Well, welcome back, and Owen Flanigan is going to start us off with a question. So Sheila, thank you so much for a very, very interesting talk, sort of brings out the social dimension of these problems. I was curious just from two things, you were emphasizing being a good consumer, giving some advice about that, which was good. And you were also spent a lot of time on sort of the way in which community, in the case of these prescription drugs, I mean these prescription drugs for non-medical uses works. And I was curious about just the following, you didn't talk about, you didn't use the word addiction almost at all, maybe not at all, I think you didn't, and I'm grateful for that actually. Because we know, I think the audience probably knows too, that at least a lot of the diagnostic manuals no longer use the word addiction much, they use words like substance dependence and substance abuse. But I was curious about what you've learned about the information flow among, say, young people who are taking these medications. What kind of information do they get from their peers about the possibilities of harmful effects from these uses? So for example, sometimes, at least at my university, we hear that amphetamine use is high in exactly the ways you said, children who have been diagnosed with ADD or ADHD get extra, pass it around, it's reciprocated. We don't hear as much about opiates, prescription opiates. I think the alarm bells would go off if we heard more about opiates, and I think the Adderall is sort of allowed to flow. So I'm just curious, A, what is the information flow like, and are there cases where we should be worried more about some of these uses, some drugs that are being used this way versus others? What is this? Okay. That's a lot of questions, but I'll try and address them. One of the things that I was talking about was that, well, as my friend John Morgan used to say, he was a psychopharmacologist, he said, you know, it's all in the dose. One person, you know, the same substance is poisoned at one level, and at another level it does something completely different. I think that the information about, in terms of information networks about drugs, certainly there were some of the people that we interviewed that seemed to know a lot more. Certainly the Internet is a very good source. People do use that. But mostly, you know, I think mostly it's, you know, it's in a social situation, it's at a party, and they say, take this, you'll be up for four hours. You know, they don't talk about, it's not indicated if you have to live or disease, and they don't do those sorts of things. But, you know, they do talk about, they do describe strategies for how, you know, like, don't take your Adderall afternoon before you're not going to go to sleep. So that sort of thing is, of course, is very helpful. In terms of whether Adderall is particularly bad as opposed to Vicodan, which certainly these kids were also using, their sense of when they got in trouble was if they were using Adderall to study, and then they used it to go party, and then they drank so much alcohol that then they had a hangover, they saw that as the worst part of it, in a sense. And it was sort of a cautionary tale. Their friends would tell them, you know, you're using too much. They'd stop hooking them up. And this happens in all forms of drug life. You know, crack sellers won't sell to someone who's pregnant, not all of them, but certainly a good percentage of them. So that drug users do form social bonds, they care about one another, they share information, just like we share recipes and cocktail recipes, and how, you know, never drink beer after liquor, or what is the other way, liquor after beer, or whatever the, those kinds of social norms, strategies, information certainly get shared. Thank you. Questions from the other panelists? I can ask someone, or mention something. I live in the Netherlands, and it's, as people may have heard, there's very different drug policies there. And one famous institution is the Smart Shop. It's called Smart Shops. There are Smart Shops in every town. These are not like the coffee houses. Not where you go and get marijuana, which is legal, by the way. And I mean, like really legal. But in Smart Shops you can go and get a whole variety of substances, many of which have psychedelic properties or relaxing properties. Some of them are pretty powerful. Some of them less so. They're perfectly legal. And it's such an interesting, the different way of distributing drugs, because first of all, people can walk in there and talk to the people behind the counter and ask questions about what does this drug do, how much should I take, and when should I take it, or shouldn't I take it, and they talk about it, and it's really, it's all above board. And I think in many ways it works really well. This is a big debate now about legalization versus decriminalization and the stages in between, and I think this is one of the stages in between that can be very useful. And by the way, you can go into these places and you can put yourself on a voluntary blacklist.  So it's kind of an interesting social. There's harm reduction in practice, right? Well, the thing about all of them, the notion that our young people are exposed to all these various drugs and substances, and they're given no more information, I mean, the information that they're given is most of the time just don't do it. And very little information about how to use it safely or to reduce their harms or any of those sorts of things. It's sort of like if we gave every 14-year-old a car and said, here, we're not going to teach you how to drive it. We're not even going to give you any gas. Just go. So yeah, it seems to me that people do use drugs for what might be seen, or at least from their perspective, reasonable reasons. I mean, it makes sense to do this and, Mike, this context with who I am, et cetera. But we don't facilitate safe drug use. Well, we don't actually, the National Institute of Drug Abuse to this day doesn't recognize controlled drug use or that people can use in ways that they're comfortable with. It's not life-destroying. They still have a job. They still take care of their family, all those sorts of things. We can't even acknowledge that, which makes all of it very difficult. Yeah, we haven't talked about this here, but it's pretty well known in the addiction literature that most people who take drugs do not get addicted. Exactly. And that is also the case with, quote, addictive drugs. Most people try it, and they say, well, OK, whatever.  But when you stab all drug use as evil or wrong or bad or unacceptable, then there's no possibility for information exchange. Sheila, but don't you think your presentation kind of plays into that a little bit? Particularly when you think about your comments about the doctors, the bottom line is that most doctors are doing the best they can. I know. And there will be people who try to get over on them. Right. If I didn't give that, that's exactly. I mean, that's what I was talking about with the scripts.  But I worry about the way the presentation kind of focused on the physicians because, like I said, most are doing the best they can. And in mostly any endeavor in which you have humans, you will have deviant behaviors. Yes. But we act as if the prescriptions is some unique behavior, when in fact it's not. Particularly as we think about opiates in the country, it's true when you look at some indicators. If you look at, I think, the past year use of opio as you see an increase. But if you look at the past month use of opiates, you actually see a decrease. So you don't, and then if you start to look at the numbers of new users, they're usually younger people. And then when you start to look at the people who are dying from opiate overdose, they're the older people. There are a lot of disassociation or a lot of numbers that don't go together. But we talk about these things like they're all the same. But my concern is that if we play into this sort of narrative and without acknowledging that, for example, physicians have a difficult job in that they want to make sure that they treat their patient well. And by the same token, they're trying to be responsible. So I just would ask to be careful. Let me extend your critique because I think that, I mean, the other thing that I could have talked about if I had, was the fact that when we get down on physicians for their prescribing practices, particularly in the pain management arena, we then set ourselves up for them under prescribing. Right. And people being, so I completely, and if I, in my presentation, emphasize it too much, it's a very good point. And yeah, so yeah, so beating up on the physicians is probably not a really good idea. I think I was more impressed with the strategies that they used to get the doctors to prescribe them. Not that the, I mean, there were pill doctors that they went to and get anything they wanted. Those are criminals, those are different people. But the doctors like at the student health centers and they're pretty wise or two. But the, you know, the regular doctor that they'd go to, yeah, they were fooling them. They were working out a way to present themselves in a way so that the doctor would believe them and prescribe to them. So that, I should have, that was really what my emphasis was, but you're absolutely right. We pick on the doctors, we're all gonna, all us old people that need the payments are gonna pay. One question or one theme that comes up in many of the questions has to do with this notion of whiteness and the connection of whiteness to socioeconomic status. And the questions are asking for an elaboration or amplification of what you mean by whiteness and questions about whether when you look at certain drugs, are you saying that, well, white people use these sorts of drugs, African-Americans use those sorts of drugs and a very open-ended question. Well, the first part of, the reason that I talk about whiteness in the way that I do is because I think that in particularly, I don't know if, the field I know best is ethnicity and drug use, but is that we tend to talk about white, I mean, white equals normal and everybody else is in comparison to what we're doing. So, you agree with that?  They're the people that sort of set the stage and make the laws and do all those sorts of things. Now the next part, I lost the next part of your question. I think that the assumption that whiteness is only connected to greater socioeconomic status. Well, it mostly is. Mostly. But the other piece, the piece that I think that is equally important, and I'm sorry if I didn't emphasize it, was I wasn't talking about who used the drugs. I was talking about what we as a culture and society believe about it. Early on, drugs get associated with particular social groups and ethnicities. And when that happens, irrespective of who ends up eventually using these drugs, they have a certain sort of social life, political life that sort of frames how we intervene, what kind of laws we pass. There's, I mean, there's many examples. Certainly the differences between powder cocaine and crack cocaine sentencing had a lot to do with who was perceived publicly in the public of using those drugs. And so that's what I mean. That's the way I'm using whiteness. What I'm saying is we have to look, we can't ignore the privilege that is attached to whiteness. And I think that's difficult for white people to hear, but that's too bad. I think it's more difficult for black people to hear. Another theme that emerged from the questions from the audience had to do with your word to high school students. And the interpretation perhaps, do you have this sense of inevitability that students are going to do it, so therefore do it at once. And several of the cards that I have here in front of me. I knew this wouldn't go. You knew this would come to you. It wasn't going to be easy, no. So in talking about why aren't we teaching more refusal skills, for example, or the just say no approach has been held up and we can argue about its effectiveness or how ineffective it was. I mean, is there anything in what you're saying that students might interpret as an encouragement of taking drugs rather than an acknowledgement of when we look at the numbers, it seems as if students are doing this and in light of that then. Okay. I think that what I said, or at least what I tried to say, was that in talking about this, is that certainly there are many teenagers that go through the journey from teenagehood to 30 and never touch a drug and they may be dodging bullets. They may be dodging bullets.  And I certainly think that I would hope that people waited as long as, I mean, I think Dr. Kendall talked about the fact that the younger that you start using drugs, your risk probability goes up and up and up. There's some stuff even about marijuana use that's, and I don't know, there's only been one or two studies about its effect on the so-called developing brain. I'm very cynical about whether that's gonna prove out as we continue doing this kind of research. What I'm saying is that we need to develop harm reduction for our young people, not just for the people who are in drug treatment or already, you know, adults with long relationships with drugs. I think we need to help our young people who some percentage of them, looks like maybe 30% of them are going to use drugs. And I think we have to first acknowledge that there's that interest out there. And second, talk to them honestly, not just say no, but just say K-N-O-W. We have to tell them the truth, the truth as we know it about drugs. What is the truth? The truth as we know it today. No, but what is the truth? I mean, this is where you have the real discussion. Right, exactly. But we can, yeah, well, I'm not, yes, I shouldn't use the word truth, you're right. Truth is the wrong word to use. But we do know some things about drugs that we could share. And one of the things we know is that mixing drugs, particularly when you're a young person, is very dangerous. There is never an overdose, particularly under 35 where alcohol is not involved. But we don't have to speculate. Denise showed some data, showed that young people start smoking marijuana at about 16 and a half, right? Right. That's the major one, what tobacco is like earlier. So we don't have to speculate. If we think about, if we want to protect young people, we want to know about marijuana. What are the potential, we want to know about tobacco. What are the potential harms of tobacco? And teach how to keep people safe, given that we know young people are doing this. Right. So we think about marijuana. Major concerns with marijuana, particularly of young people. We worry that young people may take too much initially. And if you do, you might get extremely anxious, paranoid. So how do you teach people to decrease the anxiety, the paranoia and that sort of thing? While standing on that very, very precarious bridge between it's okay that you use this, we... First of all, nobody's encouraging people to use drugs. I mean, that's, we are beyond that. I'm not, I'm not. I think I started out by saying you'd be better off leaving it alone, if you, you know. But we know that's not realistic for many young people. Why do we know that? I mean, I agree with Professor Hart. The whole discussion is this, if it's a good thing to take drugs, we just have to measure the amount of quantity. I don't think cigarette smoking is good for anybody. I can tell you as a physician, you know, if my kids ever started to smoke cigarettes, I would discourage them. Show them these statistics. Why, give me a discussion of a drug you'd encourage your child to have. What would you go to them and say this? I'm really not talking about encouragement. And what I'm talking about is harm reduction. What I'm saying is... Could you explain what harm reduction is? Some of our audience might not know what that orientation... What harm reduction says, what harm reduction says, is that when you come across someone who is using drugs or having problems with drugs, you meet them where they are. You help them to reduce the harms of their drug use. You talk to them about making changes in their lives. You don't immediately say to them, you can never use any more drugs and you must be abstinent tomorrow. You say, I will help you where you are basically. That's a very bastardized definition of harm reduction. What I want us to think about is just what Carl was talking about, is how do we talk about it? But I don't think just saying to people, don't use drugs, you should never use drugs, you should never use drugs while we're all not smoking anymore, thank God, but drinking wine and taking all kinds of drugs, where if you watch TV at night, every third commercial is about some drug that you should be taking. So I think it's very disingenuous to not acknowledge the fact that drugs are pretty exciting, interesting things and that young people, particularly those, and that are going to be interested in trying them. And if that's the case, I gave them what I thought was my best advice, which is do one at a time. Because we don't know everything about the bad effects. That's one thing we're pretty clear about though. I think the evidence is in, that if you mix alcohol with the benzos, with heroin, with those drugs, that you're greatly increasing your risk of overdose. And the evidence too is that if you mix alcohol with a stimulant, you can offset the negative effects either. So I mean... Yeah, exactly, yeah. So the point I was trying to make is that if we are really concerned about young people's drug use, we acknowledge the fact that we know that young people start using certain drugs at a certain point. And we target our education accordingly. That's the point. The point is if we're worried about young people primarily using tobacco, alcohol, and marijuana, that's where most of our education should be. Right, exactly. And they don't really, yeah, exactly. That's really true. And I think it's very important when, I mean, some of the dare programs that started in kindergarten talking to kids about drugs were ridiculous. These kids didn't even know what drugs were. However, I think in kindergarten, in your science class, you could teach children not to take medications that were not to take medications without an adult. I mean, that's... And it also, it's like, there's also the part where you sort of silo the drug information. You know, it should just be a part of your science class. It shouldn't, you shouldn't have, okay, now we're gonna talk about drugs. I mean, we should incorporate it into... And because drugs are so interesting, I think we can really do some really engaging things with kids if we incorporate it that way. And as we start, as we think about the drug education and sort of program, the thing that people must remember, particularly as we think about drug use by young people, particularly young, very young kids, parents still have the parent. Right. You know, oftentimes, when it's... Yeah. Oftentimes when we have drug use, drug use occurring at very early stages, drug use is not the biggest problem. There are supervision problems and a wide range of problems, and it just becomes easy to point to the drug use as the problem. But you can almost be assured that there are larger problems going on. And so be clear about what your target is. I like that idea, that is the role of the parents in this, because I think they're very important.  There is a Jewish myth that I don't think anyone has ever obtained empirical evidence for. You know, it's a Passover Seder. There are four glasses of wine. You don't have to complete all four, but you have to touch all four. And so kids see at the Seder, their parents are drinking, and they're permitted to have a little bit. And I'm told as a result of the fact that they learn this in a parental and a social context in a, you know, way that you don't find serious alcoholism among Jews. Is that true? That's true. I think the big studies were Italians versus the Irish. I mean, there are some studies. That's at least my knowledge. At least that's what I've written in my textbook. Yeah, so. I can't go to Ohio so much. Actually, I'm something of an authority on this part. Actually, this is again about parental role and the social dynamics. There's actually in George Valiant's work on the natural history of alcoholism, he indicates that unlike a lot of sort of street lore, there's no personality types, temperamental types, et cetera, that predict alcohol use. But there are ethnic, and it almost, and so then when people go in and look at the sort of various ethnicities, the one variable that he thinks is important in explaining Irish excess is that there's jokes about adult alcoholism that are permitted, sort of about, you know, isn't it funny that Uncle Shlomo ran into the garage last night and he's on the wagon again? That kind of humor, it tends to sort of encourage, it looks like children in certain ethnic groups to think, oh, it's not so bad if I behave like so and so. So it's interesting, I think these, these are clearly- And also doing it in a social context. That's a cultural thing, not evidence. Yes, true. Well, right. It becomes a broader sense. You know, doing it in a family context has different meaning. Yeah. But I think one issue that is really coming up, particularly with the number of psychiatrists I've met here, is that, and this again goes back to your point, at the heart, and that is, parents may be overlooking real problems their kids have and part of the reason they may turn to drugs and be very much influenced by their peers, although every adolescent is influenced by their peers, is because they're trying to solve some problems. So being more sensitive to your children's issues and learning how to be sensitive to it may also be an important part of this. But don't you think that's true across the life course? That essentially people that get in real trouble with drugs are what the treatment feels called dual diagnosis. I mean, most of the drug use that is going on is self-medicating. People are trying to figure out how to make it through the day. These are the substances that are available to them. So that's why it's always confused to me. I mean, I understand how the politics of it, but why we have a mental health system, a drug treatment system, and a primary care system when the folks we're trying to intervene with need to be in all three of those places at the same time. That's absolutely right. You know, I mean... And the idea of overcoming the stigma of seeing as a kind just. I mean, you have no stigma about seeing the internist. What's the problem of seeing as a kind just? And I would just like to say that these final comments are actually a wonderful preview of some of the issues that will come up tomorrow in the treatment panel at three o'clock in the afternoon. Before I send you all away and thank our panelists, I want to remind you of the opening at the Hillster Museum at six o'clock, during which there will be a dance performance. At 6.30 in here, we have what we've called the front line triage panel. So people whose professional work has them encountering people struggling with drug use or addiction. And at eight o'clock, we have music in the Christ Chapel. So it is a full evening. Have yourselves a good supper, and I hopefully will see many of you right around six o'clock. So please join me in thanking Professor Murphy and all of our panelists. Nice job with the clip.


Hello and welcome to the session in which you would look at dollar value life. Oh, it's very important to distinguish dollar value life Oh from traditional life. Oh traditional life Oh is what we learned in prior session where we keep track of inventory per unit separately And for a lot of companies they have many many units thousands if not hundreds of thousands of small units So it's very expensive to keep track of inventory per unit It's time-consuming and it could be subject to life of liquidation because you are eroding Old layers. So the old layers are there and you're identifying them specifically the dollar value life Oh is a little bit different. It's simpler. Although you might think it's a little bit more challenging for us Hopefully I can simplify it, but it creates pools the dollar quantity of inventory inventory rather than keeping per unit So under the traditional traditional life. Oh, we keep track of everything in unit, which is time-consuming Under dollar value life. Oh, we're gonna group Stuff together inventory together and keep track of it in dollar amount Specifically item that's that faces the same price changes In other words, they go up and down and prices in the same way or they go up and down and they cancel each other That somehow it makes sense to put them together. For example, flat screen TV Smart TVs DVDs they all electronics. So they work the same way from year to year So the purpose of dollar value life. Oh is to reduce life. Oh liquidation It reduce it not eliminated. You eliminated. You could still be subject to a little bit of erosion But you would reduce it and you would reduce clerical cost to keep track Clerical cost errors to keep track of each unit separately The best way to illustrate this concept is to actually look at an example before we look at an example I just want to let you know that whether you are an accounting student or a CPA candidate to take a look at my website farhatlectures.com I don't replace your CPA review course or your accounting course. I'm a useful addition to your CPA review course I'm a useful addition to your accounting course. I explain the material differently I offer you additional resources Additional explanation the theory behind the concept your risk is one month of subscription. Give me a try If you like it, you keep it if it's here. Let's help in you. You will know the difference If not, that's fine Then it doesn't you it doesn't work for you If not for anything take a look at my website to find out how well or not while you're university doing on the CPA exam I do have resources for other college courses You can take a look at them here advanced accounting, managerial accounting, auditing, so on and so forth My CPA materials are aligned with your Becker, Roger, Gleam, Wiley, Ratsurgent, so on and so forth and I do give you access to all the AI CPA Previously released questions 1,500 of them with detailed solution If you have not connected with me on LinkedIn, please do so take a look at my LinkedIn recommendation Like this recording share it with other connect with me on Instagram, Facebook, Twitter and Reddit The way we convert inventory to Dollar value LIFO is through a three-step process. It's very important to understand those three-step process and what I mean understand means Absorb what you are doing you can memorize the steps But if you absorb if you understand it it makes it makes it much easier to recall Step one, we're going to deflate ending inventory to current prices using a conversion index Okay, so we're going to be giving you might be giving FIFO And you'll be told to convert to dollar value LIFO So first thing you do is you deflate ending inventory to current prices using conversion rate You're then you're going to compute the difference and the difference will be the layer of ending inventory either created or sometimes eroded your inventory might go down And you're going to take this layer and you're going to reinflate this layer Using the cost index in the year acquired very important the cost index of the year acquired I'm going to look at a introductory example here. So listen to me carefully I'm going to look at an introductory example here in the next session You're going to have a more advanced example So first learn the basics then learn how to do the advanced example Let's take a look at this example. Adam company was using dollar value life formatted on january 1st x1 when the inventory cost was 400,000 December 31st x1, which is the end of the year the inventory was 455,800 and the cost index for the year was 1.06 or 106 percent Okay, let's go through this through this process now. We need to know what is our dollar value life form first step Let's look deflate ending inventory using conversion index the the conversion, which is the inflation rate Well, let's do that. How do you do this you deflate? We're going to take 455,800 current prices divided to take out the inventory And now we're going to come up to 430,000 What does that mean? It means the true increase if we factor the inventory out is from 400 to 430 So there was an increase of 30,000 of new inventory That's so we factor out the inventory from the total figure. That's step one. So we're done with step one Step two find the difference in the layers. Let's see if we added a layer or if we eroded a layer Obviously, I just told you we added a layer of 30,000 Therefore what we did in step two we step two basically saying you started with 400,000 you added the layer Now your inventory at base year compared to base year you had 430,000 So if we're comparing base prices Base prices to base prices between year one the beginning of year one till the end of year one. Okay. This is 2001 which is December 31st So comparing the beginning one one Or 20x1 to 1231 20x1. We're talking about a 30,000 layer. So this is step two done with step two So we added a layer Sometimes the layer might be eroded and this is what I will do in the next session when you would look at the example Then what we look at now, we're going to reinflate each layer using the cost index in the year Acquired this very important. So let's take a look at the first layer. The first layer is the 400,000 which is 11 20x1 what's the price index always year one because it's your base year. It will be 100% or just one So ending inventory will be 400,000 for 11 20x1 The second layer i'm going to reinflate remember I added 30,000 of base dollar, but I had a 6% inflation Now i'm going to reinflate this 30,000. It's going to be inflated and i'm going to multiply it by 1.06 And that's going to give me 31,800. Now. I know my dollar value lipo is 400 31,800 So this is my dollar value lipo now what I need to do. I need to make a journal entry To reconcile between my dollar value lipo and my fifo. Okay, if I'm if I was using fifo What do I need to do? Well my fifo the method that I was using Was 455,800 therefore I need to reduce my inventory to this much I'm going to create an allowance account and I'm going to reduce my inventory therefore my cost of goods sold Will go up by the difference of 24,000. There's a difference of 24,000 And I will credit allowance to reduce inventory, which is a contra Asset it means this is going to stay with you from year to year In the next session when I go from year to year, I'm going to keep track of this account So this is again a balance sheet account. It means it's a permanent account It means you have to account for it from year to year So this is the entry that you make To to come up to dollar value life or you reduce your inventory and you increase your cost of goods sold Now let's talk about the conversion index Or the consumer price index. Well the conversion index the consumer price index the inflation index Whatever you want to use Most companies uses the one that's provided by the government, which is called the consumer price index It which is cpi and you know company can use this Um companies can use more specific Price index for example, if your industry is very specialized, for example, oil prices changes differently than electronics electronics They may deflate from year to year. They may not have inflation They you know electronics equipment they get cheaper because to produce them Companies are more and more efficient because of advancement and technology versus oil Or the company can compute their own internal price index And if you want to compute your own internal price index, what you will do is you will take your ending inventory at current prices And you will divide your ending inventory at current prices by the same inventory that Compared to the prior year base at cost simply put let's assume last year something cost you $9,000 Okay, now this year the same items the same exact item are costing you let's assume 10,600 so what you do is you will take 10,600 divided by 9,000 That's 1.177 that's rounded 1.18 So it's approximately you're talking about an increase in prices of 18% So what you did is you computed your own your own price index your own consumer price index It's your own internal one So you want to make sure you understand how to compute this because on the CPA exam What in your courses you might be expected to compute the consumer price index take your ending inventory at current cost divided by the prior year based cost and If it's most likely it's an increase especially these days if you think about what's going on in the economy now We're experiencing inflation Companies will have to make sure they're using the proper consumer price index actually The consumer price index this last week grows the most since year 1990 Okay, this is I believe went up to 6.2 percent Which is quite high quite high relative to the recent history anyhow Make sure in the next recording you would look at the example where I work a comprehensive where prices Where prices where we have an erosion Okay in the in the layers for dollar value life At the end of this recording I'm going to ask you again to take a look at my website farhat lecturers.com. I don't replace your CPA review course. I don't replace Your accounting course. I'm a useful addition. I can help you. I can supplement your material by providing you alternative resources Alternative explanation that's going to help you your risk is one month of subscription Your CPA your accounting degree is a lifetime investment study hard Good luck get done with it Study hard, of course and stay safe


Next, we have our first tag team approach to QI, and we have Brandon, Tony, and Lydia talking about transformation of the Moran intern year. You guys are going to make Brandon roll up here. All right, hey everyone, it's us three again. So this is a follow-up from our project from last year. All three of us are involved in changing our current intern year. It's gone through a lot of transformations over the past two years, and we've been really excited and we're moving into phase two. Last year was going to phase one, so I'm going to start off us off with just reintroducing what we've been doing, and then my colleagues here will take it up on what the changes have been, the results, and where we're going next. So just a review on our phase one approach. This really came about when we had this mandate saying that ophthalmology needs to have an integrated first year, and three months of that first year needs to be ophthalmology. We've had this for a really long time, but this mandate has made it so that every ophthalmology program in the country needs to be on this too. And so we saw this as an opportunity for us to also make changes, one to make our program competitive and also as still a place where other applicants now want to come because all programs are now offering this, but also as a way to improve ourselves. So it was a great opportunity to look at that and see what we could do to change. So when we presented this last year, we titled it, oh, we wanted to flatten the curve. This was really during the COVID time, and it was because we were going through our PGY two year, and we really noted that there's a really high learning curve. And for many decades, this was like what happened in ophthalmology. You did an intern year and you just came in PGY two and got flattened. And that was like supposed to be the status quo. But we thought, why don't we change this now that there's this integrated year? Can we make a smoother transition and make it easier for PGY twos to assimilate and make it a safer time for everyone and a better learning experience too? So this is where most of our focus has been. So we're gonna talk about some data here that Lydia will present. Yeah, yeah, I'll talk about kind of the current data later. But this is just what we got last year when we looked at the actual time that was spent in clinic. And we noted that a large chunk of the time that we had was spent with purely administrative work or H&Ps where we did not even see the patient or examine the patient and felt like that was not an optimal learning opportunity for the intern. And this is really cool props to Lydia because she collected all of this data herself without any prompt. And this is really just in a way to capture what was happening because we felt like we needed some improvement. And so after this, we started this whole project, Dr. Petty, Dr. Simpson, many other residents to help improve things. And first, we wanted to look at developing our curriculum and thinking of what are some places that we could work on. So we looked at first the console service and the triage clinic. And so we revised our schedule, built that in so that the VA intern could come over to the Moran and work in a triage clinic and along with the consults residents. So the first six weeks in triage Tuesday and Friday and then in the last six weeks there on consults. And there was a little nuance here where every other Tuesday they would have a half day and seven full day. But regardless, this was the current schedule. And so we asked last year's interns how they felt about all this. And so this is where we went into phase two. Thanks, Dr. Mai for the comprehensive review. So moving forward to phase two. So like Dr. Mai kind of said, we want to look at everything that we did. We want to look at the data which Dr. Sauer will present here shortly and also look at feedback from the interns based off of satisfaction regarding the changes and if any other changes need to be made. So back to kind of that data that I showed earlier. And I want to focus your attention on the numbers of the data or the time spent on clinical time. So seeing patients, writing notes, attending lectures, all of that. That was about 27 to 36% for our class. The current interns, I got feedback from three interns but two of them actually wrote down the numbers in minutes, how they spend their time. And this is the data on how it has changed. So I think this is a huge success. We went from kind of in the lower 30s numbers to the upper 80s of clinical time. And this is just incredible to see how this has changed and really transformed the intern year. So we were super stoked about this, very happy. But we thought, what if we can make it even better? So that was the idea of doing the survey. And what we did is we had a couple of questions. We asked the interns after these changes, please write the following on your experience with consults versus triage. So the two main changes we made in phase one. You can see here the mean in regards to autonomy, overall learning and diversity of pathology. They were all higher with the consult experience than the consult rotation versus the triage. So we kind of scratched our head and said, okay, well, maybe we should just do all consults. And that's the next question we asked. It would be more beneficial just to do both six weeks blocks on the consult service and a whopping four out of four said yes. And then we also asked another question, how comfortable do you feel performing each of the following? And then in regards to the ones that kind of stuck out to me, these would be the lower ones. So Peds consults 2.75, inpatient consults 3.75 and treasuring telephone calls. And there's all things that we do extensively in the consult service. So we thought that we could benefit these interns with more consult time. And lastly, all roads here lead to consults, as you can see. So just kind of highlighting, we asked the general question, how can we improve your overall experience? A lot of them basically just said more time on consults. So we snapped our fingers, bang, switched it over to consults. So now we have a revised, revised schedule where the interns are spending more time on consults less than triage or still some time on triage. And we're hoping that this will do the trick. Thank you, everybody. And thank you to the awesome team. Any questions? I also have a short comment on credit. So I think it's a great improvement for the first year residents. But who's doing the administrative work now? Well, thank you. So we were able to switch around some of the processes. A lot of time was spent intentionally on the H&P visits that were scheduled into our clinic. And they were like pure H&P visits where we were just doing the H&P for the patient without even really examining them. And that entire visit got completely cleared out. So if we go to that data set, like that whole, sorry. So the whole category of H&P without an atomic exam did not happen for any of the interns this year. And then a lot of the purely administrative work that still remains is making chief packets. I think anti-corregulation consults and placing certain things is still in that category. But what we are not doing anymore is scheduling all the follow-ups for all the patients, for all the surgeries, and doing a lot of the scheduling administrative work that came with the H&Ps, which is currently done by Jay, who's our new surgical administrator. So he took a large chunk of the administrative work. And then, yeah, the H&Ps are kind of not there anymore. Judith, that's a comment.  There's a tendency when you've gone through medical school and done your internship for everything to be very heavily weighted towards inpatient care, which is not at all the real-life experience of every other practicing ophthalmologist after they've finished their residency. And I guess I would wonder, I know that the inpatient consult service is very cool and interesting, but how well does that translate to your long-term sort of career experience? And I'm not sure if the PGY4s could sort of comment on that, the skills that you learn. A relevant piece of information, which is out of the scope of what they presented, is that we will now have a resident in triage every afternoon, not interns. And it's a really great point, you may, Judith, as far as the timing of when we're teaching things and being in triage versus on consults. And if I may sneak in at what I really suspect the answer here is they start out on consults for years as lone rangers now at Teresa Support straight away as just running the whole service in pediatrics and at the university. And that's such a significant burden to shoulder that that opportunity in the intern year to prep for that really has seemed to be the thing that's driven that strong desire to make sure they're prepared for consults, where they clearly are going to become experts in the other side of undifferentiated patients coming into the clinic. And then again, during chief year, now this is new, each afternoon we'll have a resident in triage the entire year. And that's, again, a new change. The comment I wanted to make during chief year. The comment that I wanted to make is just an overall comment to every one of the speakers so far. This residency is very much a living organism that thrives on you and your ideas and making it better. The VA is the perfect example of a bureaucracy where there are so many reasons why we can't make change, because so many things are really out of our hands.  I'm thinking back to even how we pay for you as residents, the fact that we're having you go over to the university while you're at the VA and how that could land Dr. Simpson in jail, for instance, if she didn't do it right, where she had this now, the glaucoma chief is going over. And that's a tremendous burden, administrative burden on leadership to be able to make these things happen. And anyway, it's incredibly heartening to see how many improvements you guys are making in the residency and caring enough to make it happen. Thank you.


Well, hi there! I'm Sandy Olnok and I am going to show you a technique for stamping with watercolor that I've been sharing on my Bible journaling channel lately. For today's video, I'm going to show you a little technique that I've been using quite a bit lately in my Bible and I will show you how I'm going to do it on a card. I've got a piece of watercolor paper ready and I want to have a whole collection of all of these cactus together. So I kind of laid them down and I want to look for which one is going to be in the foreground. So this little guy is going to be in the foreground and I'm going to line my block up so I get his spacing right. I don't have to think about it later by lining the block up with the edge of the paper. To stamp with watercolor, you mix the pigment first so that it's thick enough that you can see your brush strokes. And the reason is because if you don't and you dip your stamp into it, you're going to get puddles inside the crevices in the stamp and then you're going to end up with bloops and you don't want bloops. It's going to be a lot easier to work with if you have lines rather than bloops. So I'm going to stamp first the little cactus head here. And while it's wet, if you work with it right away, then you can get a little of that color to move. And if you wait for it to dry first, then it doesn't dry completely permanent, but it dries fairly, fairly stiff, I should say. So that you will mush it out completely if you end up doing watercolor over it later. But I would recommend as you go to watercolor each little piece, unless you only want to add watercolor to it. Because if you're able to blend some of those edges a little bit, it's going to help to make it look a little bit more natural. So I'm going to clean off with a baby wipe my top portion and then stamp the bottom into this brownish color. And then since I've already lined up my block with the edge of my card here, I can just use that same alignment to get the little pot done correctly and get it put in here. And I'm going to just use a little bit of water and you can see how it moves just a little bit of the color using water while that paint is wet. So it's the same theory as what I've used before using markers, water-based markers to do the same kind of thing. But this will dry more permanently. It won't dry permanently, but it will dry more permanently than, say, a zig clean color marker or that sort of thing. So I've got my next stamp ready to go and I've got my colors for the top and the bottom. And I'm just going to use a shredded little post-it note because this is really easy masking to do, really simple. It doesn't need a whole lot of detail type of things in it because it's going to be loose watercolor by the time it's done anyway. And I'm going to stamp the top of this in here and I've got my, the bottom of my block is going to line up with the bottom of my paper so I know how high it'll be. And now I've got the top section of that all done. Make sure that my pot is, my little pot mask is there so that I just get that left corner of the next pot, which I technically it's just a little square, I wouldn't really have had to stamp that. And if you have easy stamps like this, you can draw some of those parts back in yourself. So for this one, I wanted to have the highlights on the right hand side and the color on the left so that each one of those sections of cactus. And I don't know if they're leaves or if they're petals or what you call them when they're cactus, but each one has a highlight on the right hand side gives it just a little bit of dimension and creates a little bit of realism there. And then the, the color in the bottom I could make as, as intense or as weak as I want, whatever color you want to paint your pot, you could go for it and do all kinds of crazy things with it and make sure it doesn't morph into the other pot. I want to make sure it doesn't bleed together at all, but give that one a nice yellow pot. Now I'm going to mix up another color for another one of my cacti. And if you add a lot of water, if your brush has a lot of water in it, you could bake your puddle really watery. So you want to keep mixing more color in until it gets thick enough that you can stamp in it. And if you're just struggling with it and you don't want to keep wasting paint by making a bigger and bigger puddle on your little tile or plate or whatever you're using to stamp, then you just let it sit there for a while. The air will evaporate some of that out and it will get thicker over time. So just give it a minute. So I've got my stamp ready to go. I'm going to use this tall one and stamp it once the pigment starts to thicken up over there a little bit. In the meantime, I'll just put my masks on there so I can get my top portion of my cacti ready to stamp in here. Just tap it in there. And you can also test it out on another sheet of paper to make sure that it's thick enough because you'll be able to tell right away if it gets rolling washy. So there's a little mushiness down there in the bottom of that cactus, but not too bad. And then I'm just going to do that little section on the left of the pot itself because, again, like I said earlier, with pots like that, you can get the shape by just painting them in yourself real easily. It's going to add some color in each one of those vertical, veiny type of areas and leaving some whites. When you're doing watercolor, it's always helpful to have some whites in it so that it just has that fresher look. If you try to fill every square into it in, it just starts to feel like you wanted to use Copics. And with watercolor using that light space and that water, that white paper, I can't even speak today. The white paper is going to really help. So here I decided just for fun, since I had a really boring pot next to it, I would add some interest to this other pot. You can add patterns to them and do all kinds of crazy things, make them all different kinds of beautiful pots, if you wish. I'm going to mix a little darker color then to drop into this cactus. And if I'm doing it while some of that green that's already down there is wet, then I'll get a little bit of blending and then a little bit of hard edge. So I get the benefit of both soft edges and hard edges and I can use a clean, damp brush to blend some of that out as well, just a little bit. But being careful to still leave some of that white area, so keeping it looking fresh. And with each one of these, you can paint them all different colors. You can do cactus in rainbow colors. You can do all different kinds of fun things. I will probably be stamping this one soon and coloring it just for fun on my social media in Copic or something because cactus are really fun shapes and can be really interesting in all different kinds of fun colors. Let's add a little bit of color now into the pot on this guy. Just leaving again a little bit of that white space, not really stressing out too much over it and trying to fill in everything. But this pot now needs needed a little more oomph to it because it started feeling weak next to the other ones. Next up, after all that's dry is stamping that last little one in there, that last guy. And I'm going to I've got my block all ready to go get my mask ready. And then it's a matter of figuring out what kinds of colors I'm going to want to put on that one. And for all of these using a varieties of blues and greens, all different colors from my palette. That's kind of why I haven't really showed you the palette because it doesn't matter what colors you use. You can do all kinds of things. And this technique allows you also to use colors that you might not have in inks or in markers. So if you're used to using water based markers to color on your stamps like this, this is a way you could do that and you don't have to have all those colors. You can make up whatever colors you wish by making a puddle of whatever that color is. And on this particular little cactus here, I wanted to do a few other things to it. So I'll make some adjustments as I go. I debated whether or not to try stamping in the pot on this one.  Notice that the pots in the back, the bases of them, the ground that they sit on is higher than the ones in the front. So it's going to make them look like they're going back in space. But now that I drew that in, it almost felt like I needed those little leaves from that cactus or the petals or whatever they are to stick out further on the right hand side. They needed to hang over more. And then I also decided to add little tips on each one of the leaves and make them a little more spiky. And that's, again, another fun thing you can do if you're not trying to rely just on the stamp, but let the stamp be that base guide for you and then adapt from there. So I'm going to add some color down here in the bottom just to give them something to sit on. It could be a window sill, could be, you know, the sand in the desert. Well, I guess you wouldn't have pots in the desert, but going to let some dry brush area be down there at the bottom to allow someone, that white paper to come through. And then right where my pots are, give them a little bit more color right underneath of them, because if the light is coming from that right hand side, all the shading is going to be off to the left. And I'm going to even add some more dark color just right in the area closest to the pots themselves, because that's where the deepest, darkest shadow is going to be, is right in those little sections right there. And then let that slowly blend out toward everything else, mixing up more of a mid-tone color by whenever is left on my palette and then spreading that out. So this technique is really fun. I will link you to the Bible Journey video using this stamp set so that you can see that one as well as the card, the finished card for this one, Paper Rose also has die cut sentiments. And I've used a thanks on this one. It will be one of my cards that I get to send out to my patrons because I love sending them cards. And here is the Bible Journey page that I thought you might be interested in seeing another way that you can use this stamp set for another use. Thank you so much for joining me today. I hope this was a fun video for you and that you learned something, got a little idea on a different way to do some stamping. And I'll see you guys again in the next video. Have a really great day. Go make something really beautiful and share it with another person. Bye bye.


The protest by frontline anti-corruption crusaders against the chairman of the Economic and Financial Crimes Commission, Abdul Rashid Bahwa, entered its fort today in Abuja on Tuesday. The activists vowed never to be intimidated by what they described as fresh falsehood, peddled by the anti-grab agency. The protesters, who marched through the streets of Ikeja and converged on the Lagos State House of Assembly in Laosa, noted that the majority of Nigerians were intelligent people who could easily differentiate between a genuine cause and sponsored ones. The activists alleged that the EFCC had resorted to cheap blackmail to divert the thinking of the public away from its lawlessness, pointing out that these had only compounded the commission's problems and further exposed the dangerous political agenda of its chairman. We are saying that EU must come to equity, must come with clean hands. If Bahwa uses the instrumentality of office to take people before courts of jurisdiction for conviction and people obey such a conviction of the court, if the court has also found them guilty of one offence or the other, it should honorably obey the court ruling. Nobody in the land is bigger than the law. And all we are just saying is that Bahwa just have to excuse from the office current occupying. He that must come for equity must come with clean hands. And what do we mean by that? If Bahwa as a person or as somebody occupying a position in this government that claims to be of corruption free and he has been committed to prison by competent court of justice and he had disobeyed such court orders, I think it's not fit to occupy this position it's occupying today. Honorably, he should resign and go. He should leave the office. He is found guilty of corruption. He has also found some people guilty before and they were sent to jail. So he is found guilty. He should honorably resign. He is not above the law. He is not bigger than the law. The law is bigger than him. All we want is Bahwa should go. We are not deterred to the extent that as long as there is disobedience to the rule of law, we will continue to make this demand. And you see, it's the biggest home of corruption. You cannot be fighting corruption. Why at the same time you are so disobedient? And you see, we are in love every when this man sits in the comfort of his office and he says they have obeyed the decisions of the court. Why you have never at once been sent to obey such and this is just a recipe for anarchy because you cannot govern an institution that is so democratic or that should be so democratic and begin to operate as an autocrat like a one like one man who is an island who has you know as if you are running a private enterprise. Hello, hope you enjoyed the news. Please do subscribe to our YouTube channel and don't forget to hit the notification button so you get notified about fresh news updates.