things all of my fellows have put together over the years so it's like an agglomeration of three or four people as they were reading their books to study for their board review right or their board test I they just came up with the questions that they would ask or they would think would be important so and I think it's pretty helpful as far as that goes so all right this is not one that's like hold on I want you guys just to talk but I was going to give you information we're to that point of where when's your real cap yeah so this is just Peru memory eyelid cancer simulates a chalazion yeah how long do you usually take before somebody is diagnosed with the sebaceous so it's like is it like three months six months some studies say ten months even crazy right because people just keep treating it in the busy clinic and then all of a sudden they realize wait this isn't going away they biopsy yet and then why does it look like papillar conjunctivitis so this is really important there is some question of how you do biopsies on this now but map biopsies for your sake looking at your book look to me like that's what they still recommend and often you'll do a sentinel node biopsy as well with this so extension with sentinel node biopsy tissue handling staining those are big and yeah they'll actually they can actually do a study that shows them where it's draining and they go to it yep so typically it's going to be right here but they'll actually do a study to see and these are so what they deemed where the most important things are in red so why are cells vaculated on the slides classic look at how it distorts your architecture this is a good so does this work okay which glance do they come from so think about that it's also Zeiss each time i look at that i'm like oh yeah that's right most common location that's how i think of it i don't know this is really true but there's more what is it is it 40 and 20 so depending on the studies you looked at you look at some say like 60 and 30 some say 40 and 20 but there's about two times as many for the good dimension yeah so usually neuroblastoma is when they'll give you a bruise there was an infection that you hardly ever see anymore they used to do this too hemophilus yep so they burratto and then also but realistically here i would think neuroblastoma so the rap is in there as well derived from so these are from the same cells this does not come from the recti it does not that is a very important distinction management came on radiation if you have an isolated rhabdomyo sarcoma to the orbit and you treat it with radiation in most studies what is the prognosis 95 cure really good so if it's not isolated to the orbit though they're going to get that once it once it leaves the orbit or once there are meds a lot worse but i would say here i would still think of this the bruise doesn't make you think of a neuroblastoma if it's bilateral neuroblastoma what would the age difference between rhabdomyo sarcoma and neuroblastoma yeah so i usually think of like two and eight so rhabdomyo sarcoma around eight neurons usually around two stain for abnormal cells desmond you tell is superiorly located why because you have displacement downward right so you have x-up thalamus and downward displacement of a globe and it's the kind of stuff so most common is embryonal right eight percent of cases location spiron nasal specifically superior spiron nasal is the most common survival is good again 94 95 with isolation to the orbit most lethal is aviolar which is usually inferior 10 survival that's a bad one okay and then bad survival is pleomorphic look at that so it's i've only seen this one a couple of times i've seen this a bunch of times i've only seen this a couple of times everyone might know this but there's a really good mnemonic everyone has embryonal awful alveolar and please give me a pleomorphic for like the different types of like you know what they're known for that's great it's an awful questions but just in case you guys haven't read that very very good i'd like to say that again so everyone has embryonal so it's the uh it's the most common awful alveolar the most lethal and then please give me a pleomorphic because it's the best right diagnosis that's a great way of thinking about it Chris Baker thinks we're killing that man all right so let's see let's do orbital wall bones which had the spinoid wing all except for the floor right what's the floor made up of psychomatic what's that last one yeah the palatine the none ever sees right it's a little tiny bone in the back okay so roof lesser wing okay mea candle swallowing in an infant okay it's above the mea candle tendon what are you considering what are you worried about what's the differential on it yeah anything that was still hanging along those lines right so you want to get MRI do you want to probe that as it's been done you know when this usually happens is when someone has them multiple craniofacial anomalies and why would you probe a kid urgently like in an icu or something like that infant they're obligate nasal breathers right so about 30 percent of nasal alachema duct obstructions will also have a sac that goes into the nose blocks off their way they can't breathe so a great question i think would be a two-day-old baby is in order to be in respiratory distress and they have bilateral mea candle swelling what do you do i don't show there's a person makes us what i was doing but then you probe it it's blow let me look at the tendon it's sometimes bluish not always what's the management of a deckers is to seal so massage is a typical thing it's interesting how many of these you look at most studies i can't remember what your book says but a lot of days will show these things get infected but if you can reduce it just by massaging it that's great a lot of people advocate if there's any question at all these are causing any breathing issues or if they at all are getting read or anything you probe them pretty pretty quickly daggers it's still you have a blockage where superiorly and inferiorly right that's exactly what you normally would do unless it looks like it's problematic and then i can tell you so i had a colleague he was a pediatric ophthalmologist he read our main satellite and that guy can get these things to go away he was just like massage times one minute yeah he does you remember uh what's campus oh yeah yeah so what about there handbags first let it cool off and then probe it i let it cool off first why because you get more nasal you get more false passages probably and then also the infection gets spreading through is my thought but that's a general consensus you admit you might have calmed down on that problem okay forest highly closure is the orbital portion fairly closure retarcell okay mussel how many millimeters of elevation you typically get if you do a mularectomy yeah is a mularectomy considered a reticle in the acroplastic world no it's not two millimeters of the average where does it insert that's the superior border of the tarsal plate right inserts where so i think this is a great question so any any guy to come up with these my fellows did it anytime i'm cutting down onto the anterior surface of the tarsus i'm cutting there upon uruses i'm cutting the limiter right but there's so many attachments it doesn't make a difference it's the inferior one half of the anterior tarsus so if you've got a question that said if you take a pin and you stick that pin through the lid at like two millimeters above the eyelid margin if you see the aponeurosis listed underneath the obitularis then that's the answer right a lot of times it don't list this and i don't know why because that is a critically important thing to mention so most of the time you'll see the books will say it goes through skin orbicularis then tarsus and then conch it's actually not exactly right it's skin orbicularis upon uruses then the tarsus and then the conch right so if you saw that now you remember that thing's attaching down there it's like people don't even mention t-nots or something right so this is stuff he's got to memorize so intraocular millimeter to orbital this becomes a big deal for me like when i'm doing an obstinative glioma resection or something like that or a nucleation if they have a intraocular tumor or something i want to try to give as much of the nerve segment as i can so nix says to me he has 22 millimeters or 25 millimeters of obstinerm on x-weights that's pretty good but you know if i have like two millimeters on them like if i see that more you should kind of look at their nine right and then intracranial 16 obstinator segments okay which segment is the most susceptible to injury with blood trauma to the head so what do you get oh shoot it's just obstinoropathy right traumatic obstinoropathy um which bone makes up the optic canal it's a lateral there a contralateral nipple oh that's a good way of looking at it okay so okay so is it is it anterior or posterior okay is it lateral or medial lateral you guys are going down but then it's also posterior i guess the way out in lateral is lateral though from the punctum it's lateral from the punctum because think about where your turbinates are think in your nose just follow your nose trajectory it's going to go down like this so that's how it will go so if you think of where your turbinates going to be that if you're a turbinate this lateral nipple where does this go which nipple is it so that's awesome where where does this enter where does the nasal angle duck enter in the nose if you're amniatus when we do a dcr where do we put that new hole amniatus right big difference well bones you're removing when you do it in a dcr the anterior lacrimal crest and the posterior lacrimal crest is essentially right so what makes up the anterior lacrimal crest what makes up the posterior lacrimal crest are important okay so let's do canaliculitis pretty classic looking they call it a pouting punctum or whatever usually i just see some pus right here and then i see some red surrounding it right this is the most miss thing i ever see next to probably thyroid eye disease what's the number one sign in thyroid eye disease most common finding eyelid retraction it's like list one through 50 right eyelid retraction so canaliculitis though almost every time i see this the person will say i've been to like five different people right it's probably similar to i just keep treating a dry eye and then i find out they have like a critical dystrophy or something um usual bacteria genomyces israeli right okay which muscle is not affected with your retrobobar block so these are just good to know what are the possible complications of a retrobobar block respiratory depression yeah so it can have permanent diplopia from it right open globe yeah all those things um diplopia is actually a relatively common one that doesn't go away so i haven't maintained encyclotorgy okay structure between the greater and lesser wings of the sphenoid okay it's growth of fissure right structures that go through this growth of fissure it's time so before we digress what i'm doing something surgically and i'm even right back there this never crosses my mind has never never will all i know is i don't want to get into it all right so i'm much more worried about my planes i'm much more worried about if i can see i'm much more worried about what i'm doing then having some academic thoughts in my head as to what is there that whole area back there's bad you just want to stay away from it all right but you have to know these that i know it's great there's a bunch of mnemonics for all the stuff i would recommend that's a good one yep and then is a squared is it insights into is it the sympathetics there's an at somewhere you get nasal squared yeah because of nasal squared okay okay and then look i'm actually gonna say football team tell them what i do like think of the lfts are out so all those will help you just think through it and if anybody wants i have a good have a good power point on that that has all those mnemonics and if you wanted to see my meals in it yeah that's a lot of fun stuff right there so this is why let's get into this for one second okay let's say somebody has a bb oh i don't know like right there and they ask me if i want to go chase after it and they're 2020 and they have no deblopia and they have no issues whatsoever but they have a lawyer but they have a lawyer do you think i want to touch that no i don't think anybody should touch that and the general consensus is you don't so if you have an interactive form body like a bb and it's not causing any problems then you don't do anything with it because the chances of you giving that person problems coming way back in that apex like that is crazy high if they didn't have to deblopia afterwards i would be shocked or they'd lose some vision so thinking through things is helpful so branch of which nerve of family division one branch into what super orbital instrument real clear maxillary nerve grab that McBain all right this i think is really really important and we do surgery like when i do a lot of combined cases with ent these days so this is awesome so to get back into the sphenoid sinus they do it through the nose which is really cool what sinuses yeah it's a sphenoid right so if they have like sweet they have the sphenoid if they have really really bad sinusitis right to their sphenoid i can start to actually affect things pretty quickly right so i think this is a really good question because your basic science book on your whatever you call your orbital book i read that thing over christmas right spain falls well written now it is very well written so i'll tell you there's one thing i disagree with in that book but then i'll tell you and this is where you should know for your test i think so medial pretarsal is the angular vein right lateral pretarsal is a superficial temporal and then the orbital veins deep branch and your facial and material plexus here's a picture of it i think just having a general understanding of that drainage is important so i'll tell you so in that book it says to image the orbit ct is the imaging modality of choice it's not in my opinion i like an MRI for anything that's truly in the orbit itself now the book does say something in the apex you want to use MRI which i agree with and i think for trauma and for how to mean the ct is obviously superior but i think the answer for you is image modality of choice you don't know if the ct scan initially on an orbit if i'm trying to see what something is i can be able to add enough information or something like that and i can never write no question orbital septum where does it come from what's the structure it's from it's off the periostean where is it fused in Caucasians this is hugely important in surgery hugely so to the elevator about two to five millimeters above the tarsus so when you see any of us make an incision through their lid crease which is going to be at about 10 right in a woman it's a 10 the guy is typically what in a Caucasian 8 centrally right so 8 centrally in a man 10 in a woman you make that incision that means the septum is quite a bit above that so if you cut through and through it let's say you're at 10 right and you cut through and through we're going to go skin or vicularis then what are you going to have their leafator right because the septum is stopped and then the leafators there and then you're going to hit something really fun what are you going to hit their peripheral arcade because it runs right on top of the tarsus right and then you're going to hit the miller's muscle and they're going to hit their cons and all of a sudden you look in their eye so anytime we make a lid crease incision we are always angling like Murray what do i do every single time so we'll always pick it up we pick the tissue up right so i always grab since i use my right hand i always grab for on the right side i grab the bottom portion of the incision you grab the top portion and you tent it up i pull it straight back you tent it up and i go in and like a 45 degree angle that allows me to go through the sub it's a retrovicularis plane is what it is you're going underneath the ovicularis in that basically that the stuff is on top of the ovicularis muscle right and then you're getting to the aponeurosis or not the aponeurosis you're getting to the septum and you're opening it so you'll never see any of us go straight through the lid crease and just keep cutting straight through right there we're always angled the one exception is if you're trying to get to the top of the tarsus then we'll make that incision then go through the ovicularis and we'll aim down actually to go to the tarsal plate like we're putting in a gold weight so that to me this is critically important to understand is it fused to the so the orbital septum comes down does it fuse to the like the aponeuroses of the levator that's essentially we're going to be hitting on because by then the muscle is transitioned to the aponeurosis and is it like i mean i guess does it come down and it's i would assume it's like the anterior portion of the aponeuroses it's the anterior portion of it and the septum to be fair is like multiple onion layers so the books draw it's like one like structure almost like a muscle it's actually multiple it's like multiple amela but you can think of it as one structure just to like simplify and make it make sense but just realize the reason it has to stop there the reason you have a lid crease is because this does stop higher and then the levator fibers can come forward and give you a lid crease in a classic asian lid it doesn't do that and that's why it comes down much much inferior when we're talking about there in a second it comes way more down and that's why the lid crease is lower it all has to do with where the orbital septum attaches so it's huge in the previous slide it says that the levator fuses to the anterior portion of the tarsus so does it have like fibers that go there and onto the skin so the septum comes so the levator now comes out of this so so septum comes straight down like this right so the septum comes straight down the levator is going like this right septum hits it right here and then on the anterior surface of it and then that allows the levator fibers to come forward and attach down onto the bottom half of the tarsus but what about the actual lid crease the lid crease it says it's for it the fibers go anterior to the orbicularis muscle so it's both that the levator fibers so it's got it's got multiple attachments and that's why if i cut through that the lid doesn't become tonic because there's multiple attachments and insertions does that make sense i didn't get that for forever but that's why you have to aim up and i think this is like one of the most important things you'll learn from this whole lecture is understanding that in the upper lid that septum stops because the levator is coming it's coming at this angle so the septum is coming straight down the levator is coming like this hits into it that then allows the levator to send its fibers everywhere and that's what gives you crease and that's what goes to the inferior border of the tarsus and that's how you pull it is anybody want me to talk more about it good one other question about the so like i know that one of my friends sisters she's asian and she had surgery to like create a crease so what what is that surgery exactly what do they do so actually to do that that's a very very common procedure that's performed so you would make an incision in the lid where you want to put the crease let's say it's a woman i'd say it's a 10 and you would have this discussion with them very very clearly beforehand so you make that decision at 10 where you want it through one at two you go through the obi-cularis right you get down to the septum which will be really low because it comes all the way down onto the tarsus which is way low you open that up to expose in the levator and then all you do is just take a bite of the skin to the levator at the height you want the crease to be at and then a bite of the bottom skin that makes sense so you've got your incision here you take a the bite of the top portion of the incision the skin and then you go through the levator you have to attach to the levator right where you want that crease and then you attach it to the skin but it's pretty easy to do because essentially if you've made your incision right where you want your crease to be once you open up your septum the levator will be right there you just make the bite right there it's not heart surgery at all frankly it's a very lucrative surgery so does that does that make sense are you cinching the the um the septum then? no you just open it oh you just open the septum and you leave it why why do you not recruit why do you not put the septum into the suture scar but what will it do? lack of families they won't be able to look down right so the septum is really strong when it comes out of the periosteum right so it's a very strong structure and the way you can tell interoperatively if you have it or not what do you do start on it you say look up look down look up look down the septum will not move if it's the levator they look up and down it'll move it's a huge it's a great way to tell nothing there's times I can't tell doesn't do that's like a weird one uh and then on that skin you have to leave with a bluff tougher bluff okay this is hugely important that's a bare minimum right and I see this violated all the time and then the brows like like this there's like no skin there and I can't close their eye really important okay so then here I'm actually showing you the incision uh okay doing a lower lid bluff you have to be careful when removing the fat because what is positioned between the blank and the blank fat pads so when you do this I'm gonna go through this with you a little bit so when you do this when you do this surgery and you're trying to these days most people will only debulk these a bit and then they reposition them in the tear trough right and either a sub periosteoplane or a pre periosteoplane so what they've done is they've they've elevated this mass everything all those muscles will move your face right and then you just stick the fat down in there to try to get rid of the tear trough to make this a safe procedure what has been more recently described and people are doing is they actually will move the two fat pads because they're contiguous right and you should be able to go like this they call it reverse shoe shine technique as an api master give it you just you move it and you should be able to freely move because there's a bunch of adhesions between these fat pads and that oblique muscle so you want those all gone you'll see if you will do that with a cottery I think that's crazy you can damage all the tissue there right so like a q-tip we'll totally separate that right up just one nice section that's important because if you hit it and they get torsion all the plopia it's extremely hard to fix all right three main causes of anvilish lantropion you have to go I think rubbing might be one of the reasons they got it right oh more than a laxity okay disinsertion of the lower eyelid tractors of a rhinovicularis okay so you need to correct all three of them so how do you fix this I think this would be a great question how do you fix that it's the same thing as an epiblophoron as well by the way same idea so lower trussle strip but then you have to advance the retractors how do you do that what do you make your incisions infracellary right because the way you're going to get to the retractors infracellary so that gets you to the retractors which means you have to open the ubiquularis and the septum those muscles are always under the septum so you open the septum and they're usually disinserted by like a centimeter or so they're usually pretty far down it's crazy so you find them you reattach them and then you also do a lot of trussle strip because you have this laxity right what can happen if the retractors are retracted so much and you reinsert them what can you get out to the surgery yeah the plant can have this position about what millimeter is higher than the so where is the pervarkate we just talked about this yes and exactly where is it superior to what yeah so think about think about a pin and the key that's so hard for me to get this is some structures are going straight down inferior is superior to inferior right like the septum is straight down the levator is going like this everything else is going like this so and then the tarsus is going to be relatively like this too straight up and down so you have to if you think of it from a side profile i think it'll be easier for you in your head to picture what's going on and where thinnest bone a thinnest portion of the maxillary bone and orbital floor so where is the most commonly fractured right there most commonly fractured orbital bone the floor the ethmoids actually the thinnest right the laminate pervrisha but this actually the most common places you fracture so so this kind of stuff you see you do right so the big ones you're going to see are mucor and then aspergillus aspergillus will often actually be more of like an allergic aspergillus i used to see this in kids all the time in houston bridge you see this a lot houston might you see this houston uh this will just like just like i was better i mean this is literally it's like excuse me now it was brown just like peanut butter and the consistency peanut butter disgusting stuff it's usually an allergy okay what should you what should you not use entropi could somebody describe what you see here i don't know what you see here just know you didn't understand they've got some weirdness going on here you just did your internships it's probably a right bundle branch block guess just did you receive utah's intern here what an amazing year here's what i'm saying if you see some weirdness on their stuff you want to avoid the monopolar connery just don't use monopolar monopoli you gotta be careful i think it needs a piece he has a piece but he has a piece and you can't use it with a pacer yeah so you have this uh yeah this is what you do on the holidays so you don't have to worry about this all right what's the mechanism i actually have lied to came right this is so irregular sorry jenna walker right okay what's the mechanism actually botulinum toxin inhibits release of acetylcholine and the neuromuscular junction these things are important so clustering of botulinum gram positive or negative so angiolachymalcrest botulinum toxin right okay where is she be entering let's see that's just maybe happy yeah maybe i saw something so i asked the resident once we were doing they reminded me of doing like an endoscopy of your other right i asked the resident what time we're about to go do surgery on one of his herbations right and i said what is a blepharoplasty in here she said i don't know but i know you use an endoscope i want you to show me all right anyway dcr four weeks post op okay and this can be the same for any lid surgery yes do you see this you do fun times fun fun times to get that treated they're on stuff for months and months and months trying to get rid of that okay so what do i do for this yeah i get i d involved we figured out it takes some months to clear it it's a bad deal you don't see it much but when you do it's horrible what it does you just keep getting more and more of these things all over their face so something that occurs about a month later these are thinking about things like atypical mycobacteria if it's if it's a cue it's going to be staff or strap and it's extremely rare but if it's a month out atypical mycobacteria orbital mass what's going on in one time women even if it's unilateral yeah it's thyroid eye disease a unilateral disease it can be very very asymmetric right and then an adult's bilateral thyroid eye disease in kids it's actually what we're saying is so all right in large extract and muscle and imaging and i remember this slide oh yeah tendon sparing what tears sparing what spares tendons tendon evolving i run into this all the time so this becomes a big deal when i'm trying to get rheumatology to treat this and these days rheumatology will be treating this too right with temporal tumor map i haven't just got FDA approval so that's pretty cool by the way does it work uh studies look pretty good yeah yeah so the thing about this this is important and these are relatively what what's the mnemonic for knowing the order of involvement in the muscles right actually does follow that pretty well okay so steroids are initially what we do with this typically an orbital pseudo tumor with the exception of ITG formulator disease which we think is the equivalent of what we have called sclerosing pseudo tumor for many years but with the exception of sclerosing pseudo tumor or ITG formulator disease they're usually very sensitive to steroids i expect them to respond within 24 to 40 hours max okay you don't need to biopsy it initially that's a big deal if you're on scan if it looks like non-specific global inflammation you can do a steroid trial that is considered reasonable and you do a systemic work up if they don't improve or if they rebound right once you come off the steroid and it was a if you did a slow taper and they come off of it and the disease reactivates then that's when you do a biopsy and a systemic work up right i actually think that's a very safe way to go if if you have a good CT or MRI that shows it looks like a specific orbital inflammation it's a safe way to go it's unilateral if it's bilateral you gotta consider biopsying it would i ever biopsy both orbits simultaneously never ever ever would i do that why would i do that what's the advantage to doing that lower eyelid structure analogous to the levator in the upper lid rises from the inferior rectus okay inserts where so it's just a little different right it's on the border of the lower tarsis whereas so kind of more like what muscle right and that's just one major difference traction after you do it if you're just recession right so this is why in thyroid eye disease you do a decompression first and then you do their strabismus and then you do their lids this one the major reasons why right some of the abs i'm slow demonic usually involves your inferior rectus right okay okay so wolf ring non-marginal tarsis borders right and they crowds is in the corner right fantasies yeah how everyone wants to remember this they are excellent plants okay but i can ask you something i'd ask you this kind of stuff so if it's difficult to manage a cannula and it refluxes through the same kind of liquefus that means you have narrowing right there right so you go through the pumpkin you can't push your cannula and far enough how many millimeters should it go in about eight right because it the pumpkin you have two it's two down then eight over right so you go in let's say you only get in like three millimeters and you can't go any farther and then you try to irrigate it just comes right out that same cannula so that's even pumped in that you were in right and that means you have some cannula scarring so where your options to fix that picture lower and they're tearing like crazy you have two options really cdcr is where i would go you can also try to cut out that scarring portion and put it back together and just put tubes in like a croffer tube right my experience with that has been it works if they only have little scars there's a guy brian beesman's one that blacks people around here he does a ton of that stuff he has good results but i think he figures out kind of if they only have a small portion that's like a stenotic area or something then that's how it works for him and he basically just marks it off as he goes in he marks up where it stops he cuts it out and advances it cdcr be a very reasonable answer right there okay difficult to advance and you get reflux for the opposite cannuliculus how many percent what percentage of people have a common cannuliculus yeah 90 right able to advance in the sack but you have reflux of saline and americamucoperyland stuff it's gonna be these lackable ducts right because the sack you actually know you have some sort of blockage down farther most common epithelitumor of the lackable gland benign mixed tumor clemar forget know my how do you treat it complete excision why you can as a malignant right this is a good remember complete excision most common auger finding a Parkinson's disease yeah decreased blink how that affect my world well if they have a reduced blink rate and they command because they have ptosis or dramatic laces and they live in utah with our dry climate i need to be really careful right i'm going to raise our eyelids so conversation you have to have before and end most common primal legacy of lackable sack sack organism responsible for necrotizing fasciitis there are many things that can cause it what's the most common how do you treat it so these days IV antibiotics are used you admit them and then limited debulking on the lids as little as you have to do so you're preserving as much tissue as possible i hardly ever debulk a whole lot of these of these these days because the IV antibiotics are so good but the answer is essentially you keep cutting tissue way until bleeds right all the tissues dead and bad so you do okay it's the same for something like mu core you just keep cutting until bleeds i teach you just dead marcus gun jowl winking oh man somebody pinned me on this one day so let's go back to that they're going muscle so and so what happens they move their jaw they go into lateral contour a lot of how's it change external pterigoid raises the eyelid and internal closes it just so i think that's actually so if they go to the isolato cycle usually happens kind of goes tautic and then you go to the other side it goes retracts my bomy glands locations pure and your tarsus so they're superior more they're spacious it's kind of something about every day it's so exciting you know what though right okay 30 cc is volume the widest part is one centimeter posterior to orbital rim so why does that become important for me well if i'm draining a roof abscess orbital roof abscess right if i make my lid crease incision on my brow incision or whatever i'm doing let's say do a brow incision okay and i'm coming down and i cut the periosteum and if i just go straight back i'm into orbital contents who knows what right whereas if i aim up deeper then i'm going to get into the actual plan i should be in so you don't want to be poking straight back because that makes sense you want to be aiming up and it's really weird because think about it you're aiming fill your orbit fill how far back that goes up you need to be aiming it's really it's kind of an awkward angle so i actually move and i come so i'm looking at the patient like their heads here and i'm looking up and i do it that way it's an easier approach but that's actually very important for that surgically to know that shortest wall so when you see people have a floor fracture and it involves all the way back to the inferior orbital fissure that's where it ends when you're fixing the floor fracture you chase a posterior edge no you don't because if you chase a posterior edge what are you going to put the implant on what's back there you're going to be back in their apex right by their optic canal does this happen all the time like all the time the implants way too big and then the person will say stuff like when i look up i get this real dark spot my vision is crazy right they're too long so you don't chase that posterior ledge if it's a if it's a fracture that only involves the middle portion of it then fine you can find that posterior ledge which don't keep dissecting and try to find the posterior ledge it's not there how do you know if there's a posterior ledge you look at the sagittal view before you do the surgery i mean if it's a huge fracture they won't have a posterior ledge does that make sense so if you fixate it immediately laterally and then superior anteriorly there's plenty the implant's not going to go anywhere right over lymphoma most common location lacrimal gland fossa vast majority are of which type non hodgkin's b-cell or malt lymphomas very good prognosis how do you say in the biopsy yeah fresh why for flow cytometry right specifically here at the university of Utah i have found flow completely utterly worthless they always tell me it's poor viability doesn't matter how much i send them it's like but it's the standard of care a lymph operative lesion arising in this proactive site gives the highest risk in developing a systemic non hodgkin's lymphoma i think that is a great it's not the lacrimal gland fossa locations of island basal cells list from most of the least common locations so lower me you can't this upper lateral can't this tire tire yeah i think that sounds right yeah yeah it is actually right yeah that's a good way to look at it so but now what side you're looking at right this is where you can get into trouble with the basal cell if this gets back into the orbit that's a problem what's the drug you can use now if you have somebody who can't have surgery and you're worried about trying to control you have his monogib is a sonic hedgehog inhibitor i'd be aware of it that never one side effect side effect if skin changes in the air loss later on on the island most important prognostic factor for patient survival it's always going to be the depth right these oda risk of you know my 1 in 400 what percentage giga coma 10 risk of you know i'm uh six in a million can't you know island ever malice sorry i'm going super fast because we don't have much time i had a whole other lecture for you too um so this what is this specifically this is an epigliferon in a kid right how do you treat it the same way we were talking about this overriding orbicularis you make that infracellular incision right here get the majority of these kids need surgery or can you watch the majority watch okay why why can you watch it it's a lower lid if ever the upper that was doing that you'd probably have a much bigger problem because the excursion of the lid but as their nasal dorsum grows as their nose grows it tends to actually pull that whole region into a better position so a lot of the kids will grow out of this same deal we talked about right so let's see oh what's that how do you treat that it's awesome he's cut the thing um this inseparate so then what's this how do you treat a urethra you can try this that's what i would what i would do is pull on this just like i would to see if like you have a cicatricial versus the involuntary tropion right i would see how tight this is and you could consider a lot of torso strip you might have to do a skin graft right here and you can't in a kid you really can't do like a mid-face advantage or anything it's not as if the mid-face descended they still haven't a fancied lamella right so now let's do classic condition is it blepharophimosis ptosis epicanthus inversus telecanthus right so almost invariably these kids need that lids raised let's see how much brow recruitment there is here and then usually you can do treatments here too so you do need transnasal wiring is a good way to do it i actually don't do that i do a little icky sign incision right here um i just learned from watching a cool video on a yo's website it's great and you just you tuck that in used to be they did that little like the little man victor right here you just bring all that stuff in multiple incisions it looks terrible but a small little swish right here it can get rid of all this stuff it's pretty nice so it's interesting i've only seen that in a couple of people so and it is as i have one family like every single person has that but then the majority of ones i see are sporadic so and then this is based on your book i don't necessarily agree with all this but it is what it is right so if i have a defect it's even 90 percent of the lower lid i'll still do a tensile flap i take it all the way over so i was at a conference where gt period was describing that i'm like that's what i'm going to be from now on instead of doing a uh a one instead of doing a hues flap right so hues would be if you're doing the lower and then a kelly beard to be if you're doing it into the upper from the lower like sense so direct closure again these numbers are really arbitrary because if you have a young person they have a 33 percent defect i can't close that directly i can't they're too tight like if i try to do that in any of you i don't think i could get it closed i think you're literally probably going underneath your eye particularly if you have a negative vector right so if your mela region is is less than your eye protrudes it's probably going to go underneath your eyeball right so i don't think that's an ideal but anyway for 30 50 lotto can thought of me in semi-circuit flap or tensile right and then debugger than 50 cut the beard for your intensive purposes that's what i would say realistically for me that's still a tensile flap i only do a hues flap if i know so you only do a hues if it's like more than 90 percent and then i would do all kinds of other stuff over your intense purposes that's what you do thyroid disease are responsible we're okay fibroblasts right so what do you get the cosinic like it's right more common in females very good most common scene that you're fighting is the libretraction right okay we're almost done we are not actually so okay so i think all that stuff on there is important to understand the gland things are just easy and it's so when i said the okay i thought this stuff was like a joke nobody cared it didn't matter they care a lot now so just do your best as far as like fellowships and stuff go it's the only time in your life when you can actually like dedicate this much time to studying it's hard because you're busy on calling stuff do the best you can it's worth it so steady hard and just for that kind of stuff all the question answers are supposedly in the basic science book tips down used to be my chair is the chair of that okay committee and every and he makes it very clear every question comes


Deep brain stimulation, DBS, devices with capability to measure differential local field potentials, dollar backslash partial, allow for simultaneous neural recordings alongside clinical therapies. To identify oscillatory correlates of various brain disorders, or disease readouts, efforts have grown but must be conducted cautiously to avoid distorting the data due to environmental factors. In this study, researchers identified, characterized, and mitigated a major source of distortion in dollar backslash partial known as mismatch compression, MC, which occurs when impedances between two recording electrodes differ. The team developed and validated an open-source mitigation pipeline to remove these distortions, enabling more reliable oscillatory readouts for adaptive DBS applications. This article was authored by Vanit Tiravati, Samuel James, Ryan Hull, and others. We are article.tv, links in the description below.


what's up everybody I'm evil rabbit today we are on torque drift almost 30.5 million sessions played here on the game so today we are gonna talk about some things that I would like to see in the game the game's been out for a pretty long time now so everybody's had a chance to play it get acclimated with it and discover what they like so obviously there's a lot of been a lot of big improvements with the game as we continue to play it so what kind of races can we get into do the downhill I was having a lot of fun red dance for cats so it was super in the live streams I feel like we're gonna drive this as we talk about things that I would like to see maybe coming to the game here in the future so I think one of the things that was actually brought up in the live stream and I thought is a really good idea is once this matches over I'll really talk into that but so one thing that I would really like to see in the game would be maybe some drift teams ability to create a team with some fellow drivers or friends and maybe have like a clan tag or something on those lines and be able to like have a proper like drift team in a sense on the game you know with your friends or with some random people or some good drivers and whatnot and just have a clan tag and be able to put that clan tag in front of your name or a team name such like that that way you know you can get your friends together and be on a team is the one cool thing that I think would make the game a little bit more interactive being able to have teams and stuff like that another big thing that I thought would be a good thing to have with maybe a way to share other than through the through the hub a way to share tunes like a way to almost I guess you would say kind of like for the where you could put your tune up with all the parts and stuff like that and you could buy that tune for a sum of money without having to buy all the parts below it such as like buying an import engine to get a pro engine to get a custom engine like if the person's tune has a pro engine you just pay for everything outright for the tune and you get the car tuned with all the parts they have on it as well as the tuning settings now you couldn't change it because it's a bought tune but it would be a way to save people a little bit of money when they're trying to build a car so like I could throw up at my s14 tune and you could buy the s14 tune on an s14 that was a mismatch I want to get a rematch on him could buy the s14 tune and now I have to buy all the lower parts to get up to the higher end parts in a way it will streamline building a car yes and you but of course the cost of the the car will be you know a lot higher I was way off gears oh the cost of the car would be tremendously high you know to make up for having to have all those high-end parts bought so that's one thing I thought another thing I thought would be a really good feature that could maybe come to the game you know it would be a way to share tunes in a sense because I know there's a lot of people that are on there now sharing tunes sharing stuff like that and it's amazing to you know try other people's tunes out so a way to buy that person's tune without having to sit there and like wait for parts to show up by the parts and stuff like that would be kind of a kind of a cool thing to see come into the game you got to qualify we got lucky there so that's that's you know two things I think would make the game a little bit a little bit cooler just my personal opinions if you guys have anything that I don't say it's about the video that you think would be a cool thing to add into the game you know let me down let me know down in the comment section down below what you guys think I just a tap so I think those two things are a good thing another thing would be obviously more cars like a 180 a 180 SXX Coupe and S13 maybe some big big daddy drift cars like some four-door skylines chasers jzx 190s you know jzx 100s you know stuff like that would be a cool add-on to the game you know as well as obviously we would like more cars which I know they're working on getting more cars to us it's just a matter of them getting them into the game and licensing and stuff like that because they've been doing a lot with we're getting a lot of licensing and sponsors and parts and stuff like that so they're definitely working on you know trying to broaden their you know broaden the game with you know real-world stuff which is which is why the game I believe does not have as much as say some of the other games out there right now is because they're doing real-world cars real-world parts you know stuff like that so they there's a lot of licensing and you know copyright things that need to be taken into account obviously so that they're you know they're legally allowed to have it without you know potentially getting sued we are driving this guy's door right now and literally driving into his door right there so I do have a pretty good chase runs with this rad amber cat Supra I do like it a lot probably one of my new favorite cars to drive so on top of more cars obviously this thing right here where it says rematch was brought up in the stream and I think it would be a very good thing to change that for the rematch to change it to one more time like FD when they go out again it's a one more time change that rematch just to say one more time and it's more of a drift thing which I think would be a very cool thing to have instead of saying rematch have it say one more time I think that's a I'm not sure how hard the coding would be to change that or get that in but I feel like that would be kind of a cool little change that's big for drifting especially with the formula drift cars and everything in the game obviously we probably would like to see more FD cars in the game as well some other big-name competitors in the FD game like maybe force Wang one of my probably one of my favorite drivers force Wang be sweet to see his F15 in the game but I'm pretty sure there's a lot that goes into getting a pro car with all the sponsorships and stickers and stuff on the car to be allowed into the game such as like I'm pretty sure big Teja and stuff like that would they'd have to get permission from all force playing sponsors as well as all the companies for his car like his body kit which is a rocket bunny or a super dupe sorry stuff like that would have to be brought into the game so I understand all that stuff so you know we can hope that all this stuff comes to play and they're working on getting this stuff I believe they are making very great strides in this and you know the game is getting better and better every day so on you know tangenting off of you know more FD cars more tracks like maybe some more real-world FD tracks like road Atlanta or Long Beach circuit would be up amazing and primo to have in the game to be able to run say like some proper tandems at the Long Beach circuit or the road Atlanta circuit you know Evergreen Speedway I mean we have Cali Banks which is basically Irwin Dale but you have all those other places like Texas and you know the high speeder sections but like I feel like Long Beach and road Atlanta would be probably the two best primo tracks to have in the game would be amazing I mean even if it was like kind of like a rendered version of it that isn't exact we just barely won that one because that's kind of what Cali Banks is it's a rendered version of Irwin Dale with a little bit of differences so we'll be sweet to get some more FD proper FD tandem tracks in the game that be amazing I know they added some new courses in the game like the captain's hook and stuff like that so they are adding more features so these are just some of the things that I would like to see in the game you know other things such as maybe you know Falcon tires coming into the game you know with Nexon being a big sponsor of the game you know maybe we get some Falcons in here maybe we can get some you know hand cooks in the mix you know stuff like that you know it's it's just a little things and you know I feel like they made a big update the paint shop with all the you know extra grime vinyl graphics and stuff that we can do now which was a huge thing and it was a big thing when it came out and you know it makes it so much cooler as well as maybe fixing some of the bugs with the sponsors and stuff like that because I still have for the life of me cannot figure out how to get my own sponsor in the game and I've been trying to figure it out I went back and forth with them and they they're look they were looking into it because it shows it's active but for some reason I get no penalties at the on the drift and I still on jump and I still don't get it I know a lot of you guys have messaged me about it too saying hey you know what's the trick or hey why isn't this working and I don't know what it is I'm sure it's probably something that needs to be adjusted or and or we're not doing something right but you know just little things like that but I mean the game's gotten very very better I'm very very better that's not really correct sensitivity but it's gotten so much better since it first came out when I played it in beta to where it is now it's ten times better and you know it can only get better from here but the biggest thing I think guys is you know they're listening they're watching their you know paying attention to you know suggestions you put in in the hub as well as you know you know I don't know how much pull I got with them I mean I do talk to them a little bit back and forth and you know stuff like that so you know I'll do what I can but you know the like I said maybe a drift team the ability to have teams in the game you know another big thing maybe an easier way to do private matches because people who don't know each other are just meeting each other like on the hub and want to do some sort of match it's kind of hard for them to you know get a code through the hub because you have to go back and forth back and forth back forth so it's kind of hard so maybe a way to have like a friends list and you could have you know click it you can see if somebody's online you can click you know maybe click on their name to go you know battle and sends them a little pop of saying you have a battle request and then you could just go hop right into the game we're on a winning streak we are doing a rainbow in this super right now here on the downhill section so like these are just little tidbits that I've picked up throughout you know playing the game and you know hearing from you guys when I do the live streams of what you guys think and stuff like that it helps it's definitely a big thing to hear from the players of the game and to hear you know what what they kind of what we want so if you guys have any other little tidbits that you think you would like to see in the game other than things I've already said you know let me know down the comment section down below and let me know what you guys say because you know I'd be very curious to see what other people other than myself and the few people that I talked to would like to see in the game now I know a lot of people are gonna say a lot of new cars you know new cars and new tracks I think that's a given and I think Turkish is definitely working on that so I mean other than new cars and new tracks like I said like teams of easier way to get into lobbies with people or maybe a friend's list or you know stuff like that like what other little tweaks would you like to see in the game because they're listening they're paying attention to us they are definitely listening I know I've said this before but you know I mentioned in one of my videos we should have numbers and letters and stuff like that and I don't think it might have not been from what I said maybe they were working on a prior but it just so happened like a week or so after that an update we had letters and numbers so you know not saying that you know what I said in my video was what got us all that but you know it was just something that I mentioned about in the next you know we have it so they do pay attention they do listen and they are making this game you know better and better with our input you know beta they got a lot of input in the beta and they implemented a lot of it but now that the game's out and we're starting to play it more we're probably starting to see things that we want in the game that we didn't know we wanted in the game like teams something simple so you know that's why I said if you guys have any other ideas that you think you guys would like see the game put it down in the comment section down below I'd be very curious to hear what you guys have to say and you know I'm gonna try my best to see what I can do to help me out make the game you know better you know because you know I messaged them with ideas and stuff like that we're gonna try to hit that 10 10 win streak right now in this Supra so like I said let me know in the comment section down below make sure you guys follow me on Twitter and Instagram all of which found you know in the description box below as well I hope you guys have a very good weekend it is a holiday season well it's already been the holiday season was a holiday weekend so I hope you guys have a good weekend and I hope you guys are having a very exciting time waiting for Christmas to show up and if you guys don't celebrate Christmas then I hope you guys have a good Monday Tuesday because you know I don't want to be that guy that says I wish you guys a Merry Christmas and you don't celebrate Christmas for one reason or another you know but have a happy holiday if you do celebrate it a Merry Christmas for the season so like I said follow me on Instagram and Twitter all of which found the description box below I'm having so much fun in the Supra I think I may have found one of my new favorite cars to drive so I think that's gonna give us our 10 win streak here on the downhill in the Supra which is amazing and a like I said you know it's just a little tweak like one more time instead of rematch would be something that would be really cool and it would be into drifting like into Formula D another thing that I just thought about and I totally forgot to say it maybe a way to have like a tandem like a competition or a ladder bracket where you know it's like a tournament style it for you know a big chunk of money you know if you got a battle you battle your way in you know almost like a top 32 competition but pretty much a tournament style or even if it's a you know an offline tournament where you can race you know race bots but I mean bots aren't what the reason of this game is this game is mainly about player versus player so like maybe like a tournament with you know a good chunk money prize at the end you know would be a cool would be a very cool thing to have in the game you know and it would make the game oh man I got to build a car I got to go in this tournament you know enter in the tournament before whoever is entered in tournament next thing you know you're running you know tandem tournament either 1632 or whatever how many ever tiers they want to do for a big chunk of change is the end if you can make it all the way to the top and then you know maybe have like where the drift king logo is maybe have like a little a little icon that says that you placed first in a tournament like something like that so people know hey you know this guy placed in tournament you know he's got to be a good drifter so you know it's things like that like that would make this game the playability of the game the replayability of the game so much better because I I've seen a couple people saying that the game is getting stale for them because it's kind of the same thing and I know the devs don't want the game to get stale I know they want the game to keep being played so maybe that's why we don't have all the cars right away or all the content out right away because they're trying to do it and release it in strides so that you know there's a reason for us to keep playing and if that's what they're doing then you know it's probably a smart tactic and you know they probably know what they're doing so like I said make sure you guys follow me on all social media and if you guys have any other ideas let me know down in the comment section down below we're just running walls with us super right now so I think we're gonna finish this battle off and we're gonna end this episode off here for today and I hope you guys enjoyed this episode I hope you guys enjoyed my take on what I think the game should have if you guys agree with some of the things let me know as well down in the comments if you agree or if you disagree let me know because like I said I stay very active in the comments section they say very active on Instagram and stuff like that and I try to stay very active on the Game Hub so let me know what you guys think if you agree if you disagree if I miss something and you think it should be in let me know because I'd be very curious to you know get into some discussions about what you think the game should have because I don't think maybe it's you know maybe because nobody's really making a discussion about it or something like this that maybe this will help in increase the game you never know they're listening they're watching they put me in the sponsor tree for a reason and you know maybe they're watching what I'm saying you know I know they're watching because they watched my videos and you know they've been in the live stream so maybe you guys commenting on the video and like this video and stuff like that we'll get them to watch it and maybe something will come out of it can't promise anything but it's always was a shot so as always I think you guys coming back and watching I appreciate all the support on the channel I appreciate all the comments like I said I do try and be very active in the comments section so until next time guys I'll see you guys on the next one


Hey fellow buddies. Thanks for watching. Okay. This is a Poshmark. What sold video? Don't leave these things sell on eBay also. All of my items are cross posted to eBay, Mercari, and eBay, Mercari, and Poshmark except for the items that Poshmark does not allow. But what I wanted to say is these items just happened to sell on Poshmark first. So this will give you an idea of what items sell well and faster on Poshmark, maybe. I don't know. Anyway, I'm gonna tell you where I got it, what I paid for it, and what it sold for. These are Bolo items. Items to be on the lookout for. That is the basis of my whole channel. If you guys are new, be sure to check out my category Bolo videos. Videos like about like things that you can find in the bathroom that are Bolo's. Things you can find in the garage. I have a Christmas Bolo video. I feel like I'm getting a little bit of a delay. So sorry if I am. Halloween video Easter. I've got tons of Bolo videos. I feature sellers, other YouTubers, other people that are in my Bolo Buddies Facebook group. So definitely check out my Bolo Buddies Facebook group. Links are down below in the description of the video. And I have said enough. Let's look at these. What sold? All right. What sold on Poshmark? Let's do this. Okay. And the first item I sold is this, well, I should say my husband sold. This is one of his items. It's a Caravell men's watch. So he sold this for $40 and on Poshmark, the buyer pays the shipping unless you send an offer with a discount. Which I don't know if I did or not. So the next item are these a lot of 14 men's ties.  So if anybody is looking for men's ties, I have them listed in my Poshmark closet. I purchased these from a moving sale. I wish now that I would have done smaller lots or maybe sold them individually, but at this point I'm not starting over. So these sold for $20 and the buyer paid the shipping. And I bought the whole box for $5 and there was probably over a hundred ties. The next item came from my, I bought it on eBay to sell on eBay. My bulk buy of 344 pounds of jewelry. These earrings are amazing and this is what they look like on the back. They sold really fast for $40 and the buyer pays shipping on Poshmark. So definitely be on the lookout for this brand. It's Laurel Birch and these are vintage and very cool. Kids clothes. I talked about this and I talk about this in several of my videos, but I buy kids clothes at garage sales and I usually don't piece them out. I usually just say, how much do you want for all of your kids clothes? And then I bring them home. I sort through them. It's quite a task, but they seem to do well on all platforms. So I lot them up in small lots like this. I sold this for $15 and Poshmark takes 20%. So not a huge profit, but if you can bundle it at a garage sale for one price and get stuff super cheap, it's definitely worth it. And then I just let them know that I have a bunch of kids and baby clothes listed when I do that. So definitely something to think about, something to consider. It is a lot of work sorting through the items and making the lots, trying to find the sizes that are the same, but I think it's worth it and it's fun. Well, it's kind of fun. I do it when I'm in the mood. Otherwise they sit and they wait on me. The next item are these Lane Bryant pants.  I picked these up at a discount store for $3 and I sold them for $15 and the buyer paid the shipping. I have tons of clothing items in my store if you are a subscriber or if you're watching this, I guess. Feel free to check out the links below. I have links to all of my selling platforms.  All right, this item is a Kaseek bikini top and it sold for $25 with the buyer paying shipping and I picked this up at a discount store for $3. It's super cute. The next item are these Express Joggers. This is an older listing because you can see I still have it on the carpet. I picked up probably 50 to 100 pair of these at a discount store. I paid about $3 for them. Sold this pair for $18 and the buyer paid the shipping. And I have quite a few of these left. So if you're interested, come check out my store. The next item, again a very old item you can tell because I have it on the carpet. I don't do that anymore. I sold these for $13 and the buyer paid the shipping. I picked these up for a buck or two at a discount store. I think these were a dollar if I remember correctly and sold them for $13. This is a retail arbitrage item. I paid, I'm going to say between $6 and $8 for this. I picked this up online and I sold it for $25 and the buyer paid shipping. Retail arbitrage items you're not going to make as much. Now if you're at a discount store and it's on clearance, there's bigger margins there, but this was, I bought this online. So it's new with tags. Nothing's black lined. It's like you bought it from the store. The next item is a retail arbitrage. Picked it up at a discount store for about three bucks. I sold this for $15 and the buyer paid shipping. This is new without tags. It does have the sanitary liner in it. This is one of those items where I lost my photos. So, nope, I'm sorry. I was thinking I only had one. It was a different listing, but you can see this item is black lined. It does have the sanitary liner, but no tags. So it is new without tags. This is a Victoria's Secret Brawl discount store. Paid about three bucks for it. Sold it for $16, buyer paid shipping. These I picked up at a garage sale for a couple bucks. They're Doc Martens. They are a toddler's size six, so they are small. Sold them for $25 and the buyer paid shipping. This Batman ring sold to a subscriber. It is super cool. I think it is vintage and it does have some issues. You can see it's got some plate wear and that's fine and dandy. People still look for items like these because they're hard to find. I could not find this exact ring when I tried to find comps and I did not clean it up or anything, so it may clean up a little, but just disclose. I put pre-owned does have condition issues, plate wear and discolorations. Not sure of age. Sold as is as seen and again a subscriber bought this. So thank you so much. I really appreciate it. I hope you're enjoying your awesome Batman ring and I appreciate you and I thank you for helping support the channel and thumbs up. Thank you so much. I get so excited when my subscribers buy things. Links to all of my stores are down below in the description of the video. This item came from my bulk buy. I bought it on eBay to sell on eBay. 344 pounds of jewelry. If you haven't checked out that playlist, definitely do that amazing find. All right. I want to take a minute to say please hit that thumbs up and I want to show you my Instagram. My Instagram is below underscore buddies underscore resellers and I'm trying to build up my Instagram following. So please come check it out and I do some different things on there and I wanted to share that my video where I wore the hat from the items that I got free at that garage sale, I decided to list the hat. So it is up for sale and all three on all three platforms. So if you're interested, this is what it looks like. Feel free to make me an offer and I do do I do do some different things on Instagram. I post the little videos. I've been trying to incorporate some of the videos into some of the unboxings and stuff like that. I put them at the end just for fun, but you will definitely see some different stuff different from my Facebook group, different from my YouTube channel. So definitely go check it out. I make giveaway announcements, different things like that. I show you like how I packaged this item. So if you're not following me on Instagram, I would greatly appreciate it and I just wanted to give you a little shot of that and Instagram is posted down in the description if you guys want to go check it out. Thank you so much. I appreciate it and I hope to see you all on Instagram soon. All right, this I purchased from Trinox Connection. He was doing an auction on I believe it was T's channel auctions for you and he had a North Face law and there were a couple of North Face shirts that I was interested in for my husband and I figured I could resell the rest. This literally was just in good condition. You know, mow the lawn, rake the leaves type jacket. It's pre-owned, show signs of wear. I just disclosed that. I sold this for $15 in the buyer page shipping. The next item is this retired Boyd's glass Jeremy frog. I have sold a bunch of these frogs. I sold this one for $20. Most of them have sold on eBay, but this little guy sold here on Poshmark, $20 in the buyer page shipping. I got this at a garage sale in a bulk buy of all these glass frogs. I think it's like a quarter, 30 cents maybe. I can't remember the exact number, but not much. Very happy with that. The next item is this vintage Mary Kay case. I bought these at a garage sale for a dollar each. I had two of them. The other one recently sold. I am very happy to see them go. I think I had them priced too high. I thought they were more special than they were. This one sold for $25 and buyer page shipping. The next item is this Jake in the Neverland Pirates outfit. I got this at a garage sale. I think it was a dollar or two dollars. I can't remember, but I sold the other one. I bought two of them. I want to say they were a dollar each. Sold it for $15 in the buyer page shipping. This Hope Faith and Live wall hangings. I purchased these at a garage sale. I just did this to show the measurements. Easy peasy. Then they know. I sold this for $13 and the buyer page shipping. I picked these up for a buck or two at a garage sale. This vintage agent, small handheld mirror. I want to say eight to ten of these up at a thrift store. I thought about lauding them together and then decided to sell them separately, which I'm glad I did because I'm going to make way more money selling them separately. They are super cool. I want to say it was either $8 or $12. For some reason, those two numbers are in my mind. Then I had a 35% off coupon. I'm going to say I have less than a dollar in this. Very cool item. Sold it for $25 buyer page shipping. This Kaseek skirt came from a discount store. I had about $3 in it. I sold it for $18 buyer page shipping. Photo album. Great item to sell on Poshmark because if it's five pounds or less, they pay $7.11 shipping. I think on eBay, if the shipping would have been a lot more for a priority mail package based on the dimensions and the weight. I sold this for $20 in the buyer page shipping. These cute little London fog toddler shoes sold for $12. Again, just a pre-owned item. Garage sales. Perfect place to get things like this. These look to be in really good condition.  Overall, $12. Not a great Bolo, but definitely an easy to list and flip item. This is a bundle that I sold on Poshmark. $42 was the offer price. Poshmark took $8.40 and my earnings were $33.60. This necklace came from a, I believe it was an estate sale. I've had them listed for quite a while. This is from my bulk buy. I bought it on eBay to sell on eBay. Part of that 344 pounds of jewelry. I think they probably, I don't know, this was a newer listing. These were older. I went ahead and took the $42 offer and I was very happy with that and my earnings were $33.60 and I'm going to say I have less than two bucks in all three items. The next item are these bracelets. I don't know. I think I did a video on it. I bought a whole table at an estate sale. I have had this listed for quite a while, but somebody bought these three bracelets for $50 and they paid the shipping. This Victoria's Secret baby doll I sold for $20 and the buyer paid shipping. I paid $3 for this, but I did have my, the gal that does my consignment stuff, I did like a test run of having her list a tote of Victoria's Secret items for me because I just wasn't getting it done. It was a whole tote. I don't remember how many items there were, but I paid her. Gosh, I can't remember. Maybe $5 or $600 and she listed all of them. Some of them were duplicates, so that was great. I'm going to say that I probably ended up having between $0.50 and $1 for her to list each item. I cannot remember what the breakdown exactly was. I think it was closer to a dollar. I had about four bucks in this by the time I paid her that extra fee to list the item for me. Typically, I just give her my items and she consigns them at a 50, we do a 50-50 split. I give her the items. She does it from start to finish and then she gives me a 50% payout. This was a little bit different because I just wanted to get these items up in my Poshmark closet. The next item is this brawl. This was a retail arbitrage. I bought it online, brand new from the store, sold it for $26 and the buyer paid shipping. I sometimes will source online when I have coupons or when they're having a sale. That's what I did with this item. This lot was a, I think these two were garage sale items because they are new with, I'm sorry, they're pre-owned. This was a discount store. I think I paid $3 for these and this was a discount store also and I think I paid a buck for those. I probably have about $5 total in all of these items so I went ahead and took a $40 offer. Poshmark took their $8 and I earned $32 on this lot. For those of you that have made it this far, would you prefer if I showed you each listing like this where it shows the breakdown of what I made but you can't really see the item or do you like the way I'm doing it? Comment below. This brawl just sold today. I sold it for $15. I had approximately $3 in it and I picked it up at a discount store. These jeans also sold today. I picked them up at a discount store and about $3 all in and I sold it for $25 in the buyer page shipping. These are my Poshmark solds and let me know how you would prefer to see that if you want to see the breakdown of profits or if you prefer to see the picture bigger so that you can actually see the item. As always, thanks for watching. Be sure to like, comment, subscribe, and share. I have Mercari what sold videos. I have eBay what sold videos and I have Poshmark what sold videos and I have one Etsy what sold video. I am newer to Etsy still learning trying to figure out that platform, trying to build up my feedback so hopefully there will be more of those in the future. If you go to my playlist section, there are playlists if you want to look up like certain things. As always, thanks for watching. Be sure to like, comment, subscribe, and share. I don't know if I already said that. If you made it to the end, comment, I made it to the end and tell me below what platforms you sell on, what your favorite platform is, and if you're thinking about branching out to other platforms, let me know if you have any questions. Thanks for watching.


sort of agile coach, agile trainer, consultant, all of the above really, and if you ask my mother, my mother will tell you one called Pixie. Once was on bodyguard detail for the queen. I have any phobias, but I have an extreme dislike for mushrooms, I'm kind of bare to have them on my plate. In an apocalypse, if mushrooms are the only things that are left, I think I would choose to die. I'm probably buying my flat, it's one of those kind of landmark moments of your life. I cannot ride a bike that I'm quite creative, I'm smart, and I like to try and do new things and I'm a fast thinker, really competitive, really competitive, and that'll probably come out for the course of the day.  Like everybody else, I'm sure you're going to do really well, but ultimately they can be only one winner and hopefully that will be me.


Okay, a question here about social media engagement. And I've gotten this question over the years. Basically, the person's asking, like, do I need to engage with other social media channels and accounts so that the algorithm will try to reward me with more visibility on my content? Now, they're not talking about replying to the comments underneath their own content. They're talking about like, oh, let me go and engage with this account, that account, this account. And that somehow helps the visibility of my content. This has been a long-standing myth. And the reason why it's so long-standing is because there's a seed of truth there, but it's not what people are thinking.  So we're gonna show them your stuff too. It doesn't work like that. The algorithm does not work like that. Trust me, okay? Because I have plenty of people comment on my stuff. I never see their stuff, okay? No, seriously, okay? And not just, you'll find this to be true yourself when you scroll, you know? So here's what's actually happening. When you comment on other people's stuff, they might get curious about you and click over to your page and they click over to your page, that's considered an engagement right there. Now, that's a weak engagement. Now, if they click over to your page and then do something more, like they'll read some of your posts or watch your video or click like or that's even stronger engagement signal.  They haven't even followed me, not gonna see my content. But if they follow me, they came over because they're curious about my comment, they came over and they followed me and then they looked at some stuff, maybe clicked them. Then social media is like, hey, well, that's your new friend or your new follow. You got interested in this person. This, let's say Wesley, I went over to Wesley's thing, I commented, Wesley got curious about me, came over, followed me, then the algorithm will say, hey, Wesley, you've got a new person you're following. We're gonna show you their stuff. We're gonna partly test whether you're really interested in this guy's George's stuff. And so, yes, Wesley will start to see my things, but you see that it's not because, yeah, so now you know how it works. It's really the curiosity of the person if they follow you. And also, if I comment on Wesley's thing and my comment is interesting, Wesley's followers might get curious about me, click over to my thing, follow me, comment on my thing. And here's the thing, if Wesley's followers are commenting on my things and Wesley follows some of his followers, you see where this is going, then Wesley might see the fact that some of his followers are commenting on my thing, even though Wesley's not following me and the algorithm might, you know, so it's really more like that. It's not some magical, wow, gosh, I'm just gonna comment on a bunch of people's stuff and therefore the algorithm will make show my stuff to all of them, it doesn't work that way. So I hope this is helpful.


Hello and welcome to People's Dispatch. Today, we're joined by Dr. T. Sundar Raman of the People's Health Movement and the Jan Swastia Pyan. And we're going to be talking about the World Health Organization in the light of Donald Trump's announcement that he's going to cut funding pending a review. Thank you so much Dr. Sundar Raman for joining us. So the first thing we wanted to know was, of course, we've seen the political aspect of it. Trump has been trying to find a scapegoat. He's blamed China. He's blamed WHO. He threatened last week that he would withdraw and finally two days ago he did withdraw support to WHO that is. But in technical terms for the World Health Organization, what is a funding cut of this size and at this point of time mean? It is a serious setback because many of the WHO funds are tight funds. I can't use that liberally. When an emergency arises and much of their core works out of something called the CES funds, where each nation which is a member pays something in proportion to its GDP. So not surprisingly, the largest single donor will be the US. The US has already got arrears even before it has the tune of $200 million. And it has chosen from the 1980s, mid-1980s to freeze its contribution initially or to a percentage and then later in nominal terms also so that it pays the same amount instead of letting it float with the GDP. So therefore the US instead of paying as part of the CES, it moves its contribution to what are called voluntary donations which are basically bilateral agreements which are signed with WHO which have very project specific and very clearly earmarked so that it in fact in effect and doesn't allow WHO autonomy on display using its funds. In effect it means the autonomy of the WHO to spend that money on its sense of priorities is completely abridged and there are certain vertical programs that they each choose to focus on. It also means that in a number of systems development areas the WHO will be subcritical in its function. Now as it stands, the US and its allies, especially in the developed world, who not only mechanisms of funding but mechanisms of bilateral negotiation and by its overall influence, dominate every key appointment and decision making, all the resolutions are meted by it and therefore it is very surprising for them to actually be seen as having been not supporting them enough. The point is that currently there is a great perception of threat within the US with respect to its own rather poor performance which is now being increasingly compared to China much to its own. So whereas we are now exceeded in deaths and in a number of cases far beyond the Chinese, they need to now point fingers and say no the Chinese under reported. They may have, they may not have that's beyond the point but it's really not in WHO's remit. Does the WHO stand guarantee to the US figures or the India figures or the figures of any country? It's not within its scope. There is a diplomatic protocol. It can persuade, it can negotiate. It is not like the IAEA, the atomic energy regulation that it can go in and command an inspection and demand papers. It has to go by the record. But in terms of its international commitments, it had raised it to a global pandemic by January 30th. It had already called upon isolation and identification and contact tracing as mandatory requirements. Now remember if you actually freeze international contact travel, then there are huge economic implications and countries do not like that being done easily nor is it necessary unless you are unable to restrict flow from a particular country. Otherwise, and WHO has sort of quietly maintained it even as compared to lockdowns, what are really required is the process of identifying, of quarantining, of contacting. These are what is really going to sustain you in the wrong level. Anytime now international travel will restart and with it when it starts the virus will restart. The world has lived yellow fever for years. It has lived with Zika virus. It has lived with Ebola. We don't have to have complete star cessation of international travel. This is a new virus but precautions are needed and to that extent the WHO had warned. So I don't think the WHO can be faulted on its performance. What is really there is a delayed response from the US in starting up contact tracing, in being serious to the thing. They first started with suspending flights but even after that more than 3000 flights have come in from China and that was anyway not the main way. Trump himself came to India on February 24th. He had a major event over here with lakhs of people attended. Obviously that sense that you need an international travel restriction had not happened at that time and it's not anybody's particular fault because the focus of the epidemic in any way shifted to Europe by then. China, even China's distant provinces have not really gone into the epidemic. The epidemic has been largely confined in the Hubei province. So it was what measures were taken are adequate as of today. So also to continue a bit more on the WHO aspect itself. So you mentioned about how say the funding has now been connected to certain programs and certain verticals and how it's very almost corporate in terms of deliverables in terms of performance measurement metrics and issues like that. So what is the more problematic aspect of this kind of a model of working when you keep say public health as a concept on the other side? Essentially that your autonomy in terms of prioritization in terms being able to build capacities of member states or being able to support a higher degree of self-reliance approached. You are not able to work within a health systems understanding rather than a vertical understanding. So you have the GFATM will support your interventions in tuberculosis and HIV but when it comes to larger disease surveillance for example that sort of support is not forthcoming and this is within that sort of area or if you are supporting nations to be more self-reliant in essential health commodities the WHO is not in much of a position to do that. It has done some important work in pooling of for example for flu pandemics to create a patent pool it has taken such measures but those are precisely the measures. So behind the US insistence is also that potentially as the US overcomes the hum the developing nations are going to need a lot of the supplies and other than China the next big supplier is the US and at some point the building of US monopoly in testing kits and in vaccines and in ventilators are things that we need to worry about a lot of patents have been released for 3M on the ventilator side a lot of patents have been released on the testing kits side. Now at some point whereas the US the WHO is going with the Costa Rican proposal for patent pooling for being able to have a pooled resource these areas of the future play out of COVID-19 and corporate profits may be some of the concerns so it may not just be anger and distraction it may also an attempt to monopolize the global supply chain in a post COVID-19 pandemic phase and also question the authority of the Chinese who are now in effect commanding 80% of the supplies saying roughly for example almost all the supplies of PPEs testing kits the orders that we have placed are gone to China right and identify mass so and finally as far as the countries of the global south are concerned and for a matter for that matter when you look at say India's role in an organization like WHO at this point what are the possibilities they have to sort of say shore up the position of this organization when the US is taking such a stand. So the positive news is that the African countries have tended to strong stand up strongly to the US and being able to express their dissatisfaction with what the US has done. Some of the European nations have also expressed it and his credit Gates Foundation has also expressed it but the Asian nations have been remarkably silent and India as a major player has been remarkably silent in this particular role and that is a serious failure. So too have nations like Brazil been very silent in this issue and I think it is important to recognize that without this oxygen of support the WHO will be even more stressed after all whatever the US is unhappy with it is Lisa V the way WHO reaches out to the LMICs the low and middle income nations and in fact the LMICs will become far more dependent on US hegemony if the WHO is not there to act as a barrier and it is in their interest to speak out but unfortunately except for select African nations we do not yet see a response from other nations. Thank you so much Dr. Shankar, I am going to talk into this.