Good morning. First, before I begin my talk, I just want to take a moment to thank the Planning Committee for putting this conference together. So thank you, Deb, Kathy, and Anne. And if I've forgotten somebody, I apologize. So the evolution of ventricular assist devices at Texas Children's Hospital. Let me just say it is short of miraculous the changes that I have personally witnessed over the last 25 years. Going from having nothing to offer children and infants to what is available today. And I would like to share that with you. These are my disclosures. I thought this picture taken 25 years ago would be an appropriate way to start my presentation. Me standing between Dr. Bud Frazier and Dr. Robert Jarvik. What great bookends. Dr. Frazier is who first placed an assist device in one of our patients back in 1989. And now our newest VAD that we are currently trialing was designed and created by Dr. Jarvik, the Jarvik 2015. Here are all the assist devices that we have either inserted or implanted over the last few decades.  You know, what I discovered while preparing this presentation was that Texas Children's has been recognized as the most active pediatric VAD program in the world. I mean, I knew we were busy, but I had no idea that we held that recognition. I will address each one of these devices in chronological order along with their positives, negatives, and outcomes. So let's start at the beginning. The Hemopump. The Hemopump was the very first intravascular continuous flow device developed. And there is an interesting story behind the pump. And it has to do with its inventor, Dr. Richard Wampler. So during his medical training, he went on a mission trip to Egypt. And while he was walking along the Nile River, he saw a water pump using the Archimedes screw principle. And he stated that about 10 years later, he had this Eureka moment to miniaturize the pump using the same principle. But the motor back then had to be on the outside of the body. So it was strapped to the leg. Texas Heart Institute actually began FDA trials in 1988. And then in 1989, Dr. Frazier inserted a Hemopump into an eight-year-old patient who was suffering from acute rejection. And she was supported until she recovered. There's a picture down at the bottom of the screen. And that is a picture of Dr. Wampler, Dr. Frazier, and one of the Hemopump patients at Texas Heart Institute. And interestingly, this pump is the precursor to the current impella. And next on the list is the Medtronic Biomedicus BP50 and BP80, which all of you out there who are listening today are probably quite familiar with this pump. It's a short-term centrifugal device. It can be used as an L-VAD, R-VAD, or Bi-VAD. It primes easily and is very quick to place on a patient. Now, at Texas Children's, we never shied away from placing a patient on a VAD versus ECMO as long as their lungs were in good order. So this particular patient on this slide was born with critical AS and required postcardiotomy support within his first 24 hours of life.  The negative of the Biomedicus is the intense heat generated on the backside of the pump. And it required us cutting out the pump about every three days and replacing it with a new pump. The Biomedicus was used from 1989 to 2008. We inserted a total of 28 as VADs, 17 weaned, three bridge to transplant, and five bridge to another device. Next on the list is the ThorTech P-VAD and I-VAD. It is a long-term pulsatile device. It also can be used as an L-VAD, R-VAD, or Bi-VAD. And the positive actually is the console. Even though it's big and plunky and weighs over 500 pounds, it actually, the rate is variable on it, according to the pump fill. So if you're hypovolemic, your patient is hypovolemic, the pump would actually slow down. And if the patient became hypervolemic, the pump would speed up automatically. So this, I thought, was fairly sophisticated for such an older style console. The negative is that the P-VAD is opaque and impossible to visualize the blood chamber.  And you do this, this picture right here doesn't really show it very well, but we use a flashlight and put it up next to the pump. And if you see a flash, that would indicate that the chamber was fully emptying. We implanted a total of nine P-VADs, one I-VAD, and we inherited one I-Bi-VAD from Hurricane Katrina, who was airlifted to us. And we had a total of 11 patients, seven who were transplanted, and we used this from 1999 to 2007. Then came the Micromed debakie child assist device. And we were all very excited about this because this was the first implantable continuous flow device designed just for children. And oddly enough, its range was in age rather than in weight. So it was six years old to 16 years old. And what we found is that we really struggled with this pump for two reasons. First, it had a physical flow probe attached to the conduit and in smaller sized patients it just was very bulky. And then secondly, the platelets tended to stick to the blades and we had a lot of power surges. And one patient actually had to be placed on platelets to get through to transplantation. We used this from 2004 to 2005 on three patients and two were transplanted. Next came the Berlin heart assist device, which is a small version of the Thorotek P-VAD. It's a pulsatile and it also can be used as an L-VAD, R-VAD, and by VAD. It was the first long-term device for infants and toddlers. And although unlike the Thorotek, the rate was not variable. It was set. But with this device we could visualize the blood chamber. And if we saw a beginning of thrombin, we would change it out and do change it out quite frequently. But it's very quick, easy to prime, and we do it right at the bedside. It only takes a couple of minutes to change out. When we began using this device back in 2005, it wasn't used in the United States. When FDA approved. So we were required to petition to the FDA for compassionate use on each and every patient and then order the equipment from Germany. Then in 2007, we did enter into FDA trials. Texas Children's actually acted as the PI for this trial. And then in 2011, it did receive FDA approval. And this little fella right here sitting with Dr. Frazier was our very first Berlin heart recipient. He at the time weighed 3.3 kilos when he was implanted.  And you could see her picture throughout Houston on many Texas Children's billboards. Up to this date, we have implanted a total of 57 Berlin hearts. 49 have transplanted, one ex-planted, and we have one active patient. The next on the horizon was the heart mate too. Finally, we had an implantable, continuous flow design that was small enough to put into teenage males and females. And actually, it was also the first device that our patients could be discharged home. And actually, Texas Children's was the first pediatric hospital to discharge a patient home that had an assist device. The positive was that it rarely had any kind of thrombus formation inside the pump. And the only negative that we saw was that it was still too big for small teams. We began implanting this pump in 2008 through 2014 and planning a total of 17 patients, 13 were transplanted, and one was ex-planted. The next pump that we introduced into use was the McKay rotoflow centrifugal pump. This also is a short-term device, and it replaced the Medtronic Baumeticus. It actually has a much improved design with very little heat generated on the backside of the pump. So even today, we rarely have to change out one of these pumps while they're in use. Also, the console includes a lot of safety features, such as a bubble detector and a low-pressure servo regulation. The negative, like all short-term vads, is that there is a chance of possible air entrainment, and the patient does have to stay immobile. We started using the rotoflow in 2009, have inserted a total of 39 patients as vads, 15 have weaned, one transplanted, and 16 bridged to another device. The next pump that came down the chute was the tandem heart. This is a short-term centrifugal pump that can be inserted in the cath lab, and you insert it through the femoral vein up into the right atrium, through the septal wall, and then into the left atrium. We only used it on three patients, and that was because, as the nurses were repositioning these patients, all three patients' catheters flipped out of the LA and into the RA. So, after these three experiences, our surgeons were pretty much done with that device. We used it from 2009 to 2010. Two patients weaned quickly, I must say, and one patient was bridged to another device. Then we were introduced to the Sincardia Total Artificial Heart. It is basically two thoratex, literally velcroed together, and it replaces a heart that is in complete failure. It's now available in two pump sizes, the 50cc pump and the 70cc pump, but it still requires quite large chest space area. With our first patient, up at the top picture, all we had available was our big blue console, weighing in at over 500 pounds.  And then for discharge home, the freedom driver is available, and this particular patient right here is, he has his freedom driver on inside his backpack. So we began using the Sincardia in 2011, and both of our patients were successfully transplanted. Then a new, small, innovative, implantable, centrifugal assist device came along, the heart ware. This theory was conceived actually right here at Texas Heart Institute by Dr. Bud Frazier, then engineered by Dr. Richard Wampler. The heart ware is small enough that we can actually implanted in toddler-sized patients, but actually it can go on to be able to be placed inside large adults. And because of its centrifugal design, we rarely see any kind of thrombus formation inside the pump. To date, our smallest patient that we have implanted is a three-year-old, 13.2 kilo toddler, and he is doing quite well. This particular patient over here, right there, actually was our very first heart ware recipient, and she was actually in middle school nine years ago and was implanted as destination therapy. And since then, she's traveled to London for her make-a-wish, and in this picture, she is actually headed to her senior prom, and right now she is completing her freshman year in college, all with her original heart ware pump. So only downside of this device that we can find is there is a weakness in the patient driveline. Or maybe our patients are just hard on the drivelines. We're not really sure. We began putting the heartwares in patients in 2011. We, up to this date, we have implanted 65 patients, 40 of which have been transplanted, five have ex-planted, and 15 are currently active. The impella, again, it is a redesign of the hemopump, and is the only FDA-approved intracardiac continuous flow pump that's on the market. There's two flow sizes available, 2.5 and 5.0 liters per minute, and both can be easily inserted in the cath lab. And there is an impella that's designed for the right side of the heart, but we haven't had a chance yet to use that. What we have found, though, is that it's very beneficial to use the impella in tandem with our ECMO patients, and it helps decompress the left side of the heart. We began using this pump in 2014 and have inserted a total of 31 with 28-weened, one bridge to transplant, and two bridge to another device. Now, this past year, Texas Children entered clinical trials on a new device, the Jarvik 2015. It is an implantable, continuous flow device that can be placed in infant-sized patients. We have found that the study criteria is rather strict, and because of that, of the four patients that we have implanted, only one has officially entered into the trial, and the other patients were implanted as compassionate use. We did find that there was homolysis with all of these patients, but it was manageable, and one patient did have several power surges to the point that we went ahead and changed out the controller. Three of the patients did go on to bridge to transplant, and one was ex-planted, and all are currently doing very well. And you'll notice at the bottom of this slide, there are two publications noted. They are both written by Dr. Ikki Adachi, and they're describing his experience with the Jarvik 2015, if you're interested. And then earlier this year, 2020, we implanted our very first HeartMate 3, and it's much like the hardware in design. It's just a little bigger and a little heavier, and so we're going to reserve this particular pump for our adult-sized teens. There's a unique feature of the HeartMate 3, and that is that there's this artificial pulse every two seconds, and it's to better flush out the pump and reduce production of the thrombus. So so far, we've placed three of these pumps, and all three patients are now waiting for transplant. And then what is out there for the future? Well, the bivocor is a total artificial heart using centrifugal design, and it currently is an animal study testing, and it does show a great deal of promise, so we might see it on the market before too long. Also, wireless vads are coming closer to reality for implantable pumps. So if this does come to pass, there won't be a driveline to deal with. There'll be fewer infections, bad patients can go swimming, bathe, shower without any worries. And before I end my talk, I would like to give a huge shout out to both Barb Elias, our VAD coordinator, and Dr. Iki Adachi, our VAD medical director. I cannot begin to give enough kudos for each of them and their dedicated work that they give every single day. And again, it has been an honor to participate in this conference because Texas Heart Institute has and will always be my home. Thank you for your attention today.


Hello, Oslade Sink here. This little artifact here is Oven from Crow's Electric Music, a small company from Vancouver, Canada. And it's an instrument that I've really been enjoying recently. And I want to share it with you. This video is not sponsored, I bought this with my money, and the only contact that I've had with Crow's Electric Music was to ask them who their retailers were in the UK. But I'm keen to try and shine a light on interesting instruments from smaller makers. And this certainly is an interesting instrument, at least to me. Let's give it a little reverb, why not? And in this video I want to introduce what Oven is on a technical level, but also how I've been enjoying using it, and how you might enjoy using it. So let's talk about what we have here. So Oven is conceptually a really simple instrument. It's basically five things repeated, each of these columns here represent one of five voices. And each of these voices have a slider which gives us a volume for that voice. We have a pitch knob here which allows us to change the pitch of the voice freely. It's unquantised, just knob to pitch control. This toggle switch here allows us to switch between two different waveforms, a triangle wave which is the core of the oscillator, and also a square wave. This knob at the top is a tone control which is a simple low pass filter. And you can hear even with the triangle wave that there's a good bit of fluff on top of that fundamental for us to filter off. The range of the pitch goes down sub audio where we get clicks on the square wave up to that pitch there. Of course the fun comes when you start to combine different frequencies because everything is freely tunable we can find interesting in between tones where we can hear the interaction of the different voices. And although it's fun to play with it solo as kind of a sound toy I guess certainly a device which likes to play well with others. So for example adding some reverb immediately brings us into a lovely space for these different voices. And it's also absolutely lovely to add some overdrive to because overdrive or distortion always emphasises the differences between voices. So while we're on the subject of smaller makers this is the accomplished badger from Frederick FX. This is the Mark 1, there's an even better Mark 2 when it's pretty much my favourite drive for electronic instruments. And when we bring in the drive the relationships between yes the different voices become more obvious and things become dangerously blissful or frighteningly discordant. And although it's fun to use it just on its own to create these lovely drones I found it particularly gratifying to pair with other instruments. So for the bulk of this video that's what I want to show you. Some pairings that I found enjoyable with Oven. This is the Wingy 2 from Menki, an instrument that probably deserves its own video if I'm being honest. It is a digital stereo resonator. At the moment we're just hearing the dry sound from Oven albeit with a healthy dose of reverb of course. But if we bring up the mix on me we should be able to start to hear some of those resonances. Because we have these freely tunable voices on the Oven we can really go and search out the various resonances. And because it's in stereo with different resonators on each side it provides a lovely spread. This oscillator is currently set up on the square wave and down in the clicks. So this should excite all the resonances all at once. It pings them. Which is right, rather lovely. I've got the version 3 firmware on Wingy here which allows me to access the alternative tunings in this particular mode. I think this is the well-tuned piano temperament. It's rather haunting. And if we go full wet on Wingy, I'm pretty much just listening to the resonators at this point. I can kind of strum them by detuning and retuning the voices. We have very small movements we can find. It's lovely. Sometimes slightly dangerous resonances. It's a rather lovely time. It is quite meditative and kind of the combination you can really get lost with. There's Oven on its own. There are those slightly dangerous resonances. Yes, quite lovely time. We live in a world where we've literally never had better access to high quality sample libraries, paid for free, instantly downloadable. And it's a wonderful thing if you want to work with samples on a sampler. However, there's something extremely satisfying about sampling something that is new and using a sound that literally has never been used by anyone else ever because you've just recorded it. And the Oven makes for a really lovely sample fodder. So let's sample a couple of things. Scroll to that. And what I've got here is just a square wave on every single oscillator all tuned to the same note to make the fattest super square in the world ever. And let's just grab a few seconds of that. Maybe probably four or five seconds will do. Yep, lovely. Thank you. Turn all those back down and we will save that. Yeah, we'll terrible sample management. I'll stick it on eight. That'll be fine. There we go. We have a square super square there. So maybe shape that a little bit with an envelope, a little bit filtering. Yep. Go to that. Let's make a high hat.  Yes, please. Don't need much of it because I'm going to be short. And yeah, we'll keep that and we'll stick it on closed hats. Resonance. Let's make a kick drum. So we'll just grab, go away. Wrinkles with detune between them. Yes, please. That'll do. And yes, I want it. Yes, we can call it that and I want it there, please. And we'll bring these friends back up. And yeah, we're building up a track, which is all of our own because no one else has these samples because I've just made them. Hope it won't last thing unless maybe like a chord or something. Save that and we'll stick it. Yeah, so we've got our very own samples from the FM that literally haven't ever existed before. And that's always so much fun. But if sample several redux just to get some of that woodiness in there, that's nice. And we can go on and build a whole track just using samples from the open. If we wanted to, of course, other instruments are available to sample from. I'm going to simply play with this for a bit longer. I'll let the video transition to something else. So we should take a brief moment out from exploring the sounds just to talk about the build and the IO. Firstly, what's probably not obvious from this sort of top down view is that most of the unit is actually made out of reclaimed wood with rounded edges here. The top panel, I believe is aluminium. That sort of looks that way from the side. The knobs and sliders, the knobs feel good. They have a nice deceleration on them. The switches are, well, there are many toggle switches. They feel like many toggle switches. The sliders are not the smoothest in the world. They're certainly not unpleasant. They do have a bit of wobble as well, but then sliders almost always do. I'm not particularly worried about them in normal use. But in terms of the overall look and aesthetic, I really, really like it. Taking a look at this top panel here, we've got a volume control just on a slidey pot here. We have our output, which can also drive headphones, so it will push out a left and the right signal. So just be aware that if you plug in a TRS jack into here and plug it into a balanced input, you might have issues in terms of the signal dropping out, same way as you do with Valkers. And the power is on USB type C, so although it doesn't have a battery inside of it, you can power it off a USB power bank. And the power requirements are pretty low, so it should last a good while. I guess if there was a main reason I wanted to pick up the Overmits this, and I was to use it as a side car oscillator bank for the LiRate. The LiRate, obviously, is a wonderful synth for drones and ambient music and experimental music. And part of its fun and why it's an enjoyable instrument is that it has an element of unpredictability to it, the way that everything interacts is chaotic in a way. And sometimes at the patches I made I was kind of left without something to hold everything together. And so I thought the Overmits would be perfect to introduce something a little bit more controlled and static to hold everything together. And I could now combine chaos with something a little bit more controlled if I needed that. And because it's going through the external inputs, it's still able to take advantage of the delicious distortion, the self-mode on the delay. So we are actually affecting the modulation of the delay by putting stuff in on the Overmits here, which is always fun. I think if you own a LiRate, it could well be that the Overmits would be a very good friend. The Overmits is fundamentally a bunch of oscillators in a box. So if you have a synth with a number of oscillators and an audio input, like the monologues or an external input that's sometimes called. And we want to add some oscillators to the synth. We can do that with the Overmits, especially if we're interested in introducing a static pedal tone, which allows us to establish harmonic ideas. So there's a nice bass note in there that's staying static against the melody. That's what I'm highlighting. 20th thing happening in there. Another chord tone. And because it's going into the audio input, it's being affected by the VCA and the filter. And we can mess with the tone control just to dial some of them back into the background. I'm using the square wave and all of them here, but we could try the triangle as well. But it blends really nicely with what's going on inside the synth already. A bit of finality to get the tune just right. But it's a nice way to add these pedal tones to a patch. So adding pedal tones to another synth. I suspect that in many ways the Overmits somewhat of a divisive instrument. And you probably decided very early on in the video whether it was something that was interesting to you one way or another. If you decided that it wasn't, and you've made it this far into the video, your objections are almost entirely, I suspect, practical. Overmits is unconventional. It doesn't have a conventional playing surface. There is no keyboard. There is no sequencer. There's no LFOs. There's no envelopes. And if you need those things to create the music that you want to create, then Overm is not right for you. And you are absolutely valid in those views. I think similarly a lot of those criticisms are probably for the people that think that it is an interesting instrument. The things that are kind of turning them on to it. The fact that you have an unconventional playing surface that is not like most other keyboarded instruments. The fact that you can tune the voices independently to find these interesting interactions. These are all of the things that you're probably thinking are the cool things about this instrument. And both views are absolutely valid, aren't they? And how blessed are we to be living in a time where electronic instruments of such variants are available to us, and in the case of the Overmit, relatively inexpensive prices. The final thing I kind of want to talk about is that although this isn't a review, that's not my intention, I am aware that at this point there are probably some people who are thinking, yeah, this is something that I would like to take a look at and maybe purchase. And to that end, I want to make sure that I give it a fair shake and level some criticisms where they are deserved, I think, so that you don't feel misled by anything that I've shown you in this video. Now, nothing I'm going to talk about, in my opinion, is a reason not to grab one of these, but I just want people to be aware of these things. And the main criticisms all sort of sit in the tuning of the instrument. This knob, in particular. So we have a fairly wide frequency range on this knob, and this knob is really quite small. And as a result, finding particular pitches with accuracy can sometimes be a little bit tricky. But what's slightly worse is that if you're not careful when you even remove your hand from the knob, see, I've been practicing so I've got good at not doing it. Yeah, when you remove your hand from the knob, just the act of removing your hand because of the tension in your fingers along this small control, you can nudge it out of tune as you let go. And in the heat of a performance, in the heat of a performance, that might, see who's doing it now, of course, in the heat of a performance that might not be in the heat of a performance that might not be certainly isn't a desirable thing. The other thing when it comes to the tuning is, although it has a wide range, actually don't find that the top end of the knob is necessarily as high as I might like. Maybe like to go a little bit higher so you can get those sort of squealing into modulations between different notes. To that end, I'd like to offer into the ether some suggestions for the ways that I think the oven could be elevated and maybe I can manifest an oven v2 just by saying these things out loud. So the first thing when it comes to the pitch, I think it would be great if there was a range control and you could switch the pitch between a low and a high range, essentially halving what this knob has to do, giving you more accuracy and less likelihood of a small nudge pushing it out of tune in a in a meaningful way. I think that would be a worthy addition to make it a more performable instrument. Beyond that, there are some sort of timbre things that I think would again elevate it and I recognize that any sort of addition to an instrument like this is going to increase the billet for materials. It's going to make it more expensive. So take all of these things with a pinch of salt. The first is that in pretty much all of my favorite situations where I've been using it, it's been in conjunction with something providing distortion. So either distortion pedal or for example, the distortion on the lyra or on the syntax. And as I showed right at the start of the video, having a distortion combined with these slightly detuned oscillators really enhances what's going on between the oscillators and that creates these really beautiful and sometimes fragile or dangerous textures. So I think there being a built-in distortion or just a simple clipping circuit on the output could really elevate what you could do with the instrument from a timbre perspective. And I think that one would maybe be a smaller technical hurdle to overcome. The two other things that kind of spring to mind would be it would be great if there was intermodulation between the different voices. I recognize that that's quite a jump in the feature set and what I'm essentially asking for is a tiny little lyra 8. But you know, if you say these things out loud, they might happen. Some form of cross modulation, whether that's ring mode or FM, I think would be a really interesting thing. And finally, it would be great if there was panning. I love anything in stereo. And if we had panning on the different voices or even on some of the voices and had a stereo output, again, it would elevate what you could do with it. But that's a big jump in terms of what you'd have to deal with to build the instrument. So again, that's an increase in the price, which might not be desirable. Anyway, I hope you enjoyed this little exploration of an interesting little audio artifact. I've put the details for Crow's electro music in the video description. So if you want to check it out, then you can easily find it. Otherwise, as always, thank you so much for joining me. And until next time, take care.


Hello, everyone. I'm Gabrielle over here at Oxford Toyota. You all, we have a brand new 2023. This is a Toyota Corolla. This one is the SE. So I just wanted to take a minute and talk a little bit about it. Starting on the front, you do have the LED headlights.  Now that exterior color is in the classic silver metallic. You are going to have your alloy wheels. And this vehicle is going to have the black badge overlays.  And you do have your dual exhaust going into the interior. You are going to have an eight inch touchscreen. You'll have Apple CarPlay with Android Auto. That interior color is in a moonstone. And there is going to be the all weather floor liners throughout. If you all have any questions on this Corolla, feel free to let us know. Now all of our contact info is listed right here. Thanks all so much for watching. Have a wonderful holiday. I'll see you soon. Bye.


and cuff him you're not supposed to shoot him in the back like you know in the wild west they used to call them yellow-bellied cowards you got a melly saps you got a stripe running down your back you cow you were you yeah shoot the man in the back supposed to tackle him and cuff him right so one bullet goes out the guy gets shot in the back he goes down now all the extra bullets to me that's those that's hatred and personal feelings going into that's why I said murder and hate crime combined could be because why alright he's white he or she is black okay well how come because hey what about the black woman in California that the cop just rougher up on on us on the highway punching her in the head and part you know I mean you got your handcuffer you you know you subduer and that's it that's it and if you got a call for backup you call for backup yeah but they don't do that because they're bad seeds do you think some you think it sounds like now talk about patterns it sounds like as a pattern connected with the Republicans taking the Congress and all this fascist storm trooper behavior well they do like it yeah they do like it yeah this for years and years and years when you followed the conservatives but politically and etc it was always that they were they hated Miranda rights oh my god you know do anything you want to the guy the perpetrator is read them is remember Miranda rights no way when the Democrats had control of the House and Senate I didn't see all this fascist hate racial hatred stuff and police brutality I didn't see any of this did you see voter IDs no what's new about that well that's what came about as soon as the Supreme Court gave the the Republicans the right to do that shit because they wanted to discourage minorities and poor people from voting because they know Democrat because they know these people vote them that's correct now when I watched the Donald Trump documentary last night on the history channel very long documentary but very fascinating I sat through every minute of it the part when you know Donald Trump were said those disparaging things about Latinos at the end he he says well I suppose some of them are good now I suppose some of them are good to me was the racist the most racist comment of all because you are you oh I guess I suppose it's like saying well I'm assuming some of them may be good well then you when you say that it's like well that most of them are not good to him to Donald Trump well I would say that most of the 11 or 12 million whatever figure you want to take of the illegal immigrants that are right now in the United States obviously have to be good or they would be you know arrested or put in jail or just any other thing right yeah well these are these are ones that broke the law because they came in illegally well then some of them may be brought over by their by a relative you know some might some might have I mean is it possible for a tourist visa to allow someone to work or do they have to have the no I'm sorry they have to apply for the card it's not an H1B it's a it's a specific illegal working illegal it's a specific card where they take your biometrics and blah blah and it looks like a driver's license has your photo on it and it's a car that allows you to work in the United States this is before you get a green card this is you don't even have your green card yet but there is a car which lets you work hey my hunch is the government allows them to do it because if you don't have a green card that means companies can screw you with with a low wage lower wage yeah I believe that was that may have been part of the bill that was they tried to get through called e verify which would have given these illegals information like that and everything and then the corporations wouldn't hire them if you had to verify that your people that you were paying were illegal then you know the companies wouldn't hire them yeah like now recently was a Boeing decided to cut the pensions to end the pensions of of on tens of thousands of employees I forgot what it was 50,000 60,000 it was a hell of a lot of employees cut their pensions and said that on in order for us to keep our cost down we have to do this that's just a feeble excuse what about the CEO of Boeing cutting his salary how about that no no no no all the money must go upward it must go so much so much for trickle down economics right okay job creators you know that's a lie don't you of course I do but they don't anyway let us sink our teeth into these readings before we get too long-winded here okay what do I got here let's see what you got to start off with if Republican presidential front-runner Donald Trump speaking of Mr. Trumple shows up at the next CNN debate it will be for free wow I thought he was charging CNN how magnanimous of him CNN president Jeff Zucker said Thursday that his network does not pay candidates for showing up at debates I agree with him the first time I ever agreed with a CEO and that rule applies to Trump and if he doesn't like it don't let the door hit a money ass on the way out who has been a ratings magnet for the Republican primary debates in the 2016 race for the White House Trump said on Monday at a campaign stop in Georgia that his presence at the debates has turned them into revenue windfalls for the cable news networks well the experts said last night in the in the documentary that Donald Trump uses his outrageous comments and statements to gain publicity for himself and he ends up being bigger than ever he plays on that and that he wanted five million dollars for CNN's next debate scheduled for December the 15th five million per debate in Las Vegas sounds a little low for Donald Trump isn't it oh the next one is gonna be in Las Vegas the 15th is is that a Tuesday Tuesday yeah Tuesday I hope in the next Democratic debate I hope Bernie Sanders stops being such a perfect gentleman to Hillary Clinton you know get real she's not sugar and spice and everything nice Trump oh excuse me he said he would donate the payment to charity no he didn't he said he devout devoted to the vets let's say charity he says when are the vets charity that's your duty that it's your duty to care for your vets coming home for crying out loud no no no no they put that they got their legs blown off in their arms and some of them their their head piece of their head their face and come back dead no no no no they did that for their country and it's your duty to take care of the vets correct Trump made a similar demand before the last GOP debate that aired on CNN on November the 14th CNN ignored it and the candidate showed up anyway watched by 22.9 million people the debate gave the cable news network the largest audience in its 35 year history I watch it for the comedy that's the only reason why I watch it I never watched CNN no no no no I know Bill Morrill says oh they're very fair and unbiased yes sure no no none of them are but I watched a Republican debate for the comedy I actually watched Fox News to keep up with the enemy you mean because keep your enemy closer that's correct keep your friends close but keep your enemy closer because you will learn more from your enemy than you will from your friends actually because your friends aren't going to tell you the truth all the time you know what I mean your and your enemy won't miss will not miss a trick or anything they'll tell you everything exactly they'll tell you everything it's their it's their job to wear you down and screw you up yeah because they're they are your adversary that's great oh I forgot where is this guy I want to honor all unions in the United States especially those that support Bernie Sanders and I want to honor the United States a postal union and the United States Post Office there is a a metallic die cast replica of a postal truck go go postal union go all unions and a go I post office US PS I salute you with my lucky black thorn she'll daily all right I just want to pay homage to the postal union and all unions and may you not support the Gorgon Medusa headed which Hillary Clinton okay go ahead after years of stymied efforts to address the nation's aging and congested highways and bridges to find Congress found the sweet spot for passage on Thursday a five year three three hundred and five billion dollar bill laden with enough industry favors parochial projects safety improvements and union demands to gain overwhelming support overwhelming support the bill was approved 359 to 65 in the house and 83 to 16 in the Senate the bill now goes to the White House for President Obama's signature the bill boosts highway and transit spending and assures states that federal help will be available for major projects it doesn't include as much money or last quite as long as many would have liked and it doesn't resolve how to pay for transportation programs in the long term despite that the 1300 page bill was hailed as a major accomplishment that will halt the cycle of last-minute short-term fixes that have kept the trust fund teetering on the edge of insolvency for much of the past eight years by the way Obama wanted you know this money to be going to infrastructure since day one Republicans and leaders can point to the bill's passage as evidence of their ability to govern govern my ass and President Obama can claim progress on addressing the nation's troubled infrastructure a major goal since the early days of his administration Republican Congress shot that down to that's correct they wanted because it would provide jobs Obama would be a job creator so it's there's still obsessed with sabotaging Obama's administration and record if they have their way I can guarantee you after Obama leaves office they'll continue in the history books there will be an asterisk next to his name he never was okay well isn't there a saying called the proof is in the pudding if that were true everyone would not believe conspiracies and lies and sub-diffusion well conspiracies you know conspiracies that are that are against the elitists and the people on top I call those good conspiracies well that can't be a conspiracy then if a conspiracy is true if you prove it it's not again a conspiracy actually means conspiracy much right no people joining together conspiring that's all that is but no every every cult religion is a conspiracy yeah okay like when Hillary Clinton many years ago said the great right-wing conspiracy yeah you know you could you could actually call the Republican Congress a great right-wing they are or the Senate and the things that the Supreme Court has done in the interim like Citizens United right way catching and etc etc etc people like Anthony Scalia and his crone and his buddies up there they're part of a right-wing conspiracy yes often crazy and and and zealot you know religious nutty but yeah they're part of it so well he's a cat like you know Catholics can be just nuts but he don't like what Francis that Pope Francis is saying because Pope Francis or in etc you don't like that or they they sure hate the poor don't they yes they do they just stain it the Bible says Pope Francis has a good heart and he cares and that's not good for the Catholic Anthony Scalia no not good for capitalism compassion empathy helping the poor that happens to be in the Bible many times and that just doesn't scratch them where they itch no one hallmark of the bill is the creation of new programs to focus federal aid on eliminating bottlenecks and increasing the capacity of highways designated as major freight corridors oh yeah another thing that just came to mind what about the the high-speed rail system that the world is enjoying that the United States doesn't have light rails monorails of bullet trains and I mean we'll probably have to import all that shit from China oh I really feel comfortable going 225 or 250 miles an hour in a Chinese a monorail I feel really confident in that trip yeah I mean they China does have a bullet train yes it does and I don't know what's going on with it but everyone except third-world countries seem to have bullet trains and United States has those old dinosaur Amtrak's I just saw a country the other day I'm not sure I'm gonna say Brazil but I'm not sure it just it had such a bad traffic problem that it put in a train and it helped hey man a metro let me tell you something those those trolleys of the old days that ran on electricity I believe yeah those trolleys overhead wires those trolleys were a great idea that they should have just kept on modifying because it alleviates traffic because you have much less cars on a road it alleviates pollution and and and it helps out with people that really can afford the the auto insurance to have a car there are many people that you know and they're I think they're better than buses I think they're well there's no pollution with them they're they're electric aren't they aren't they less affected by traffic also well they have their own tracks compared to buses yeah they have their own tracks so I guess so yeah so I mean well I read I know that when I lived back in Pennsylvania Wilkesbury had them for many many many years yeah of course the only ones that use it but they do for tourists in San Francisco the the old the baseball team called the Brooklyn Dodgers it was actually the book the Brooklyn trolley does yeah they dodged the trolley the Brooklyn trolley Dodgers and they were there were trolleys in Brooklyn and I'm sure there were trolleys in many parts of the United States yeah well John D Rockefeller didn't like that okay he wanted to sell his oil baby he wanted that car engine all right sucking up that oil well isn't he wanted it one of the fat cats that Thomas Edison sold out to was Rockefeller fat cats and sell out Jay capitalist JP Morgan Rockefeller did not go with Nikola Tesla they want with Thomas Edison because it because they wanted to charge people for electricity and everything else well we just saw that recently in the 90s with the with cable they took away our free TV and gave us cable which we have to pay for I remember when the first company the first bottle of bottled spring water hit the market my grandfather was mad he says no fucking way I'm paying for water there's no fucking way I'm paying for TV that was cable yeah he had a point you are he says what's next they're having a meter on the amount of oxygen we have yes it's coming look at China look at the pollution in China oh you know it you know if the pollution doesn't change in Beijing and let's say China became like like Columbia let's say China became pure capitalists right pure they could say oh you want to be able to breathe and live you have to pay this amount of money for a gas mask every time you go outside you got to buy one of our gas masks that's something that's very capitalist yeah that's why it'll probably be here first you know but well there are oxygen bars around the world you know well you can go in and breathe pure oxygen you know and the very very few times I was in a hospital let me tell you something that oxygen tool they stick in your nose yeah well you're just making that sound because it's something they're putting your nose I had it put up my dick no no this is stupid catheter no no no there's no comparison this is actually pleasant why is anyway the oxygen the pure oxygen is very invigorating to the body and mind okay fewer cases of diabetes are being diagnosed in the United States in adults according to start startling the new federal statistics released on Tuesday diabetes had been climbing for decades driven by surging obesity rates in 2009 the number of new cases reached 1.7 million by last year it had dropped to 1.4 million after so many years of seeing increases it is surprising said a diabetes expert who has been tracking the numbers at the Centers for Disease Control and Prevention in recent years the number of new cases seemed to be leveling off or even going down but researchers wanted to see a few more years of data before declaring an improvement the figures from the last two years confirm a significant drop the biggest declines in new diabetes cases rates were in man white people young and middle-aged adults and in people with more than a high school education but there have not been substantial declines in other groups like the elderly and minority the data comes from a large national survey conducted by the government every year this is a little bit of a dip and that's encouraging said Dr. Robert Gabby but we probably don't want to say we won the battle and everyone can go home there are still 1.4 million new adult cases every year overall there are about 22 million Americans with the diabetes why the number of new cases is falling is not clear officials would like to think it's the result of a push to get people to exercise more and cut back on how many sugary foods and drinks they consume let me tell you I was in I was in a store yesterday and actually I was in Walgreens and I see this I see this young child extremely I would say a little a little bit older than a toddler but not far from it very obese can barely walk he was waddling from side to side like a penguin he had a pacifier in his mouth and he was like he was like knocking into things almost like he had trouble walking and then I hear a woman scolding him and it was the mother and the mother was very obese so I considered a child abuse when you feed when you make your children a carbon copy of you and you're obese and you feed you're feeding your child the same poison that you're feeding yourself to become a piece of obese in my opinion that's child abuse and you know when when these obese people say well we're we're just an alternative lifestyle and blah blah you know no no you you're living a self destructive lifestyle you're not an alternative lifestyle and what you do into your children should be considered obese I mean considered unlawful as child abuse feeding a kid whatever you're feeding him to make the child grossly overweight that's another problem with nutritional information it's like it's like trying to give the cultists the religious cultists more accurate information it doesn't work they have their own stupid ideas you know well they might say oh I went to the doctor and had a blood test and my blood pressure is normal and and my blood work came back okay and meanwhile the person is like 400 pounds and and then you look at their family their family lineage family tree and you notice that every one of them is obese so they grew up with obesity as Gary know has said many times nobody who is overweight can be healthy I agree with him okay even though we bucked heads a few times I agree with him very much so you know I mean he is a very determined vegan you know I mean there are extremes in everything


What is up guys? Joe Holland here, really special one for you today. I am here at Jack Traps in Monmouth, Maine, home of the famous Jack Trapp ice fishing trap. And the special thing for you guys today is I'm gonna meet up with Sean, the owner here at Jack Traps. We're gonna build a trap, a special custom trap for you guys, and we're gonna give it away to one subscriber to this channel. All you have to do is subscribe to my channel, leave a comment in the bottom.  It'd be cool if you told me what type of fish you like to target and maybe what state you fish in because we got viewers from all over the country.  It's as easy as that. You're gonna win this Jack Trapp that Sean and I are putting together. We're gonna specially sign it to you and we're gonna ship it right to your door to the lucky winner. I hope you win. Here we go. Let's go into the famous Jack Traps. Here we are, guys. We are at the world famous Jack Traps. There he is, Sean. There's Sean. All right, buddy, you ready to do this custom trap? What do you need? We're gonna make a custom trap to give to one subscriber. It's gonna follow your social media, follow mine and leave a comment of what type of fish they like to catch, what state they're fishing. We're gonna show you guys how he builds the traps. We're gonna build one trap and then we're gonna give it away to the lucky winners. So what do you think? You got it. Take your size and style first, I guess. There's 10 million options. People come in and then it's like I'm overwhelmed. Yeah. I thought that she's gonna be easy, you know. Yeah, I've had people just be like, can you just pick out five traps for me? I'm like, well, it goes a little deeper than that. There's a lot of different options. So as we're talking about options, I'll just run you down and show you guys some of the colors right here. There's different sizes, different colors, different flags, different size reels. There's so many different options here. So the cool thing is, Sean and I are gonna pick it out right now. One of my all-time favorites, and this is one of the very first jack traps that I ever owned back in the 1990s, is the clear, clear sides, dark upright. I actually like this for fishing-wise because that dark upright stands up really tall in the snow and looks good. And the clear is just beautiful on the side that ash is just gorgeous with the grain. So, yeah, let's do that. 31 inch. Yeah, what do you think? 31, 26? Let's build a 31 just in case the winner is fishing up north a lot. So we're gonna go 31. It's not for you. It's not for me, no. This is for a viewer at home. So there's a lot of different options we could... What do you think? 31? You like the 31? I like the 31. All right, so 31 inch, clear sides. Dark upright, and for a flag, we have to do my favorite flag. Gotta go with the main flag. All right, and then what would you recommend for a reel on that one? The three or the four for this one? I'd go four. All right, let's go four inch reel. And what color line? That's a real topic of the day. I like something I can see personally. I like a tan line or the bright lines. There's a lot of people that think the black and the dark green, we saw a lot of that stuff. And that you catch more fish because the fish don't see it. I'm not a big fan of the dark because I can't see it. Right, I'd prefer to be able to see it. And so when you're taking the trap, when you've got your flag, you've got an idea of how to approach them. You go with that dark line, you're basically looking at nothing. And we use long enough leaders where they're not gonna see it anyways. You run out of five, six-foot leader, you're not gonna worry about it. All right, so let's go with my favorite line color is bright orange, hunter orange. Yeah. All right, so we're gonna build this trap for you guys. So main flag, dark center, orange line. Yep, orange. 31, four inch reel. Yeah, that's the options guys. We narrowed down from 10 million to one. And that's what it is. This is a custom trap built by the man himself, Sean here at Jack Traps. We're gonna build this for you. So first we're gonna find the frame. Jack's getting his diaper changed. Oh, we won't show that. That's how they make the dark upright too. No. So all the way down here at the end, we're gonna find 31 inch, and these are all four inch reels here. Dark summers, so we just need a frame. Nice. So contrary to popular belief as well, you guys have been very busy in the summer. This one came with a tripper on it. Oh, nice. We're halfway there? Yeah, so we spend all summer just filling these racks. So these frames are all ready to go. We just, you pick a frame, we come and get it. We're gonna head back through here. And I'm gonna hand this off to one of these fellows because I'm not set up at my bench. Put these two end clips on. I got one with a tripper. This is Ethan, he's our, how are we doing? Realign, end clip. Tripper expert.  That's a lot of sand in these. 65,000 sticks. So they actually do work around here in the summer? Yeah. I thought I saw them lying, you guys aren't working in the summer. Maybe you guys could do a little work in the summer. No, it takes all summer. Still isn't long enough. That way it doesn't get pinched too tight. Nice. Pull this under it. So, that's ready to go. Yeah. You're doing all right? We're gonna come down to the bench. We're gonna find the rest of this stuff.  Main flag. Main flag for four inch orange. You go to the bend, you hope it's there. Beautiful. Man, I hope I win this one guys.  So what is it, just one comment? Yeah, all I have to do is comment on the video, subscribe to the channel and then follow your stuff on Instagram and Facebook at Jack Traps. Draw it random. Yep, and it's gonna be a random draw. It's all about spacing. It tends to go a little easier on new traps, but you never know, like you said. It's all handmade stuff. All custom handmade here in Maine. Just doesn't all come out uniform. Be too easy. We switched to this new nut this last year. It's a knurled nut, so it's kind of like got a built-in washer that locks into the wood. So, it helps avoid keeping this in the wood. Save a lot of hair, the thing a lot of people don't realize are there. Little brad nail. It's a tension spot between in the upright position that keeps it from dropping down. That was pretty slick. You rolled that one in? Pretty much, I'll go like that. Sometimes they need a little tweak. And the flag should always go one way or no? Yes, so, see this is the seam? Mm-hmm. We always seam down. Hey, there's more truck. I don't know who took that for a ride. Came back. Kit, the kit truck. So seam up, pretty good. And down. Down, okay, thank you. The flag will wait for me up. Just makes assembly a lot easier and then all these holes have polyurethane in them. So, when this thing's out in the water. Oh, that's wonderful. Ew, they don't know it. Nice. I'm gonna sign this side right here. What do you think, here or right here? It's gonna be here, so yeah. Right in there is probably a good spot. Right here? Yeah. A lot of room. Not a lot of room, beautiful. All right guys, there it is. So one of you lucky winners is gonna get pretty much the best possible trap I think you could assemble right there. Custom built trap from. Custom built from Jack Trapp? The owner of Jack Trapp. Two scribbles on it. Couple scribbles.  And we're gonna ship this out to you once we find out who the winner is. Good luck to everybody out there. Don't get gravel if you don't win. Stay tuned to the channel cause there'll be more of these giveaways in the future. Thanks, Shawn. Thanks guys.


Grounded theory is a qualitative research methodology which involves collecting data and analyzing it to develop a theory about a particular phenomenon. It is based on the idea that theory should emerge from the data collective rather than being imposed upon it. The data collection and analysis process is iterative and cyclical, with each cycle involving the collection of new data, analysis of existing data, and refinement of the theory. The goal of grounded theory is to create a theory that explains the phenomenon being studied. This article was authored by Alona Chantai, Melanie Berks, and Karen Francis.


This paper proposes a novel approach to separating single-wall carbon nanotubes, SWNTs. The authors introduced anionic surfactants into the traditional mixture of anionic surfactants used in aqueous two-phase extraction, ATPE, which increases the resolution of the system. By analyzing the parameters of the system, they gain insight into the interactions between SWNTs, surfactants, and phase-forming agents, which drives the partitioning process. Using this knowledge, they propose a separation mechanism based on their findings. Furthermore, the authors demonstrate the effectiveness of their method by successfully isolating, six, four, SWNTs from various raw SWNT materials, including SWNT waste produced over the years in the lab. This article was authored by Blasier Podlesny, Kevin Arhinko, Keita Hayashi, and others.


Let us go straight to the topic. Any woman who is pregnant is at risk of having a fetus with aneuploidy. And this risk is called as a background risk or a priori risk. And according to the age, we have tables which tell at a particular age, what is the risk for a woman to have a child with a fetus affected with trisomy 21. Now the question is, can we detect and diagnose genetic abnormalities most of the times? The answer would be yes, but with a combination of multiple parameters, especially three methods for detecting aneuploidy. One is by the use of serum biochemistry, other by use of sonography, and the third by use of DNA testing. When we talk about serum biochemistry, we have the double marker test in the first trimester, triple quadruple and pentascreening in the second trimester. So in the first trimester, sonography plays an important role in giving us certain clues telling that this fetus could be at risk for aneuploidy or other genetic abnormalities. We will quickly go through the markers of the first trimester, aneuploidy. This is normal nuclear translucency, and this is increased nuclear translucency. This is normal nasal bone demonstration, and this is a unnausified nasal bone in the first trimester and in the second trimester. This is a normal tricuspid waveform with E and A waves without regurgitation, and this is a large pan systolic waveform from a tricuspid valve with regurgitation. This is a normal ductus venous waveform with a forward flow during the atrial contraction, that is the A wave is always forward, and this is an abnormal ductus venous showing a reversed A wave or an A wave reversal, which is a marker for aneuploidy. So these are the common four aneuploidy markers, which give us an indication that this fetus could be at a higher risk for aneuploidy. So a combination of the maternal age and any one of these markers or multiple markers, along with the maternal serum, beta-HCG and PAPA will give us a risk for aneuploidy. In the first trimester, we have to use certain softwares for arriving at the risk, and these softwares will ask you for the patient details, the maternal age, maternal weight, maternal height, background conditions of the mother, like diabetes, SLE, lukers, etc. Also details about previous gestations, and the input page for the present details would have the CRL, the details about the nucleotranslucency, the thickness, the nasal bone presence or absence, the tricuspid valve regurgitation, doctor's venous regurgitation, the uterine dopplers and their PIs, and using a combination of the maternal age, maternal race, maternal weight, height, the CRL, the nucleotranslucency, and also if we have the blood sample of the patient by a combination of beta-HCG, PAPA, mumps, we can arrive at a risk in the end of the first trimester. So at the end of the first trimester, the maternal a priori risk is converted into a combination of ultrasound findings and the maternal serum markers, which is called as the combined risk or the first trimester risk. So at the end of the first trimester, we will have to assign a risk for the mother. So when the risk for the fetus comes as less than 1 in 1000, we call it as low risk and no more testing is required. We can proceed to an 18-week stifa scan. When the risk comes as a high risk, which is more than 1 in 250, then we need to counsel for a Corian Willis sampling or we need to ask for a 16-week anomaly scan for a stifa scan followed by an amniocentesis. When the patient has a risk between 1 in 250 to 1 in 1000, then this is called as intermediate risk. In cases of intermediate risk, we have to advise for a 16-week genetic sonogram or an NIPT and then take a call at the 17th week, whether to go for an invasive testing or not. So this is how a risk is assigned at the end of first trimester. So the maternal age-related risk is converted to a first trimester risk at the end of first trimester. We move on to the second trimester, where we have the chance to do a triple marker test or a quadruple marker test and then we have the ultrasound which can be called as a genetic sonogram or a tifa scan. So when we do our tifa scan or genetic sonogram, we have certain findings which are called as soft markers or fetal aneuploidy. So these are usually seen between the 18 and 22 weeks. These are not abnormalities but indicate an underlying aneuploidy or a non-chromosomal abnormality. So we will quickly look at the second trimester aneuploidy markers. The first marker is the nasal bone which can be absent and which will be called as an unossified nasal bone. The second would be an enlargement of the cerebral lateral ventricle which would be called as ventricleomegaly when it exceeds 10 millimeters in the axial plane in a medialateral direction. Third is the nucle fold which is a measurement of the nucle fold thickness in the axial plane. Fourth is an aberrant right subclavian artery which arises as a last branch from the iota and moves towards the right shoulder close to the spine in the posterior mediastina. Then we have the echogenic bowel which is an increased echogenicity of the bowel which is equal to or more than the bone. And then we have pelvic tessia which is an increase in the anterior posterior dimension of the renal pelvis measuring more than 4 millimeters. Then we have echogenic intracardiac foci which are echogenic nodular structures on the papillary muscles of either or one cardiac ventricle. Then we have single umbilical artery which shows a two vessel cord. And we have coroid plexuses which are cystic structures in the coroid plexus. And we have enlarged cisterna magna where it measures more than 10 millimeters. A lot of analysis has been done on these second trimester markers and one of the best compilation of all these analysis is by Agatha Cleos where which is an article which says meta-analysis of second trimester markers. So this second trimester markers from almost 15 to 20 studies of these markers have been collated. And then the findings for the increased findings for echogenic focus, ventricleomegaly, increased nucleophore, etc. All the markers have been collated and they have arrived at detection rates, false positive rate, likelihood ratio, positive likelihood ratio, negative likelihood ratio and likelihood ratio when there is an isolated marker. I would spend a minute more here for us to understand what this means. In the second trimester the aneuploidy markers are unosified nasal bone, aberrant rights of cleven artery, ventricleomegaly, increased nucleophore, echogenic bowel, pelvic tecia, echogenic intracardiac focus, short humerus, short femur. So each of these markers indicate the presence of aneuploidy by themselves or by combination. And each of these markers according to their strengths of, according to their strengths of identifying aneuploidy have a positive likelihood ratio and a negative likelihood ratio. And when these markers are isolated then we have a single likelihood ratio. Now likelihood ratios talks about the strengths of these markers and their ability to identify aneuploidy. And if you see that the likelihood ratios are arranged in their descending order with the nasal bone having 6.5 as the highest, ARSA, ventricleomegaly and increased nucleophore having approximately 3.8, echogenic bowel having 1.6 and pelvic tecia, echogenic focus, short humerus, short femur having 1. So these are arranged in their descending order and you can see we can group them into four groups. The first group is unosified nasal bone with 6.5 as a likelihood ratio. The second group which has ARSA, ventricleomegaly and increased NF, all of them in the upper part of the body having likelihood ratio of half of 6.5 approximately which is 3.8. The third group is echogenic bowel which has a likelihood ratio of half of it 1.6. And the last group with all the four markers with the likelihood ratio one. So the numbers to be remembered are 6.5, 3.8, 1.6, 1.0, approximately half of each. So this is how we need to group these likelihood ratios into four groups and remember the numbers. Now, let us see how we can do risk assessment so that we can do genetic counseling. When the patient comes, she comes with an age risk. Then we convert the age risk using a first trimester scan and give a scan risk. Then we send them for a double marker test and combine the first trimester scan report and arrive at a first trimester risk. At the end of first trimester risk, we have a first trimester risk. Then if we do a triple marker or quadruple marker and a TFA scan or genetic sonogram in the second trimester, we can arrive at a sequential risk. So using these results, we can come to a final risk after our genetic sonogram at the 18th week. So we can see that the performance increases as we add on the test and by using a sequential scan, we can detect 95 percent of aneuploidis.


Anti-vaxxers have concocted a new conspiracy theory about the COVID-19 vaccine that is so bizarre that these anti-vaxxers, who are also simultaneously anti-maskers, are now switching sides and slowly but surely they're becoming more and more pro-mask because they're afraid of vaccinated people. Now, if you're wondering what does that even mean? Well, let me just read a couple of headlines to you that gives you a little bit of insight into what news agencies are having to debunk. Reuters reports, fact check. COVID vaccines do not shed from one person to another and then cause reproductive problems. Associated Press reports, no. COVID-19 vaccines do not shed. USA Today writes, fact check. No, interacting with a vaccinated person won't cause miscarriages or menstrual changes. Now, your first instinct is probably... That sounds kind of... Obviously, right? The fact that this many news organizations have to come out and say this is a little bit bizarre. But what exactly do these anti-vaxxers believe about vaccinated people? Well, for more details on this, we go to a Vice News article which explains a conspiracy ripping through the anti-vaxx world may finally drive some anti-maskers to do the unthinkable. Wear a mask and keep their distance. The conspiracy which comes in several shapes and sizes more or less says the vaccinated will shed certain proteins onto the unvaccinated who will then suffer adverse effects. The main worry is the shedding will cause irregular menstruation, infertility, and miscarriages. Jesus Christ. The entirely baseless idea is a key cog in a larger conspiracy that COVID-19 was a ploy to depopulate the world and the vaccine is what will cull the masses. This is literally the plot of Utopia. Anti-vaxx influencers are instructing their fellow anti-vaxxers as well as anti-maskers at this point that two communities overlap to a huge degree that one of the best ways to defend themselves from this blight is to co-opt social distancing. The very strategy they have long decried. Sherry Tenpenny, an anti-vaxxer who was found to be key in spreading COVID-19 conspiracy theories, suggested on a recent anti-vaxx live stream that you may have to stay away from somebody who's had these shots forever. Only we were that lucky. Another prominent anti-vaxxer suggested quarantining people who have been vaccinated. There is something being passed from people who are shot up with this poison to others who have not gotten the shot, said Larry Pilevsky, a New York pediatrician and anti-vaxxer on a separate live stream. They should also have a badge on their arms that say, I've been vaccinated, even though it's not a vaccine. So that we know to avoid them on the street to not go near them anywhere in society, he said. It's not just social distancing that anti-maskers slash anti-vaxxers are begrudgingly accepting. Some conspiracy theorists are wondering if perhaps their long-time bane, the mask, could become their salvation. One perplexed poster on the fringe site 4chan asked their fellow anons if they should wear a mask around the vaccinated because they shed the mRNA stuff. Wow, how the tables have turned. Now all of a sudden, the anti-maskers, their argument has come full circle. Now they're the ones who want to mask up to stop the spread of something that they think is going to make them sick. But really, they're just delusional and they're seemingly literally pulling all of these lies about the COVID-19 vaccines out of thin air. And you know, just when I thought that the conspiracy theories about COVID-19 and the COVID-19 vaccine couldn't get any dumber, they like took that as a challenge and of course they surprised me.  Now I will say this, as someone who's almost fully vaccinated, I'm about a week and a half away from being two weeks out from my second dose.  I would love for you to stay as far away from me as you possibly could. If that requires me to wear a shirt or a badge that says I'm vaccinated, I think it's totally worth it. I think it's totally worth it if it drives away the dumb fucks. I'm 100% down for that. 100% down.  You're complaining about the lockdown, you're against masks, you're against the COVID-19 vaccines. It seems like you're on the side of the virus and now all of a sudden you're afraid of other people. You told us not to be afraid of the virus, but now all of a sudden you're the ones who are afraid of a different illness being spread to you. Now you're delusional, you're making that up, but forgive me for kind of enjoying this. I'm enjoying your fear because you downplayed the significance of COVID-19 for the last year and now you're kind of reaping what you sowed. So, uh, good.  Now, based on my preliminary research, what these dumb fucks are saying is that they're not just worried about shedding, but they're worried that through the shedding, I believe, and this isn't necessarily clear to me yet, that people can also transmit besides the mRNA stuff, they can transmit the virus as well. And it's because they believe not necessarily that if someone is vaccinated comes into contact with someone who's positive for COVID-19, they can spread it. No, no, no. They believe that if you get the COVID-19 vaccine, you're getting injected with the live virus and therefore you are then contagious. It's hard to honestly follow their logic because there is none.  But this isn't just some fringe movement contrary to popular belief. These weird conspiracy theories are already being put into practice in the real world. Like it's having real concrete consequences in society. So, in Miami, there's one private school that idiotically decided to ban vaccinated teachers from being around students. I repeat that. They banned the vaccinated teachers from being around students.  Now, to make all of us Americans feel a little bit better, there's a business in Canada that banned people who are vaccinated from coming into a store. And I want to play this clip. This is from Global TV. It'll make all of us Americans feel a little bit better. Not all of the crazy people are in our country, but he kind of gives us a little bit of insight into his deranged thinking. And it's almost like I almost feel bad for him. But nonetheless, let's watch. An Okanagan business is causing a stir in Kelowna by banning vaccinated people and the wearing of masks. We'd rather not be exposed to people who've been vaccinated and who could shed the virus. Sun City Silver and Gold Exchange's owner, Steve Merrill, says the ban on vaccinated people is to protect his clients and himself. Shedding is real. It's a problem now and it's going to be a bigger problem as more and more people line up for these experimental vaccines. Signs outside the store tell patrons no masks are allowed inside and the same goes for anybody vaccinated.  Wow. So, um, yeah, look, whether or not this conspiracy theory continues to gain momentum is yet to be seen. So far, it's not as widespread as something like, you know, anti-vax generally speaking, the baseline anti-vax, and that people don't want to take it because they think that they're unsafe or experimental or Cuban, like it's not that popular yet. But does it have the potential to spread? Absolutely, unfortunately. But it is a little bit funny. I have to admit that if we come to a situation where we're in a post-pandemic world and all of the vaccinated people are no longer required to wear masks, but the former anti-maskers are walking around wearing masks because they're afraid of the vaccinated people. Okay, I can't be mad at that.  But, um, have at it, I guess. Um, you're gonna look silly. But I guess if you feel safe, go ahead.


it is difficult to build an app, it's expensive to build an app, it's expensive to market an app. And even if a user does download it, it's hard to retain them and engage them and so on. So anyway, apps are sort of fairly saturated. Works well for maybe the top 100 apps or the top 1000 apps, but sort of the long tail, it's very, very difficult, right? So, and then lastly, user retention spans are sort of very, very limited, right? So it's really challenging for businesses to engage and many businesses are just excluded from it, right? If you're like a restaurant, a retailer, a mall and so on, how do they even engage with consumers from mobile phones? I mean, they really just don't for the most part, right? Meanwhile, you know, what are users doing, right? Users sort of on mobile phones, they love messaging apps, right? Messaging is the one format that has outsized usage far greater than any other app out there or maybe even all of them put together, right? I mean, these are just some examples but WhatsApp user growth, Instagram user growth and this is just the user growth, right? But on top of it, if you look at the intensity and frequency of usage, it's extremely high, right? So in that sense, this is where the business, this is where consumers are, right? And what consumers are saying is, look, you know, we love this format. We love chatting with friends and family through messaging apps. Why can't we chat with businesses in the same way, right? And therefore what's happening is these messaging apps are now becoming the new digital storefront, right? In the, the analogy I like is in the mid 90s when the web came about, the web was the digital storefront. This is where customers would come and talk to businesses, right? And therefore every business had to build a website and the hindsight, we know that there are, you know, just, I don't know, billions of websites. In the same way now, consumers are coming through messaging apps and looking, searching for businesses, looking to interact with them. And that's the new digital storefront. And we believe every business is going to have to build these sort of experiences, right? To engage with users in messaging apps, right? So therefore what it means for businesses and brands is that, you know, they have to go where the customers are, right? They have to engage with them, in fact, converse with them, right? Because that plans to be a thing, handle natural language on query, the chatbot needs context, right? It, for three sentences ago, right? What is it to the blue shirt able to have user is communicating and so on. As this, you know, there'll be a heading and it's sort of like a personal relationship but gets a person, I think, you know, and it's almost up, but advantage, you can have personal with everyone, right? And like, revenue gain opportunity, business focus on it should consider it, talking about and like, is that a doubt? Anyway, thanks for having me.


The Tug Valley area CVB is looking to do some spring cleaning this Saturday with the Make It Shine Williamson Community Cleanup Project. The project will kick off April 6th at 7 30 a.m. at the Fifth Avenue Church of Christ and all are welcome to participate. We have two different time slots for different people because not everybody is early risers like some of us. We will get underway at 7 30 and then if someone wants to join us at noon they can join us at noon and start the other half of it. A lot of us will be out there all day but a lot of people don't want to get up that early or whatever they may have something going on. So they don't actually have to work the whole entire time period but if they just come out and do part of the cleanup we're doing it city-wide from West Williamson to East Williamson and then from Harvey Street Bridge all the way back to Williams Memorial Hospital in a Vincent Street. Make your ride one of a kind and see the experts at J&M Custom Auto and off-road. It's your customization candy store. Visit jmcustomauto.com and select your Make It Model. It's that easy. Window chaining, remote starts, leather interiors, sound systems, front and rear bumpers, spray and bed liners, bed covers, wheels and tires, lift kits, step rails, even underglow like kits and so much more. If you can dream it we can do it at J&M Custom. Lunch will be provided for all volunteers and bags, gloves and litter picker sticks will also be available. Well it's been a while since we've done one. We did one several years ago pre-COVID and we kind of got out of it but we have some big events coming off this summer. Of course we have tourism with our trail riders that comes into town so we really want Williamson to shine. We want to encourage friends, neighbors, family members. It's election year in Mingo County so we expect to see politicians out that if you want you know to be elected you need to be outside and shining with our area and help us make Williamson look really good. Church groups, anybody that wants to get on board that wants to make the city look a lot better. For more information go to Tug Valley Area CVB on Facebook. Reporting for Mountain Top News, I'm Brianna Robinson.


Ahead of the November 11th Gamership Election in Biosur State, the People's Democratic Party PDP has inaugurated its campaign council, with a vow to work tirelessly to re-elect Governor Doye Deere and his deputy Lawrence Erujapo. The party's State Secretary, Don Isaac Burrow Expressway, was feared to brim as the re-Erujapo State Chairman of the PDP Solomon Agwanana, a man-chief-teens and members, were present at the inauguration. Honable Obrador Mitema, a force-term member of the House of Representatives in the Tens National Assembly, representing the Old Biafredo constituency of the state, emerged the Director-General of Deere Law Campaign Council. I'm going to perform this responsibility with the wings of victory, because we will be relying on all your achievements. Pain shall be issue-based, our campaign shall be glasswood-based, and we are convinced that we are riding to victory, because we know that the candidates we have and the candidate we are presenting today is one that is sellable. This is a big-fast election, we have the numbers, we have the committed and determined people across the Biafredo state, and nobody is going to write a result. Security will do security, this is a standalone election, and local government, we have rural development authorities, and local government, we have local government-categorical committees, and then thousands of appointees. So what are we afraid of? So please, as you go back, those of us who nominated agents, they are very, very important to our way of this election.


To really keep their hopes alive. Great start from Vasily from gate 2. Wonderful gate. Now Yanovsky tries the inside run. Down the back straight they go. Yanovsky through the middle. But Vasily holds the line. Wonderful move and now Yanovsky will try and go wide. Lindgren comes through. Look at this, a low wheel. Unbelievable speedway. Yanovsky in second place on the back wheel. Very nearly got himself to the front. Now he does. Martin Vasily working hard on the outside. Vasily is there. Can he get back to the front? Yes he can. Brilliant. What an effort from Vasily. Freddie Lindgren back in third place. Superb action for second and third. Yanovsky now hit the front again. What a speedway pressure witnessing. Can he come around the outside? No. Up the inside maybe. Absolutely. Absolutely and now Vasily tries the inside run. I think Yanovsky is stepping up here. Terrific ride from Magic. That's a great break. Yanovsky. Yes, holds the inside run here. And it's Matze Yanovsky. The pole who rides here for Takana in the Swedish league in Molyla. That is a terrific ride. A popular winner. Stunning ride. Yes. And Freddie Vasily as well. Even though Freddie Lindgren was in third place obviously the crowd are generous to Yanovsky as a home rider. Smash him right between those two boys. Won't see better. It really was outstanding stuff with Martin Vasily showing great courage around the outside.  Super ride from Yanovsky. He's in this meeting now. Yeah, he's on eight points. Yeah, he's looking good. Should go through. Should go through. And that's the latest after, what, 15 races here now in Molyla? 11 points for Artem Laguta. He's the leader of the meeting. The world championship by the way to level again. Schmarzlik 68, Manson 68. Yeah, tight at the top. Nothing in it. We see Martin Vasily getting right to the outside in the first turn. Bike actually pulled him there. I'm not sure he wanted to go that wide, but that's where he ended up. Look at him whining it on. Totally committed again. But Yanovsky rides a very clever race here. Doesn't panic, keeps his composure. Not easy when it's such a tight, such an exciting race. And of course you've only got less than 60 seconds to prove it, but that moves there up the inside. That little bit of extra grip. The fresh dirt on the inside proves to be a winning move from him. Two wins tonight. He's on eight points. Looking good, Yanovsky. He needed it.


What's up everybody? Jay is here with jasperjasecasebrakes.com shows the 1920 panini chronicles basketball blaster 20 box case break Random teams number one sold out And again, as you can see number two has already been posted. It's actually already down to like 27 But again early bird guys you buy one of the first 20 spots in this break to get entered a free spot on the break Remember all cars ship and then of course, it's the blaster edition So here are the early birds here from Mark down to Andrew here the customers in there straight up And then we'll give away that spot. So we use the same dice roller to determine Who gets the early bird spot? Which is a three and a six for nine times? Good luck early bird one two three four five six seven eight I nine times John I think congratulations little early bird There's your free spot and Yes hip parade did sell out. So we'll be doing that after this but the road is really quick to see who sold it out Now let's go nine times on the teams now. We're names and teams one two three four five six seven eight And nine John So I heard you're the turn to find out who was missing All right, I'm tired here maybe BD once we sell out the first one that's on there I don't know I don't know I guess you could do that. She won my what? Man, maybe they're about to bet it without you. I know man I don't know that's true compare I see that too sgc a lot of people are grading with them, too Is it maybe they're cheaper? I'm assuming they have less Yeah I don't know I wonder what the difference is Like four months it's like six months and then one month is two months Yeah John there with the pelicans rob with the nuggets Roman with the magic John there with the wizards Matthew the Celtics rich with the heat marg with the hornets there with the kings Thomas you have the util jazz Gary with the bugs marg with the lakers ace with the pistons brandy with the pacers rich you have the thunder Chris with the cows they see with the bulls Matthew the two was Adam with the spurs Andrew with the mavericks Josh with the same sixes rich as the blazers Uh adam with the sons Robbie with the grizzlies Mike with the knicks rich with the hawks Rio with the raptors Justin with the nets Brandon with the rockets Matthew the clippers and marg with the warriors I would submit it Yeah Unless you think the center is dead on Yeah, and that's when it's like just people aren't willing to take that risk So if you think the saddering with the saddering is like dead on you can get a black nibble maybe Yeah, yeah the blackboarder kind of thing does pop the card a little bit Yeah, I put an SGC card in the yesterday's effect. They're just big Yeah, yeah, they look bigger. Yeah. Yeah. All right guys any trades? They got a revolution card and then they made it like eight by ten I know SGC like ten Jordan's so far in town They did I see that they're ten Jordan's itself a lot, but would that be equivalent to that's the one thing Hero just got shot on my militant I didn't look at it. Is it a mea sugar? Because last I like the baby Last game it was his ankle, wasn't it? That was my stuff. I thought it was his ankle When he got injured You see today, uh But Because I guess they thought But I guess the judge or whoever there's a bunch of them they could have oh here. Oh They said he could have uh, they could have reversed it and just gave him a penalty or like points off So why are j barrett?  That's pretty nice right there I was like Tyler her winning on and off the court Brandon Clark No, I don't know if she is actually but she could be though. She has better things to do Nice little silver All right, I'll pen and save these all later in the video just so that we did not take it too long, but I'll do that no worries THICC, right? I know man Luca little recon rj barrett I know Tyler here was just living his best life. He's living in Miami Zion Willingson Tyler here should come all out if they had an NBA baller Yeah There you go, there's Tyler here right there. Three quarters like the equivalent of pinning home runs. No, it is. Yeah, especially when you're hitting him like that That's like tying the game right there Janice Now we're here on the court. You have to make both of them.  That's the thing It's not even confidence I saw a thing where he originally committed to wisconsin. That's where he's from And then like I guess he'd be committed and went to Kentucky and California today.  We better come. That's our bag. Sorry. Yeah, that's uh Nebraska Really pink Usually it's good basketball It was probably like guarantee the play there and then you probably got a better offer. Yeah Remember that like you had sandback or any Franklin Metski? Oh, that's right. That's right. They did There's Tyler here right there That's all right. It's okay. Miami.  I don't know. That's a neat. So maybe They didn't have they haven't started over silver I'm gonna say because it seems absolute rest of the series. This doesn't matter I don't know. They played ball today I I said Milwaukee seven but that was before they lost game three Yeah, there's garland And then you gotta there's basli sir Yeah, yeah, I got him Yeah, no, I guess right like everybody Yeah, I know that's the one I was in this game because dude kelvin johnson did so well It's pretty much almost everything kpj Kendrick nuns a little bronze games kept for the juniors saku kind of gaffer pink luka Little Zion they're gonna try to win a park right now So try to burn apart right now Or what? So the conference is anybody near one apart. So I'm gonna have a ton of mosaic. I'd rather I would buy it But I'm not getting for the money All right guys, we're driving right now. We'll be back Little Zion marquee All right, I just feel like OC for some reason doesn't care for sports Who's that a numbered person 99? Look at that. That's your little xr. Kachimura Kam reddish Is that a band-aid over his name? He's like good job guys. He's gonna stay alive for one more game A lot of panic state top loader cars guys. I know That sweeps it off Boston, Toronto's 2-2 Yeah, dude, Boston was so close to just being up 3-0 already Yeah, Denver played good yesterday I know you look so good It was like that meme of like that one guy was like Lakers Twitter Coming back from the dead after the flip of Boston.  I hate pj Tucker, but I don't know how any day was doing school. I know but I don't know how he Didn't school him. Yeah, the height event is like big time Lakers Yeah, that's right Update there at the end of the rustle Dude, it's so hot outside. It was today was way hotter than yesterday Yeah, I woke up and it was like in my cell service It was like 85 where we were like god damn I was like man that was in the morning though. It was like 100 by the time you left. Yeah I was like man, and then where my parents are at 19 it was like 110 Yeah, I was like there were 95 at like nine in the morning. I was like man And then like at midnight it's still like 90. Yeah Kobe white marquee look wrong I know dude, I turned it on today Yeah, someone said the power went out last week Yeah, that's what it went off for like a quick like 30 seconds or something. I'm gonna turn back on All right job around recon Yeah, guys the thing with chronicles is just so much value with these base planes Surprised I haven't seen so many of these great. Yeah, it's because it's taking too long, huh? Yeah, we'll see them in like two months Two three months all of these rickies and being graded Lebron John Moran another flux of Essentials RJ There's no baseball or nothing Seen Serena play yesterday. She lost the first step and then came back Man Adrian Peterson found a home pretty fast I think yeah He's like, oh man Other Zion back-to-back little luke, hawaii marquee Kendrick nun has three zons in the same box or no guy Lebron marquee could you watch them pink? recon John Moran rookie some stars He go dolla update Yeah For Lebron flux usually a handful of blasters if you find an auto, but none yet You did get a numbered car though.  You're racking up some nice jaws Luca marquee. That's pretty nice I'm reddish Lot of value in this guy's honestly whether you mean if you don't get the pelicans, of course, you know, but still Cameron Johnson's a stud as well. You have a Kobe white Saku Pasha little RJ Lucas second year stuff. I saw a lot over Pasha pink Kevin Porter Jr. Steph pink The 100 is another Zion And another marquee Zion There's just a ton of value in this Look all that's going to be top-loaded and penny sleep for you guys Our penny sleep top-loaded At least like But not 200 I guess but Pretty good amount John marquee We're trying smoky. There's a couple makes it if you want to let me know if it's football It's just that one. Uh, that one filler there plus the 16th. Oh nice pink hometown heroes John Moran. That's very very nice Zion basketball probably a couple If it started off at 15 then we probably took out half of them So What is it at 12 right now? How many did you buy? Six left, right? So I'm assuming that we probably do three packs Looks like fat pack number 88 sold out. So that's good. So maybe one more after that number 89 90 maybe two I'd have to go through the orders but Probably at least two maybe three 89 90 so yeah Basically, we took out 18 total spots. We left 12 in there for straight up. Yeah. Yeah so Two more fillers and six spots monkey So we took out 18 and then we sold we're going to sell 12 straight up. All right, child hero Carson edwards Langford Rui pj Or sorry, that's not shay. That's uh, mckiel rj kawai dirrick culver kelvin johnson luka james pardon Jackson haze John moran suku It's a nice little bit right there marky Oh, did we get an autograph? We did. Nice. Apprentice auto a nazi rave minnesota and a recon So minnesota with that one matthew All right one here and the last four blasters. So right there held in jackson haze ruy pj culver A little xion xion again Got a job pink couple jobs back to back.  What's under here? I don't think it's I don't think it's numbered. I think it's orange just for uh For maybe the hawks color Or that is that just how the base flux looks? I think that's just how the base flux looks Or maybe not. I'm not sure This one's really nice. So look at that pink crusade john moran's refractor For a little prism Very nice There you go rob Very very nice.  We got a little uh Carmela anthony update prison Heartland with that one rich John moran pink John moran pink recon Oh, is that a fible autograph? nice for philly at these table autograph out of flux josh of the 76ers Very very nice. All right down to our last box guys again.  So There you go guys all everything ships But all that right there is going to be top-loader for you guys and I just just penny sleeping like the jaws and Some of the bigger stuff here got two autographs out of here guys a lot of nice value in here a lot of zions And john moran's huge stack coming your guys's way And then right here bible auto the crusade pink job hometown heroes And a pink flux zion So appreciate you guys the second one's already in the store guys We can get another one of these rolling jasky's casebricks.com