here keeps on it the needle the sampling is happening it is going and to and fro and keeps cutting at the same time the mass is falling on the truck and it gets aspirated under vacuum into the vacuum chamber so like this you have to continue till you reach to the anterior edge if the mass is just under the skin you can give local anesthesia between the mass and the skin and if the mass is again very close to the chest wall again to make some space you can inject some local anesthesia between the mass and the chest wall so that you don't hurt the chest wall or you don't hurt the skin so this is how it is done so once you're in the correct position it takes around five to 10 minutes to complete the procedure so this is the fibrodenoma this was the pre biopsy and you can see after post-wired what is the outcome you can see there is nothing inside just small collection this is the post-vab area there is no mass at all and the skin is completely scarless there is hardly two mm of skin incision is there which heals within a week so that's why it is called scarless breast surgery for removal of the benign breast lumps you won't be wondering if a lot of research is going on even for malignancy cases as I showed you that you have to place a clip for new adjuvant cases within the mass and after new adjuvant chemotherapy almost entire mass is resolving so doctors may ask you to do for malignant cases as well and already research is going on in many places in UK and US that they are comparing the vab excision versus BCS and so far the results are very encouraging so maybe in few years we may have to do vab excision for malignant cases as well as of now it is only approved for the benign cases so contraindication for the vacuum massage breast up biopsy is there is no absolute contraindication you can go ahead and do for any mass which is less than three centimeter and the relative contraindication is that sometimes patient will be on anticoagulants so they will have more chances of bleeding you put on the color doctor if you see the mass is very vascular in those cases again better to avoid doing vab because chances of bleeding is higher with vacuum assisted breast biopsy and if patient is on any anticoagulant they can stop for few days you can check INR and then you can go ahead and do the vacuum assisted breast biopsy so this case looks pretty benign well circumscribed oval hypocoic mass with central cystic area likely to be fibroidinoma so this is the ideal case for vacuum assisted breast lump excision but when we put the color Doppler the color Doppler showed very highly vascular mass so we abandoned this case for vacuum assisted breast biopsy because we did not want any kind of complication so this was sent for the surgical excision of the mass they can use some other sclerotherapy to control the bleeding but in OP procedure we cannot do all these things so this was sent for the excision so again you have to put color before doing the vab it is very important to avoid any kind of catastrophe in your department so complication rate it is very minimal if you are careful if you have chosen the case very well like if there is no there is minimal vascular probe within the mass you can go ahead and do the vacuum assisted breast lump excision or biopsy so in those cases chances of hematoma is very minimal but if you don't see the on color Doppler and mass has got moderate to high vascularity chances of hematoma is more and if you cut some normal tissue again they will have normal vascularity that also can cause hematoma formation so make sure that you apply a good complication after doing the biopsy for five to 10 minutes so that there is no hematoma formation infection rates are very minimal or it's extremely rare because we do under ASEPSS so chances of infection is very low we don't give them any prophylactic antibiotics so maybe a patient has got pain she's pain sensitive you can prescribe them some NSAIDs so to summarize we have talked about fine needle aspiration biopsy core biopsy, clip and tissue market placement who acquire localization WAP and vacuum assisted breast lump excision under indication contraindication procedure complication and how to manage the complication so this should be sufficient for you so to start with so I think if you have opportunity to perform FNS if you have never done any start doing it I'm sure you can do and as you do more number of cases I'm sure you will do much better job later on, thank you so we are going to start one mentorship program from 15th May onwards so any of you are interested you can send an email to this email address this is email address of breast imaging society of India or you can send message to one of us and we can proceed further so already almost 50% seats are full so if you want to book any place you have to hurry up thank you very much for giving me opportunity


So this one's easy, right? Because I just convinced everybody here that inequality is not a problem, so why would you raise taxes for that? So no. And this really goes to the heart of what I think, you know, he promised I would talk about rights, so I'll talk a little bit about rights. And really I want to talk about the role of government. Why do we have government? What's the purpose of government? In my view, the purpose of government is to do one thing and one thing only. And that is to protect our freedoms, to protect our rights. And rights are not whatever you want them to be. Rights are not whatever we feel like we want. Rights are something very specific, at least as understood by the people who articulated these ideas way back. Rights are about your freedom. You have a right to your life, which means you have a right to pursue the values you believe are necessary for your life, and nobody has a right to question them. Nobody has a right to stop you unless you do one thing, unless you try to use force on another human being. The whole idea of rights as John Locke saw it, John Locke was the first to really articulate the theory of rights, was the idea that force, violence, coercion is bad, and we need to extract it from human society. We need to leave individuals free to pursue their life, liberty, happiness, free of force, free of coercion, free of fraud, free of people trying to steal our stuff from us. And that is the purpose of government. Government is set up to protect us from crooks, from frauds, arbitrate disputes, help us with things like defining property rights, because that's important to that definition of when do I cross over and violate your rights, when am I using force against you? But other than that, government has no role in our life. Healthcare is a voluntary transaction between us. There's a provider and somebody who has a need, just like in any other industry. That is a voluntary transaction needs to be left voluntarily, unless again there's fraud or theft or anything to the private sector. Education, in my view, I'll get 100% disagreement. Education is a voluntary transaction. The best thing we could have in education is to privatize it, is to get the bureaucracy, the standardization out of it. I find it amazing that entrepreneurs today are trying to make the latest, greatest little app for this thing. Who cares? Imagine that brain power going into innovation in education. Something really important. Let's bring the profit motive. Let's bring innovation. Let's bring competition to education, rather than granting it to a bunch of bureaucrats who you don't trust with your mail, but you're willing to trust with your kids' education. That to me is bizarre. So none of these, these are market transactions that are done voluntarily, none of them, in none of them. The government have a role. In none of them does the government have a role. So taxes should be a significant part of our life, because the fund defense, the fund police, the fund, the real protection of our rights, of the opportunities that we have. You don't need much government. You need a very small government, a very limited government. Taxes should be way lower than what they are today. And not only would taxes that are way lower, I think, be more correct from a normative perspective. But I think that the formula to getting economic growth is pretty simple. It's low taxes and massive deregulation. If we lower the regulatory burden on American businesses, on you guys, if we lower taxes on wealth creation, what are you going to do with that money? You're going to invest it. You're going to produce. You're going to create. You're going to build. And that is what drives economic growth. And that's what drives economic opportunity. Opportunity is there when there are jobs. Opportunity is there when there's new businesses being created. Opportunity is there when people with money are investing in production rather than sitting on it, because they're so afraid of what the government will do next year, they don't want to commit it to anything, which is what's going on today with a massive uncertainty in our economic world. So again, the whole issue of inequality, in my view, is not the issue. Just think about what would drive our economy to be successful. What would be helpful to low-income people to drive them towards greater economic prosperity? And the laws that we have today do the exact opposite. The level of government intervention in the world today does the exact opposite. I don't know how much time I have. Where's the timekeeper? 30 seconds? We've done it. You can't do that. Four seconds. Thank you. When I'll pose to you as a rather practical question, better yet, I'll pose a quote and then a practical question. No one would ever call Oliver Wendell Holmes the great jurist, the great Civil War veteran, the great Massachusetts citizen. I never want to call him any liberal or progressive, but he's the one whose name is on there in front of the IRS that says taxes are the price of a civilized society on this thing. Now, you can have too much civilized society, perhaps, on this, but we all know that we have to find some way to fund what we do. And a practical question is this. If not taxes, then what? Are we going to have a bake sale for the Defense Department? Are we going to go have hyperinflation, which is a tax on all of us, and print these little coupons that say US dollar with nothing to back on this type of thing? If we had said those things in 2014-15 right now, you might say, yeah, that's a great idea. Think about saying those things in 1941. Think about saying we're going to go and we're going to raise it all with war bonds and have Jack Benny finance the defeat of Hitler and Tojo on these things. There is a role for government and sometimes it's a quite substantial role for it in the common defense and the promoting the social welfare and making a more perfect union. It was Eisenhower who told us in the mid-1950s that building an interstate highway in order to make it all more efficient for all of us to transport goods and services was a matter of national defense, of national security. He saw those things and couched it that way for his individuals, his Republican brethren, who were a little bit concerned about this creeping socialism in the way of this. Are there enough in the way of highways or enough space for this? It's a little bit like those farmers' prices and those interest rates again on that type of thing. But what it tells us is that there is a role for government. Sometimes government has a very important role to play with this and taxes and government action step in when others will not. Think about that great socialist Richard Milhouse Nixon who gave us in 1973 the only federal agency that ever makes a profit every year, the Overseas Private Investment Corporation or OPIC. Why did it create? It creates and provides political risk insurance for companies like yours to go to difficult parts of the world where they may see the government stepping in to expropriate them. Where was the private market on that? It wasn't there. Their feet were as cold and running for the doors every other investor there was. Somebody had to stand up and step in and we find that with government. Now they can overstay their welcome, right? Perhaps the post office has overstayed its welcome in terms of the scope of its business and that's fine. That's all part of the evolutionary notion of what is community and what are the other things that we share in common. But that doesn't mean that we throw everything out and all this business about the market. There's nothing magic about the market. The market is a set of rules, a set of conventions, a set of norms, I dare say the set of ethics. The open outcry in the Chicago Board of Trade, the electronic trading in the New York Stock Exchange, currency modes that go around the world, they set up on something more than just zeros and ones. They set up in part based on what we bring in the way of our sense of what a community is, what we have in the way of shared obligations. Indeed, the whole idea of rights has with it, and I'm a lawyer, excuse me for that, a Hofeldt in sense, Hofeldt was a legal theorist who said for every right, there's somebody's obligation. For every privilege, there's somebody has no right. We have to be very careful about what we do in terms of right because what it does to create in terms of the reciprocal obligation to others. Taxes are part of that obligation. Other forms of support for that are that obligation. I want the government to have the capacity to step in when I need them. And I want them to step back in many of the times that I don't. That's your choice. That's our choice as members of a community. Thank you. So we could get into a very long discussion of rights, but I do not believe rights impose obligations. You're born with inalienable rights. That's our Declaration of Independence does not say, and responsibilities and obligations. It says that you have a human being have a right to your life. And as long as you don't violate somebody else's right, again, through course of action, you're free to do as you please. That is what a right means. But let me give you an example and a very quick example of the damage that government does to the people that I think we care about. Everybody cares about. And I'm going to use the minimum wage because it's in the news.  What the minimum wage does is raise the price of labor, unskilled labor, the most unskilled labor. What happens when you artificially raise the price? Demand for that good goes what? Goes down. This is, again, very simple stuff. All you're doing through a minimum wage, any level, I don't care what it is, all you're doing is institutionalizing some people into never having a job. Because some people are priced out of that market. And if you raise it, more people are going to be priced out of the market. Anytime you try to manipulate prices in an economy, they're going to be untold unintended consequences. You're not helping anybody. Indeed, you're hurting the exact people that you're trying to help. And these are kind of the kind of structural problems that we have all over the economy that actually holds people back, that actually hurts people because when you don't give a person that first job, then they're not going to have that second job. If they can't work for $5 an hour, they're probably never going to work for $10 an hour. The real tragedy is in a city youth today where unemployment is close to 20%. And a big cause of that, a big cause of that, is the minimum wage at any level. 7.25 today doesn't matter. These are the kind of programs, government programs that we all feel good about, everybody's for the minimum wage. And yet they have horrific consequences. Your own brought up the minimum wage, which is about now, I guess, about 80 years old, part of that socialist Franklin Delano Roosevelt on that. I want to talk about another federal intervention in the market that's 50 years old this year, the Civil Rights Act. What did that do? We pay for that in our taxes every year. We pay for its enforcement. We pay for what it does to get people into those seats for education. What it pays to get people into the waiting room for that interview. What it pays for individuals to be treated in that workforce based on what they do not necessarily where they go to church or where they go to mosque or what the color of their skin is, although what their ethnicity is on these things. Here's government stepping in where government steps in best. Where government helps make markets work by bringing more people into the room to demand those goods and services as consumers, as home buyers that are no longer under unfair racist covenants and the like, as voters, as having the opportunity to be a member of a community. Sure, government can overstep. I'm not sure that raising the minimum wage to 10 bucks is gonna do much in the way of that. It might get us to somewhere where we were somewhere around 1980, at least in terms of real terms. But I know the government does so much in order to make the basis for markets, for individuals to live out what their liberties and rights really are, those don't come free. These are the best investments that we make in terms of the public infrastructure that is physical, the public infrastructure that is invisible, but no less important and probably more.


Hey guys she bear 1,000 today. We're gonna find out why? this Bissell Pro heat times 2 is Not spraying water. Okay guys if you remember in my last video. I got this free, right and Everything seems to work The brushes turn everything, but it's not spraying water out anywhere So I'm either suspecting a clog somewhere or maybe the pump is not working But we're gonna take this thing apart And we're gonna find out why now there's a couple things you can always check before you take this thing apart Number one when you pull this up out Look down inside here Right in there and see There's that little rubber grommet there shoot There's a little rubber grommet there make sure that rubber grommets on The tank and not down in there if it's down in here go ahead and Just use a you know fair needle nose pliers or Straight screwdriver and pop it out and put it back on your tank now I've made a mess, but of course make sure your your water your water tanks full This is your solution tank same thing make sure that it is a Make sure that that red grommets on there because what that does is go in there like that and Make sure it's clean That's a couple of things you want to check first now. There's also on some of these Every time over here on some of these there's a little red cap and inside that cap you take that cap off Inside that cap will be a little filter You might Want to check that if yours has got that? Okay, so let's All right, let's make sure that's on there and let's see if we can get this thing to spray Then if not We'll commence to taking this apart And checking everything. Okay, let's turn it on noise alert Record turn it on and squeeze the hand nothing So Let's go and pull this back off We'll get these out of the way. We know these are okay Now we've got a bunch of Phillips screws to take out in here All right now up under here is your pump So in order to get to that pump we have to take a bunch of these screws out But first Let's see if we get this top off of here. There's a screw here a screw here and There's one two three in the back Okay, I'll see if I can get you over there one there One there and one there so I'm I'm either thinking there's a clog Whoops for the pumps bad. Let's go ahead and take these screws out. Oh And there is one Down in the top of here, and yeah, we're back outside.  I gotta use screwdriver guys I don't have my long bit. I think it's in the truck and of course I don't have to tell you this but make sure you have this thing unplugged before you start taking it apart Because there are a lot of electronics in here now right here's your pump guys right here And this thing should spin when you pull the trigger and it didn't spin So There should be a filter on here, and I think that's it But from what I'm seeing there It does not Look real dirty like it's clogged or anything So Now I'm gonna plug it in and see if we can't see any water Moving out of this thing anywhere When I'm turning off and on this is spinning a little bit So let's go ahead I see something funky happening down inside there. Let's go ahead This has a heater on it so the heater Has passageways in it. So let's go ahead and pull this top off of here And uh, we'll get the heater out of it. Let me unplug it first All right Now it's unplugged We're going to take this off now. We're going to take these screws out around here Take that front one off there You go see because that's got to be moved These are shorter screws. So you want to keep the shorter ones separate from the long one Make sure you don't lose that it goes up into here now right down in here's your heater So we're going to take this heater up out of here And we're going to take a look at it Okay, it's a lot easier if you take all this stuff off, but you gotta remember which hose went where So Get you down in here Good look at that heater Now out of these little relays in here Now I can see I can see the tubes that one looks a little dirty. So let's go ahead and take these screws out of here Just be very careful I may be in your way For just a second Let's go ahead and take these out not good when that happens try not to there's a gasket under here try not to hurt the gasket in Let's see if this screwdriver will do any better. Let me get Let me get another screwdriver. There we go When you get it on there, just give it a quick A quick little twist That should do it. It is. All right, cool Let's see what we've got under here. Okay. Yeah, I see clog already or it's looking like a clog Yeah, I see that That's a clog Now there's that little rubber gasket. I was telling you about try not to hurt that But I'm guessing This is my clog See all that stuff coming out of there Yeah, it is so clogged up in there guys. So what I'm going to do Is I'm going to get me I'll get all this stuff cleaned up I'm going to get me a smaller screwdriver and a q-tip And I'm going to get all this cleaned out. I'm going to take these hoses off and make sure these These inlets and outlets aren't clogged Now once I get that cleaned back up cleaned up. I'll turn you back on let me get you a little closer Look at that all that stuff in there So that could be Well, I'm I'm going to venture to say it is the clog because The water has to run through this heater to go everywhere else because if you want to run the heater That looks like uh, that's from hard water Down here in florida. We've got a lot of that so That way if you want to run the heater the water runs through that and if you don't When you turn the heater on it turns your heating elements on top of this on that's what heats your water up Now so it has to run through here before it runs anywhere else So let's go ahead And I'm going to get this all cleaned out. I'm going to use some compressed air Any q-tip and then we'll go from there. All right guys This best I could get it with what I have. I didn't want to use any harsh cleaners on it like break clean or anything the best way to do this would be with uh A vinegar i'm out of vinegar guys So And I also want to tell you these little red grommets here You see them There should be five of them One on each corner one in the center now I went lost one These are little rubber rubber o-rings Damn it And they just keep it from leaking around the screws So What I've done I'll show you here in just a second. I lost one of these o-rings So I made I cut a little piece of rubber fuel line And I'm going to make that work as long as it squeezes around there. We should be okay so What I'm going to do is I'm going to put this back on And get it set back down in there and everything and we're going to try it and see if it works But that's the best I could do with what I had right there So I'm going to go ahead and get this put back on and I cut me a little Tiny piece of fuel line Yeah And that'll squish around there and that'll seal it so I'll be right back with you guys All right guys, I got you zoomed in because I got the camera away's back, but I pulled this one out So you can see if it squirts and this one out and see if it squirts And I did try it briefly and it seemed like it was okay So Let's see what happens All right, I didn't realize I had the heater on that That's some hot water So let's get the rest of it put back on there.  So there it is. It's ready to go and needs good cleaning now and uh I think I can get 10 or 15 bucks out of it So guys, thanks for watching appreciate it and uh Remember she bear the myth the man the legend gone for now guys. Bye. Bye. Take care


Hi, I'm Deepak Khurana. I'm founder and CEO of WeServe. We were just having a very interesting discussion around commerce media. And we had a very interesting mix of people on the panel, a couple of people who represented the market place themselves, one person from the agency side, one person from the brand side. And then we had one more person on the platform, which is a non-seller on a market place, but leveraging the platform from a media perspective. So I think commerce media is something which is a fairly new platform. Think of it this way that probably a decade ago, people started talking about social media platforms. In a similar breadth, I would say that commerce media is going to be a conversation for this decade. And clearly that's a new avenue for brands to kind of go ahead and leverage a point of sale platform where people go and transact and figure out how they are able to really get a share of product searches or they are able to drive sales utilizing these platforms.


The way this came to me is really reading an article that was published in the Wall Street Journal on the 10th anniversary of the death of Steve Jobs. And it was a short commemorative piece about Steve Jobs who died on October 5, 2011 by Johnny Ive. Johnny Ive was Steve Jobs' partner. He was the chief design officer at Apple for many years. He was part of the team that launched Apple's revolutionary products and ultimately responsible for their design. He worked very closely with Steve Jobs over these years and I think developed a deep friendship with Steve Jobs. And I think got to know Steve Jobs really, really well during this period. And so Johnny Ives wrote this commemorative piece in the Wall Street Journal. You know, what was it now? Four weeks ago I intended to do the show earlier and then other stuff got in the way and I didn't get to it. And there was a paragraph that Johnny Ives wrote in this that really struck me.  I am a huge Steve Jobs fan. I love my iPhone, right? And I use my iPhone in my talks and in my presentations quite often. But it's not just the iPhone. I have real admiration for Steve Jobs as a entrepreneur, as a businessman, as a thinker, as a visionary, as a designer and as a human being from what I know about him. Not to say he wasn't fraud, not to say he didn't do stupid things taking care of his health or as the case may be, not taking care of his health and not applying reason and rationality to the issue of his health is sad and disappointing from somebody like Steve Jobs and sad in a selfish way for me in not having Steve Jobs around for another 20, 30, 40 years. It's, I think, sad for all human beings, all human beings who value human life and value human progress, not to have Steve Jobs around to guide us with beautiful products, with efficient, productive products to guide us towards greater fulfillment and a greater manifestation of our lives. So, I'm a huge Steve Jobs fan. I love heroes. Steve Jobs is a hero. I don't really believe many of the nasty stories that have been written about him and been told about him. You know, and everything that Steve Jobs ultimately touched was a massive success and a massive success in an inspiring way, in a pro-human way. I mean, just think of Pixar, the movie studio that he became CEO of before he rejoined Apple the second time and just the beauty of those movies. And what they meant and how they revolutionized animation and how the best movies in those days, the best movies in those days, were made by Steve Jobs, in a sense, by the team under Steve Jobs. So, the nastiness that so many people tell about him is inconsistent with the level at which he was successful. Anyway, that's just our background, because the paragraph that struck me was this, and I'm quoting from Johnny Ives' article about Steve Jobs, short article about Steve Jobs. He was without doubt the most inquisitive human I have ever met. His insatiable curiosity was not limited or distracted by his knowledge or expertise, nor was it casual or passive. It was ferocious, energetic, and restless. His curiosity was practiced with intention and vigor. Now, this is, I think, a stunning paragraph, and it connects in my mind to books that I've read about other great people, whether it's Leonardo da Vinci or whether it's the book I just read about, you know, the bio-scientists, Dauden, who was one of the key people in the CRISPR, you know, CRISPR biotech revolution that we are living through right now. They're all, all these people are ferociously curious, energetic, restless. But there's something about this term, ferociously curious, ferociously inquisitive. Most people assume that being curious is something you're born with, something you cultivate when you're young. And, you know, it's just kind of passive afterwards that curious people and less curious people, and it just is what it is. But what you get from this paragraph, and what I think is so inspiring about the way it's written, is that Steve Jobs' curiosity was intentional. It was focused. It was not casual or passive. On the contrary, it was ferocious, energetic, and restless. And to find a sentence, his curiosity was practiced with intention and rigor. Now, I think curiosity is essential for a flourishing life. And it says a lot about one's attitude towards the world and towards one's own life, the extent to which one is curious. And, well, I think one can train, you can train yourself to be curious. So, you know, a lot of the traits that we require as adults are developed when we're children and developed in a sense out of our control. Developed, you know, or not in full conscious control because we're not full conscious control of our minds when we are children. Curiosity can be drummed out of us when we are children. Many, many parents do their best to drum curiosity out of their children's minds. But I think what is important here is curiosity is something you can resurrect. Curiosity is something you can activate even if it has been drummed out of you as a child. And this is how you do it. So what does it mean to be ferocious when it comes to curiosity? What does it mean to be intentional? It means that you know that the world is rich with knowledge. The world is rich with opportunity. And opportunities for you, for your life, for your growth as a human being. You know that you don't know everything. However much you know there's always more to learn, more to know, more to gain. And you're constantly seeking that knowledge out even when it's not clear how this particular knowledge connects with your values right now, with what you're doing right now, with what you're pursuing right now. Because, and this is philosophy, teaches this and an objectivism teaches us this. If you, you know, Leonard Peacock talks about this quite a bit in OPPA. Reality is a whole. It is one. Everything is connected to everything else. Knowledge is integrated. Now, not everything necessarily is important. Not everything is with the effort, but so much is. So many connections can be created. So much knowledge is related to one another. The more one knows, the more one knows about the things that one wants to pursue, about one's own goals. And to realize this, to realize the unity of knowledge, to realize the scope of what is available to us in terms of information, in terms of knowledge. I think if one realizes that and one knows that, you want to find out about stuff. Now, many of us were curious as kids. And I think as kids, you know, our minds are in a sense, in a sense, empty. They're empty of knowledge. And we spend that time trying to fill it in. Fill in that knowledge. And part of that is we want to understand the world. We want to understand connections between things. We want to understand a cause and a fact. We want to understand what's going on around us. Everything is new. Everything is exciting. One of the things I love about babies and children is how exciting the world is to them. How exciting knowledge is to them. How curious they are. Every child, when they reach about two years old, every healthy child, when they reach about two years old, starts asking, why? Why? Why? Because they're curious. Because they want to understand the world around them. Because they want to integrate, not consciously, but they mind, is demanding. It's an integrating machine. It wants to connect the thing that's observing right now to the things that it learned yesterday to everything else that it thinks that is going on around. And it wants to understand the cause and effect relationships. Why? Why? Why? Just watch a two-year-old, three-year-old, four-year-old. And it drives the parents crazy. I can understand that because it's non-stop. It's constant. And you explain something and they go, why? And you explain that and they go, why? And the challenge is to explain these things in a terminology that is both true and at least somewhat comprehensible to the child. And that's difficult, challenging. You have to keep pursuing it. You have to at some point, they ask you, why is green green? And you just have to say, it just is. So, you know, an important part of being a parent, an important part of being a parent, an important part of choosing to be a parent is willingness to engage in cultivating this curiosity and not suppressing it against so many. Stop asking why. It just is. This is just how the way it is. There is no, you know, they start yelling at their kids.  Don't bother me now trying to destroy. And I'm sure you had, some of you had parents like this. Never explaining, never teaching, never encouraging. But that curiosity is that wanting to know the world is so exciting and so thrilling. It's what much of life is about. It's about discovering the truth. It's about knowing what's out there. And it's about then learning how to use that knowledge to make your life better. And you never know where the next piece of knowledge might be that might really help enhance your life. It might be that book on biotechnology that tells you something you didn't know about gene editing that might be able to resolve a genetic issue that you might have. Who knows? But part of it is just the love of knowing what children have. The love of just understanding the world around them. And you can see it in the eyes. You can see it in the, when they get an answer that they understand, that explains something to them. Oh, wow, they're so excited. You can see kids in a Montessori classroom from a very young age when they figure something out for themselves, the level to which that becomes exciting. So that excitement about knowing the future, not knowing the future, knowing, knowing the world, understanding reality, understanding cause and effect, understanding the world around you. Of course, that's what reason is about. That's what cultivating your mind is about. That's what is required for human survival. It's certainly required for human flourishing, for human success, for productivity, for creativity. Knowing the world around you, understanding it. And some of us as children are super curious and maintain it and sustain it. I used to read encyclopedias when I was a kid. I used to, I mean, I love just sometimes just opening an encyclopedia at random on a particular page and reading. And no matter what the topic, it was interesting. I mean, and it's the problem I have to this day. I can go into a bookstore and I can very quickly say, I want this book and I want this book and I want this book and I want those books. All of the different topics, all of the different subjects, all of the things I don't know right now. I want to know who has time. I don't. But it's a wonderful sense, that curiosity, that desire to learn. And again, it gives you a scope of knowledge about reality when you learn it.  That you can't just imagine rationalistically trying to plot your life into the future. You need to be engaged in the world. In its challenges. Engage means understanding. You need to be engaged in understanding the world around you. To really ultimately benefit from the world around you. Now many of us, I know a lot of people who this curiosity is stomped on when they're children. They lose it at some point. I don't know any child who's not curious. But I know lots of 16 year olds who are not. I used to gobble up biographies and history books and science books and just a whole variety of things from all over the place. Because it was all fascinating. You know what? Why? Because reality is fascinating. The world is fascinating. And again, if everything is connected to everything, it's useful to know important stuff about lots of different fields. You actually never know when the information will become useful specifically. But in the sense of your mind, in the sense of grasping reality as a whole. It's useful to have examples from biotech and example from physics and examples from business and examples from finance and examples from politics and ethics. And history, history, history, history, history. No one says curiosity killed a cat. Yeah, but we're not cats. We're integrating souls. And we need fodder for that integration. We need knowledge. We need concretes. We need examples. We need to understand the world around us. A survival depends on it. And indeed, I think the most creative, the most productive people in the world also tend to be the most curious people in the world. The most inquisitive people in the world. Doudin, as an example, the bio-scientist sees biological phenomena and wants to understand it. And ultimately, what drove her was want to understand the origins of life. And in order to understand the origins of life, she understood earlier that she needed to figure out RNA. That RNA was the key to understanding the origins of life in a sense more important than DNA. And she did. Doudna. Doudna, yes. I highly recommend again the Code Breakers, the Code Breaker story of Doudna and CRISPR, the use of CRISPR, the discovery of CRISPR as a gene editing technology. Fascinating book. Fascinating book. And she's a hero.  That's another thing. Johnny F. talks about Steve Jobs. On the one hand, he's super curious. He wants to know all the stuff from all kinds of fields, from all kinds of parts of life. On the other hand, super focused on what he's got to do. Super focused on the particular project. Says no to lots of things. That's the kind of combination that I think makes for great producers, great scientists, makes, you know, for interesting people. I've continues about Steve Jobs. Many of us have an innate predisposition to be curious. I believe that after traditional education or working in an environment with many people, curiosity is a decision requiring intent and discipline. Yes. So what we have this, called it innate curiosity as children. It's discouraged. It's stomped upon. Not just by our parents, by our teachers. What an irony is there. And by the people around us, by our bosses, don't ask. Just do what I tell you. And therefore it requires of all of us to be intentional and disciplined about it. So Iran's rules for life is be curious, which means activate it, pursue it, do it. Thank you for listening or watching the Iran Book Show. If you'd like to support the show, we make it as easy as possible for you to trade with me. You get value from listening. You get value from watching. Show your appreciation. You can do that by going to iranbrookshow.com.  Also, if you'd like to see the Iran Book Show grow, please consider sharing our content and of course subscribe. 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