Hello, welcome to ToveyTV, episode four of the FIFA career mode joined by Cam once again. Let's jump into it. So the last game Max Aaron's got an injury. Obviously Holgate's already out for two months, and then it was bittersweet. Been a bad news Max Aaron is out for two months with a dislocated shoulder. Another dislocated shoulder and another right back Holgate's on the right back But what's going on is what I've not even made his Premier League debut and he's already out injured. Should we bring in someone who can play centre-back as well because if he comes back fate and Cummins fate Depth. So it becomes third option. So we get someone who can play centre-back as well. Depth yeah, strength in depth Who are we going for them? I'd say Tommy Ashu. He can play both. He's played both in there for Serie A this season, he's a young player. Let's go. See if we can shift hands Ray Gomez again. Yeah, I'd say let's just go all out full whack Ray Gomez yeah, someone's got to take him. That's it. Someone has to take him What? Simon? No 13.6 million. That's the last option. That's the final offer. Take it or leave it. They've left it. Look at what I'm cumming. Look at him. How's he ending up here then? 14.5 million. Final offer. Final offer. On the table. They've taken it. They need time. What? They haven't taken it. They're going to come back and say 16.9 million. They're going to say now. Right, so we've sinned a week and we've got some scouting nonsense going in France. Get a bit of that. When I had sold for 10 million, we've got 8 million in our profit budget. Bit of a profit. We like that. Nice bit of money that. And we've got a transfer off before he wore me. 22 million pounds. And we've got one for 21 million pounds from Atlanta. So two Italian clubs and just say yeah, straight up, except in both. Check him. We've also got an offer for Yeri Meena, but... Enough. Not a new castle. In fact, block offers. Yes. But Man United has gone for over the 28 million pound offer from Michael Keane. Some big money floating about here, you know. Are you kidding me? Ah, you're saying that? 28 million from Michael Keane. 27 years old. What do you say? Do you sign a new contract? I think I should just navigate around. Then Buttons again. Oh, sorry about that. So as we expected, Tommy Asher, you've come back and said 6.9 million. Just pay it. We've got... Keane's going. We've probably made about 50 million pounds on getting played out the door. And we need another centre half anyway. We will probably sign another centre half. Actually, if he's gone, Godfrey Meena is our number one. Yeah. And he can be our backup and he can play right back all. So we've got Coleman. We could just go and spend 50 million on a striker or something. It's an interesting. Never know. But there you go. We made quite a bit of money. I'd say we just put it into our back pockets. Yeah. That is a lot of money. I'd take that. There we go. Ronald Cooman is made up with that one. He's asking Ronald Cooman, isn't he? He will be had sold for 20 million. Atlanta's obviously had to pull out. Oh, okay. So 20 million for it will be. Keane has sold. 28 million for Keane. Question is, Ned. Do we go back to buy a Labour Cousin for Bailey? Or do we stick with our stubborn selves and say no? I say we go back in and say right. Andre Gomez and 10 million. Andre Gomez and 20 million. That's a lot. You can't spend 50 million on Bailey. Right, so we've decided on another option. 25. Andre's going to offer Gomez to see what they say. You know what it is, Wafford? Should we just rub it in Labour Cousin's faces and offer 48 million? They're in the championship. Gomez can be a grip. Oh. Wow, people really don't like Andre Gomez. I know, yeah. Right, so we've given it a week. We're going to give it one more try. We're going to go in with a plastic mustache on this time. So they don't think it's us. Let's just offer okay, we'll give you Gomez again. But we'll offer we'll offer 12 million on the side. You know what? 38 million, we'll offer 17 million. It's unrealistic, but it's FIFA. FIFA think that everyone has got it. It'd be a realistic sign. To be fair, I'd take as many as I had. We don't play it out the door. And we've got Tommy Ashu in. We've got Mark Sammons in. We've got Dan James in. Dan James, a little back-up. I've supposed Sar could play centre-forward as well if he needed him. So we've got a good squad depth now. We bring him in. 38 million. Get him in. If he scores 20 goals, that's a decent bonus. If he scores 20 goals, I'll give him 19 million. There you go. Tommy Ashu is Miles Sarr. And Max Arons. That is a good transfer. We've gotten rid of Bernard. Michael Keane. Awobi, Fabian Delph. Bessage. Bessage has got a job in B&Q. Kyle John, this next game is so important. I feel like I'm doing a better job than in Konkuk. Tommy's not even playing. I'll make the decisions. We're dropping morale quickly. Right, it's our first game against Premier League side. First of the league match, let's sort the line up. So it's got to be DCL up top. It's got to be... I don't know, you know me? Yeah, actually, yeah. And then, it's Miles Sarr. We bring Sarr in on the right for his debut. Yeah, bring Sarr in on the right. And then Dan James, that bit of pace off the bench. 60, 70 minutes in. When Tottenham are tired, you get him in. Right, here we go. First game of the Premier League season. Come on up the test. Oh, it's really hot. He's in, he's in. Got to be. What's he doing? Get in! Oh, what a great start to the Premier League season. Absolutely perfect. Dominic Calvert, Lewin running away with his arms in the air. We're gonna win the league. It's on? It's on. Top in September, top in August. Look what it means to them. Look at this, by the way. Fans in the stadium as well. Excellent ball across the box. Not too sure Tottenham are doing defensively there, nevertheless it doesn't matter. It's so nice to see Gladys Street rocking again. I know. That's excellent. Discipline. Look at Dean. Oh, it just couldn't... Oh! It's excellent! What is going on? Dominic Calvert, Lewin with a brace. 10 minutes in. We are beatings first. 11 minutes. Oh, yeah. He's beaten for paces. There's this chance. He's got to shoot. Just too close to the keeper. Oh, skillful as well. Just what we'd love to see. The build-up was all right. Everything else before, hadn't you? Let's just pass it next time. That's it. That's what we want to see. Oh, there's Miles. He's having a field day. And Ben Foster is loving this, by the way. He's got to go all out and everything. Ismael, you beauty. Keep it going. It's excellent. There's Rainbow Fix. Oh! Got to do better. Nice. Play him. He's away. Ismael again. You beauty. You beauty, Ismael. Honest debut. Absolutely phenomenal. Why don't we have a player who can do that in real life, too? Just look at that. Even right foot. I mean, it's exclusive. It's awful golf. You can buy it. Oh, no. Got to win that to go on it. Oh, it's excellent. That's another excellent challenge. He's blown up at the finish.  In a half-time, and it's 3-0. Second half, this will be a big game where we can get the three points here. Three in a lot less, not botting. What's the run? Great tackle, Yerry. We're just on the same wavelength. So many great individual performances. Oh! What's that about, Yerry? Nice, man. The last thing that we want to see is the raw pace of Daniel James or the raw pace of Dominic Calvert-Lewin. Dominic Calvert-Lewin. I'm lucky. Good effort. Didn't really have much other option to win. Got him there, got him there. Goes that, JP. Great save, JP. Getting. I think Saad had a good debut. He didn't play any three-season friendlies. Great save again, JP. He's on fire. I'd set Saad off. He didn't have any three-season games. Played an hour and a half. Saad, you've had a great debut, but it's time to rest. Excellent goal. Excellent assist. Well done, Saad. Great debut. Oh, that is... Oh! I'm going to the French Magician. I think Sonny's playing. There he is. Now, where's my old friend? The Balmain Centre. Should we give Tommy Aschew a go? Yeah, put Tommy Aschew in there to go. Gorman's books, and we don't want to lose another right back, so let's get Tommy Aschew in there. Well played. Well played, Seamus, lad. Excellent performance. Excellent shift. Come on in your first touch, Tommy Aschew. Good pass. We know what he can do. It's absolutely excellent. Oh! I think we've got a star here. We should play him up front. I think everyone's had a really good performance today, and he did himself. No, he's not brilliant. Where is he? Hattrick for Dominic Calvi! He's been so good today. Absolutely brilliant. Great ball through by, I think it was the core. I thought he was going to give a penalty. It's just become too easy for us. There we go. 4-0 on the opening day of the season. Dominic Calvi, Lewin, Hattrick. There you go. 4-0 for our first game of the Premier League season. That's the ball. Let's get into a post-match. What did the press want to say? Our manager looks about 10. Looks like all of a twist. Delighted with the first win. It was 100% about Effie. We tried hard. The morale is flying up. We buttoned Mash all day. That's it. He had a great... He only touched the ball once, and it was a great touch. I wanted to see how we fitted him. And he looked great. His mouth, Sa. He's already made his mark. Sa was... beyond par. I know it's only the one game. Top of the league. Everyone in the comments in the first game saying it was a car crash. There you go. We'll see you in the next episode, episode 5. What a great way to finish an episode. Our first PL win. We lost our first pre-season game in 9-0. We've come a long way in four games. There you go. Don't forget to comment the top scorer. Thanks for watching. If you want more videos including live exclusive videos head over to Patreon. Thanks to Cam for joining us from The Mighty Blues. Thanks for watching. See you later. Up the toffies.


You and everyone Sometimes wear clothes that don't make us happy personal branding expert Lisa and Berman is here to tell us to stop chasing the trends Welcome, Lisa. How are you? I am fantastic? I'm so excited to be here today. Okay. Now. Why is it that women are wearing clothes? That don't make us happy. Why do we keep chasing these trends? Well, first of all, there are a number of reasons Primarily they want to look good. They really do. I mean these women They're chasing these trends because they either see them in the fashion magazines or the best friends are wearing them They want to look their best, but they just don't know how to pull it together And they also don't have the self-confidence to know that if a trend is not right for them They shouldn't be wearing it You're speaking to me because we have some of our clothes here. Amber is here We have some clothes that we wanted your help on. Okay.  You don't wear these very often. Do you? I don't because they just don't feel like me I know they're cool and hot and all that, but they don't feel like me Well, I have a question for Lisa not to cut you off.  Yes. Now, what would be a great kind of outfit for women who you know Have the hips and the buttocks and all that great stuff. Well, first of all, you have to know about balance You have to celebrate the curves. You don't you don't hide them with a dress thing And you don't want to expose too much. Those are the those are the big no-nos too much exposing and Ted dressing so Sunita in these pants here. Do you show your booty? To hide that Feel comfortable in them so she so the fact is you either work with finding something It's gonna make you feel comfortable in these or you know what take them back They sold the tags on them or give them as a present. Okay, but do you think or do you think I should just like you know Kind of own it since everyone loves it on I think you show you listen You can't own it unless you choose to own it No one's gonna make you take that look on and feel your best if you don't have the attitude Wait, you ain't got to take it off the Favorite outfit and I wear it at the beach. I wear it at formal places and really Yeah, you can you can hook it up you can put like some chains on there and make it really nice, okay? So I mean do you have any suggestions or like broaches or like you know or maybe not wearing it to all those places? Yeah, there are some pieces that you can rock to a lot of different places. Thank you I don't really see this as formal where are you wearing this for like work stuff, right? If you don't wear it to a formal party, that's it you don't wear it to auditions, right? Well, I did wear this to an audition He said he wanted somebody who was African, of course I'm not, you know Distended but I'm just saying and I didn't get the part but that makes sense Like I said, I have the hips I have the buttocks and I just like how it flows because it's a nice big tent Yeah, right. No I think you just leave this for the beach. No, try wearing something else to an audition Okay, other than this. I know this is your go-to happy dress. Yes, it makes me happy and I love the orange and it brings on my skin I think if you wear something It's fabulous that you look fabulous and get the part. Okay, then you go celebrate in that dress Thank you. Well, Lisa, I know you you mix and match all different styles and all of that And I want people to go to your website your website is go to style diva.com Yes, you have so many more tips for us on how to wear things that absolutely I do Thank you. Thank you. We'll have more for you with every way woman come back Every way woman gives back to the community go to everywaywoman.com to find out how you can match our donations of undergarments for needy kids Thanks for getting to know every way woman


YouTube what's up, man? This is a gameplay video from weekend league I played 50 games of weekend league this weekend So you weren't watching live Saturday night Friday night Sunday night man Make sure you hit that link below twitch.tv To make sure you're tuning on to live action You can see all the wins all the sweats all the turn up everything that's involved in a stream Also, man, what I want you guys to do is follow these social medias Everything's been booming. We are moving in to man in 21 and just keeping that momentum I appreciate all the support you all have been showing me on these gameplay videos and that's why they watch man also Just like this shirt right here this physicality shirt I also put up two brand new shirts on the needed game and store website man That link is below make sure you go ahead and copy for watching this video, man If you type in the code at the end of your checkout YouTube you get 25% off your entire order So no matter what you get whether it's the we are mad and shirts or it's you know Some of the needed gaming merch 25% off that but I said this was weekend league So, you know what we do before this before this video pops off I'm gonna take a look at my team real quick one big addition to the team was p willy I did grab that Patrick Willis that 99 Patrick Willis there he is right there I use this card art because that's the best card art for me I think it's just that's just that's the best looking card art one of the best features in the game They added is that we can change the card art. So this is when I choose. So let's take a look P willy 98 speed I actually sold my Troy Palomalu middle linebacker golden ticket for p willy One I probably made 700 800k and p willy a little more physical I'm not going to activate any of my linebackers.  They're not going to jump from footballs as you're going to see in this video. They're not going to You know really do anything outrageous So you just want the more physical player. You got that 95 block shed 98 hit power I mean Patrick Willis has been just a dominant player in madden for years And glad to have them in the game this year really So I'm going to run Shazeer and Patrick Willis and middle linebacker both 98 speed Both absolutely Demonic the way they play the run and you know that that's what you need and we can look and you'll see this game The run was pretty much a problem I mean, that's if you guys can stop the run and we can leave you can do good And that's pretty much what it's about. Uh, the like I said, I've told you guys this pretty much every video Only card I'm waiting on Is that shawn taylor to play strong safety for me? Now I have golden ticket tiller maze and calvin johnson activated I use those guys at linebacker and pass defense and safety and run defense uh three four they play safety and in Past defense they play linebacker so I can use with them a lurker over here. We have miles garret He is my detactable people always ask me during the videos. What do I have on miles garret? Um, I will show you guys the abilities that I use Uh one unstoppable forces pretty much been the same all year Pass rush elite. I feel like it's the only pass rush community. You don't need a double stack pass rush chems That's all you need and forster to hit stick people Not only if he blocks she has right away and his sticks on a Inside zone sometimes if you're running a stretch, right and somebody runs outside Then they want to slow down kind of cut back across the middle here comes that detact What that was blocked earlier and boom out of nowhere hits sticks Uh, I feel like if you have four abilities and forster has to be one Run stopper. I love it. I think works good Um, that's what I use in a secure tackler. Why secure tackler? Sometimes secure tackler gives you that reach ability to reach out and grab people.  Miles garret Uh, I said and on both of my safeties. I have Acrobat lurker universal And enforcer I don't have any any tackling chems if I were playing a hundred thousand dollar tournament I would have tackling chems instead of acrobat But I just love the way calvin and taylor mays go after the ball with acrobat and everything. So That is the defense I want to put out here I I really feel like all I'm waiting for is that shone taylor To take night train spot and then night train will play the slot along with mike evans. Um But let's go ahead get into this gameplay. It was a good game Like I said, uh played 50 games a weekend league this weekend and this was one of the best All right, so we're playing this game against the giants team and for me, um Every time you play the giants every time you you know Play against anybody that's a giants fan cowboys fan. You just gotta beat them That's just how I feel in moss. We put him out the first play. He runs four people at him So we hit that in route over there to julio jones get a nice little 23 yard gain early in the game Uh, I hand off the walter paint in there just trying to do modibles get everything set Next play look for a blast look for a hole really don't find anything man. I like this new oranless playbook That's what I'm using if you guys want to check out the ebook It is at man turf.com that link is below So make sure you guys check that out man But uh first drive we're going down to feel pretty good now your first drive a lot of times a man Is a fillout drive like what is your defense? What's your defensive call? What are you like running this guy was primarily every play cover three and it takes Probably to the second or third drive that you realize man This is it's just cover three every play as I missile in this corner route for the touchdown on that cover three Linebackers not going to play a corner route without an ability You can pretty much throw at his face all day But we got underneath of jill and ramsey there nice little swerve get my feet in there with julio jones There it is miles garret and forcer run stopper In the area.  He goes for moss. This is what I do I move away from the receiver and then come back and swap the ball What you want to do is you want to detach yourself from that two that one on one animation That's how I stop moss. That's how I stop double me You don't want to be stuck in that animation if you're right next to the receiver You'll be stuck in that animation So I take my user take my db swerve outside and come back and try to meet him at the top At the highest point of the football now doesn't work all the time But if you stay in that animation you will get you'll get put in a moss animation give up a huge play So that's what I do to try to avoid getting mossed as they say And I said just trying to establish and we're up through we're up seven up and points here is pretty much In control of the game now when I start mixing in this out route That's when I start realizing dude. He's really just in cover three every time and the curl routes another great little dot against cover three Little play a little read option there. Michael vick got somehow the enforcer found me Once again, we're gonna hit this little baby in this baby hitch underneath pick up a couple yards, man Five for five so far mixing in the run given the ball to walter payton given the ball to michael vick That's pretty much what what it's about on munt man. I feel like munt offense is hard You just got to take what they give you we get to a second and eight here going for the corner out swerve underneath Get that big body of julio jones catch the ball at his highest point next play We want to dump it underneath little hitch. We are closing in two minute warning Little blast at his third and goal right here We're gonna look for this wheel route over here to walter payton But he can't get his feet in perfectly What I did here is I did not move my arrow when I kicked and I tried to overcompensate for that and We missed even worse so It's hard being a streamer sometimes man. Sometimes you're looking at a chat sometimes you're reading sometimes you're talking about other topics And uh, just forgot to move that arrow started my kick meter tried to overcompensate but went a little bit too far And right here. This is when he gets in his demon I want to know huddle runs to walter payton. Now walter payton kind of killed me this game I'll be honest guys walter payton. I I I mean I feel like he's a golden ticket running back He has 99 everything human joystick Uh, and I believe he has evasive and he was putt. I just it's just absolutely geeks running back So if you don't have walter payton Probably pretty cheap now I don't know who you guys are using to run it back as we see miles garret the absolute horse in the middle Of my defense just balling for me Uh, he tries them right here now. This is smart by him I probably could have called a timeout here, but I didn't want him needed to touch down I and he milked enough clock to where I'm not going to have any time to do something After he kicks his field goal. So pretty smart clock management by him But I was okay with it because I didn't want to give a runner extra time Didn't use my timeout said if you if you're cool with a field goal I'm cool with it too because I don't feel like you'll keep getting down the field and I will definitely score more points So second half starts more of this guy walter payton holding the ball with one hand acts underneath him glowing He's just kind of killing me and there he goes But mike evans is going to fight get yourself a mike evans golden ticket lays out Stops him at the two-yard line and he fought so we can have this goal line stand And we're going to blow up this full-back dive for a loss of four But christian acoya had different ideas that could have been second and goal from the four But acoya fought ran through von miller. Maybe I got to put erin donald there at the end Maybe von miller doesn't had a boots to play the end in in three four. Maybe he's just an outside linebacker, but We have von miller there acoya went through. So now we're down three How are we down three because we're down three and we almost get baited there, but ever angriom fights breaks up the pass Uh, this is when this honestly is the best drive of weekend league for me And I want you guys to watch this drive carefully because I'm going to take five minutes off the clock here We're just going to take what's there third and three We put a curl out out here. It just was not open Try to swear to the spy, but you know, we didn't fumble because we're on conservative You won't fumble on a sack in a pocket on conservative fourth down once again that crossing route bring that receiver back Use his body to shield off the db caught the ball right there with julio jones I'm just running mixing it in. Uh, what's there once again cover three. We hit the baby out route There it is linebackers will not get out to cover The outside wide receivers in cover three.  They're not going to reach up and catch Knock the ball down. They're not going to do much of anything and here We're closing in on the end of the third quarter out route again. Julio jones. Boom time is ticking fourth quarter we get into We're gonna go ahead and dump this ball off the ingram, but he drops that one We see cover three There's so many holes in in it and I go for the post route here But he covers it hit that little check down that little underneath and it's third down So we're gonna run blast get a yard slide stay safe It is three minutes. We are closing in on the end of the fourth quarter Just going to blast get closer. This could be blast full back dive dive Whatever it is every single run needs to take 30 seconds off the clock And that's our goal here closing on a two-minute warning third down We're going to go ahead and punch it in finally and that is a 17 play drive 17 plays 83 yards Five minutes off the clock and we can leave that's pretty insane Um and to do that just demoralizes your opponent. It takes the ball out of their hands I don't know what progressive fatigue is a thing Whereas the defense eventually got tired by the end of that drive But man, they didn't have much will at the goal line there and I need some will to tackle walter patin They're worth a two-minute warning now. All we got to do is tackle walter. We see reggie wade just getting blocked I feel like he breaks the tackle every play. He's glowing when he's glowing He's running through she's ear ramsey actually gets enough bodies around the ball But I said we use so much time that time is against him a little bit as laurence taylor gets the sack But honestly, I feel like he should have just kept running Uh, we're down under 50 seconds left in the game goes for the in route there hits it the tory hole That is his first completed pass of the game Uh, once again everything box. He goes two post routes takes a terrible sack with laurence taylor This is why runners don't pass man, but there he goes there It goes that man walter breaking through a tackle brian dawkins night train mike evans laurence taylor wrapping them up right there third and 18 Uh, we're scared to run. We're afraid to run even though there's 20 seconds left. He only has two timeouts We're still afraid of walter patin gonna rush for got a spy goes for the in route But jamlin ramsey golden tickets not having any of it fourth in 18 and fourth in 18 for a man with no passes Is definitely going to be an interception acrobat lurker on this golden ticket calvin johnson That's going to end the game Now like I said, this game was great because simply for me because of that one drive Uh, 17 plate drive taking what your opponent gives you I don't know how many times I do the ball over 10 yards in that drive mixed in probably 10 runs Whether it be an inside zone or read option or a blast Mixing up the entire playbook really and just keeping them on her toes But they if someone runs the same defense you can run the same coverage beaters all the time I do that curl route a lot the out route a lot the crossing route a lot just you can mix it Especially if they stay in the same thing, you know what to expect, you know what the time up You know where to throw the ball and that's pretty much how that game went Uh, what stop stop walter paying you win the game miss the field goal It happens man. It's hard being a streamer. Sometimes you lose Attention to detail and you don't move the arrow before you kick and uh, that's rough, you know But like I said, it was a good game one of the 50 games of week in league I play so if you guys aren't checking these games live, please twist that tv slice dub that link is below


Woo, nice throw! Nice catch! Nice throw! Relax, turn to the back, back double biceps Relax Face on As long as it works


I'm going to go ahead and start because I'm trying to stay on time. How were your concurrent sessions? Yeah, a few of them ran over. I take that as a good sign. I heard some conversation, a little bit of laughter. A lot of people in some of those rooms. We didn't want to close the formal part of this conference without getting in the weeds and being really practical. I took as the animating idea behind my talk the notion that we have a responsibility to bend the arc of healthcare toward justice to take a little liberty with Martin Luther King's phrase. Some of you who signed up for this conference very early know that Jim Conway was going to give this closing lecture. He's a terrific guy. He was my colleague for many years at Boston Children's Hospital where he was the assistant hospital director. Then he went to the Dana Farber as the executive vice president of operating officer and then he went to the Institute for Health Improvement as the senior vice president before he eventually went as an adjunct professor in organizational ethics to the Harvard School of Public Health. He would have been perfect. I will not be perfect. When I talked to him about this talk, I said, Jim, I really need a cleanup batter. Someone who is a power hitter, kind of fourth in the lineup whose job is to clean up everybody on the bases, bring in all those walks and talks and base hits that we've been putting on the bases all day. Besides Jim as Irish, nobody can tell a funny story or a joke as well as Jim Conway, especially not me. But Jim is sick. I'm very sorry to say. I'm so excited to miss the opportunity to talk to all of you and he feels badly about not being here. So you're sort of stuck with me. I'm the pitch-pinch hitter. I've just exhausted my entire knowledge of baseball. But I do have a lot of experience with ethics committees and organizational ethics. So what I want to do is just get practical if I can make this work. Okay, so my objectives are to identify the procedures and talk about those in some detail, about an approach to doing organizational ethics, at least as one of our hospitals developed it, the one that Bob Trug and Jeff Burns and Mike Epstein and I over the years developed. And I want you to learn from our mistakes. So I'm going to talk about some of those consults because I think we learn best sometimes from the things that don't go quite the way we thought they were going to. So in the beginning, so I'm talking about the 1980s, we did the same thing that everybody else did. We did those policies that had to do with decisions not to resuscitate. We didn't get it right the first time. We've since revised it. We're still talking about the revision we just did. But anyway, we did that kind of ordinary policy work, including addressing cases and issues of intractable conflict and possibly medically inappropriate care or medically futile disagreements about medical futility and so forth. So we did those kinds of policy development and review that we all understand to be a core part of the things that clinical ethics committees in hospitals do. I want to tell you about a time when I was up on what we used to call the Multidisciplinary Intensive Care Unit for rounds, just kind of hanging around and see what was going on.  And he had been involved in looking at the autopsy. The resident had gotten the consent. The autopsy had been done. The patient had gone to the pathology lab and after the results were back, this intensivist met with the parents to talk about, this is what usually happens, the results from the autopsy. And as they were asking questions, they realized that their daughter had been buried while our hospital still had her organs. And they were pretty surprised. The intensivist asked whether we ever do ethics consults about things like that. That's not at all like the kind of individual case consults that we usually do. I said, you know, we haven't and doesn't mean we won't and we'll talk about it. And a number of us talked about how to get involved in this and whether or not this was something that was appropriate for our hospital's ethics committee to get involved in. In fact, you know, as we discussed it with people, some people said, why do we even worry about autopsies anymore? We can look inside bodies before people die and maybe this is not really an important issue. Now, remember, or maybe you don't know, that Boston Children's Hospital is the place where Stella and Richard Von Praugh where Stella Von Praugh was a cardiologist and cardiac pathologist and she and her husband together developed the system in pediatrics for categorizing congenital cardiac anomalies and Richard Von Praugh's office, which I've been in has jars, not anymore, of hearts in them that were used for teaching purposes to show, for example, tetralogy of flow and its various permutations. So, you know, we really cared about getting medical autopsies done and doing them right. That said, there were a lot of us who didn't know very much about autopsies and didn't know how much other people knew about it. And so Bob Trug and Jeff Burns and others and I decided that we needed more information and we had a really good fellow, Glenn Rosenbaum, who actually did a national survey looking at all pediatric and adult hospitals that had critical care fellowships and asking chief residents, as sort of the stand-in for residents generally, about what the autopsy practices and the autopsy consent form looked like and also checking their knowledge about autopsies. One of the shocking things about this, and I'll detour and I'll try not to be very long, is how little they knew about what a complete autopsy really was. Now, these are the people who, in the middle of the night, are the ones who are getting consent from families, so if they don't know that it's pretty routine for the internal organs to be retained, then how are the families going to know? And if it isn't mentioned or it isn't said clearly in the consent form, how are families going to know? So, among the things we found from that study was that 72% of the autopsy consent forms had no mention of what would happen to the organs, and 97% of the places that were surveyed, and this had a very high response rate, had no educational materials for the family. Now, there was a fair amount of opposition to doing this look at autopsy consent practices at our hospital, especially from, but not exclusively from the chief of pathology, who really sort of felt that we ought to be minding our own business, and he hadn't asked for our help, and why were we doing this? He didn't think the ethics committee ought to be involved at all, and he said so, I didn't ask for your input. Not to say that there wasn't some support. Our associate general counsel, for example, thought that it was a good thing to do now. There's another possibility that we might be sued over something like this, and if we actually took seriously a concern that the families had, and really changed our practices and made them better to address the concerns that they raised because of what had happened to them, it's sort of doing the right thing if for maybe not even for the best reason, maybe not for a wrong reason, at any rate. Mostly the question to us was, what gives you the right to go looking over our shoulders, meddling in our business? Now, not being someone who's easily stopped, we didn't exactly quit, and we did end up making some recommendations for changes in the autopsy consent form. We spent hours and hours of ethics committee meetings talking about whether we should have a checklist and let families have a buffet, and we talked about differences between complete and partial autopsies, et cetera, et cetera, et cetera. At any rate, we also looked at the education for residents and attendings about what an autopsy actually involves and the kind of educational program for the multidisciplinary team around things to do at the end of life, particularly when a child dies. So when I was preparing this talk, I went looking for our revised autopsy consent form, and I don't want to seem narcissistic. When I googled Boston Children's Hospital Autopsy Consent, that picture came up, and I thought to myself, God, that's how I felt. It seemed like this never was going to end, and nobody liked the fact that we had their nose in their business. We did end up five, five years later with a different autopsy, a different chief of pathology, but I had nothing to do with that. A new consent form that lists, writes, explains what an autopsy is, offers some options for what happens to organs and also included permission for research if tissues were retained and information about other limitations. Now, this is not about autopsy consent. This is about organizational ethics consults and one of the things we learned from this is, you know, it's a little hard to go mucking around in an institution around broad system issues and policy concerns without some sort of authorization for at least looking at it. And so we had to resolve this problem about, at least in this case, that we had not had formal institutional authorization. So we sat down with our chief administrative team and Bob and I, I'm not sure, I didn't tell him that I was going to say this, but I'll take responsibility if he doesn't want to, outlined a process for going about doing organizational ethics consults. And I outlined this list of things to do and this talk will be in a PDF on our website if you want to go back and get it later. Because it sets out a process that we developed whereby we actually work with the CEO or whoever the administrator is around the issue that has been coming to us and we think raises some pretty important ethical issues and figure out whether or not there's enough of a problem there that they and we both think that we ought to devote some attention to it. And then what we do is move forward by proposing some way of doing that. And as James mentioned earlier today in the panel discussion, our standing clinical ethics committees or sometimes our IRBs, research ethics committees, don't always have the requisite expertise in those groups already. And so sometimes it's best to put together a task force or a study team or a working group specifically around a particular issue when there's administrative authorization, draft a charge about what they're actually supposed to be doing and I can't tell you how many times you go back and look to see what that charge says you said you were going to do and a timeline with internal, interim deadlines and a date for getting a report done now partly that's in there because administrators think when they've told you to do something it should land on their desk before the end of the week and if it's not, you know, you can't do it that fast before the end of the month and I don't think we've ever done one that got done in a week and there might be one that got done in a month but I can't think of which one it was and so we also said that the idea would be to pair up the people who lead this group in addition to putting on members who are the key stakeholders around the various aspects of the problem so that they would be led by someone from the office of ethics or from the hospital's ethics infrastructure the clinical ethics committee or the IRB along with someone else who is also an expert in the issue that you're dealing with so notice we have just in coming up with this process taken a step toward conceding that the things that we hear about that are issues in our hospital as the variety of people on the ethics committee are working on the front lines aren't always exactly the same things that the administrators think ought to be attended to and we have essentially said not exactly that we wouldn't take them up unless we had permission from the CEO or the relevant administrator so once we got this process worked out I think the fact of doing it sort of got some buy-in right away and so the next thing we knew our CEO wanted us to use it and we had a couple of parents whose children needed surgery they were Jehovah's Witnesses they wanted their children to have the surgery but they also did not want their children to have blood during it and we knew that there was a process within the hospital of finding surgeons and anesthesiologists and a team that was willing to be in the operating room under those circumstances so we also knew as we talked to these people that were they to get into trouble around blood loss to a person they were planning that they would intervene and give blood if they had to rather than let the child die in the OR although the understanding in going to the OR was that the parents had agreed to the surgery but not agreed to the blood and we also had a patient coming up who had a very significant spinal deformity that needed a long complicated surgery that might well involve some blood products and so the way we handled that ethics consult was to put together a team that was co-led by Judy Johnson and one of our senior surgeons John Emmons and of course we had Byin from the CEO who wanted this to be done and we identified a working group with co-chairs and members and a timeline and we did a report with recommendations and just a cut to the chase we basically said that rather than singling out patients whose parents were Jehovah's Witnesses really what we ought to do is change our practices in the operating room to minimize blood loss for all our surgeries and have these various alternatives to blood transfusion available for all patients including patients whose parents were Jehovah's Witnesses it was in my opinion an excellent report and it went on the shelf and it's still on the shelf now partly that was our problem because we didn't get into the finances we didn't talk to people about what it would cost although we had done some exploration and provided some information about alternatives for things that could meet this recommendation so the lesson learned for us was that we really have to anticipate in advance who's going to get this report and have responsibility for responding to the recommendations that are made and even though our co-chairs went to the medical staff executive committee described the process and the recommendations and so forth and we tried to follow up later by talking to various people in the OR in fact I hope people don't feel terrible about having invested so much work and something that didn't happen we did learn a lot but in fact we didn't change practice now should you get discouraged let me just say we had lots of positive effective organizational ethics consults that did have good outcomes one of them had to do with cases that were coming to our ethics committee around issues regarding staff and families involvement in social media at the time we had like 20 different words for describing what was happening on the internet and what the problem was and so we use this same process there was definitely institutional authorization in fact there were a number of managers who wanted to take the policy approach of just say no and there were a lot of staff who wanted the opportunity to cite a policy or talking to families that the hospital forbid them to do to be Facebook friends or whatever it is we had a nurse who was on the care pages of a family who was reporting about their son and his illness at our hospital who learned through care pages not through taking care of the patient but one of the family members was suicidal and so when you're not exactly a lurker but when you're on these social media and you find something that's clinically relevant what are you supposed to do about it we also had a patient whose child received a donated organ who did an internet search and found out by looking through the news and the obituaries and so forth who the likely donor had been and contacted that person and then got nervous after the plan to meet the mother of the donor, dead donor in our hospital lobby and told the clinical team that she was worried but this is going to happen like in 15 minutes so there were all these issues around how you learn this information and what staff are doing in participating in social media and so there was this tug about whether to just say no or to actually have a professionalism conversation about helping people develop the judgment regarding their responsibilities and boundaries in interacting with patients and their families in this way among other things we had a student who was taking an ethics course and in an MPH program from Tufts who worked with us to do focus group interviews both with families and with staff and that formed a piece of the data that we included in our report recommending that we actually have an educational program which we do now have around social media it's in mandatory yearly reviews the sort of thing that gives everybody a groan when they come up to get done but we also had an educational program that was carried out through ethics rounds on the clinical units to give people cases for discussing what would you do, what should you do why wouldn't you do that with their peers so that they had some sort of anticipatory ideas about how to handle requests to be a Facebook friend from a mother of their patient, for example and there are some definite things you shouldn't do like post pictures of your patients on your Facebook page and so we wanted to get some of that message out too so that was just to say they're not all unsuccessful but I'm going to go back to learning from our mistakes because I think that's most useful so we had had a couple of inquiries and conversations with people who were involved in continuing to care for children who had early infant and toddler surgeries around genital reconstruction for what used to be called intersex conditions as a general category and there were still a number of parents whose children were in school age or adolescence even a couple of young adults who had not disclosed some of this information to their children and as you might guess as we were getting more and more knowledge about what's possible through genetics everyone was worried, the staff in particular about these growing children being a bucle smear away from learning genetic information that they wouldn't have any reason to know if they hadn't been told decisions that had been made early in their childhood and our CEO is a urologist so we thought, he knows this problem in spades isn't this just exactly the right kind of organizational ethics issue to suggest we try and tackle and so we put some stuff together and Jeff and I sat down with him and he looked at us with something close to this and I was not prepared I just didn't even think about the possibility that he might not think this is a great idea that said, you might remember that the Intersex Society of America and people who feel very passionately about this issue were picketing outside hospitals and after I got my balance back and thought about this for a while in spite of the fact that we'd already done an educational retreat all day on it and invited some staff and our whole ethics committee to talk about it I realized, geez he doesn't want them outside Boston Children's Hospital picketing and if we open up this box where is this information going to go and who's going to hear about it and I would have liked to have done this consult but we didn't do it and in fact what we did do is find other ways to talk about some of these issues at the time well still, David Diamond is a former fellow from our bioethics program he was the person that we were recommending co-chair this task force he has since developed the gender management service at Children's Hospital for children with disorders of sexual development and works with Norm Spack who's now retired but there have been other opportunities to find other ways to tackle some of this but it wasn't done through the kind of process that I'm suggesting so lastly I want to give you an example about pediatric organ donation using cardiac death criteria as you all know most deaths in intensive care units today are deaths by decision to withdraw life support and if you're working on a clinical ethics committee you're probably involved in a fair percentage of the hard cases that come up around withdrawing life support although that's now I think getting routine enough for not having to go to ethics committees for discussion but this does mean for a while that there had been fewer organs available for transplantation because patients weren't progressing to brain death and that was one of the ways that organs were procured and so in the 90s teams began to talk about using so-called non-heart beating donors and we got a call for an actual individual case consult somewhere near the middle of the night about a patient in the operating room and a question from one of the surgeons about how long we actually should be waiting before declaring death and making that first decision to procure organs and actually all over the country that was a huge and in some cases still is debate you know is 60 seconds too short I think most everybody thinks so now is 90 seconds is it 2 minutes is it 5 minutes is it 10 minutes and especially in pediatrics where the capacity to resuscitate young children even after a fairly extended period of time is it's pretty remarkable so as a result of that middle of the night discussion among the surgeons and the critical care folks and some of us from the ethics committee the hospital decided to put together a task force on pediatric organ donation using cardiac death criteria that Charlotte Harrison I don't know if she's still here but she was involved in along with Bob and a number of other people in our hospital and they made recommendations now the reason I picked this one to give as an example is because one of the things that this task force did is decide that there were issues that we really needed some community input about and so the Harvard teaching hospitals have something called a community ethics committee some of you went to the session that Carol Powers and Inos Gardner and Jolene McGreevy did around their most recent report regarding unknown and unrepresented patients and so this was the first case that came to that committee and Charlotte provided a very detailed memo that was drawn up by the task force to the community ethics committee with some very specific questions that we wanted their input about and just to tell you about one of them this discussion in the pediatric organ donation using cardiac death criteria's task force was very contentious this is about do children die still in the intensive care unit with their families there and then get raised through the corridors to the operating room to procure the organs or do we set up the operating room so families can be there and we watch them as we withdraw life support and see when they die and then we do the incision to retrieve the organs so there were a number of people on the task force who went into the conversation and never changed their minds about this just being a terrible idea and there were other people who went into the discussion feeling like yeah we need to find out a way to do this and do it right and so among the things we entertained was the possibility that we would not tell families that there was this other way of donating their child's organs unless they asked us and if they asked us then of course we would tell them all about it and so we explained to the community ethics committee that this was what the task force was considering the community ethics committee sort of looked back at us and said what and it may be the only thing in all the reports they've been so emphatic about they said this quote this approach was unanimously, thoroughly resoundingly rejected by the community ethics committee that's about as emphatic language as I've ever seen in their reports and they also talked about the organ donation language using this presumed presumptive consent process which they thought was creepy so anyway this was an example of getting at least some pretty informed and thoughtful input from people who are not on the inside about something that could affect any parent whose child very unexpectedly and tragically ends up in an intensive care unit and is going to die and who might want to think about donating organs so and one of the lessons learned from this was when you pick members don't pick people who are so dug in as a task force ahead of minority report in our hospital so just to say that there are a whole bunch of kinds of ethical issues that can be handled by the kind of method that I'm describing I'm not going to talk about these in any detail but they'll be on the PDF on the website and to review what the pitfalls are you know you have to deal with giving advice that is or isn't institutionally authorized you have to arrange in advance for follow up on the recommendations that these kinds of task forces make getting to know is a little hard to hear because you've gone to a CEO and you find out that what you thought really needed to be handled they don't want to hear about and figuring out what to do with that your advice is probably as good as mine and then figuring out how to construct a task force that's actually effective in getting their work done without being deadlocked in disagreements is important so I've only talked about ethics committees as a multidisciplinary group in most cases here specially formulated for dealing with some of these kinds of inside institutional issues which is not all there is to organizational ethics but it is I think one way of getting into the weeds and getting very practical about how you could actually when you identify an ethical issue in your institution that you want to do something about in a broader way use this kind of process so in closing I am convinced that there's a role for ethics committees in addressing organizational issues not just ethics committees looking at individual case consults after 30 years of working with ethics committees not just my own at Boston Children's Hospital but also reviewing ethics programs around the United States and a couple in European countries in fact I'm going to an ethics committee in Maine next week to talk with them it's clearer and clearer to me that healthcare ethics committees are an underutilized resource in our hospitals and healthcare institutions now I suspect if you're working on an ethics committee you might not feel that way because for one thing you don't get a separate salary for doing it and for another thing you know it's kind of a mixed blessing when you get a request for an ethics consult but I'm talking about not just those individual consults but the problems around them that are really bugging you and that sap morale in an institution and finding a way to try and address it and that sometimes gives you energy you didn't know you had in my opinion members of ethics committees include some of the most committed, energetic still idealistic value centered staff who feel called to continue working in a hospital people who care about doing good not just doing well and who work long and hard to try and solve ethics how many of you have been in ethics committees they usually are scheduled for an hour and a half or two hours that went over time in trying to talk about a case consult yeah so you know and that's not billable hours right in my opinion ethics committees can be relied on to think creatively and also speak candidly about ethically justifiable alternatives about what to do and what not to do they want as we all should want to be proud of our hospitals work and mission in the world they want as we all should want to help our hospitals fulfill their missions to heal the sick ease the suffering and prevent the sickness of those around us especially the most vulnerable and least well off it is not that ethics committees don't understand the pragmatic and financial goals of keeping a health care system solvent it's not that ethics committees don't understand that phrase we've already heard today no margin no mission they know it takes money and operating margin to provide health care but ethics committees are also likely to say no mission no margin when hospitals lose sight of their ethical responsibilities especially in the domain of their clinical mission especially when staff don't feel able to fulfill their mission to serve the sick with care and compassion the human infrastructure starts to crumble and the margin as well as the mission is compromised in ethics committees hospital administrators have already in place a group of committed staff who bring multiple perspectives and disciplines to the examination of inequities and broad social justice problems in delivering health care I think it's time for ethics committees to partner with hospital leaders and for hospital leaders to partner with their ethics committees to identify and address bigger problems in health care not all of them at once spoken or two at a time that we can all agree need our attention and a compassionate values-driven mission-driven solution to make our institutions a better place so that's all I have to say I'd love to have comments or questions and see what you think Bob for many reasons and part of that being that they would not be more likely to respond to the opinions of the committee although as you pointed out not always could but I think that that same strategy also leads to one of the arxist criticisms that this committee has overall which is that they have been completely co-opted by the hospitals in which they were and that unless leadership agrees to support exploring a certain issue then it doesn't get done so any of the more contentious issues remain unexplored we have Charles Foster who was last year discussing his book on this and I mean he was partially critical of the complete absence of the inability of that committee to be outside and to look pretty at what's going on in hospital and it's particularly relevant to the topic here of social justice because I think very often hospital administrators do not want to talk about that they see it as a threat to their sort of financial plan and so it's kind of a mixed bag it's not all on the positive side and I don't know what we can do about that because we do work in these hospitals our salaries come from them and to to pick on topics that they don't want you to talk about can be very counterproductive to our existence yeah and I think sometimes we actually do have to take risks I know you know this because you know it may not save lives but Elaine and you and I and a bunch of other people have been very involved in talking back to our hospital about the decision they made around Proudie Gardens so you know maybe not the most compelling ethical issue in the world but I think it matters and so there are times when you actually have to decide is this an issue that's so important that we're going to find a way to deal with it and if I lose my job over it I'll have to look for another job now I'm not telling you all to do this I'm just saying it has occurred to me more than once has it ever occurred to you has it ever occurred to you yeah, yeah I agree and I had kids and I didn't look for another job but those are risks that are very hard to take and you don't necessarily have to take them and it's not that hard to find one that could get administrative buy-in unless you have a CEO who really isn't able to step up to being the chief ethics officer and if that's the case then it's a really hard environment to work in Danish you know the financial incentive to do the work then is that the way to go about it or is that another it's very clear you're not going to be effective if you can't take into account and see from the perspective of hospital administration the relevance of the financial consideration so it's just do matter of course they matter okay, tired, ready to go so let's close I want to say a bit about the poster session I'm not sure whether you all know first of all we started a master's program last fall and admitted 21 students 10 of whom will be graduating in May a part of that master's program requires a field experience so in addition to getting an academic a rigorous academic education they also can't get out of our program without having some familiarity with the work of bioethics in the real world and so those students who are graduating this year have prepared posters of their field experiences and their capstone projects and you have on your name badge a number on the back that corresponds to a number of one of the poster boards it has two posters on it and so what we would ask you to do is go to the poster boards that you have the number for to give our students a chance to tell you about the work that they did at least two of them and then you know we don't think it's going to last for more than you know one group at each post a set of two posters but after that you may want to go and look at some of the other ones and also go pick up something to drink and something to eat we're going to have a nice reception I want to give a thank you to our staff you know we are now two years into this new center for bioethics we've hired 14 adjunct and part-time faculty and six staff Lisa Bastille who's here is our program and finance administrator Lisa Mayer designed this great booklet she's our communications coordinator and Blair Kahn and Paula Atkinson and Tony Tuggenberger here along with Brooke Tempesta who's the coordinator of the masters program so if you had a good time today please tell them thank you we have just started yesterday a fundraising effort our budget didn't change between when we were a division of medical ethics and our new center for bioethics we have hired all those staff I just told you about and quadrupled our programs and we found money in various places and we're working with a development officer to try and actually identify some philanthropy and we've gone after a number of grants including the one that supported this conference but we are also providing a card that's on the table if you didn't get one for individuals to let us know that you're willing to financially support the center now we're not asking you to put us in your will although if you want to do that that's okay what matters to us is that we have your support that could be two dollars or twenty dollars or two hundred dollars or twenty thousand dollars you can do the math I would be happy if we had over the year a hundred percent support from the people who interact with our center for bioethics even if every single one of them is a two dollar donation what we care about is your participation with us in the work that we're doing so you can either put a check in here or you can go to our website and click on the button and use a credit card but please also know that this is something that we're going to be doing that we will want your help with as we figure out how to raise funds for the center we were allowed to become a center at something around ten percent of what's ordinarily required of a budget to start a center at Harvard Medical School and we're trying to be very good stewards of that money but we also this is the thing you learn about being an administrator like it's money matters and I was really into thinking about just do the right thing yeah so anyway that's it for fundraising on behalf of our planning committee our staff Bob trug and myself we all want to thank you for coming so go see the posters and by all means stay and have a drink with us and go back to your home institutions and take up some of these broader institutional problems that bend the arc of healthcare toward justice thank you


Okay, very good morning everyone. Hope you're doing well. In order to practice what I preach, this briefing is not going to take long because there's not a lot going on. So I definitely want to convey the idea that when it comes to monitoring, aggregating the news that sometimes there is just not a lot of new information that's relevant really for the market open and that today is kind of one of those days, so I'll keep it keep it relatively brief but looking at the charts this morning things are basically flat The Dixie's unchanged oil is unchanged Equity index futures are broadly flat So if anything a lot of Consolidation happening at the moment particularly with the US indices after the rally that we saw on Easter Monday With the slightly lighter just general volumes with UK and Europe out of the market So then coming back yesterday didn't really add too much in the way of a great deal There's certainly not in the way of any new real Fundamental catalysts in on a macro sense Volumes on US exchanges actually slipped below 10 billion shares for the first time this year Yesterday, so from that perspective one of the quietest days we've had so far of the year Asia then overnight Not too exciting Mixed to flat so again not a great deal to comment on a few things that have just happened as I've switched the record button just to be aware of In the currency pair seeing a bit of a divergence at the moment Euro-dollar or positive dynamics and the pound were negative. I'm just speaking to a couple of other analysts They're noting a technical break in euro sterling Again, nothing from a fundamental news catalyst perspective much more technically driven this morning But you're a dollar here just having a bit of a break out of what was the restrictive area of upside? Resistance both late in the US session and the Asia pack session It's a euro dollar just having a push-up through to the 119 handle Whereas on the downside cable continues to decline having gone through the low that we saw from yesterday evening UK time and the 138 handle this morning Otherwise elsewhere. T-notes have just broken as well a short term double top That was seen just before the close kind of really towards the back end of the US session And so some further upside there might contribute as we have been seeing of late then further the kind in yields A softer dollar to support that euro move Generally as well that yield backing off as we were commenting on yesterday Which is in step we've been seeing some dollar weakness has been supportive of some of the commodities and gold Which was flat just a few minutes ago It's just seen bit of an upward move there with the 10-year just breaking out a little bit movement in the in rates market But overall as I said very quiet Overall not too much to to really comment on so I'll get straight to it and a quick update on the Covid vaccine situation and this is one of the major headlines coming out on Bloomberg this morning Madonna COVID-19 vaccine being rolled out in the UK for the first time still gonna be I believe it's about two more weeks before it Actually does get officially rolled out with a ministered or available to be administered and it's going to be focused in Wales specifically But what's happening here is that this announcement has come where the vaccine from Madonna's going to be with us two weeks earlier than expected Now I guess the the question mark there is that is that positive? Is that going to help make any real definitive change to the vaccine speed? In terms of the program for the UK and consequently couldn't have any impact and the answer to that is no not really To give it a bit of context This is what we're looking at at the moment and so as we've as we you guys I'm sure I'm probably aware the basket of vaccine orders from the UK is heavily tilted on AstraZeneca Of which we we've talked about many times before if you actually look at it Madonna is the smallest orders right down here at the bottom at 17 million and and as to what we could expect for manufacturing and supply Kind of timeline with we're talking hundreds of thousands of shots to get this thing up and running so In a sense, then it's fairly Inconsequential in terms of really moving the needle on the road map Which the government has still said that they're looking to do which is the final kind of reopening of the four-step plan on 21st of June and then more broader nationwide inoculation by a month or so thereafter In context as well what what we have had of course in the in the UK as announced a few weeks ago is Supply issues with the main Astra drug and obviously that's really important because that is the key one to facilitate the rollout program in the UK Now why does that happen? Well lots of supply issues coming by way of India and serum and that that batch of five million But then new production coming out and so forth So a lot of what's been happening is a halt to new first shot Being administered and therefore then what we're seeing is a convergence if not a change of second Doses on the seven-day average exceeding now the first shots and Without Astra being available in terms of their vaccine We've had a various infantry and still supply of the fires of my end tech drug And those people are coming due for their 12 week second shot then and that's what they've been receiving So a lot of what's been happening has been more focused on Second shots while we await then to get first shots underway in the coming coming weeks So overall the Madonna news certainly is a it's a positive thing to hear from a from a COVID Kind of health crisis point of view from a markets point of view It doesn't really make a great deal of difference and we were expecting this to come at around this point anyway In other vaccine related news University of Oxford has said that it's paused a small UK trial testing COVID-19 vaccine It develops with Astra in children and teenagers as it awaits for more data on rare blood clotting issues in adults who receive the shot Had a great deal of time to read in more detail into that story, but Putting two and two together. I would really get too Nervous about that announcement. I'll probably say that's normal procedure if anything just given the ongoing review It's happening for the shots in regards to some of the knock-on conditions that have happened after receiving that that particular vaccine And then elsewhere in the US President Biden has come out last night It says he wants all American adults to be eligible for the coronavirus vaccine by April 19th Which is basically two weeks earlier than his previous goals So the US continued to get more and more kind of ambitious with their targets going forward A few other things to be aware of On geopolitical front and we can talk mainly about oil now oil has unchanged this morning But Iran have said that nuclear talks in Vienna Aimed at restoring its 2015 nuclear deal with world powers have been constructive They were talking yesterday But they have stuck to their demand for the US first to remove all sanctions for any real progress to be possible So it's kind of one of those where it's good that they're talking, but nothing's happening at this point So there's nothing really there's no meaningful impact for price for the time being as we've kind of said before in previous briefings This Iran negotiation is not going to happen quickly. It's going to be over many months So I wouldn't be looking for any definitive kind of action on the back of this And then we had the API trees last night crude was a draw of two point six one eight million cushing 84,000 draw gasoline and build a four point five five three million and we'll be looking out for the DOEs later Remember it was only a holiday in mainland Europe UK or on Easter Monday So the US schedule for the infantry is completely as per normal So it'd be 330 London time. We'll get the DOEs this afternoon And on that point then just having a quick look at the calendar It's a fairly quiet calendar again. This week is quite quiet overall. And so looking for this morning We do get the Service PMI numbers coming out of Europe and the UK, but these are final March readings. So Not expect to be to market moving if at all Then looking into the afternoon Excuse me There's no major 130s coming out in the US We've got CAD trade balance. So then we look to the oil infantry's at 330 and then the FMC minutes on today at 7 o'clock and I've not really read a great deal about people talking about the FMC minutes and a lot of the time That says it all in the sense that it's probably not really that important And I can understand that the last meeting that we had if you remember just a few weeks ago Did include the summary of economic projections where everyone was looking for any movement in that dot-plot Which we didn't see where we saw rates then committed to the fact that they're going to rise still through 2023 Rates markets nonetheless have continued to bring forward their anticipated first rate increase now into the end of 2022 nonetheless given some of the really strong economic data. We've had out the US But what new information we're going to get out the minutes probably none at all really and so hence the reason why it's it's Most likely going to be a Feddy dull event typically when they release the projections if you think about it We're getting clear indications about their latest vision about what the future looks like for unemployment for growth for PCE for rates in terms of federal funds rate forecast. So It's not like We're we were short of any information to then have the clearest possible Understanding of where the feds heads were at at the time So the minutes unlikely really to unveil much in a way of anything new I would say But one thing we do have is a couple of Fed speakers no happening this afternoon In particular the two that I'd look out for really is feds Evans and feds Barkin Both of which are voting members and generally have a neutral disposition in terms of where they sit on the hawk-dub spectrum Evans is speaking on current economic conditions and monetary policy at 2 o'clock London time and then Barkin is speaking at 5 p.m London time Daily who is a voter and also neutral speaking on climate change and equality is also as a side point talking about the economy and Mary daily will be speaking at at 6 p.m. London time as well All right, and that is it as I said I was going to keep it brief. So I'll stick to my word Any questions at all? I was talking to some former students in Bahrain actually last night And they said that they still watch the briefing every day So I'm going to give those guys a shout out to the kinds in in Bahrain Thanks for joining me last night But otherwise for everyone else have a good day ahead again market conditions are very quiet And I've not really looked at the the charts too much from a technical perspective But certainly when markets are quiet from a fundamental news point of view I definitely would be putting a more of an emphasis on the technical setups of charts across assets as a As a almost a more weighted component for market direction today and with that good luck See you later, and then I'll see the others in the in the discord ruin out by live. Take care


to journaling with movement part three. In this part, we're gonna explore creating diagonal movement across our pages in our art journal. Again, I am still using the Moleskine planner diary thing that I found at Goodwill last year and I am loving working in it. I love the texture and printing in the background. We're not trying to cover up the whole entire page. We're trying to work with what is already there to create an interesting composition. This is about leaving the blank or negative space and just adding to it rather than trying to cover it up. So here I have a homemade stencil. Literally, this is made out of a piece of junk mail and different round paper punches that I had. I am using some turquoise Dina Wakeley media paint and I am just lightly stenciling on these large circles in a diagonal manner across the page from the lower left-hand corner to the upper right-hand corner. I am interested in using organic round shapes for this and layering different fun interesting colors. So that's what we're gonna do. Here I am using another blue from Dina Wakeley's paint called Ocean. This particular bubble stencil, I believe if I'm not mistaken is a Mike Deacon stencil. So again, I will link his website in the description below where you can take a look at the stencils he has available and that he makes. They're not always in stock, but when they are, I try to snap up the interesting ones. So I'm just like trying to line up one of the bubbles as I move up the page. It doesn't have to be perfect. I just want that movement on the page. I'm already loving the way that looks and it's just like basically two colors of blue. But it really does make the eye travel up from the one lower corner to the upper corner across the page. And it, without doing anything, you're incorporating the background into the composition, I think. And this is again, as I've said in the other two videos, my favorite way to journal. This is a neon orange from Derivan. I was sent a little tiny bit of it to try from my dear friend, Cindy Utter. And at first I grabbed the red and I realized the red's probably not what I wanted. I wanted just a little pop with his other round, organic-y shape. This stencil might be from eye stencils I don't remember. Anyway, so I grab a little bit of that paint on the same brush. I'm not bothering to clean my brushes and I am just lightly stenciling these round, organic-y style of shapes. I think this is a C-themed set of stencils, I think, because there's more than one in the set and this is just one of them. I don't use all of them, I think I only use this one. It's just something I have in my stash.  Use what you have to create an interesting composition in your journal. Using this video as your inspiration point, your jumping off point. In this particular instance, I use almost all paint. That is not always the case. Sometimes I create these pages and they have no paint on them. In this case, there's a lot of paint. I do end up adding a couple bits of collage but here I'm using my color wheel to try to sort of figure out what other color I wanna use because I know I need one more color. And so I'm looking at my color wheel and I'm thinking, hmm, okay. And I'm looking at what colors I have and what ones I think I wanna use and then I go and grab the Dina Wakely Lime colored paint, lime green. And I'm just thinking. I'm like, okay, which one do I wanna use? Which one do I wanna use? And I'm like, I'm gonna use a lime. My first instinct is to use the lime. I'm gonna try to listen to that. My muse does talk to me in my head. I know I shouldn't say that out loud. It makes me sound insane. But anyway, and she does tell me, stop. And then when I don't listen, I regret not listening. And she also tells me which colors to use. Again, when I don't listen, I regret it. So I'm gonna listen. I have this little other tiny organically shaped stencil. Again, again, I think these are from ice stencils. And I am going to put some of these shapes on there with green. And I have very little paint on the brush and I'm very lightly scrubbing through the stencil in a circular pattern to get the shapes on there. While I don't care if they're not perfect, I don't want too much paint on there to be blotchy or blobby. I want to be able to see the suggestion at least of the shapes across the page. This is about a more perfect rather than imperfect stencil job. And I love the way that looks. And I could have just stopped there and been perfectly happy. I did decide as always that my page needed words. I always think my page needs words. For me, that is just something about art journaling. I have to have words on my page. Some of you may not feel that way, but for me, it just doesn't seem like it's complete without it. So again, I'm getting out my multi-pen that's just full of different colors of ballpoint ink, nothing fancy. And I am looking to see if there's a color that I like and there wasn't. And so then I looked to see if I had a bic pen that wasn't a color that I liked.  I have a lot of pens, but these are the ones I use most of the time. And then I'm still not happy. So I'm looking, I find a gold pen in there that I think I might want to use. It's a gold Uniball Signo pen. Look for, there they are. Then I'm like, wait, I have these PaperMate pens. These are PaperMate Flare pens. They're nothing fancy. You can get them at any art supply store. Target has them. A lot of your big box stores. Any place that carries PaperMate pens probably has these. They come in different colors. And I want a blue one. So I'm looking for which color of blue because there's a number of different colors of blue. And I am working on a giant pad of drawing paper. So I'm using it to sort of test the pens off camera and try to pick the ones that I, or one that I think will work. And I find one that's more green rather than blue because the page is really green. And so now I'm just tracing out and adding some marks to some of those big circle-y shapes I put on there initially. And I'm just, you know, again, nothing perfect, nothing fancy, just tracing around the circle, adding a little swirly flourish. And that's it. You don't have to be good at drawing to do this. I am tracing the ones that I think I need to to continue with the movement up across the page diagonally to encourage the eye to travel up from one side to the other or down from the top side to the lower. So I am looking at the different shapes that are on there. I always want to do something right in the middle on the fold. Again, there I am again. What is with that? So then I keep trying to put the pen away and thinking, oh, that's good. No, wait, here's another one. And then of course I have to add some little doodly hash marks to some of the spaces between the doodle lines. That's one of my things. And if you are a fan of my rubber stamp line, you know that because it is in a lot of the rubber stamp designs. And I just spend a little bit of time adding marks even in places where on camera, you can't see them, believe me, they're there. So whatever your instincts tell you to do, do that. Don't worry again about covering up the background because it's not about that. It's not about taking a lot of time with it. It's not about agonizing over this or that. These videos, including this one, are filmed in real time. So each one of these videos is about 20 minutes-ish. That's real time. That's how long it took me to create the pages. Sometimes when I do this, they turn out and I like them. In this case, thankfully, because I was filming, I like all three of them, that doesn't always happen. But it does happen more often than not. It's more about practicing and experimenting than it is and playing than it is about being worried about creating a perfect page or one that I love. Sometimes the ones that I don't like are the ones I've learned the most from. Usually that's the case. So anyway, now I'm just adding some gold dots with the gold Uniball Signo pen. I love that pen. It always works. It never is clogged. I love that pen. I have such a problem with clogged gel pens in particular. So off to the left side, you see this piece of note paper here. Then I got an happy mail from somebody and I honestly don't remember who. It says Ed Hardy at the bottom, which is a restaurant, I think. Anyway, it has these two little fish on it. I keep looking at it thinking, I really want to use those fish on here. And of course, I want to find a quote or words to use on here, which I do eventually. But I'm looking at the fish and I'm not sure what I want to do. I end up using the fish on this page and I end up not throwing the rest of the piece of paper away and using it on a different page in a different journal. I didn't film that one, but you can see those gold dots while there. It's a simple thing with just random dots. It really did add a lot to the page, I think. And the movement on the page. I like this because it's like the shapes are dancing around in a diagonal manner, but up and down that imaginary diagonal line and like they're dancing up and down the line. I love the way that looks. So here we're gonna tear out these fish from the background paper. And I don't want too many of the straight edges. So I end up being careful not to rip the fish by putting my finger there to guard against the image being ripped to rip out the edge of the image so that it is at least mostly torn and not straight. So it's more of an organic shape. So in placement of these images, if you're gonna do this, especially when you have a page where you really already love the movement on the page, make sure that when you put them on, they don't conflict with that movement and that they just enhance it or work with it. And you'll see me sort of play with that a little bit where I'm like, I know I want this on there. I know it should be on there, but where exactly should it be? Yep, there it goes. So we're gonna glue those down and we are going to get them on there. I do decide to add some writing. This is a piece of old book text. This is from an address book of my grandmother's and that is her handwriting on there. And I decide I want a little bit of that texture on the page, that writing of hers on the page. And there's my quote. I always dry fit my pieces before I glue anything down to make sure that I really am okay with the placement of them, that I like them and that I'm okay with it. Kind of, I know I want these on here, but I'm struggling a bit with where they should be and where the placement of everything should be. So you see me, this is why I dry fit things. And then I realized that maybe that other piece is just way too big. And I think, hmm, yep, I think that was the case. It was just too big. It was covering up too much. You lost the diagonal dancing across the page and I wasn't okay with that. It was covering it rather than enhancing it. So now that I know for sure where they should be, I'm gonna use some fluid matte medium and I am going to glue the pieces down. You can see there that the gel pen wasn't dry. And of course, I stuck my finger in it because, you know, that's what I do.  I've said it in previous videos, it's just different kinds of white paint that where the tubes or bottles were mostly empty, I scraped them out and put them in this little gladware container. And whenever I have one that's any kind of a white shade whether it's titanium white or a buff or anything, I scrape them out and stick them in here. And I use this white mixture in my journals. So I am going to try to not cover up the smear, but I'm going to add over the top of it some white dots from Mike DeConstencil. It doesn't cover it up and I don't expect it to, but it will disguise it and push it into the background a little bit and that's okay. And then you can't just do that in one place. So if you're going to do that, you need to do it in other places. And I needed to be mindful of, again, my diagonal movement, my dancing across the page, sort of feeling I had from this page while I was doing this. If you like these kind of videos and you'd like to see more of them, please let me know. Don't be afraid to ask any questions. Leave something in the comments below. Like, share, and subscribe if you will. I will try to leave relevant links to everything I've mentioned in the description if I can. If I've forgotten something, please ask. All of my social media links, my Etsy shop, and my YouTube channel. If you want to support the free content here on YouTube, all the links for how to do that and everything are in the description below. There's a link to a site called Linktree in the description below. If you click on it, you're going to find every single place I am on the internet. So that being said, let's finish our page. And I love that stencil on my deacons, by the way. It's really nice. And I'm not saying that because he sent it to me for free. I bought that stencil. So now I want to put my pieces back on there, but now I'm like, okay, wait, now the paint is wet. So I don't want to smear anything else. I already goofed up one corner. So I'm using my glue stick, love my glue stick. And I'm going to glue everything down with a glue stick, including the old pieces of paper for my grandmother, the little fish. And I think the little fish paper was probably white or something and was sprayed with spray inks or something, it looks like it. Anyway, I don't know what that paper is from, but it was really cool. If you gave it to me, if you're the one that gave it to me, thank you. So before I put the quote on, I'm going to get the big elements on. And make sure they're positioned where I want them to be. And then add the quote. I cut out quotes from all kinds of magazines and newspapers and junk mail and all sorts of things. I love to add words to my page. I'm going to use an old gift card to push things down and make sure that everything's pushed down and well attached to the page. Of course, trying not to smear the paint, which I do a little bit and I don't know if you caught it on camera. If you did, you can leave a comment below and tell me where. All right, that's it. I want you to play this week with movement in your art journals. This week, play with diagonal movement and let's see what you come up with. If you want to share, you can join my Facebook group, A Life of Art and Self Expression. And I have another group that I teach in. I teach with a few other teachers. If you want to join that one, you can, the links for all of them are, again, they're over at Linktree.  Don't be afraid to make mistakes. Don't be afraid to make a mess. It's part of the process and you should just go with it. Here, I decided because of the smear, I would just go ahead and just add some more paint. So I did. And it did work the pieces of paper into the background, which, so it did two things. Anyway, the most important thing here is to go out and have a great day, have some fun, explore your art, play with movement in your journals and have a great day. Do something nice for yourself because you deserve it and I'll see you later. Bye guys.


And here's a new Ronin SC. Alright, so who are you? I'm Patrick Santicci, I'm a communications manager for TGI. Right here is the Ronin SC, which is the second version of the Ronin. SC stands for Ronin S and the C is compact. So this is actually a lightweight system compared to the Ronin S. This system was actually designed specifically for mirrorless systems that are increasingly popular nowadays. So all the Sony systems, the Panasonic systems, some of the mirrorless systems from Canon and Icon are all compatible with this Ronin SC. So what this does is it's a three-axis gimbal that helps you capture stable video. It also has a suite of creative features built into it. One of the biggest design changes from the Ronin S is that we've instituted these axis locks. That's on this Nissan NSR2 and essentially just makes it easier to travel with compared to the Ronin S. A lot of the features are similar to what the Ronin S offered, except this is just more lightweight than that system. And it just travels a bit better. And what is this setup right here? So this is the Ronin SC again, but this guy has the dual hand grip. So a lot of videographers like to have the extra stability of a dual-handed grip. It's a little bit more comfortable, especially if you're on longer shoots. So the dual-handed grip just adds to that comfort level. And what's really cool about this is it also has our focusing motor, which is off. So this can be purchased as an add-on to the Ronin SC, and essentially it sends the power to this external focusing motor. If you want to do manual focus, you can absolutely do that. So we're going to put this down and I'm going to open this up. So one of the really cool features with the Ronin SC is that it's the first DJI handheld stabilizer to have a more active track. So essentially it sends the data from the Ronin SC to track a subject automatically. So it's tracking through the phone camera on the app. But it requires you put this up there. Yes, and that's a good point when you, as just general awareness, when you balance your gimbal and you plan on using the active track feature on the phone, make sure you balance it with the phone on it and the system already on it. How does it change the balancing to have a phone on there? Does it change something in terms of back heavy a little bit? Another really cool feature that's on here, but I can't show it because if I take it off it's going to unbalance it, is Force Mobile. And what Force Mobile is, is it's taking some of the technology found in Force Pro, which is one of our professional-grade products. And what that does is it synchronizes the movements of your... Yes, that's awesome. It synchronizes the movements of the gimbal with your mobile device. This one, yeah, awesome. Oh, nice. So it just depends if you need to synchronize it with this one and that one, right? Yeah, yeah, we're using the ground with that sync too. Yeah, so essentially you open up Force Mobile, and then if you want to move the gimbal from far away, you can actually just move the mobile phone and it'll synchronize the same exact movement. Again, it's similar to the technology found in the Force Pro, which is one of our high-end synchronization. For a team of multiple people to work together, trying to get the best movements to make the most professional kind of style. Yeah, yeah, and it's taking advantage of the gimbal and if someone wants to do a specific position, we're going to be dealing with the master wheels as well. All right. What's the weight of the system? 1.1 kilograms. So it's getting more and more usable for a whole range of mirrorless cameras. Yes, I mean, it's matched up with a mirrorless system. So the mirrorless systems were designed to be lighter, easier to transport. So that's where the Ronin SC comes in and it's a similar concept. It's lighter, it's easier to transport, and it pairs perfectly with the modern mirrorless cameras. So it's the Panasonic Fuji camera synchronization? Yeah, not all the Fuji systems. So I recommend if you're going to buy this, just make sure you go onto DJI's website and check the compatibility list which we list out on the product page. But also know that we consistently look at the cameras to try and make more and more compatible with these systems.