Hello everyone, my name is Dr. Ashin Finto. So I'll be presenting my paper on the role of higher resolution computer tomography in assessing various manifestations of COVID-19 infection for the CTPRS conference 2021. The co-authors of my paper are Dr. Manu Pratap Sir, Dr. Prajit Kumar Sian, Dr. Sanjay Yadav and Dr. Madhu Srimal. So coming to the introduction, so we know that the COVID-19 has become a major health problem causing severe acute respiratory illness. Currently we have the RTPCR study which is a standard method to make a definitive diagnosis of COVID-19. But the RTPCR results can be affected by sampling errors and low virus growth. That is why medical imaging techniques have a potentially important role to play in the early diagnosis and managing the treatment of patients with COVID-19. Small pattern chemical changes can be missed on X-ray. That is why CT is particularly important for the early diagnosis of patients, especially in those with a negative chest X-ray and high clinical suspicion of COVID-19. The early diagnosis of a patient will enable the patient to be isolated and treated early and is essential for avoiding the spread of the disease to improve the prognosis and to reduce the mortality of the patients. So AMS and Objectives is basically to describe the HRCT findings in the thorax and the imaging characteristics in patients with COVID-19 infection. So coming to materials and methods, so a descriptive study was conducted in our department, a tertiary care hospital, care hospital attached to myso-medical college for a period of six months. 78 patients were included after taking informed consent. The inclusion criteria was either sex, patients of either sex more than 18 years of age who were positive for COVID-19, RTPCR positive, and also patients of either sex having a high suspicion of COVID-19 above 18 years of age with lung changes. Exclusion criteria where pediatric age group people and the pregnant women they were excluded from the study because of concern of radiation hazard and also patients without lung changes were excluded from this study. In each house, this patient was subjected to higher resolution computer tomography of the chest using the machine. Siemens 128 slice somatotome dual CT scanner. So coming to the scanning protocol, a region from both the apex of the lung to the adrenals were included. Patient position was supine with the arms above the head and the following parameters were used. 20 MAS, 100 KVP, slice thickness of 0.6 mm, a scan orientation from cranial to cordil, and images were reconstructed in the sagittal and coronal plane, and all examinations were evaluated for the number and which of the lobes were involved. The distribution, the patterns and other parent table changes. So here in this table, you can see that the pie chart is showing the male preponderance 73% of the patients were male patients. And in this age distribution bar chart, you can see that the age of 41 to 15 years of 50 years of age and 51 to 60 years of age where the majority of the age groups which were involved in our study and followed by the 61 to 70 years. So elderly patients were more involved. And coming to this bar chart, which is depicting the location of the gg1, the consolidation. So the center of parent came a location was the least common, then followed by the subdue location and the combination of both was the most common in our study. Then coming to the distribution, the frequency distribution of gg1 consolidation, pure ground glass opacities were found in 41% of the patients, pure consolidation was seen in 32% of the patients. And the combination of both of this was seen in 27% of the patients. And this is the pie chart depicting the other findings of COVID-19. So among this, the majority were the linear opacities and the interlovelous septal thickening at 35.9%. And the other patterns we've seen were halosine, reverse halosine, air bronchogram, interlovelous septal thickening, pure liquefusion, pericardial liquefusion, lymphadenopathy. So coming to the results, so the majority of the patients were male patients. The most common age group affected was 4th and 5th decade, 4th to 5th decade, and the youngest patient was 23 where the oldest was 85, a mean age group of 50 years of age. The most common pattern was pure ground glass opacities, which was seen. And the distribution predominantly was seen both central and peripheral distribution. And additional patterns which we've seen were interlovelous septal thickening, crazy paving pattern, halosine, reverse halosine, cavitations, pericardial liquefusion, medicinal lymphadenopathy in their percentages, which we've seen in the graphs. So coming to the discussions, we know that the characteristic CT findings of COVID-19 infection are bilateral, multifocal, patchy, ground glass opacities, which progressively will coalesce and form consultatory patches. Following this, there's gradual resorption over the weeks, and then they'll result in sequelae in the form of fibrotic strips. So these lesions are initially peripheral in distribution and subtrude in distribution, and then they come more centrally and involve central areas and bronchopulmonary distribution as the disease progresses. And we have the other findings, which other CT findings which we've seen in the graph. So these findings together help differentiate COVID-19 pneumonia from other forms of pneumonia. So coming to discussions, so ground glass opacities, which is the most common pattern is basically because of partial air space filling and interstitial thickening. So the hallmark of CT finding is basically bilateral peripheral distribution of ground glass opacities and consolidation. Okay, so GGOs associated with consolidation is the most frequently encountered pattern. And a study conducted by Wang et al showed that predominantly GGO pattern was seen at the symptom onset, and following by which as the disease progressed over the period of six to seven days, there was presence of consolidation as well, which were with the percentage of 24% over the following days. And a study conducted by Zhu et al reported that in the first postpartum biopsy conducted, they observed that the mechanism for this GGOs was basically because of pulmonary edema and hyaline membrane formation. So this is a high charge image of a patient which is showing ground glass opacities. So basically ground glass opacities if a vessel passes through, you can see the vessel clearly, but in consolidation, it is obscured. And this is the subterranean distribution of the ground glass opacities in another patient. Then coming to consolidation, so basically consolidation means not partial but complete replacement of the alveolar air spaces by pathological fluids and cells. So these two also can be multifocal, they can be patchy, they can be segmental, subtural or very bronchovascular distribution. So what is the mechanism of this consolidation is basically because of accumulation of cellular fibromix or dexudates in the alveolar spaces. So a study conducted by Keiichi et al showed that so whatever changes we see in the pulmonary interstitium, that is the interstitial thickening and all is basically because of inflammatory cell infiltration edema and interstitial thickening. Whereas the pulmonary parankamal changes are basically because of alveolar hemorrhage edema, cell exudation and hyaline membrane formation. The third most common pattern we saw is reticular pattern. So this is basically a network of linear opacities because of interlobular and interlobular septal thickening just because of lymphocytes infiltration.  So this is reported in 5 to 36% of the patients. So this is considered as a sign of progression. So a sign of progression of GTOs and consolidation is basically crazy paving pattern. So in this one of the, in one of the patients, you can see this is the actual HRCT image, which is showing subtle distribution of consolidation. So if a vessel passes through here, we cannot see it because the consolidation means the areas obscured obscures the bronchial walls and the vessels. This is another HRCT image showing crazy paving pattern predominantly in the subprol location. Then coming to air bronchograms, which are basically air filled bronchial, which is seen in the background of consolidation. So a study conducted by EA at all proposed that bronchial ectasis is a better terminology to be used. And he hypothesized that the high viscosity of the mucus, which is present in the bronchioles, this will lead to the bronchial damage. And this is what results in bronchial ectasis and the characteristic dry cough seen in COVID-19 patients. And then we have the other airway related mechanisms, that is bronchial ectasis and thickening of the bronchial wall. This is basically because of the inflammatory changes, which causes destruction of the walls, which results in fibrosis and consequent adjacent fractional bronchial ectasis. Then nodules, which are seen in the viral pneumonia is basically rounded irregular parenchymal opacities of less than 3 centimeter in diameter. And the most common plural changes, which was seen in COVID-19 patients in our study was plural thickening in 32% of the patients and less commonly, plural effusion in 5% of the patients. So these findings usually are seen in critical patients who are in ICUs and all, as proven by the study, Kaichi Liu et al. And it indicates poor prognosis. So this is an ideal HSCT image, which is showing reticular opacities and fibrosis with resultant adjacent fractional bronchial ectasis. And this is another patient with COVID-19 showing consolidated changes with air bronchogram, which is seen clearly in the consolidation. Then coming to halosine. So we all know that halosine is basically a nodular mass, which is surrounded by a ground glass opacity. So this is not a specific sign. It's a non-specific sign of COVID-19 infection, which is also seen in other, which is the basic mechanism of this is because of angelinvasive fungal infections. Sometimes it can also be seen in aspergillosis or mucormycosis. And also because of other causes like perillational hemorrhage, viral infections, hypervascular metastases also. Then coming to a reverse halosine. So basically compared to the halosine, the reverse halosine means there is surrounding consolidation and a central clearing of ground glass opacities. So previously to COVID-19 infection, this finding was initially described in cryptogenic organising pneumonia. Then medial senile lymphadenopathy is basically when the short axis diameter is more than 1 centimeter. So this finding has been reported in 4 to 8% of the patients of COVID-19. Basically, it is because of a bacterial super infection, which occurs along with the COVID-19 patients. So that is the most common cause apart from COVID-19. And then pericardial effusion is a rare finding, which was seen in 5% of the patients. So this occurs because of severe inflammation and usually seen in severely affected critical patients or ICU patients. So this is an axial HRCT image. You can see the nodule, which is surrounded by a ground glass opacity, which is the halosine. And in this second image, you can see a patient axial HRCT image. You can see a consolidation with central clearing of the, there is central ground glass opacity, which is the reverse halosine. Then coming to CT severity score. So CT severity score. So the severity of the lung involvement in the CT, it correlates with the severity of the disease. So by this method, we can give percentage to each of the phylobs. So we grade them from 1 to 5 each low. So less than 5% involvement, 5 to 25, 25 to 50, 50 to 75 and more than 75. So we give a score from 1 to 5 for each low. And the maximum is 25. And all phylobs are involved and more than 75% involvement. And minimal is 0 with no involvement. Then corads, we all know the full form is COVID-19 reporting and data system. So 0 stands for the study is not interpretable and technically it is insufficient to assign a score. Score of 1 means very low suspicion.  If corage 2 criteria, it means the suspicion level of COVID is low. So the findings are typical for other infection, but not COVID-19. And corage 3 means it is equivocal. So it can be compatible with COVID-19, but also these findings can be seen in other diseases. Corage 4 is high suspicion, suspicious for COVID-19. Corage 5 is very high suspicion, which is not suspicion, but typical for COVID-19, but they have to be proven by RTPSR, may be proven, but may not be proven. Proven cases are RTPSR positive SARS COVID-19 patients with the lung changes. So in conclusion, to conclude the interpretation of HRCT images of COVID-19 pneumonia are important in the diagnosis and management of COVID-19 infection. In comparison to other forms of pneumonia, the hallmark pattern and distribution of COVID-19 pneumonia shows bilateral multifocal ground glass opacities predominantly in the subcurtial and basal location, often seen with consolidation and interstitial thickening. Because of low sensitivity of the lab investigation RTPSR, CHESH-HRCT ensures early detection of COVID-19 pneumonia in the correct clinical setting. So also it plays an important role in the fall-up investigation to assess the progression of the disease which may parallel the disease severity. The only possible limitation of CT is the radiation hazard, as COVID does not spare any, it does not spare even newborns or pregnant women also. So these are the references which I have used during my study. Thank you very much.


Good morning everyone and thank you for attending this very interesting session today. My name is Harry Barkskeva and before I start my presentation I'd like to take a moment and thank the EIA for organizing this wonderful conference. As you see on the screen the topic I'll be presenting today concerns the transition from the Calculative to the Bronze Age in Cyprus. And for those unfamiliar with the archaeology of the island this transition was accompanied by drastic changes in all facets of the material and immaterial culture ranging from pottery, representational art, and metals to architecture, burial customs, and everyday practices. The course of these changes and the mold they unfolded historically are the two core issues Cansforth explored. As this is a complex topic I've decided to break it down to three sections which include an introduction to the issue and the methodology employed followed by section and key results regarding chronology, pottery, and topography. The presentation will conclude with a synopsis of the novel theoretical argument proposed regarding the transition into history. Interestingly the topic has been under debate since the 40s and it goes without saying that it is time-wise impossible to present a full account of all the theories proposed. However it is possible to distinguish at least three general approaches that have been developed over the years. To begin with one group of researchers argues that the changes leading to the emergence of the bronze age were brought about mostly due to the action of exogenous actors that arrived on the island and gradually replaced the indigenous social cultural systems due to their technological superiority. At the end of this approach another group of archaeologists maintained up to a decade ago that all the changes observed during the transition can be attributed to the effect of intra-insular evolutionary processes that led to gradual self-transformation of the social cultural groups inhabiting the island. This past decade, due to the near definitive proof for the arrival of foreign populations on the island at the beginning of the early bronze age, we witnessed the appearance of the third approach that tries to fuse concepts from previous schools of thought and argues that this arrival triggered complex sets of interactions that brought about transformations of both indigenous and foreign social cultural systems and eventually led to the consolidation of what we would call the early bronze age coinage. Now all these models and theories despite their theoretical prowess face two important challenges. On the one hand they assume that the events leading to the emergence of the bronze age are largely unilinear. On the other hand there are still many things we don't know particularly for the period before the bronze age which naturally leads to the formation of new questions. And the first necessary step to asking questions is the construction of a suitable framework to support their answers. In this case I've built a custom database capable of handling, storing, curing and distributing for statistical and spatial analysis all the different interrelated types of information. The second step was to analyze in depth the available archaeological literature. Thousands of volumes were examined and a select 2,500 publications were eventually found to contain useful data but they also revealed several weaknesses in approaching the specific matter. Such a legume regards our level of knowledge on several prime bronze age sites, the system of chronology, the pottery typology for the entire iron and the lack of modern spatial analysis for the calcolific. As a consequence these issues determine the strategy employed to approach the matter, which included the re-establishment of the temporal framework, the delineation of the calcolific pottery typology at an island-wide scale, the reassessment of relative dates for hundreds of sites, the analysis of data in terms of space and time and finally the synthesis of the new knowledge in an effort to investigate more effectively the transition to the bronze age. Before going into the new theoretical model proposed I will attempt to deliver some of the curious also the separate strands of research on the topic. Unfortunately time will not allow an in-depth explanation of how the results were reached but they are crucial for providing some context for the new model. Starting with matters of chronology it is observed that the advent of Bayesian modeling in the past decade has promoted consensus among researchers concerning the temporal framework of the island. In order to re-validate the results of recent studies I gathered the available radiocarbon data for the island, checked their intrinsic properties and modeled them by several differently configured models in OXCAL. These models were then cross-ploded and compared and after assessment they finally produced reliable temporal boundaries for all periods. As in every rule however there is an exception. In this case the models did not return acceptable results for the termination between the late calcolific and the filiac culture phase that marks the beginning of the early bronze age because we have too few and significantly overlapping dates that span this transition. In order to remedy this situation I turned to a crucial element that chronometric models cannot take into account for analysis namely pottery. More specifically there is a type of pottery called Dread-Polished Filiac which forms an integral part of the new cultural material package brought by populations arriving on the island at this time. We know that this way represents island-wide informity and comes from a limited number of production centers in the north that date to the filiac but has also been found in layers of the calcolific settlement of Kishonera Mosfilia in southwest Cyprus. As such I re-established the Stradigraphy of the Latin Resettlement traced the Dread-Polished Filiac and established connections with the radiocarbon dates which allowed the definition of the filiac culture boundary between 2600 and 2550 BC. In turn this led to a significant revision of the chronological framework as it proves that the late calcolific ended in the north much earlier than it did in the south and west while it also hints to the fact that the filiac represents a phenomenon that is spatially and temporally confined to the northern half of the island. Turning to another duo of subjects examined namely pottery and hematopography it is noted that prior to this study the topology of calcolific pottery was developed on a per site or region basis and was based mostly on static stick-up tributes a tendency that led to the overproduction of terminology and non-comparability of the assemblages. To tackle this issue I re-examined assemblages from close to 40 benchmark sites around the site noted attributes regarding fabric, surface and shape established by a statistical analysis on island-wide typology based on manufacturing technology and blind tested it to validate its applicability. The typology merges several of the types proposed by earlier typologies in two overarching groups sets as the basis of evolution to technology of manufacture instead of style and is finally cross-correlated to the radiocarbon chronology. Eventually the new typology was utilized as a means to evaluate the specific dating of some 450 pre-bronze age sites while the ceramic assemblages of about 150 sites surveyed by the Cyprus survey which is a large-scale survey project of the 50s and 70s were also re-examined and redated. As a result of the above endeavors the map of prehistoric Cyprus is no longer dotted by sites dating vaguely from the Neolithic to the Bronze Age but we now have period-specific maps for the middle and late apocalyptic as well as the filiaphas which allows a much more nuanced examination of human topography in space and time. Having elucidated matters of chronology, ceramic typology and topography became possible to integrate old data into a novel theoretical argument regarding the transition to the bronze which on the one hand transcends the unilinear paradigm and on the other hand renders untenable the notion of cultural uniformity during the filiac culture phase. In order to understand what happened on this transition however it is necessary to take a step back in time and look first at what happens on the island the immediately preceding periods. Starting with the middle apocalyptic a total of 106 sites were detected which are concentrated mostly at the north central west and south parts of the island. The pottery analysis identified use of common manufacturing technologies and stylistic treatments of pottery across the sites while the bibliographic study noted similarities in all aspects of the material and material culture of the sites. These results fully justified the characterization of the middle apocalyptic as a culturally uniform period where egalitarian small-sized settlements isolated from the outside world peacefully coexisted on the island. These situations changes dramatically in the late apocalyptic which is characterized by the breakdown of the cultural coining and a marked increase in regionalism the onset of metallurgy and craft specialization accompanied by the emergence of social inequality, surplus storage and external trade. A total of 86 sites date to the late apocalyptic and generally lying similar settings as those in the middle apocalyptic. The pottery analysis indicates experimentation with new igneous and bentomidic clay sources while firing technologies also improved. These developments coincide with the recipients of extractive metallurgy and may point to links between the two as it is in this period and an increase in sites situated closer to copper sources is attested. Moreover the pottery of this period indicates the onset of extrinsular trade as relief decorations similar to pottery from Anatolia appears along with imports like fiance beads and spur-tangular pendants. Simultaneously few artifacts made of superior copper appeared sites in Jordan and Crete which hints to the role of the island as a minor player in the instrumented terminal trading networks. Perhaps the most radical development of this period however is the emergence of regional cultures expressed as different pottery traditions on the island. More specifically we can trace one tradition at the north-central part of the island producing red monochrome pottery with reduced interior or exterior surfaces. One at the south coast producing plain red monochromes and finally one in the west of the island that produces red monochromes with varying surface bearings and praising effects. The emerging regionalism of the late apocalyptic is considered a hard figure of social instability and from this point onwards each region seems to follow its own historical path. The literal term in Metiares becomes highly relevant in this case for the beginning of the fifth year culture as new population migration episodes interrupt an ongoing process of social transformation that started in the late apocalyptic. The new populations seem to arrive from Anatolia and carry with them totally new types of material cultural as well as new technologies and habits. Their appearance around 10600 BC coincides with a period of turmoil for Anatolia which may have acted as a push factor for them. Turning to the mode of migration it is proposed that these populations do not come as peaceful migrants but rather as colonists carrying advance technologies and weaponry. Their attempt however was most likely not fully successful so we may label it a failed colonization attempt. This argument is based on the following three elements. The radio carbon dates indicate a broad overlap between the late apocalyptic and the phila which means that the new social system on the island did not replace the indigenous systems in operation. Two there were numerous late apocalyptic sites in the north coast which is where the migrant populations made their first landfall. Nevertheless there are no late apocalyptic sites with phila culture pottery in the north which suggests that these sites were either abandoned or their inhabitants were violently displaced while the sites in the south continue to exist. Three there are many cemeteries but few settlements associated with the phila culture which hints to increase mortality for the migrant populations while the phila tombs are filled with significant quantities of metal weapons that potentially reflect increased violence. Despite not being able to expand significantly the migrant populations managed to establish what became a regional culture namely the phila culture attested at 21 sites in the central and north parts of the island. At the same time the indigenous populations continue to exist and resist the assimilation although certain sites did elect to conduct minimal trade with the new populations as exhibited by the limited phila pottery at Gissone Ramos phila. Nevertheless the passage of time probably eased the coexistence of the indigenous and migrant populations which likely led to an intensification of the inter-regional trade. Also after this initial period of uneasy coexistence a new period of complex interactions with the kings. In respect to these matters we have just started to scrap the surface but already there is evidence for bilateral cultivation entanglement and technological cultural transmission. Specifically the pottery analysis indicates that indigenous populations start to adopt technologies like better clay sorting and phila shapes in calcolithic fabrics while the migrant populations adopt stylistic elements like the reduction of vessels. Again there is no dominant cultural on the island no assimilation of one culture by another and no uniformity. The final outcome of this persistent and long lasting complex interactions in the parallel insistence on retention of cultural identity can be identified in the marked regionalism of the early Bronze Age which is a direct antecedent of the late calcolithic regional cultures plus the phila culture. As such the regional culture producing red polished with reduced interior exterior surfaces emerges of the north central parts of the island. A second regional culture operates at the south coast producing multiple red polished and finally a third regional culture develops in the west which produces mostly draught polished pottery. To sum up it is proposed that population migrations led to the emergence of the phila culture in the north and aided technological evolution of indigenous populations but never fully replaced or substituted. Whereas the indigenous regional cultures were already following the virgin historical trajectories from the late calcolithic onwards and with that I'd like to thank you for your attention.


The following is a presentation of TFNN. The TFNN Bull Bear Trading Hour. Every trading day, live at 10 a.m. Eastern. Call now. Toll free at<PHONE_NUMBER> or internationally at<PHONE_NUMBER>. The TFNN Bull Bear Trading Hour. Now, Tommy and Tommy O'Brien. What folks, appreciate you growin' and prowlin' with us out here. We have the Dow Industries down 153, NASDAQ off 86, S&Ps down 19, Gold contract up $18, trading at $14.50 an ounce. We have Silver Flat, $16.18 an ounce, Light Sweet Crude, high volatility in all these markets, Light Sweet Crude included. Up a buck 60, it was down $4 yesterday, you had $55.58. Bolts and Bonds, those are the numbers folks, 10-year note, up 4-6, $128.26, 30-year up 14 at $158.04. They both blew away their B-point yesterday, have the volume behind the move, their monster ABC structures on the way out. Kingdollar, Kingdollar looks like it's gonna have a failure on the continuous contract on the weekly out here. Kingdollar right now is down 169-6, trading $97.975. The Euro is at 111, the Pound is at 121, and the Yen is at 106.73. To one U.S. dollar. iPhone number is<PHONE_NUMBER>. It was called folks, I know what's going on in your world, and the world of the S&Ps, let's take a look at them. Okay, so what do we have out here? Bottom line, you had multiple ABC structures on the way out, you had a price target out here of $303, we made it to $303, $302.23, bottom line, that baby's over. Why am I saying that? Well, what you had out here yesterday, or we had out here Wednesday, of course, they come out with the Fed meeting half a point, no, quarter point rate cut, bottom line, market goes south, has some volume, market comes all the way back top side yesterday. So picture, the high of Wednesday was $301.20, the high of yesterday was $387, Trump comes out with a tweet, bottom line, they're gonna go after $300 billion in additional goods at 10%, bottom line market tanks, and bottom line, these companies are gonna be paying big money taxes, we're gonna be paying big money taxes, it's gonna be spread out, we'll see exactly how this thing shakes out. You had Walmart, that one's south, that's gonna go a lot further south. Hasbro, you're gonna see these, what nailed on this one, folks, is that you have the, you have sneakers, you have toys, you have clothes, you have electronic components. Hasbro, that came down fast and furious, that baby, get down from the 126 to 113 remember, Nike's gonna be the same thing, because we'll see whether it's gonna be 10, they're saying that it can go up to 25, that's big money, bottom line, Nike goes from a price point of 86 down to 82, and so, S&P's what I'm suspecting now is this, this is what you've done, you've got back inside the lower range, once the S&P got back inside 2954 or 2936, what is that set up, that sets up right down to the bottom of that range, which was the lows of June, which is 2728, what you're gonna be looking for, and I'm gonna be looking for specifically is this, is that you break that area, then what you have is that you have a much larger consolidation inside this marketplace, and the bottom of that consolidation, folks, has to do with the lows that were established last December, that's how this baby is set up, because what we have, if we pull this back a little bit more, what you're gonna see here is that once you got back inside this 2940, which are inside, the bigger picture is game down to 2346, and that would be a huge consolidation, which by the way would make sense because of the expansion that would have, I mean, you go back to 2016, you're at 1812 bucks, and the S&P's, you go up 1,100 points, months to move, 50% move, right, while you can picture that you can consolidate for quite some time up at those levels before that market wants to go higher. Gold contract, gold contract has it all, bottom line, you're gonna see this gold contract, what we've done, and what we will, I suspect, have at the end of today is that you're gonna have a break top side out of the six year consolidation that gold has been in. Right now, anything over 1428 was a break top side. Right now, we're at 1442, that is saying, next leg up in gold, 1794. The correlation inside of that goes right into the bond and note market, folks, okay? This is a monster move. I expect what we have here, you have a B to C, you have a C to D of an ABC structure on the way up. We blew away the high, yesterday, the high that we're talking about inside the 10-year is 12814. Bottom line, it's a monster one too. You're talking about 132.5 on the 10-year. So if we bring the 10-year back, let me get this back as to the continuous contract. Okay, so you're at 12826 right now, 132.5 is approximately the number. So let's see where this is. That the next swing? Yeah, 134 is the next swing. So we're on our way to 134. The all-time high is 13529. That's how this is set up. If we go take a look at the 10-year, as to yield, what you're going to see out here is that we're at 1.86. I've been talking about the 1.71 for quite some time. My take is that we're going to blow right by that because of the ABC structure on the way down. The 1.71 was the election in 2016. That's when bonds took off topside. Within one month we went from 1.7 to 2.4. Guess what? You're barreling into that number. That puts game on at 1.31. If you break 1.31, that's the all-time low for the 10-year. Then guess what? If anyone's guess where this baby wants to go? 30-year, same type of set up inside the 30-year. We take a look at the 30-year. Let me get the generic one up. There we go. 30-year out here. Right now you're at 150.805. This baby just blew away the B point also. Let me see how this one's set up. This one you have 157.146. You've got 11 points. It gets you into 164. Bring this back. You're all time high. It's 177. The lower that is, 169. 164 is the number. Bottom line is these babies are going. King-dollar. What are you going to get with King-dollar?  Had every reason to go higher with this is 96, 98, 700. Bottom line what you have here is that we're at 98.2. We're at 97.975. 98.260. You close underneath that and what that puts sets in motion once again is that you can go to 94. Bottom line is that this dollar has been fighting bulls and bears in an incredible way going all the way back to really I can when I bring this up. It's almost March of 2015. We've been in the exact same spot since October of last year and of course that's 10 months. We've been in the same spot. Some of the higher volume equities out here. If we take a look at it, what you're going to see out here today is this. You have squares getting smoked. That's down $12. You got Pinterest is up $5. They had a lot of new users. Apple's down 450. You got NetApp down $11. We have US Steel off a buck. You got inside the Dow industrials. Let's see inside the Dow industrials. The strength versus the weakness out here. Your strength is Boeing. Boeing's putting 25 positive points into the Dow. Verizon 5 taken away from it. Apple down minus 31. Goldman minus 28. IBM minus 24. Visa minus 23. 3M minus 17. And the bottom line is folks, you are going south and you have volume behind the move. Stay right there, folks. Come right back. If you're not currently using the Taz Profile Scanner when looking at setting up your trading opportunities, then your arsenal is short a mighty weapon. The Taz Profile Scanner is a standalone piece of software that instantly filters over 2,500 global financial markets such as stocks, ETFs, commodity futures and forex. Heated by Steve Dahl, Taz understands that in today's technological world, the use of top flight software applications and technical analysis expertise is essential to successful trading in today's market. 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Details on the Tiger's Den are on the front page of TFNN.com. TFNN has launched our brand new website. You can still visit us at the same TFNN.com URL. But when you do, you'll see a new and improved homepage with a much simpler navigation, whether you're watching Tiger TV live in high definition or just accessing your newsletter subscriptions. We even have new pricing in six months and yearly options. Check out the new TFNN.com now and experience all the upgrades TFNN.com educating investors. Call now toll free at 1-877-927-6648 internationally at<PHONE_NUMBER>. Welcome back, folks. Dow. Dow is down 212.  S&Ps are off 26.  We're going to take a look at Asia. Asia crossed the board out here last night. About 2% to 2.5%. The hang sang down 2.3. The Nikkei was off 2. If you go over to the Nikkei, we take a look at the Nikkei, which you're going to see out here. You had every sector that was down. Right now, we are trading at 21,087. And if we go to the yen, what you're going to see the yen is strengthened in a monster way and the Nikkei goes out of its mind. And this is why you see this gold contract surging so dramatically too. The yen folks in two days has gone from 109.32. And we're at 106.69. We just broke a B point. And I suspect let me put this here so you can see how this is set up. Yeah, we're on a way to 104. 104 is the number on a short term basis. And on a longer term basis, you get game down here at 99. So it's going to be really intriguing because when we actually do go back in the yen, all the way to 2015, you've had a downtrend going. But this is a very fast move inside the currency market. And that's what's actually moving the dollar because if we go over to the Euro, and we take a look at the Euro, you're going to see that the Euro right now, excuse me folks, the Euro is up 18 ticks. That's trying to get back inside its range. Now, the Euro is at 111.03. 111.12 would get it back inside the range. And then that would get more juice going in the decline of the dollar index. If we go take a look at the pound, the same type of setup is inside the pound. The pound however has a huge amount of work to do to go anywhere. The pound just can't catch a bid here. The low in the pound, that looks like it's going to be going after first is 118. And right now you're at 121. We hit 120.80 this week. So silver, let's go take a look at the silver market out here. So let's put this up SIU. Silver market out here, we are trading $16 and 24 cents. 70,000 contracts. That's good contract volume. More than likely what you have with silver, it's going to be another ABC structure up. So you get $16.80. It's a $1.90 A to B, which gets you $17.90. So let's bring this back and put this on a continuous contract. $17.90. That's good. Your swing points are up here at $18. So it's going to need more juice, but the bottom line is that it's picked the set up. There's no two ways about that. My take is that we're actually going to go to 21 here. You can see the differential between the aspect of the silver market and the gold market. The gold market has just taken out its 2011 highs. Now, if that was in silver, you would be talking about $25 silver. So you can see that silver needs a lot more juice in a huge way, not in a small way. Let's go take a look at some of the higher volume equities, a square, a square. SQ came out with its numbers last night. Bottom line is that this is down 12 bucks. And let's see how this is setting up. Well, you get a consolidation. The high of square is a 101. You're at 68. The lowest consolidation is at 49. Let's see what else we have out here. So Oh, want to see this. This is as to rates, folks here. So check this out. This rate move yesterday. So picture, when you get an ABC structure in the way up or the way down, folks, the A to B is a straight line move. The B to C is a consolidation. The C to D is a straight line move. Now when I say straight line move, okay, it's not just not wicked straight. Bottom line, it's fast move, though. That's how ABCs like to do. They do the A to B. They do a consolidation. And once the C to D starts, most of the time they're not going to let anyone get in. If you're in, bang, you crossing the B, you got it with volume. Bottom line, that's why they seem to be straight line moves. Now, I have the rate structure up across the world right now. Okay. So when you first put the 10 years up, you know, bottom line, France, France is a two tenths, a percent in negative. Germany is at a half a percent. Now a half a percent. Give your money to Germany as a 10 year note. Guess what? You're paying a half a percent a year from hold. But watch this. What happened yesterday? This is the first time it happened. Germany, it doesn't matter what part of the yield curls you bring, meaning you can go to the two, the five, the 10, the 30, they're all in negative. Okay. Now, if I bring this down to five year, what you're going to see is that it's unbelievable. Okay. They all flipped in a huge way. In France, our five year, you're paying them six tenths of one percent. Germany is paying seven tenths of one percent. Spain, who's broke, you're paying two tenths of one percent. Portugal, who's broke, you're paying two tenths of one percent. Sweden, they're fine, but you're paying them six tenths of one percent. Switzerland just went over a full point. Switzerland right now is 1.07. Okay. Bottom line, this is a phenomena that's happening across the world and we're right on it. Bottom line is that I don't know if we'll go negative rates, but the way that the market is trading right now inside the interest rate structure, we're going down to the lows. If you take a look at the TLT, you know, if you don't have bonds on your platform, just take a look at the TLT. You're going to see a blue away this swing point with monster volume. And there's people that not only bought hand over fist, whoever was basically shot these equities, I suspect, had a cover. And the ABC structure in the TLT is a huge one. 134.5 is your A122, so you get about 12 bucks, which is going to get you up to the 152 number. If we pull this back, and you take a look at this, the high in the TLT is 143. So the TLT is saying it's going to go over its highs. Now, this is where this gets really cool. Let me do this again, because if that's the case, that means that we're going to go break the 1.31. Okay, so let me see this again. So 134, I'll be conservative at this, 122, 12 bucks, 142. Okay, hold on, 142. Let me do that wrong. 142. Yeah, 143 is the high. Okay, so what this is saying, we're going to the highs. We're going to the highs. That's a big number, folks. And what you're going to see, there's so much cash, there's so much cash floating around. There's a couple of different things that are happening here. There's so much cash floating around that no one knows what to do with it, because now what ends up happening is that it costs you money to hold cash. Okay, and who would ever think that would ever happen? Well, bottom line, it's happened. Now, that being said, what also happens is this, each and every time that someone has bought our bonds or anyone's bonds, even when they go negative, guess what, when those are going down, what ends up happening, that you can make money in a negative rate, but you're only going to make it because they go more negative. So the trend here is like really bizarre how this thinghole is shaken out. There's no doubt about it. Let's go and take a look at Apple. Apple's going to get hit on these Tafts September. Apple got to a price point out here on Wednesday of $221. You're at $204 right now. And we put this on a monthly and what you're going to see, it never made the high. And I didn't expect it was going to make the high, by the way. And you're going to close under $215. You close under $215. $33, that puts game on the table of $142. So there's going to be some nice volatility in this market. I expect the next eight weeks. Dow, Dow Industrial is down $187. NASDAQ is off $108. S&P is down $23. We'll come right back. I'm going to try my newsletters risk free for 30 days, then head over to the front page of TFNN and you'll find market insights under Trading Newsletters. I use my years of trading experience to bisect and dissect the market every morning and give my subscribers the most important information they need to know for the day ahead. I even issue afternoon updates for my subscribers whenever warranted with important market action. I'm always scouring the market for the next great trading opportunity. Sign up for your 30 day free trial to my daily newsletter, market insights day by visiting the front page of TFNN.com. Well, go get them folks. 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We are so confident that you're going to love this new charting software that will even give you a 30 day unconditional money back guarantee. Don't miss out on this incredible new piece of software. Get your copy of the Art of Timing the Trade Charts today by visiting TFNN.com. This segment is brought to you by Think or Swim. For more information, just click the Think or Swim banner on the front page of TFNN.com. Welcome back, folks.  You get the gold contract up 24. And let's go over to the GDX and take a look at this because what you have here, folks, is that this market is not only moving, but I suspect what we have is going to have a monster ABC structure up inside the GDX. Now, if you take a look at this, what you're going to see is that first you had the one-way move. This one-way move started May 31st, the week of May 31st. You start out at $20.28. You got to get all the way up to $28. You are pushing the highs now with volume. So it's an $8 A to B, which gets you into the $34 area inside the GDX. And if you bring this back, what you're going to see is that the 2016 high was 31. So that's saying it's going to blow away that high. Now, watch how this goes because this gets really interesting. That would be saying that we're going up to 55. 55 would be the correlation of 1750 gold. And then I suspect the way this is actually setting up 31.12. So you got 18. Get your 35. Yeah, both of them. This is what's going on. You get a weekly ABC structure up, but then you also have a monthly and they're both at $35. So bottom line is that that 31 is going to get blown away. 35 is the A to B. You're probably getting up to this. This run is on. This run is on. And listen, it makes sense because the interest rates basically, they're already negative in most of the world. Interest rates go negative, folks. Let me tell you something, man. Everyone's going to figure out, am I going to pay someone to hold my money? Or in fact, am I going to buy real estate? I'm going to buy a hard asset. That's what you're going to see with this whole hard asset deal. The hard asset deal will be on and spades too, by the way. Because of the aspect that particularly, I would say, even in the real estate market because of the fact that you can lever it up. It's a hard asset, and it's not costing you money. You are extracting out of it versus putting into it. So it's a brave new world out here inside the debt markets. No doubt about that. Let's go take a look at the S&P out here. So we have the E-minis. E-minis right now, they're down 30 bucks. So let's take a look at this. So, now there you go. So you get a break with volume. So this is going to be, this is a problem challenge here right now. Big time too. Because you're eight point on this. Look at this one, man. 30-13. Okay, here we go. 30-13. 30-33. So we got, what, 63? 73 points. Get you down to 20, about 28-90. Right now you're 29-20. 28-90 is game, man. This is going to be serious business out here today. You broke a B point. You broke it with volume. We broke that at the open this morning. So this is not going to be, let me see how the trend is laying out here. So take a look at the trend. That's at 0.96. That's not a big deal. That's not anywhere in there low. And you're, look at this. Yeah, we're going low up. So what you have here, you get, you get the, you get the trend. It's almost an even market, even though we're down like that. And there's no panic here at all. Your down ticks are only a minus 1-0-2-3. That's nothing, folks. That's like, that, that is saying that we are going south. You'll get, do this ABC structure on the way down. That's another 20 points down, 25 points down the S&P. Right now you're down 33. So 43-53, that's like 58 points on the way down.  You're going into the weekend and King Dala, let me see how they're shaking up with King Dala. This, here, let's go over to the Yen for a second. Because this move in the Yen is phenomenal, man. I mean, you're talking about two major moves lower. Blowing away the last low. The last low is 106.78. And yesterday it just went from 109 to 107. Today we went from 107 down to 106.56. And right now you are laying at those lows. So they want out, money managers want out and want out in a big way. Now you get a picture something too. The S&P is so up, so dramatically. You know, we're still up, even being down like this, you're still up almost 18% for the year. If you're a money manager, what are you going to do? You're going to say, hey, listen, man, why not, why not take my money? We go delta neutral. They can put on options in order to go delta neutral very quickly. What that means, when you're delta neutral, folks, is that means that you're not going to make money if the market goes up or down. You're cleaned out, meaning where you stand right now at the market. And there'll be some money managers that do that. You know, that's, that's just normal in any market that you're up so dramatically. We go take a look at overseas. What you're going to see is that we were talking about this on Wednesday. The DAX was the first one that gave the heads up here that you had the selling coming in. Out of nowhere on Wednesday, Tuesday rather, the DAX, that went from a price point of $12,400 to $12,100. You had explosion of volume. The following day, we had the UK do it yesterday and simultaneously. The UK did it on Wednesday. We did it on Wednesday. We followed through on Thursday. And what I expect you to see out here today is that you're also going to be basically south with volume. If we take a look at the spy out here, the spy right now, yesterday, we've already done 27 million shares. Yesterday it did 42,3. Yeah, you can do, we can do more than 142 today. Bottom line is that that's setting up right now. What are we at? Yeah, it's 1030, 630. You set up 150, 160 million on the way down. Yes, they did 142. It should slow up. But what we also have is that now you're inside the lower range. Inside the lower range, different ballgame. Natural gas. Let's go take a look at natural gas. This is always a disaster. No doubt about that. Natural gas right now is trading at 214. Let's see where this is set up. This looks like it wants to break into the ones. Oh yeah, so we broke the low this morning. The low out there is that 213. You're at 214. Let me see that. That's the August one. No, no, I got to go to the next one. NG. There we go. Okay.  Oh yeah, big time. So we broke the 211. There are 208. Let me do this. NG1. I'll go to the continuous contract. Man, there's so much natural gas. It's the same. Okay, so on the continuous contract, put this on a monthly. Yeah, you got the lowest game. 161. 161 was the low of 2016. Let me see if I bring this back further. Yeah, one sixteenths game. You break 160. You break 160 and then guess what? You're down at buck 25. So plenty of natural gas out here. You can see the oil market itself. The oil market, you know, we came down fast and furious yesterday. It's trying to get a little bounce out here today. There's no juice behind that oil market. Right now you get oil up $1.36. You're trading $55.32. That oil market wants $50. And I expect we're going to get it. And what is really cool, folks, is that if you take a look at oil in general, once the oil market starts going south, the S&P likes to follow it. So this is going to be quite a ride. Hang on for the ride. Stay right there, folks, who come right back. Dow industrials right now trading down $268. Enazix down $137. S&Ps are down $33. You get an ABC structure intraday on the way down, folks. That sets up about $28.95. Come right back. If you're in the CD market and looking for a secure investment, the Tiger First mortgage program may work for you. 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Now is down 268 and has a tough 144 S&Ps off 33. Let's go take a look at this to say go for one of the Tigers out here, TGB. So okay so the low for the year is today. 43 cents the highs 88 and this baby is trading at 43 and this is coming into lows and let's see what we have here. Okay so 500. This could be a big problem child here. So you get it looks like it's going to have the volume to do an ABC structure down which would be 79 30 cents which we get this down to 27 cents. Let me pull this back and this is going to be coppers getting smoked out here today too folks and your low is 54. That's breaking that. Yeah there it is. This is trouble. The lowest that was established out here in 2016 was 22 cents and this could be 27 cents. You close this could be 27 cents and if we go take a look at this what you're going to see a copper out here today is getting taken to the cleaners in a big way. You're down eight and a half pennies and this is really that's really a copper mark. Yeah okay so the same yeah copper is going to be an ABC down too so interesting. So let's take a look. So you get three dollars is your eight point 259. So you get a 41 cent A to B gets you 230 approximately and if I do this on the continuous contract let me see this HG1 the lower end is 255. Yeah yeah 230s gain in the copper market so tgb is problematic there's no doubt about this is you know I mean they have it's copper that's that's what it comes down to or revenue wise yeah and it is a personality stock but it's going the wrong way and let me tell you something just make sure you can get a stop in and keep it in the stock because this is absolutely a personality stock and you know we'll see whether copper going south more than likely because of the amount of taffs but bottom line it is what it is and it's going south. Let me go pull SCCO and see how southern copper is doing to see if it's ready yeah it's it's right across the system so SCCO bottom line just went from 38 to 33 fcx free port mac maran let me see we got here enough that should get help just a little now it's going the same way yeah this is going after a swing point free port mac maran that's going after 3261 and monster volume is today 239 thousand and it can have the volume today too yeah so copper copper equities in general be careful with them in a big way too not in a small way we got take a look at the xau the hui on the weekly basis out here xau is at 91 bucks and what you're gonna have here folks is that you are pushing into highs with monster volume wouldn't like these are abc structures on the way up also so if that's what you have your b point is going to be what 93 your a is 65 that's a nice one you got 961061 16 so you're talking 114 and the xau oh look at that man this is awesome so the the abc structure brings you right up to the highs that were generated in 2016 and the the XAU, we go into the HUI, the Gold Bugs Index, and we put this on a weekly also, and let's see, so you got your B at $215, your A at $146, that's $60, gets you $255, I think $286 is the swing on that one. Yeah, $286, so $255, the swing's $286. Bottom line is that there's some buying in there. Now, and what also happens is this, so you got to remember something, that the gold market folks is very small, and it doesn't take a lot of buying number one to get the gold market going. I mean, it's tiny. Now what you have is that you have, this is like a tsunami, because you have negative rates across the world, you have markets that are going south, you have bonds that are going north, and then you have the dollar that's going south. So, even if money managers put a small amount into the metal market, you, there's just not enough metal, and once the momentum starts, which we have the momentum behind it, you very well may see something that you haven't seen in a long period of time, because what does happen is that this can get, it's always volatile, that's for sure, it always goes further than you think on the way up, as well as in the way down. What we've found the gold market is this, the gold market likes to do a one to 1.382 to a one to 1.50 ABC structure on the way up, as well as on the way down. Well your expansion contraction, when you're using your Fibonacci sequence, is, seems to be much larger, you know, and that's how it goes. And right now we're on the right side of it. That's what this also comes down. And it's a clean right side of it. What I mean by that, is that we've been in a consolidation, so it's done its work. You know, the last run, Fast, Inferiorist, and Gold started in, on June, on May 22nd, it was down there at 1286. You did a straight line move up to 1453. We've been consolidating since June 25th. Two months, guess what? Now it's ready to blow away the numbers. So, lots of moving pots out here, no doubt about it. Goldman Sachs, let's go take a look at some of the finance stocks, because the finance stocks with the aspect of how rates are coming down so quick, no doubt they're going to squeeze them. Goldman Sachs, you can see, we just came down two days from 221 to 206.  And what we have, oh, look at this. Man, this is a White Cough classic. So, picture this, Goldman Sachs is down from 275 and 2015. December low, 151. It came right up to ICE. ICE and Goldman's 222, and we hit, this is the classic, 222.24. This is absolutely classic. So, now what you have is this. We're 205. Goldman gets inside 203, and guess what? Game is down to 151. So, the financials are going to be, let me go to JP Morgan Chase. These are going to be really a good one. It looks to me to set up to say, okay, are we going down to the June lows? Are we going for the bigger consolidation, which I suspect we are, which is the December lows. And JP Morgan Chase, bottom line, is that this saying that's going down to 91? That's pretty clear out here, actually. And that's the December low. March low is out here at 98. Big numbers, no doubt about it. And let's go, yeah, we don't use oil, gasoline, GOS. Meaning we don't use barrels of oil, but there you go. Wholesale price of gasoline right now, buck 90, folks. Stay right there, folks. Come right back. I'm certain you are or strive to be one of the best of the best at everything you do in life. It's the most common trait that we tigers and tigers share. If you're looking to become the best of the best when it comes to managing your money, let me teach you to do what most wealth managers tell you can't be done, which is how to time the markets. I'm Steve Rhodes, author of Mastering Probability. And for the last 12 months, Timer Digest has been tracking my newsletter signals, which have earned me the ranking as their number one market timer in the nation for the S&P 500 for the last 12, six and three months. Timer Digest also ranks me as the number one market timer for gold as well. The fact is markets can be timed and I'll teach you the exact set of tools that I use that has transformed me into one of the best at what I do. 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New subscribers get a 30 day money back guarantee so you have nothing to risk. For all the details and to start your gold report subscription today, visit the front page of TFNN.com.  Sign up today. Since 1984, Basil Chapman has been using the Chapman Wave methodology to advise traders of his expert market opinion. While originally hand drawing charts from the late 1970s into the 1980s, Basil noticed that prices under most circumstances virtually always had a certain number of legs to the upside before declining sharply. Later, Basil found that computer software which included the standard market technical indicators enhanced the degree of accuracy in calling price turns as well as market trend calls. Thus was born the Chapman Wave sequence. Using the Chapman Wave methodology along with other indicators, Basil Chapman advises his subscribers of his expert market opinion each market day with his opening call newsletter. Right now you can get a two week free trial to the opening call Basil's daily trading newsletter by visiting the front page of TFNN.com. Cancel at any time during that trial and pay absolutely nothing. Get your two week free trial to Basil's newsletter the opening call today by visiting TFNN.com. This segment is brought to you by Think or Swim. For more information just click the Think or Swim banner on the front page of TFNN.com. Welcome back folks. We take a look at the GLD. You've got another ABC structure and this is already going to have the volume. So you've got $136.63 as your B. You've got $120. So we get $16 which is going to get you up to $148. We bring this back here and we take a look at... So $148 launches the whole consolidation and then you've got to remember something with the GLD which is pretty cool is that the GLD has been in existence. So you've got a four tenths a year. I think it's seven years. And no, look at that my God. Time goes quick. Oh my God. Oh my God. You're talking 15 years. So you're talking about another seven points on top of that. Bottom line is that this run is on folks. It's on in quite a way. S&Ps again, if you take a look at this S&P, the problem with the S&P right now is that you have an intraday ABC structure on the way down and we are at the price point now of $2916. That ABC structure folks is about $2895. So I suspect that's what that's $50 is about $55. S&P points down throughout the day, you know, and right now you are only not well, yeah, you're down $36. But it looks to me that you're going to get some heavy selling all day on a Friday bottom line inside the summer, you know, unusual. Yeah, but guess what does happen is that next six weeks, volatility in Spain, Europe's going south in a huge way. Europe's going to be closing a bit. DAX is already down 400. Stay right there, folks. You get a fast market coming up next and we get our man, Mr. Basil Chapman, Steve Rhodes, Dave White, be back this afternoon, a great one, have a safe one, folks. Well, we'll get them, folks.


Felly, ddysgu'r cyd-dŷlwyd. Rydyn ni'n gwybod i'r rhagleniol yma i Bencouper, sy'n cynnyddio'r ymddiad ar y stryd. Ymddiad hefyd i gyfyrus hefydol maen nhw'n gwrthod o gael 20 miliwn o'r ddweud o'r cyllid o'r cyllid o'r gael ddwy o'r 3 miliwn o'r cyllid o'r cyllid o'r 70,000 a'r ddweud. 25% o'r byddau sydd yn cyfyrddio, a dyna'r rai cyfnodd yn ymgyrchol ar y cyfnodd yn ymgyrchol. Ond yna'r cyfnodd yn cyfnodd yn cyfnodd. MSF wedi gweld i'r fforddau o'r rai cyfnodd yn darthol, yng Nghymru, South Sudan a Chad, ac mae'r rai cyfnodd yn ymgyrchol, yn ymgyrchol, ac mae'r cyfnodd yn ymgyrchol. Yn gyfnodd ymgyrchol ar Ysgol, i Siw Lleidwyr yn South Asia a South East Asia, mae'r cyfnodd yn cael 10% am gyfnodd y ddyn nhw yn Llywodraethol, ac mae'r ddyn nhw'n 10,000 cyfnodd y ddyn nhw yn Siw Lleidwyr yn South Asia. Yn cyfnodd yn ymgyrchol, ac mae'r cyfnodd yn gyfnodd yn ymgyrchol yn ymgyrchol ar y cyfnodd yn Darthol, ac mae'r cyfnodd yn cyfnodd yn ymgyrchol, o'r cyflynydd cyfaint o'r cyflynydd cyfaint yw'r amgangaeth yma sy'n gweithio'n cyflynydd cyflynydd cyflynydd cyflynydd yn cael ei fod yn gweithio'n cyflynydd cyflynydd Cymes ganllewch yn rwyf ddaeth o'r sainetaeth i'ch hunain i'r ddech Wasin Cymes. Mae'r defnyddio arddangos i'r gyrddwn ardi, ac i'r cyflynydd cyflynydd cyflynydd wedi'u llunod o'r amgylchedd i'r canllewch imeddiol, But there is a vaccine. It's safe and effective, and it's called HEKALIN or HEV239, but it's only licensed in China in 16-65-year-olds that aren't pregnant. Its effectiveness was deduced in a large-scale randomized control trial that was published in the Lancet in 2010, and that was carried out in an endemic region of China, but its potential impact in an outbreak setting is uncertain. So we decided to look at that through mathematical modelling. Firstly, by estimating the key epidemiological parameters that are associated with transmission, that's things like the basic reproduction number that tells us how many secondary cases will result from an infected case, and then use those parameters to build a mathematical model where we can then explore the impact of vaccination both before an outbreak occurs, that's pre-emptive, or after an outbreak has already occurred, that's reactive. And then to go on to look at extending the vaccination coverage to other age groups and pregnant women for which the vaccine is not yet licensed. So as I said before, MSF responded to an outbreak in Uganda between 2007 and 2009. It was in a refugee camp in Kitgum in the north of Uganda and resulted in 10,000 cases and 113 deaths. About 50% of those cases occurred in just three of the camps, that's Aguro, Madio, Pei, where the outbreak started, and in Palago. So we fitted a deterministic, compartmental transmission dynamic model to the three outbreaks. Alex, let me just explain very quickly what that means. Basically you can divide individuals in the population in two different compartments depending on their infection status, and then they move between these compartments depending on transmission dynamics. And I'll explain that a bit better here. Model 1 shows an SEIR model, and individuals can be divided between these four compartments. S for susceptible, that's not immune and not yet infected. E for exposed, that's latently infected but not yet infectious. I for infected and infectious, and then R for recovered and immune. The bold arrows point to the direction of individuals between the compartments, and the dotted arrow indicates influence. So in this case, infected and infectious individuals can influence the rate at which susceptible people become infected. I'll only show the results for Model 1, but as you can see we explored six different models that expressed the uncertainty around transmission dynamics, but they all gave broadly similar results. So this is the model fitting where we adjusted the values of the various parameters until the model fitted outbreak data. Here in circles we see the real data, that's the weekly number of hepatitis E cases in each of the outbreaks in agoromadiope and palaga. And if you look at the coloured solid line, that's the model fit. So you can see that we have pretty good fit to each of these outbreaks. And then during that model fitting we can home in on the true values of the model parameters. That's moving from the peach colour to the red colour. And so a much narrower definition of the parameters. And similarly we used Bayesian analysis to explore the vaccine effectiveness distribution from the Lancet article that was published in 2010. We assumed a coverage of 80% and a dose interval between the first and second dose of one month and between the second and third dose of five months. There was no data in that trial to show that any effect from a single dose, so that was excluded from the analysis. So we plugged all of those parameter distributions into the model and this is what we saw. This figure shows the reduction in the number of cases in grey, the number of total deaths in yellow or orange, I'm not sure what you see. And the number of pregnancy deaths in pregnant women in blue. And on the left hand side you can see the different groups that are vaccinated. And this figure shows reactive vaccination that's vaccinating using two doses after the first 100 cases of an outbreak. And we can expect to see up to about 30% reduction in the number of cases and deaths. The figure on the right shows the same scenario, but reacting much earlier after the first 50 cases. And we can see that we can expect reductions up to about 45% in both cases and deaths. But the thing to remember here is that the vaccine is only licensed in 16 to 65 year olds that are not pregnant. So when we're looking at the other groups we're assuming that it's as safe and equally as effective in those groups. And another thing to notice is that in this scenario if we're not vaccinating pregnant women we're having no impact on deaths in pregnant women. And that's because we're not responding fast enough to achieve herd immunity when we need it, which is actually at the start of an outbreak or before an outbreak. So that's what we investigated next, preemptive vaccination before an outbreak starts. And you can see already that we're seeing much larger effects if we vaccinate before an outbreak if you compare to the top row here. Another thing to notice is that if we vaccinate everyone else except pregnant women we can see an effect in reducing deaths in pregnant women. And that's because we're now starting to see an indirect effect of vaccination moving towards herd immunity. Another thing to notice is that if we simply add pregnant women to the group that the vaccine is already licensed for we can see that we don't see much effect on the number of cases but that we do... Actually maybe I should use my pointer. We don't see much effect on the number of cases but we do see a huge impact in the number of total deaths and the number of deaths in pregnant women. And if we use the whole of the three doses before the first case preemptively and we're vaccinating everyone we're moving towards herd immunity and reducing almost 100% of cases. So in conclusion reactive vaccination can lead to important reductions in mortality particularly if we implement this early in an epidemic but there's potential for much greater impact if the vaccination is preemptive particularly if the vaccine can be shown to be safe and effective in pregnant women and children and older age groups above 65. The results were robust to extensive sensitivity analysis with different model assumptions but it's unclear to what extent the results will generalize to an urban setting such as the current outbreak in Chad and to endemic settings such as what we see in South Asia and Southeast Asia and these need for future further research. And these are my acknowledgements. Thank you. Thank you Ruby. Before I open it up am I correct in thinking that the vaccine is currently contraindicated in pregnancy because they haven't really researched it in pregnant women, right? Vaccine's never been tried out. No, there were 37 I think pregnant women that were accidentally vaccinated in that original trial and they saw no severe adverse events. But they were not deliberately included in the... And that is very common in a lot of the life-saving drugs, etc. We find that pregnant women and children are sort of contraindicated not because there's real danger to them but because there's just not enough data to say that it's not dangerous. All right, questions. Come on, it's the last session. You can ask anything you want. Hi, I wanted to ask if there is any cost-effectiveness of this HEV vaccine in comparison to water treatment or other control measures which can prevent HEV? Can you tell us a little bit about the cost of the vaccine and... Actually, I can't. We haven't done any cost-effectiveness studies but also in terms of the water and sanitation responses we haven't done... We haven't seen any clear impact of water and sanitation and so it's difficult to compare the two. What's the cost of the vaccine? Do we know? I don't know. All right. OK. Yes, Alan. Thanks. How common are hepatitis E outbreaks in the places where we work? I know there was South Sudan but has it happened anywhere else where we've had to respond to a big outbreak of hepatitis E? Yeah, we're almost seeing them routinely in our refugee settings. I've responded to three outbreaks in my time and I've responded to three refugee emergencies. So, yeah, all of them. So, yeah, it's certainly concerned... Fairly common. Becoming more common, I think. All right. Oh, one more question. Hi, Ruby. Great presentation. Not many people can make mathematical modelling sort of understandable. Is there any mileage in looking at single-dose vaccination especially given MSF's recent work on single-dose cholera vaccine and secondly, how much should you include water and sanitation interventions in any of this? Or is there not that much evidence towards showing there's an impact? Actually, through this work, we were also looking at the impact of water and sanitation in that Uganda emergency and I think I've presented this in the past that we simply responded too late in the Uganda. The outbreak had already peaked in all of the camps by the time we'd got our water and sanitation response together and I think that's quite common for our water and sanitation responses. In terms of single-dose, absolutely yes. We asked the authors of the Lancet paper if they had any data on single-dose and their study simply wasn't powered to look at single-dose vaccination so they couldn't give us any data but that would obviously be the ideal scenario for MSF. Thank you, Ruby. I'm very glad that you worked peach into your presentation especially in the week where Trump bought peach between Israel and Palestine. Thank you very much.


Yes my name is Gudmundur, I'm a representative of ALDA. ALDA is a I think that we concentrate on democracy, sustainability and include working hours. Working hours is a pre-condition of course as Michael said for democracy. I have time for that. So I'm going to present to you trials of shortening of working hours that was conducted in Iceland for a number of years that has now led to contracts basically. So let me begin. So just a little bit about Iceland. Iceland is a country of 356,000, labor market of 200,000, a relatively small country. There's high workforce participation, 87% and 75% working full-time. Average working time is 44 hours a week, which is considerably higher than our neighboring countries that we usually compare ourselves to the other Nordics. And the duration of working life is quite long, 47 years, which is the longest in Europe. And however our GDP and living standards are very high and have been for quite a while that way. It is a service and exporter in the economy with all the characteristics of advanced economies, lots of digital services and so forth. So in summary it's an advanced economy. We have high living standards, however our working time is high, long and we have households whereby everyone basically might be working full-time, but there's still everything to do within the home. So this can lead to imbalance in work-life situation. And this is actually pronounced. If you look at the authorities such as OECD, you will see that Iceland is doing poorly in work-life balance and has been for quite a while. Their older studies let's show the same trend. So Altas position has been in essence that we have all the capabilities to do better here. That we can try to be a little bit more efficient with how we spend our time and gain a bit of more productivity, but use that to shorten working hours and gain more work-life balance. We view this as a first step in a much longer program, which maybe is slightly more complicated to explain, but yes. For us this is only a first step. So I'm going to switch to the trials themselves. So for a decade or so there has been increased public discussion on working hours in Iceland. Alta has participated in this. We hosted a conference last year for example, beginning of last year. There have been articles, reports. Alta has published one report and really increased awareness that you can work less, you can have less stress and burnout as a result, that you can still have high living standards even though you work less. There is more public understanding of this and increased in politics as well. Iceland is historically a country of long working days. This is an old trend. So around 2014 BSRB, which is the Confederation of Public Unions, that's the largest one in the country, proposed a trial with Reykjavík City Council, Reykjavík is the capital, and the government to trial a shorter working hours. The idea was to study effects on productivity and work-life balance and see if, study if it was actually possible to reduce hours, but still maintain same services, same output in the workplaces, still do the same things. This was actually agreed to by the Reykjavík City Council and the Finance Minister. So this is a rough timeline of the trials. And you can see 2010, then 2020 leads to new contracts. It's a long time. 2015, the Reykjavík trial actually starts with 66 participants. It included the service center, child protection service, and the next year the first results are in, and they are positive. So more workplaces join that point, about 280 participate. Year after that the government trial starts with 800 participants, included the tax office, police station, our registers, and so forth. The trial in Reykjavík was extended the next year. So 2,500 people were participating in 100 workplaces. 2,500 is more than 1% of our workforce. So on the scale of Iceland it's a big trial. The same year the government trial was extended and a hospital department joined. The point of having a hospital department was to study the possibility of shift our workers joining such a trial and how to make that function. It did. So in 2018-19 there was a number of studies, final results, and a conclusion of the trial basically. 2019 and 2020 new contracts nationwide were signed and they included shorter working hours or thousands of workers in many different sectors, public, private, service, production, etc., also healthcare. So the shorter working hours in practice, they were guided by committees. These were large trials and they were trying to find a way to do this. This was a bit new to people in a way. There was no reduction in pay. All workplaces had to apply except for the first two workplaces which were handpicked. Those workplaces that applied had to demonstrate ability to maintain services. There was criteria for eligibility in the government trial. So these were two different trials, one at the regular city level and one at the government level. They were slightly different but mostly the same. The strategies for shortening of hours were read. Some workplaces, offices, this included shortening meetings, simplifying processes, rethinking how things were done, etc., in workplaces where there were shifts, these shifts were changed. If there was an opportunity for having maybe less stuff at a certain time, this was done so that people's shifts would end sooner or begin later and those you can shorten their shifts, reduce the working hours, but still maintain the same service. These choose basically to change the shifts depending on circumstances. So there was no single template really. It was different between workplaces. These workplaces were so different by nature that this really was necessary. Also the number of hours shortened via it. So there could be one, two, three, four or five hours a week depended on workplace. There were a number of studies, qualitative, quantitative, both focusing on workers and managers. These were group interviews, questionnaires, individual interviews, and they focused on work-left balance, stress levels, home life, communications, side effects of the trials, etc. The point was to gain understanding of the impact of these trials and possible side effects as well. So there was actually a whole stack of reports on this. There's hundreds of pages of material. The results were, well, let's begin with a myth. There is no shortening of hours, only lengthening of overwork. This was propagated in Iceland here by the Employer Associations before and during the trials. But this did not materialize. People actually worked less. The numbers, because they kept track of how much people were working, the numbers show this. This was confirmed in interviews. And I should note that in these interviews, managers were not present unless they were contacting interviews with managers. So people had to try to make sure that people could speak freely. The researchers were independent academics. The workplaces were able to provide same services, maintain similar, same service as before. The idea was not to reduce service. There are some exceptions to this. For example, in one place they changed the opening hours and they actually reduced the hours of opening at the time when it was least used. This did not have an effect on how well the service was thought of by the users. That was okay. So there was positive effects on low work-life balance. People actually felt that it was easier to go through their daily lives to do their work and actually maintain their homes and do everything you need to do in regular home life. Man participated more in home duties. This was noted by pretty much everyone. There was positive impact on other family members, less stress, interestingly, and positive impact on burnout symptoms. People actually said repeatedly, we just have more time. So generally the effects were positive. If they were not positive, they were mostly neutral. And in some cases, they were negative. These measures mostly that some people felt there was a bit more speed. Everything happened faster. There was just shorter time to do everything at work. This was not a big factor. It was noted. Most people were happy and wanted to maintain and continue this. The general atmosphere was, well, if they're going to stop this trial, we will protest. So yes, people really wanted to continue this. They felt this is a significant change for their lives, impacted their lives. So in 2019 and 2020, after long negotiations, particularly for BSRB, it took a whole year to negotiate. They signed contracts. The trials did help the unions to negotiate. And as they could give good reasons for why they should implement shortening working hours, they had concrete examples of how to implement it. However, the number of hours shortened were variable. They were not always the same. And there were two forms of shortening that were common. So there's a flat reduction that everyone gets, for example, nine minutes a day, 45 minutes a week, flexible. And then additional shortening by two hours a week, or some minutes a day, flexible again, implementation. And the workers proposed a strategy to implement this. They might have to give up, for example, their coffee breaks so that they actually do get coffee breaks, but these might be at irregular times. People have commented on this and actually say in practice, it may not be such a big factor. It's because you get to leave earlier anyway. So the numbers worry. And the above is an example. There were dozens, tens of contracts, they all differ. So there's no single model for implementing shortening hours. This is flexible for each workplace. BSRB is probably the largest winner in this round of negotiations. And for regular daytime workers, their hours went from 40 to 36 per week, which is a significant change. Shift workers from 40 to 36, and even if possible to 32 hours. Also for shift workers, their work outside of the daytime amounts to more. So 80% work in the night leads to 100% pay. So all hours outside of the daytime count to more. Importantly, pay was not reduced because of these contracts. So yeah, we have a bit more information on our website and these contracts and how they're implemented. There's also information about a conference we had last year.


Changing poopy diapers. Oh, I just want to close your eyes. You got to look good. He didn't like it. Hickory dickory dock. Very well done. Yeah, the very hard ones. Hickory dickory dock. It's time for cash to eat. The clock strikes one, now cash is done. Hickory dickory dock. I can't wait to hear your laugh. She'll not just got to get his butt a special joint. Hush, have you any poop? Yes, mom, yes, mom, three bags full.


In Bakhmut, Kadyrov is not engaged in war, but in marketing. In the Bakhmut direction, a small unit of soldiers of Chechen leader Kadyrov is stationed near the village of Klishivka. There is a small unit of Kadyrov's soldiers near Klishivka, probably up to a company. Colonel Serhii Cherovati, the spokesman for the Eastern Group of Forces of the Armed Forces of Ukraine said, Cherovati hauled the presence of Kadyrov's forces in the Bakhmut direction rather a marketing ploy than a manifestation of military tactics. Kadyrov's forces are more about marketing than military affairs. That is, Kadyrov has to work off the billions that were invested in his regime and show how he is trying to thank his master. But as a military unit, they do not give any great results, Cherovati said. According to him, the colossal losses near Bakhmut forced the Russians to amass mixed troops there. In particular, an elite unit of airborne troops, a unit of the Russian special forces, a unit of the Bars Special Combat Army Reserve and a Storm Z unit are stationed in this direction. The enemy is trying its best to hold the city just as it tried to capture it with all its might before. Undoubtedly, today, in addition to military significance, Bakhmut also has informational and propaganda significance. The Russians wasted so much personnel and equipment on this city. In fact, they destroyed one of their most capable units, the Varna, and did not achieve their ambitious goals, said the spokesman for the Eastern Group of Fosses.


Everybody forced here. I'm ripping a box of 2022 certified football hobby for Diana B. Thanks Diana and good luck Gold team Tom Brady Parsons their seal of approval insert Justin Fields number to 54 out of 349 graffiti Aiden Hutchinson rookie Calvin Austin the third rookie Jersey to 349 Dark horses Eli Mitchell freshman fabric RPA Breeze Hall numbered 56 out of 249 Solid RPA there at the breeze three-color patch Trail on Berks rookie numbered 141 of 199 Damian Pierce 10 of 10 on the rookie nice numbered card there pretty good box so far graffiti Chris Olave numbered to 199 as well Gold team Jonathan Taylor Kyle Phillips on the rookie signatures 61 out of 75 Kittle John Mechie the third rookie patch number to 99 now graffiti Rookie Breeze Hall Darnell Mooney numbered 79 of 149 and Brian Robinson jr. Rookie numbered 2399. There we go pretty good box there for you Diana. Thanks again We'll get it right out to you


This study found that patients with obstructive sleep apnea, OSA, who have previously been treated with positive airway pressure, PAP, devices are less likely to develop chronic heart failure than those without such treatment. This suggests that early treatment of severe OSA with a PAP device may reduce the risk of developing chronic heart failure in patients diagnosed with obesity hypoventilation syndrome, OHS, associated with severe OSA. This article was authored by Mustafa Agassu, Baranis Awana, Jocelyn Inamo, and others.