I'm our final speaker for the first panel, Professor Anup Malani, who's the Lina, I'm sorry, the Lee and Brenna Freeman Professor at the University of Chicago Law School and also Professor at the Pritzker School of Medicine. Anup has a PhD in economics and a JD both from the University of Chicago. He clerked for Judge Stephen Williams on the U.S. Court of Appeals and later for Sandra Day O'Connor on the Supreme Court. Anup does research in law and economics and in health economics. His health economics research focuses on the value of medical innovation and the value of insurance, control of infectious diseases, the placebo effect. He's the principal investigator on an Indian health insurance experiment involving 12,000 households to study whether health insurance brings benefits to people's health. That study is being conducted in Karnataka, India. Today Anup Malani will speak to us on the topic, which I'm looking forward to hearing, an economic analysis of medical ethics. Anup. Thank you Mark for that warm introduction. Thank you all for attending this talk. What I want to do here is begin a conversation between economists and ethicists about medical ethics and the relationship between economics and medical ethics. In particular, we want to do, and this is joint work with Tom Phillips and Richard Posner and being a bunch of economists at the University of Chicago, we want to begin this conversation by being slightly obnoxious. So bear with me as I do that. It's not that we're all mean people, but we want to make a bold claim in order to spark a conversation, as is our way here at the University, especially in economics. So I want to offer you three propositions. The first one is that medical ethics can be understood as part of the economic framework for normative analysis, what we call welfare economics. And so we can think of a lot of what we do in medical ethics as really just components of what we do in welfare economics. A second thing is that we think that putting it in this framework has the added benefit that it clarifies a lot of debates in bioethics and especially fissures in those debates. And the third thing is a positive benefit. I think what we can do by applying a welfare economics framework to medical ethics is understand or distinguish which ethical controversies or ethical claims are more controversial and less controversial. And also, and I think this is the part of the talk that I think will be the most challenging is to try to understand the market for medical ethics. So it's the market for people who practice bioethics, whether it's medical ethics for treatment or medical ethics for research. So let me begin. Now a lot of what I'm going to say is not going to be super controversial. It'll seem pretty obvious, but the idea is to warm you up to some of the sorts of discussions we have in economics. So here are some examples or ways where we can translate the language that's used in bioethics, things like autonomy, beneficence, maleficence, justice, things like that, into language that's used by economists and that plug into our normative framework. So as you know, the normative framework that's going to be for economists is a lot like basically a basic utilitarian, inconsequentialist utilitarian framework, but there's a lot of fleshing out that gets done through positive economics. So let's start out with the doctor-patient relationship. When economists look at the doctor-patient relationship, they view this as basically a principal agent problem. What I mean by this is that there are some parties in this transaction that have more information than other parties in the transaction are getting and the less informed they're trying to get, the more informed to behave better, to behave in their interest. Typically view this as the doctor having a lot of information and the patient not having a lot of information. The doctor is the agent, the patient is the principal and the patient is trying to get the doctor to do the right thing. And that's not entirely true. This turns out there's kind of a two-sided asymmetric information problem here because it's also the case the patient has a lot more information than the doctor does about the patient's own preferences and that's preferences not only over health but also of consumption. And so we have you know something that when we think about things like informed consent which most of you will think about as flowing from principal of autonomy or many of you will think about as flowing from principal autonomy. We economists just say well what's really going on here is there's information the physician has about the risk associated with treatment information asymmetry. We want to get the physician to disclose that information to the patient so that the patient can make an informed decision, make a better decision and be more precise take advantage of her own private information about preferences. One of the reasons why it's important to think that this is two-sided information asymmetry is that it's also possible that instead of informed consent you could have the opposite which is if a patient could convey her information about preferences over health and consumption to the doctor accurately the doctor could make that decision as well. Of course we have to worry about the doctor's incentives as opposed to the patient's incentives. But again that's where informed consent fits in autonomy relates to addressing the information asymmetry problem between doctors and patients. Another example and there are many more examples but I'm just going to give a few other examples. So the first you know as I said the first principle is principal agent problem that's a very many ethics controversy can be thought of as just variations of the principal agent problem. Another area of economics that can explain controversies in bioethics or issues in bioethics is the idea of inter temporal allocation of consumption. This is allocation of consumption across people over time and so the best example this I think this explains a lot of research ethics. So why is that the case? Think about what research is. So particularly I like to think of the context of clinical trials and what and medical studies and that involve patients and often what this is is research is the production of information that's about medical treatment that's a value not only to the current patients but also to future patients but interestingly only current patients can participate. Unborn and I don't mean by this you know unborn children or fetuses I mean just future generations cannot participate in current research but they benefit from current research and so the the way that we conduct research really affects what future generations get relative to current generations and so when we have ethical rules and I know that this might be changed a little bit but when we have rules that limit research such as requirements of equipos or limits on wages that you play research subjects what we're really doing is placing limits on the transfers that current consumers can make to future consumers and by the way this is two way transfers because when you pay current consumers to participate in research even in the absence of equipos you're just paying them with money that you later expect to get drug companies expect to get from future consumers and so it's just facilitating a trade but bioethics takes position on this very often and tries to limit or regulate those trades okay so it's regulating the inter-temporal allocation of consumption. A third topic within economics that can explain or describe a lot of ethical controversies the idea of interdependent utility more simply speaking we think about altruism I may care about the welfare of my children that's altruism a doctor may care about the welfare the utility of patients interestingly it's not just doctors that have that preference by ethicists ethicists can also have that preference and often it's kind of strange to think about an ethicist having a preference obviously we just ethicists stand outside and observe what other people want or making judgments but no no they're not because they're making a preference over what other people expressing a preference over what they think other people should have or do want and so I don't deny that ethicists just like practicing ethicists just like practicing doctors may have altruistic preferences but they may not have preferences over exactly what we think they ought to have or you know they they pick a particular type of preference and I think the one that strikes me as most interesting is that ethicists often have a preference for health rather than utility whereas their subjects whether it be doctors or more importantly patients have preferences over both health and consumption and so economists always think about health consumption trade-offs people are willing to sacrifice health in order to get more consumption by the way that relates to the discussion that we just had about rationing but ethicists are not all ethicists but many ethicists that assert the primacy of health and not want to make sacrifices on health are basically expressing their altruistic preferences over other people's health but the important thing to realize is that they're expressing they have altruism over other people's health and not utility doesn't make it right it's just their particular preference but once you understand it that way I think it economics can can can can encourage a sort of humility in claims in bioethical claims about how much we should invest in health and what sort of health decisions do I make? The last one that I want to talk about relates to interdependent utility but is one step further removed and it's the idea that when you create a social welfare function you have to assign people weights we call them welfare weights or lambda weights and you know utilitarian typically will put equal welfare weights on everybody that's why it's called utilitarian rather than just additive utility and this is very much related to ideas like justice that you find simply described in in in a lot of bioethics conversations and then there are implications that flow from justice but that we understood it's just implications that flow from a choice made about what sort of welfare allocations you want so for example to be more country you know we think about trying to have more egalitarian allocations of human organs we don't by the way interestingly we don't do this necessary for blood but we do this for for certain other bodily parts such as organs and so we implement rules like first in first first out or variations of that to get allocations of organs we try to limit the market trades in organs for money but but again this is important for people realize this is an argument about equal equal welfare allocations or equal allocation of welfare weights across individuals it's not exactly right but it helps us understand why how it relates to economics and and how economics has addressed that problem in other areas and why that can be helpful in ethics okay so now why is it that we would why do we want to have this conversation first is we're just academically interested people right you want to talk to people from other disciplines to see how they see a similar problem maybe you can learn from that and so that and we do the exact same thing so I think it's important for for ethicists and economists medical ethicists and healthcare economists to talk I'm here obviously we can learn from from we economists can learn from ethicists but we want to talk a little bit about what economics can help how economics or the economics remarks that are proposing can help bioethicists and I think that they can do two things first is and I use this often when I teach classes even when I do law and economics and talk about legal ethics I hear it same thing with health economic health economics and healthcare ethics I think that what an economics framework can do is highlight tensions or inconsistencies between ethical positions that people often hold simultaneously so for example I would say a modal view is that ethicists believe relative to economists for sure that that that health is more important but you know when they're doing that they're making an argument about as I said before they're basically expressing their own ethicists are expressing their own altruistic preferences over other people's health and they think that people ought to defer to that to their altruistic preferences but then when you shift the frame just a little bit they're not willing to defer completely to altruism so for example if a doctor says I don't want to engage in informed consent because I know what's best for my patient ethicists will also resist that even though the doctor basically says I'm altruistic and I know what's best for my patient right so it's okay for an ethicist to express that position but it's not okay for a doctor to express it and ethicists exercising that belief will will will will argue against the doctor's position and that's a little bit attention another example is this idea of equal welfare weights so for example I pointed out how organ allocations events a preference for equal welfare weights across consumers everybody should have access to organs so we might like for example a first in first out system but at the same time ethicists make strong preferences for current patients over future patients when they put limitations on research and what you can allow how much you can pay research subjects whether or not they can enter trials where they're they're going to get something that they know or that we know might be bad for them but so that's inconsistent right because why wouldn't we weight the future patients as much as current patients obviously in each of these situations ethicists can come back and say oh well that's different because or this is different because but it requires that extra line of argumentation it's not a simple principle the simplest principle generates some sort of tension across these different views and again these are just examples there are others that we can come up with where the economics framework highlights inconsistencies or tensions another thing that I think is helpful is that and this is kind of moving away from normative to a little bit more positive but I think the economics framework can help us understand why certain ethical principles are more controversial or disobeyed than others and make predictions about this so for example a really simple one with respect to informed consent is I would expect that doctors who have the benefit of fee for service insurance or getting a cost plus reimbursement are much more likely to over treat and because they're much more likely to over treat are much more likely to hide or not disclose side effects to patients because that allows them to treat or get more payment but those are precisely the folks that are going to be the ones that are most likely to disagree with informed consent or put pressure on informed consent principles right because they want to not tell people that the treatment might be bad because they have an economic incentive to actually over treat so that's you know I expect to see more informed consent controversies when we have a fee for service system then we don't have a fee for service system such as cavitation another example is in I think this is an inconsistency or controversy so in general and I'd say still the modal position for reimbursement ethical position on the reimbursement of research subjects is you're not allowed to pay wages you know you can pay for their expenses but you're allowed allowed to pay wages of research subjects participate in trials we don't pay them for taking risk now obviously I could sit here and say well that's really you know I don't understand that we often pay for people out in the real world to take risks we pay construction workers more janitors that work in nuclear power plants more things like that we pay for health risks in fact that's how we estimate the value of statistical life is that people have made that choice but get compensated for it but it also happens even within the realm of medical research which highlights the inconsistency and why it's it's it's problematic so for example for phase one trials we try to enroll relatively healthy subjects right and we allow meaningful payments and and we relax the rules there and I think one of the reasons why we do that is because it's very hard to recruit healthy people into trials unless you paid them some money and you are you need them to take on the risk to figure out what the toxicology is of treatments and so that's another example of situations where there's an ethical rule but we'll disobey it because it's convenient for us to or because very hard to comply with the ethical rule we wouldn't get the research otherwise another example is assisted suicide right so assisted suicide is controversial although not allowing not assisting with suicide is consistent with maleficence this is the one situation where a patient the patient population generally is in favor of the principle of maleficence which is to say avoid harming patients but this is one situation where they actually want you to harm them they actually want to perhaps some want to end their own lives because of for example pain and suffering their experiencing because of the sickness and again the reason is because the population that the maleficence principle is supposed to benefit actually in that case is not being benefited so there is no gain in some sense from complying with the principle that's what becomes controversial now let me get to the what I think would be the if I were sitting in your seat the the most obnoxious thing that I'm going to say maybe there's a lot already but but this is the one and and this is kind of a puzzle and I think that that I'll express it in a way that's that's not entirely friendly but I think that it gets at a deep problem that I think ethicists ought to care about so when an economist looks at the market for medical ethics that is to say the market for people who provide ethical advice medical ethical advice we notice two things first is the prices paid for medical ethics advice is very low ordinarily when we see a market with really low prices we think hey there should be a lot of demand right prices fall demand rose but you don't see that you see also low quantity and that's a puzzle why isn't that we see low prices and low quantity in fact this is by the way that one of the reasons why we actually took on this topic is we just saw this interesting point where people weren't paid you don't have to pay for ethical advice very much you don't seek it out by the way it's not unique to medical ethics legal ethics has the same problem which raises the broader principle question for ethics but but this is a context where you know it's really interesting that you know a doctor providing medical treatment gets paid but an ethicist providing ethical guidance about that treatment does not get paid very much and so so here's some some some interesting facts that that that kind of validate this or express these this this basic point which is you know hospitals again we've only looked at secondary research on this hospitals often are offer ethics consultants for free they pay them with the salary but but they're not utilized a great deal utilization of of ethical ethics consults is quite low quantitatively even though it's free also interesting the insurance companies are not paying for ethics consults at least far as I know very much or very frequently that's on the treatment ethics side but if you look at the research ethics side same sort of thing it's not like researchers and potential subjects are the ones that are paying for ethics consults what's going on is basically the the government has imposed IRBs on research institutions by regulation by threatening the withholding of grant funding if you don't do that and and and universities and other research institutions often comply sometimes go beyond what the government requires because of fear of of consequences regulatory consequences so that's an interesting thing it is government led demand not not private demand again consistent with this idea of low prices and low quantity um and you see other facts also supporting this so for you know you look at medical uh board exams a very small percentage of them are about ethics and if ethics were important that would seem to for treatment and treatment decisions you would think that they would be more that would be more common um you see AMAs uh uh code of medical ethics is very short it's rarely enforced that contrast for example with medical malpractice liability but why is this the case and now here's I want to I want to say two things that I think are are again I apologize ahead of time these these are a little bit more aggressive uh but for the purpose of of of uh generating conversation one is that I wonder we wonder if treatment ethics are not actually binding uh we we wonder that that when treatment ethics promote efficiency they're not binding people would engage in them anyway and so we don't need the ethics controversies okay um it it's it's it's when ethics is not uh uh efficiently efficiency promoting that it's most necessary but that's why we see very little demand for it because it's not efficiency promoting um and so that's that's the that's the first claim I hope that makes sense which is if this is just about efficiency it would happen people do the do the ethical thing even without the ethics consult because it's efficiency promoting you don't need ethics ethics not doing a lot of work there ethics is doing a lot of work when things are not efficient as between two parties and in that context the two parties don't want it and you have to impose it from outside but then you have to ask why you're imposing it from outside the second thing I would say uh is uh for that that works with treat that explains treatment ethics perhaps perhaps but research ethics a little bit different um well our position is that if if we allowed for a full market uh for research subjects for example to allow payment of wages for research subjects uh you would have uh obviously patients coming in taking risks um uh to generate information and getting paid for it but uh and and and that would be fine that's just like you know a janitor working in a nuclear power plant the problem is that when ethics rules uh limit that payment right they collapse that market and so then it has to intervene again to re-regulate that market and that's where challenges emerge so uh it's it's it's it's almost as if what research ethics is doing is creating a problem and then trying to fix the problem that it's created and economics would say we why not just allow wages uh and that's how things work in other markets we don't have the ethics of construction uh the ethics of the construction industry we don't have the ethics of uh you know interesting the car if you're thinking about asymmetric we don't have ethics of the auto industry but we do do it for uh medicine we do do it to some extent for law uh and it partly could be because of of regulations uh that limit the market itself so let me stop there actually I stopped halfway apparently in the middle of that sentence um what it meant to say is research ethics matters because it limits that market okay let me start stop there and then and then uh take if we have time take some questions any questions for Professor Malani's controversial arguments Tracy so as both the ethics consultation director and the vice chair of the irb oops uh I'm going to just go ahead and duck so I actually think ethics consults is the wrong way to look at it most institutions not the University of Chicago but most institutions are going to putting ethics under quality and ethics they are hiring full-time ethicists that are fundamentally working on lots of things beyond the consult and the consult is sort of the step of there's nothing else working but setting up policies doing daily rounding and I think that they are investing in ethics and then from an IRB standpoint number one we are paying research subjects we're paying research subjects to take care of to do drug studies there's lots of drug studies we're not paying research subjects but there's lots that we are and even though yes it seems very regulatory we've had at least two consumer support groups two consumer groups that have come after protocols that fundamentally many of us in this room have argued about including a support study as well as there's also one in New York about from an endocrinologist on CAH research that they were they thought that despite regulation it was done unethically so I think we have to have some regulation to prevent things becoming completely unethical and we can all argue over those two if those two cases were actually unethical or not but fundamentally there are groups that fundamentally want research regulated in addition to other groups that want research unregulated and I think we have to maintain some degree of regulation and the new common rule will probably decrease the level of regulation nationally thanks so I don't think that I wouldn't say that we don't pay research subjects we just pay them very little so we compensate them for their time we compensate for medical expenses but we don't pay them wages like I get paid for example to teach so we don't see patients being paid a hundred thousand dollars or hundred twenty thousand dollars to engage in clinical trials even if the benefit to the research to the to the drug company would be great to in terms of being able to finish the trial more quickly and in fact one of the reasons why at least we would conjecture why it is the patients groups worry about the the ethics of trials is because when you're making the payment very low not zero but a small amount below market wages you are imposing risk that's not fully compensated and so the the consumer groups the patient groups are going to fight against that and our conjecture would be if you paid a higher wage they would not fight as much so we another way to think about this is imagine if instead we allowed research subjects to unionize what would they do well they would probably allow the research trials to continue but would want a really high wage and that would be fine by us and I think that that I mean I guess economists would say that even that would be better than just trying to artificially put caps on the wages again wages are not zero but they're not market wages if they're free market. This is the last question from Fark. Fark Erlen how would your analysis change if the the the framework that you think gives rise to ethics is not one of of unequal information and a need for information transactions but an acute and profound sort of human vulnerability that gives rise to a profession like law a profession like medicine not so much to the car industry a vulnerability in the case of sickness or in being accused by the state of some kind of crime in which you need a helper who you can't form a written contract for the kind of help you need with from them and you're not in a position to enforce that contract because of the vulnerability you're in so it seems it seems to me the reason you have legal ethics and medical ethics and you don't have auto manufacturing ethics is because of a very different sorts of human vulnerabilities to give rise to those professions. So I guess I would want to ask what what you mean by vulnerability I want to unpack that because does it mean that they as I was asserting they have less information is it because they're poor is it because they don't have the mental capacity no it's because they're sick it's because they're sick but but lots of people are very sick and have mental capacity and can be great great advocates for themselves why is it that we think as a class people with sickness well because well I guess I mean this might be something that's easier seen inside the practice but when someone is sick and all the action activities that go into your care of them can't or cannot be structured by uh what is my contract what are you paying for they have they require judgment they require a lot of action when the other person when the person cannot make innocent and can't consider all the options it just seems like they don't work like the sort of transaction which you consider the car to buy or something. So I don't think it has to do with the contract very few transactions I engage in are about contract it's just making an arrangement or a deal or an agreement often verbal and I do lots of it I guess where I would poke at this is I'd say I'd want you to be very precise about what you mean about vulnerability because what ends up happening is two problems first is that vulnerable patient there are classes of people that are not vulnerable that we also treat as vulnerable and then don't treat so for example a very competent prison prisoner could participate in that clinical trial involving prisoners not all prisoners are vulnerable I think we expand that category beyond what it really needs to for example the prisoner one another example is that we allow that vulnerable patient to make not to make decisions about health care but we allow that same person who's very vulnerable because of the sickness to make decisions about a ton of other things and we respect those decisions and so it seems like we're inconsistent even when they truly are vulnerable we're we only will care about them when they're making health care decisions which seems inconsistent and I think that what that broadly means is that I think that we need to be a little bit more precise about what we mean by vulnerability and once we do that then again we can fit it in within a framework and devise more precise I believe those people need to be helped but we need to help them in a way that's most effective thank you


Hello everyone, I am Putsavi Modi, first-year resident at D.Y. Patil Hospital, Kulapur. I would like to thank IRIA for giving me this opportunity to present at 21st MRI conference. I would also like to thank my mentor, Dr. Niranjan Patil Sir, who is a professor and Pramod Nagore Sir, who is senior resident in the Department of Radio Diagnosis at D.Y. Patil Hospital, Kulapur. My topic is cellar and supracelar masses mastering the master gland. So, we'll start with the introduction. The cellar, the supracelar space, contains a vast area of pathologies, including the neoplastic, congenital, vascular, inflammatory and infectious etiologies. It usually presents as a combination of headache, eye pain, ophthalmoplegia, usual field defects, cranial neuropathy and endocrine manifestations. So, first, what we have to do is identify the pituitary gland and the cellar tersica and determine the epicenter of the lesion, whether it is above, below or towards the lateral to the cellar. Analyze the lesion, whether the lesion shows signals, whether it is cystic, solid, showing flow voids or calcifications and then give the differential diagnosis. So, there's some common cellar and supracelar masses. We have divided into three, that is congenital, neoplasms and miscellaneous. The congenital, pituitary anomalies, that is, maybe hypoplasm, duplication, hypothalamic hematomone and rathclis cleft cyst. Under neoplasms, we will see pituitary edinoma, craniopharyngeoma and venangeoma and miscellaneous hypofysitis, a pituitary hyperplasium and internal carotid artery and uresins. So now, we'll start with the cellar and the supracelar masses individually. The pituitary micro edinoma, these are defined as tumors which are less than 10 mm in diameter. The intracelar mass is typical location and dynamic contrast enhanced T1 weighted MRI is the best technique. The tumor enhances slowly than the adjacent normal pituitary. In this case, there's a sequential coronant dynamic contrast enhanced T1 weighted images of the pituitary shows a small lesion with delayed enhancement compared to the background pituitary. The pituitary macro edinoma, these are defined as tumors more than 10 mm in diameter. They commonly extend upwards and appear as supracelar mass and usually shows the snowman appearance is due to the narrowing at the level of the diaphragm cellar. Now in this case, we have taken the sagittal T2 weighted images and the post-contrast T1 weighted images which shows a large homogeneously enhancing mass replacing the pituitary gland and a small T2 hyper intense foci noted within the mass and these are suggestive of cystic degeneration. The extension of the mass is in the left cavernous sinus encasement of the left internal carotid artery which is demonstrated over here. The next, the Rathke's cleft cyst. This is a non-neoplastic cyst arising from remnants of embryonic Rathke cleft and the signal intensity varies according to the cyst contained. In this case, on the T1 weighted images, we can see a round intracellar lesion which is hyper intense on T1 and hyper intense on T2 with no obvious enhancement on the post-contrast T1 weighted images. The meningioma, meningiomas in the cellar and paraselar region may arise from any point along the dural skull base including the tuberculum cellar, flannum, spinoid allele and anterior or clinoid processes, the spinoid wing, cavernous sinuses and petroclival region, the diaphragmatic cellar or the clevis. The height attenuation of the lesion on the plain CT enhancing the dural tail and the epicenter of the lesion in the supracellar region are the clinching points. In our case, on the axial T1 weighted images on the sagittal and the post-contrast T1 weighted images reveal a large lesion in the cellar region extending into the right paraselar region along the spinoid on the axial and the coronal post-contrast T1 weighted images shows a lesion to enhance avid leave with a linear dural enhancement along the spinoid sinus. Then the cranioferringioma, this is a benign tumor derived from the radcae pouch epithelium. There are two types, the adenomanto-matis cystic mass in the children and the papillary which is a solid mass in adults. The signal intensity of cystic component varies according to the content. So in this case, we have a well-nobulated lesion which is iso-intense on the T1 weighted images and in the T2 weighted images, we can see the fluid-fluid level in the supracellar region and the normal pituitary gland is compromised posteriorly by the lesion. Then on the post-contrast images, the lesion demonstrates subtle peripheral enhancement. Here we can see the subtle peripheral enhancement. Then the internal carotid artery aneurysm. Aneurysm of the intracavernous segment of the internal carotid artery can mimic pituitary lesion clinically as well as radiologically. So the off midline location of the lesion on plain CT should raise the suspicious of a pathology other than the primary pituitary lesion. In this case, on the coronal reformation of the CT angiography of the brain, reveals a sacular aneurysm in the right cavernous internal carotid artery and the anterior communicating artery aneurysm in the parascellar and the supracellar locations respectively. Then the lymphocytic hypophysitis. This is the idiopathic inflammation of the pituitary gland or stalk. The sagittal T1 weighted images and the coronal T2 weighted images shows enlarged thickened pituitary stalk with the loss of normal tapering. And on the post-contrast T1 weighted images, the gland stalk shows the avid enhancement. The pituitary duplication with teratoma, very rare developmental anomaly, it is usually associated with other anomalies. On the coronal and the sagittal T1 weighted images reveals a duplication of the pituitary gland with the solitary stalk and multiple T1 hyper intense areas of fat with interspaced dark areas of calcification. This is seen just beneath the gland and this is suggestive of a teratoma. The mass is seen invading into the spinoid sinus. The hypothalamic hamartoma, it is also known as tuber-sinarium hamartomas which is located between the mammillary body and the optic chasm. In this, the actual T2 weighted image, there is a hyper intense lesion predominantly on the right side in the supracelar system where there is a compression of the pons, the sagittal directly. And in the sagittal, they are directly arising from the hypothalamic area in the pre-pontine system and the supracelar system extending into the intrepidicular system comprising the pons. And then the coronal, the lesion is aberting and there is minimal displacement. The hypothalamic glioma, the gliomas of the hypothalamus and optic chasm account for 10-15% of the supratentorial tumours of the children. Large lesions are heterogeneous whereas the smaller ones tend to be homogenous. In this figure, the T1 weighted image shows a bulky hypothalamus which is iso intense to grey matter and in the post-contrast images are well-defined homogeneously enhancing lesions in the hypothalamus. Well-defined homogeneously lesions in the hypothalamus we can see. The hypothalamic tuberculosis, the infections of the hypothalamus particularly access is rare. Tuberculosis hypofisitis or supracelar tuberculomas are rare manifestations of the CNS tuberculosis. Usually occurs as an extension of tuberculosis meningitis. So in this case, in our coronal, T1 weighted image shows a thickened tuber sinadium and on post-contrast T1 weighted images reveals an avid enhancement of the hypothalamus. Then the optic nerve sheet, dural ectasy. It refers to the sacular dilatation of the optic nerve sheet and it is most commonly associated with neurofibromatosis type 1. In this figure are the sagittal T2 weighted images and the actual T1 weighted images of the brain of the child reveals a cystic dilatation of the dural sheet around the intracranial optic nerve, cystic dilatation of intracranial optic nerve on the right side and this is presenting as a cellar lesions. Now, the conclusion. So again, in order to analyze a cellar or paracelar masses on MRI we use the following anatomic approach. First, what we have to do is identify the pituitary gland and the cellar tersica. Then, determine the epicenter of the lesion and whether it is in the cellar or above, below or lateral to the cellar. If it is in the cellar, determine whether or not the cellar is enlarged. Once the location of the mass is clear, the signal intensity patterns is the lesion cystic or solid and does it contain any abnormal vessels? Are there any calcifications and so on and finally established a differential diagnosis? Here are my references for the study of the cellar and the supra cellar masses. Thank you everyone.


Buccaneer, Kraken or Cerberus, three people in one body or a new race entirely. Marshall D. Teach, also known as Blackbeard, has been the source of intrigue and mystery for as long as we've known him. Since his introduction, we were told that there's something not quite right about his body, something that he proved when he managed to eat a second devil fruit and then lived to tell the tale, a man who doesn't sleep and hasn't been able to since he was a child. And now, as of chapter 1107, we also know that Blackbeard is of a special lineage. Well, what does that mean?  So, put on your evil mastermind thinking the hahaha hat. We're going speculating. But before we do, make sure to hit subscribe because if you do in fact love One Piece discussions, then this is the channel for you. So let's go through what we know about Blackbeard, especially what makes him different and so odd. It was revealed in his Vivricard that Marshall D. Teach was born in the Grand Line growing up as an orphan. Buggy noted in chapter 966 that Blackbeard is known for never having slept in his entire life. Seemingly providing an explanation for a drawing of a young Blackbeard that Oda included in SBS volume 63 where we see Blackbeard as a child crying underneath the moonlight. Suggesting that rather than Blackbeard choosing not to sleep, he is physically incapable of doing so. It's more of a curse than Blackbeard's choice. Hence the young boy is upset, frustrated at his insomnia. Or it could just be that Blackbeard witnessed something traumatic, a core defining experience that would shape who Teach would become as a person when he grows up. He wasn't orphan after all, maybe it's a glimpse of how he became to be an orphan. But I am getting a little bit too ahead of myself so more on that later. We also saw in chapter 225 both Luffy and Zoro commenting that Teach is not just one guy, there's more than one. In chapter 577, Marko also noted that Blackbeard has an odd body, that Teach isn't normal. Which is Marko's theory for how Teach has been able to eat two devil fruits, the yami yami no mi, and then also the gura gura no mi, successfully taking Whitebeard's devil fruit even after having his own, despite the fact that we were told that eating more than one devil fruit would surely lead to that person's death. Fans have also noticed that the way in which Oda draws Blackbeard changes from time to time, most notably the number of teeth he's shown to have varies every so often, but also his personality, bouncing between cowardly and overconfident, being at times reckless, other times shrewd and intellectual. And now, we know that he comes from some sort of special bloodline. And these unique characteristics of Blackbeard have resulted in many speculations over the years. Given his Jolly Roger features three skulls, we've also been expecting that this number three will be significant to his character, in particular that he will acquire a third devil fruit, if he doesn't have one already, or that he's actually three people in one man's body. There are also some other popular theories such as the possibility that he's a kraken, or has a kraken devil fruit, or that he's a Cerberus, or has a Cerberus devil fruit. Both these ideas stemming from the fact that Octopi and the Cerberus have three hearts or three heads, respectively speaking. I've also seen the idea that it's Blackbeard's yamiyami no mi that has allowed him to eat Whitebeard's gura gura no mi, the nature of his original devil fruit, meaning that he was able to effectively cancel out Whitebeard's so that eating a second devil fruit doesn't have the same effect on his body. And now, more recently, ever since the introduction of a new race in the buccaneers, the possibility of Blackbeard also being part of this near extinct buccaneer race has also been very popular. And I too have shared my thoughts on this question of what Blackbeard's true nature might be on more than one occasion. I've once speculated that Blackbeard might actually have the hitohitonomi model devil, or akma, meaning devil in Japanese. And in a very recent video, I also considered whether Blackbeard really could be a buccaneer. And while I won't rule that out completely, I can't say that I'm personally convinced that Blackbeard is a buccaneer, especially because of Saturn's words in chapter 11107, because now that we know that Saturn knows of Blackbeard's special heritage, if he knew that Blackbeard was also a buccaneer, then he wouldn't call kuma the last of his kind, because the buccaneers clearly aren't extinct. But the purpose of this video isn't just to discredit other speculations, and I will share links in the description of both videos where I've discussed Blackbeard and his particular nature in the past, so feel free to watch those after you finish this video because I go more in depth there. But for the purposes of this video, I have to say that the dialogue in chapter 11107 has gotten me thinking about this mystery from a very different perspective, and so a very different speculation. Firstly, I want to premise the discussion with this. The choice of the word lineage or bloodline is very interesting because I think that that term specifically has a lot of implications. Now I know I may be reading too much into this, it is after all just one word, and who knows if we're even reading it accurately because translated, it could mean something different to what order intended in Japanese. Which is why I did actually dig deeper into this, which basically means I consulted our resident Japanese speaker, Sekaiichi-san. And according to Mr. Sekaiichi, as far as I understand, that word is usually used for familiarity or family line. It does not feel to have a race connotation. The first kanji means blood, and the second means muscle, but can also mean line. Which is actually just what I wanted to hear because that's the feeling I got while reading the chapter. The popular ideas about Saturn's dialogue is that this suggests that Blackbeard really could be part of the Buccaneer race, or it's talking about Blackbeard's family lineage and his family ties. And the feeling I got reading chapter 1107 was that Saturn was referring to Blackbeard's family line, that he was referring to Blackbeard's ancestry, unique family ties as opposed to Blackbeard belonging to a particular race. Which doesn't necessarily mean that Saturn couldn't at all be referring to Blackbeard's race because your species slash race definitely affects your genetics and lineage. But the use of bloodline, as it appears to be in Japanese, that I would imagine was used to denote something quite specific, as if Blackbeard came from a special family. And you could actually compare this to when Saturn talks about kuma belonging to the Buccaneer race, for example.  Or when Big Mom invites King to join her crew because she's particularly interested in his Lunarian heritage, she uses the word race. Again, because that's the standard terminology for a whole race of people. Like I said, I might be thinking about this and looking into it way too deep, but can you blame me? This is one piece we're talking about. The series is a trove of minute details that have significant meaning. And I did admit that I was a nut job at the very beginning of this video, so I'm just going to roll with it. So assuming that Saturn was specifically referring to Blackbeard's ancestry, then who or what family could Saturn have been talking about? Well, the first and the most obvious one that I'm sure comes to everyone's mind is Rocks D. Zabeck. In addition to all the unique facts about Blackbeard that makes him so mysterious and intriguing that we've mentioned so far, the man also clearly has a connection to the legend Rocks D. Zabeck. Blackbeard's ship is called the Saber of Zabeck and these two are the two sore thumbs of the D clan that stick out. Oh my god, are there actually only 10 D clan families? Did that analogy make total sense? Goldy, Monkey D, Rocks D, Trafalgar D, Nefertari D, Podcast D, Marshall D, Jaguar D, and Joy Boy D? Okay, no, that doesn't count. Damn it, only eight. Man, that would have been so awesome otherwise if it totally made sense, but still, you know what I mean. Well, all the others known to belong to the D clan are portrayed to be the good guys of the story. Blackbeard and Zabeck are the only two who have been suggested to be evil or bad D clan members. Not to mention that this relationship between the two figures was explicitly hinted by Oda himself. In the Road to Laugh Tale series, supplementary material that was released about One Piece, Oda teased the possibility of a connection between Blackbeard's ship being named Saber of Zabeck, signifying a deeper relationship to the legendary figure. So then, what is this relationship between Zabeck and Blackbeard? Well, how about father and son? Now let me explain why. Firstly, Blackbeard is 40 years old, only one year older than Shanks, and two years older than the events of God Valley, meaning that if Zabeck died during the God Valley incident, as we've been told, it makes sense that he would have left behind his son, Teach, becoming orphaned as a toddler, or at least losing his dad because he could have still had his mother, but then again, this is One Piece we're talking about, where moms are almost nonexistent. But in all seriousness, this would be a great way to deepen the parallel and rivalry between Shanks and Blackbeard, because we know Shanks is somehow related to figureland garling, a figure who seems to have been very important during the God Valley incident, perhaps even being the one that killed Rocks D. Zabeck, whereas Blackbeard would be Zabeck's son. But then why is his name Marshall D. Teach? Well, it seems like Zabeck was public enemy number one during his heyday, meaning that following his father's death, Teach's mom or someone looking after Teach might have changed his name to hide his relationship to Zabeck because they knew that it would place the young boy in danger if the world government or other people that Zabeck wronged were to find out that Zabeck had a child, so Rocks D. Teach became Marshall D. Teach, maybe Marshall could actually be his mother's name. And then this would bring about an interesting connection to podcast the Ace, Ace who took on his mother's name, keeping his father's name a secret. And another parallel between Ace and Blackbeard being that while Ace grew up despising being Roger's son, self loathing and blaming his father, it seemed like Blackbeard would have grown up hating and blaming the world, setting the goal to avenge Zabeck and take on his will, glorifying his father more than anything. And this connection between Ace and Blackbeard would also mean that these two were almost destined to fight. And not just Blackbeard and Ace, but also Blackbeard's ultimate fight with Luffy, this dynamic being a reflection and a repeat of history to when Roger and Garp fought against Zabeck, which I also think is a more nuanced approach to the idea of a rivalry spanning generations, rather than Ace, Roger's son being the chosen one and being Blackbeard's ultimate rival, it's Luffy, despite the fact that it was suggested that the rivalry was greater between Zabeck and Roger rather than Zabeck and Garp. Another detail from chapter 1170 that tipped me off to the possibility of Blackbeard being related to Zabeck in addition to Saturn's dialogue was actually Caribou's interactions with the Blackbeard pirate captains. I know Caribou being a fanboy isn't anything new, we've known that he was a Blackbeard supporter for some time, but the level of his fanboying, mirroring Bartolomeo's adoration and worship of Luffy really left a big impression on me, because it suggests that Blackbeard seems to have this level of impact on other people similar to how Luffy does, because it's been commented that Luffy's greater skill is his ability to make friends and inspire followers, but Blackbeard also seems to have this charisma, which would make total sense if he was Zabeck's son, because we would have to imagine Zabeck also likely had this sort of effect on people, given his worthy followers and crew, all legends who could have been fearsome pirates on their lonesome, but all chose for some reason or another to follow Roxy Zabeck. Not to mention Van Gogh's statement in Chapter 1107 that the Blackbeard pirate's plan and goal is world domination, which on a side note I got total chills reading that panel, but it's also obviously the same dream that Zabeck had. According to Sengoku, Zabeck was relentless in his pursuit of becoming the king of the world. Something else that could also suggest the close relationship between Blackbeard and Zabeck is that Oda stated in an SBS that if Blackbeard was living in the real world, his occupation would be archaeologist, which on another side note, sets off all sorts of alarm bells for Robin, our in-series archaeologist, who many have already voiced concerns that the Blackbeard pirates would be coming after the Straw Hats to kidnap Robin so that they could read the Poneglyphs, but getting back on track, it's particularly interesting because we know Zabeck was somewhat of an archaeologist himself, or a historian at least, which is close enough in my books. We know Zabeck was researching the world's taboos, which by world government standards, we know to mean digging up the past of the truth of the void century. So, like father like son, and also in that same SBS volume, Oda also revealed that Blackbeard in the real world would be Somalian, which I find quite funny because I get the feeling that Oda's making a reference to the Somalian pirates, which is probably one of the most well-known examples of modern day pirates, and I also think that Somalian pirates get a particularly bad rep. Maybe it's just me, but when we think about pirates from days of yore, I get the feeling that that period, or that history of piracy, is romanticized and glorified. We don't necessarily view it with the same lens of horror and disgust, whereas because of the recency, Somalian pirates feel more evil or dangerous, like their actual bad guys, which is quite fitting because both Zabeck and Blackbeard are obviously singled out as particularly bad pirates, and like I said, the evil members of the D-Clan. I've also recently talked about how Buccaneers are a very particular type or group of pirates or privateers that Oda seems to have drawn from in creating Kuma and the One Piece Buccaneer race, but now it seems possible that he also used the pirates off the coast of Somalia as a particular type of pirates in his creation of Blackbeard, and I know there are more obvious historical inspirations for both Zabeck and Blackbeard. When it comes to martial d'teach, it's certainly clear that Oda was particularly inspired by a very notorious pirate, Edward Teach, who also happened to be known as Blackbeard, and this relationship is actually very interesting because the real life pirate was also known as Thatch, meaning that his name seems to have been used as the basis of Blackbeard, but also Thatch, Blackbeard's former Nakama, whom he killed to steal the Yummy Yummy No Mi, and Whitebeard, or Edward Newgate, from whom Blackbeard also took his Grogro No Mi. So in a way, in a twisted devil fruit gobbling way, Blackbeard has become an amalgamation of three characters, all of whom have ties to the real life pirate, whereas Rox also seems to be based off a real name pirate, Roche Brasiliano, and I won't go through all the similarities or historical details, but one interesting fact is that Roche Brasiliano simply disappeared at sea, his body never to be found, suggesting that he didn't die. I mean I'm sure he did die eventually, he was alive and active like hundreds of years ago, but the myth was that he didn't die and so for the purposes of one piece, maybe Zabeck is also not truly dead. Going back to Blackbeard's weird body and what makes him unique, apart from being related to Zabeck, the whole Rockste family could have some sort of strange physical characteristics, something that allows Blackbeard to house or host Zabeck within him in some way. That way Blackbeard not only carries on Zabeck's will, but is actually literally carrying Zabeck, which I grant is a bit wild, but we do have the funk brothers in one piece, or even if it's not quite literal, I'm sure there's another way that allows Zabeck to be alive via Blackbeard, because imagine if the theory that Blackbeard hosts multiple personalities or specifically three personalities is true, and Zabeck is one of them. Zabeck might be that ruthless and cutting side of Blackbeard, while the real teach is the cowardly and weak persona, never having fully recovered from his trauma of losing his dad and growing up in fear of persecution, whereas Zabeck is that cold-blooded and vicious persona, and the reason why Blackbeard was so specifically after the Yummy Yummy No Mi in the first place is because this was originally Zabeck's fruit, and if it was Zabeck's fruit, it would also make sense how Zabeck was so powerful to get figures like Whitebeard, Big Mom and Kaido and all the other legendary pirates to follow him, and it would also explain why he was considered such a threat that Roger and Garp saw the need to put aside their differences and their ideals to work together to defeat him because we know that the Yummy Yummy No Mi is a broken fruit. Anyways, that's where my head's been at. The more I think about it, the more I think it makes sense that Blackbeard is Zabeck's son, but I guess we never know with one piece, and you guys might have your own ideas, so let me know your thoughts by leaving a comment below. Thank you for listening to one of my ramblings once again, and if you have enjoyed said rambling, then please do subscribe to the channel, I'd really appreciate it. Make sure to also like and click the notification bell, and thank you to all of our Patreon and channel members for always showing your support. This is Joygirl, and I'll see you again soon.


Okay, I am going to be, we're going to be getting seated. Please yell louder if people in the back cannot hear me. Hello, thank you everyone for being here today in support of Survivor. This walk is a part of a national-wide walk-out that Explained the Asterisks has planned. It is a court in over 20 to 50 universities across the country. National Day that falls on the last Wednesday of the month of April, which is Sexual Assault Awareness Month. Deda Sands focused around working to combat victim-blaming and educating others about sexual violence. I'd like to acknowledge the Erica Vice Provost that's here with us today. I'd also like to acknowledge the absence of other administrators. I am unsure what it will take for the administrator and administration to take survivors seriously. Before I begin what I am here to say, I would like to preface that some words I may use may be triggering to individuals in the audience. I will hold a few moments for individuals who may feel that they cannot hear what I'm about to say to take your time away. My name is Rikora- My struggle, focus on the now and rather be known that we are not alone. We are not weak and important. You deserve the best in the world, as well as our negative or their mental feelings we must have towards our users. In the end, they can walk jaggedly. Each mental photo, please.


My name is Will John from ADAS and I'm here today at Square Farm to talk about the EIP project on small-scale organic asparagus. The EIPs or the European Innovation Partnership projects is run by a mentor of business on behalf of Welsh Government. There have been more than 40 of these projects across Wales and the basic objective is to foster innovation in the rural community. This project was looking at the practical and economic considerations of growing organic asparagus. There's actually not much information out there about the economics or the practical considerations. We know the crop sells well. We know customers in shops like the short supply chain. They're like the low food miles associated with it. But there is a large cost to establishment of organic asparagus and there's also a long leading time. So for a lot of growers there are some big considerations to take into account and also farming organically will also present some challenges. It's been a really worthwhile project. My customers like it and the help I had from ADAS has been that boost I needed to have the confidence to try and to get round the problems that I found during the project. The main benefits of the projects have been assistance with funding of the establishment and perhaps just as importantly the ability for Rob to work with horticultural specialists. This has enabled him to gain confidence and has always had somebody on the end of a phone or somebody to come and visit to come and look at the crop and guide him on how the crop is progressing and what needs to be done, things like weed management, etc. Asparagus has been a wonderful crop for our shop seen as it comes in what is known as the hunger gap and people look forward to asparagus especially but any any early green crop and yes the customers have really enjoyed fresh cut everyday asparagus. Long term legacy for this project is very positive. We've demonstrated that the asparagus can be grown organically, it's been marketed successfully. Within ADAS we've had lots of inquiries across Wales for our horticultural specialists to come out and talk to them about organic asparagus.


So, with patch update 2.1 for Cyberpunk 2077, CDPR have added in new things for players to obtain. These consist of 2 new cyberware, legendary cyberware and 6 new vehicles. Today guys, I bring you a complete guide on how you get each and every one. How's it going people? My name is DPJ and if you enjoyed the video, leaving a like really helps out and if you like what you see and want to see more, be sure to subscribe. So with this amazing new update, there are new things for you to get and use. So let's start with the cyberware. There are 2 new additions to the game with 2.1. We have the Fiend X which is a skeleton cyberware and we have the Kajito Latis which is an integumentary system cyberware. Now after I looked around within Night City, I honestly thought that these new cyberwares were exclusive to Dug 10 Ripperducks, which is actually where these are from, you buy these from Ripperducks. But upon looking even further guys, I did find a Ripperduck outside of Dug 10 where these can be purchased. Now this could be random, but knowing this Ripperduck does stuck them, if you come here and he doesn't have them for you, skip time to reset his stuck and see if that helps. But yes, this Ripperduck does indeed sell both of these items, these new cyberware pieces. Also do have a feeling guys, that many of the Ripperducks will also stuck these too. Keep in mind, normal cyberware of this Rarity can sometimes be tied to your actual level, most becoming unlocked near that level of 40. So if you can't find these and you're at a low level, this is most probably why. Now there are 6 new vehicles to this game and luckily enough, unlike what I first thought, these were going to be new additions that were going to be tied behind probably the replayable car races, but they seemingly are not. I loaded up a lower leveled character who had literally just completed the main game story. I went to my mega building apartment, lugged onto the computer there, went to the auto fixer website and these bikes were here for me to buy. So there are 5 bikes in total, all available for you to purchase. These are, and you'll see these on the screen now, the Nazar Racer. We then have the Kusanagi Peacekeeper. We then have the Brennan Apollo 650S, we then have the Kusanagi Akashita, and lastly we have the Nazar Cobold, which is my personal favourite. So guys there's also a brand new car, a Porsche that you can get. Now this one is also tied to the auto fixer website, which initially you do have to purchase, but upon you doing this guys, it triggers a new quest line called The Shape of a Pony. Now I don't want to ruin anything for you, but the quest is really short and simple to complete, but upon you completing this quest line at the end of it, you get this vehicle and definitely your money's worth. And there we have it guys, all new items you can get as far as I'm aware with the latest update of 2.1. If I've missed anything secret, anything hidden that you've found, do let me know down below. On that note guys, the end of the video has arrived, if you enjoyed it, leaving a like really helps out, if you like what you see and want to see more, be sure to subscribe and hopefully guys, I will see you on that next one.


You've established that your undergraduate research is valuable, and you're beginning the publishing process. As an author, you have a responsibility to your colleagues, your research participants, and your discipline to act in an ethical manner. Let's review some things you'll need to keep in mind. If you are a research assistant or a project assistant for a professor, stop. Your professor is the owner of this research project. You must get permission from your professor in order to proceed. If you have been working on a project for a professor that may lead to a patent, stop. Publishing your results may prevent your professor from receiving a patent. It is best to wait until that process is complete. If you have already submitted your project to a journal and are waiting to hear back from them, stop. Many journals will not accept papers that have been published or submitted elsewhere. Only submit your project to one journal at a time and follow the submission guidelines or contract. If your research contains sensitive data, like personally identifiable information or culturally restricted data, pause. You can publish your research, but you must protect the confidentiality of your research participants and be sensitive to cultural issues. You might need to anonymize or restrict access to your data. Ask your professor what steps you should take. If your research is still in progress, pause. Presenting preliminary research can be a good way to get early feedback about your project, but sometimes publishing preliminary results may interfere with the future publication of your research. Ask your professor to help you decide. If you're working with a group of other students and want to publish your joint research, pause. Under copyright law, as a joint author, you have full and equal copyright. That means you can publish on your own, but it is good practice to work with your group when publishing. Once you've addressed your responsibilities to others, you're ready to pursue the publishing process. You don't have to do it all on your own. Use your resources in your department, your lab, or the library to help you publish your work.


Income tax 2022-2023, business use of your home tax software example, let's do some wealth preservation with some tax preparation. We are in our example Form 1040 populated with LISERT tax software. You don't need tax software to follow along, but it's a great tool to run scenarios with. You can also get access to the Form 1040 related forms and schedules at the IRS, iris.gov, iris.gov, starting point single filer Mr. Anderson living in Beverly Hills 90210. Support accounting instruction by clicking the link below, giving you a free month membership to all of the content on our website broken out by category further broken out by course. Each course then organized in a logical reasonable fashion, making it much more easy to find what you need than can be done on a YouTube page. We also include added resources such as Excel practice problems, PDF files, and more like QuickBooks backup files when applicable. So once again, click the link below for a free month membership to our website and all the content on it. No W2 income because we've got the business income coming in from the schedule. Let's see that flow through process going to the schedule see profit or loss from business income statement format income minus expenses the net income in essence going into the schedule one going from the schedule one to the form 1040 line number eight. We're going to have to pay self-employment tax on that income. Let's see how that works. It goes from the schedule see bottom line net income flowing into the schedule se self-employment tax calculating that at 14129 that social security and Medicare we're going to go into the schedule to that's right there flows in 14129 flows into the form 1040 page number two not the income tax but other taxes down here 14129 the self-employment tax half of that's deductible on page one of the form 1040 right there we could see that flow through by going to the schedule see net income being used to calculate the self-employment tax of that 14129 half of it 7065 flowing into schedule a number one page number two right there and that flows into the form 1040 right here. So now we've got the 100,000 minus the 7065 gives us the 92935 minus the 12,950 standard deduction and the 15998 which is the qualified business income calculated by the software at this time gives us the 63988 taxable income tax calculated on page number two 9,692 for the income tax and the 14129 for the self-employment tax gets us to the 23821 total tax we're imagining we paid 30,000 for a difference of 6179 our focus now on the schedule see imagining we now have the business use of the home so the general scenario is we've got our own sole proprietor type of business we have our home which we might be renting or we might be purchased we might have purchased the home in either case we use part of the home for business use so we can imagine we have an office in some way shape or form some designated space that we're using within the home now you would think that we would get to deduct part of the costs that are applicable to the business use of the home considering the fact that it's you had to consume that business use in order to generate revenue the problem that many of the expenses that you have are going to be for the entire home so they're personal and business therefore we need to be breaking out the business versus personal portion how could you do that well we could do that possibly with ratio kind of scenario meaning we can take the square footage of the business use and divide that by the square footage of the total home and get a ratio a percent in essence that we can then allocate these costs by we can use the form 8 8 to 9 which we will take a look at let's open that up we can also use by the way a simplified method which may be okay to use but may be low as well depending on where you live if you live in like a high cost of living area you're likely not going to want to use the simplified method because your your cost of living is going to be higher and so that might be short also note that the deduction is flowing down here and that's kind of an indication that and the reason they might do that or put it down here as opposed to up top is because there could be limitations in terms of how much you can deduct in the event that you have a loss situation so if you have a loss remember that if you have a loss here that could pull to page one of the 1040 and be deductible against other incomes such as W2 income if you had any and that could cause you know issues the iris is skeptical of that so you might have limitations with regards to the losses okay so let's go ahead and and open up the form 8829 so I'm going to open that one up let's find that over here so here's the basic layout we've got the form 8829 business expenses for business use of the home part one part of your home used for business and then figure your allowable deduction notice the two categories we have here the direct expenses and the indirect expenses for the business use of the home let's jump on over let's see if I can do a jumping format here and go to the business use of the home okay so so if we're going to use the percentage square footage method what we would basically need to do is say okay the business use of the home I'll pull up my trusty ruler and map out the square footage of the business area and let's say that that comes out to uh let's say that comes out to 700 let's say let's say 300 and the total area of the home which you might be able to find when you purchase the home the square footage you might be able to look it up online and see what the like the square footage of of the home is but you have to find the square footage of the home if you're renting obviously you can you could you could look at the rental agreement possibly to find the square footage of the home or look up online for the standard unit size of the home and whatnot so we've got our two major categories the indirect expenses and the direct expenses so the general idea would be if it's an indirect expense we're paying for something like the utility bill for example on the entire home and part of it should be allocated to the business use and that's when we're going to have to use that percentage kind of method to do that if it's a direct expense that might be something that we're paying for directly to the office so for example if we're paying like repairs and maintenance for like the entire roof of the building then you would think that you would have to use a indirect method and you would have to allocate it between the business and personal but if you're doing repairs and maintenance for the actual office itself then then you don't have to do the allocation method because you're repairing the actual office which is full business use and in that case so that's the general idea note that up top we've got the mortgage interest and the real estate taxes now and this and the state mortgage interest now these are going to be deductions if you have the purchase of the home and they also become more confusing because you may be able to deduct these items on the schedule a if you're taking the itemized deduction so then you got to think about whether or not they should be allocated between itemized deductions and the business deductions if you're not taking them on the schedule a then you would think that you might get a benefit from them on the business side because you're not taking them on the schedule a because possibly you have standard deductions that you're taking as opposed to itemized but if someone owns a home usually that's one of the big items that pushes people over from the standard deduction to taking the itemized deduction and then you run into that issue also mortgage interest from an itemized deduction schedule a standpoint is could be limited if the loan is over a certain threshold which could further complicate things usually would only happen on more wealthy individuals same with state taxes for example which are capped on the itemized deductions I think at like 10 000 so then again that kind of complicates things as well with the state taxes but let's first think about the the renting situation because I think that's a little bit easier easier so you've got insurance miscellaneous the rent let's say we're paying rent and let's say that that's going to be let's just pick a number of 20 000 in rent now the the repairs and maintenance this would be if the repairs and maintenance were on the entire home like the roof of the entire home and I need to allocate them between the two so let's say that's 1200 utilities let's say that's 700 on the whole home and excess mortgage interest state excess more excess real estate taxes and other items and then on the direct items mortgage interest real estate taxes if they were directly applied to the office which would be a little bit more unusual you know on those two items casualty losses insurance for the office itself miscellaneous rent for just the office that would be a little bit unusual repairs and maintenance it's likely that you might be able to do repairs and maintenance just on the office maybe so maybe I fixed something in the office for like 300 I don't have to allocate that between personal and business because I repaired my home but it was to the office itself utilities if you were able to somehow figure the utilities or break them out to have it just for the office portion without using the indirect method but usually you would have to use the indirect method excess mortgage excess real estate taxes casualty losses so let's keep it at that and let's start there let's see what we get so then I'm going to pull this on over and let's just check out what it populated here for the form so part one part of your home used for business so we've got the 300 area used regularly and exclusively for business and then the total area of the home we're saying was the 1200 if I pull out the trustee calculator there's the trustee calculators to come to save the day 300 divided by 12,000 is a 0.25 percent right so then we're going to say all right that's going to be our ratio it's a little low on the ratio but we'll say that's going to be it so then we've got the 2.5 percent and then the amount of the schedule see so it's going to pull this over from the schedule see because it's trying to see if there's going to be a limitation and then up top we've got the casualty losses deductible mortgage interest and the real estate taxes but we're focused down here on these items we have the direct expenses and the indirect expenses so for the direct expenses the ones that we can apply directly to the office itself we put that 300 dollars in for the repairs and maintenance that we imagined on the office the rent however indirect same with the repairs and maintenance for the whole for the roof of the home we imagined and the utilities for the whole home that comes up to the 21 900 and so then we have multiply 23 column b by line by line 7 which is our percent which would make sense so the indirect items are the 21 900 times the 0.025 that gives us our 5 48 about so that 5 48 is the portion of the indirect items and then we're gonna we're gonna add that plus the 300 the 300 and because that's the direct that we get and that comes about to 8 48 that flows into the schedule see notice it's not in the normal kind of deductions up top but rather down below down here and that's going to be then populate into the 9 9 1 5 152 which ultimately of course pulls over to the form 10 40 here so that's the general idea of it now if you own the home it becomes a little bit more complex because then you've got the mortgage interest and possibly depreciation that you have to deal with so just to give you an idea of why that's a little bit more complex it's because I'm not going to have the rent here the rest might be somewhat the same but then I've got like the mortgage interest so let's say the mortgage interest was I'm going to pick a high you know fairly 20 000 to try to also think about what would happen on the schedule a and then I'm going to say that the real estate taxes let's say we're 7 000 so now when I pull that over notice what's happened here I'm on the form 8 8 2 9 and I've got that populated up top here so now it's in this area where I've got the 20 000 and the 7 000 adding to the 27 000 but then I have this little worksheet which is telling me the allocation between the schedule a and the form 8 8 2 9 why did that come into play remember before when I went to the form 10 40 we were taking the standard deduction as opposed to the itemized deductions the things that usually kick people over to take in the itemized deduction is owned in a home because you're possibly most likely have a loan on that and the mortgage interest could be deductible as an itemized deductions as well as the property taxes so if I go to the schedule a now what it did is it basically populated now into this area for the taxes that were paid and so now we've got the the state local real estate taxes are being allocated here it's using an allocation method to do to allocate here and then we've got the interest which is being allocated here now that gets quite confusing when you do the data input because if you were to try to look at this and say well where did this data input come from you would be jumping to the the schedule a you'd be going all right where's my itemized deductions and I would be going into the schedule a and say where's my interest over here and there's nothing in the data input field for the interest why because we put we put it over here in the form eight eight two nine so it can properly allocate the interest to the schedule a and the and the home business use in accordance with the ratio so that gets messy also note that again if you did hit the limits for the amount of mortgage interest that you can deduct because of the loan thresholds that could complicate things although that's a little bit unusual but what's more common is that if your income goes above the $10,000 threshold which is typically deductible on the taxes over here for the state taxes that can complicate things a little bit as well but in any case you get the idea that you would think that you would have to basically allocate between the schedule a and the form eight eight two nine if you're taking a schedule a deduction if you're not taking the schedule a deduction then maybe that's not as applicable because you're not going to be you're not going to be itemizing so if you're still under and taking the standard deduction then you'd be in a similar kind of situation as the rent okay so then you know that so in that case we see that that is calculation that calculation is up top taking place here instead of instead of basically down here but everything else is somewhat similar the allocation as you can see is if I took the 20,000 of interest for example 20,000 of interest times the 0.025 that's where we're getting the 500 that's being allocated to the to the eight eight two nine and then the 20,000 of interest minus that 500 the 500 is where the rest is getting allocated to the schedule a the 19 500 which we just saw on the schedule a similar kind of thing for the property taxes we would expect all right so the other thing that gets confusing if you own the home is that what you don't get on the schedule a remember that the schedule a by the way is weird for these taxes so the taxes and the interest why do I get to deduct this interest it's on a personal thing if I wasn't using it for business that's weird thing to have so it kind of muddies our thinking of what deductions kind of normally are but usually you wouldn't get a deduction for the home because the home is for personal use so but so if but if we bought the home as an office if we bought an office building in other words we would be able to depreciate the cost of the office building so I would so then you would think well I would should be able to depreciate the portion of my home that I'm using as an office so that's a that's the other thing that kind of muddies things up now the other thing that kind of muddies things up with depreciation is that it'll also possibly adjust your your cost or basis in the home so when you sell the home it'll it'll make that could make that more complicated because it could lower your basis resulting in a higher gain and and that gets another thing that could get a little confusing but let's put the home on the books and depreciate it okay so if you're putting the depreciable home on the books you've got to be careful in terms of what's going to be the cost of the home because it you might have your business that started after so now you got to think about what the basis basically of the home is and that kind of stuff and make sure that you've got the method of depreciation correct and that kind of thing but let's just get the general concept here because the general idea would be that we put the depreciation on the books now we have a depreciation schedule it's the basis I said was 300,000 and the home 2.5 business in accordance with the ratio that we used so that means the the depreciation is a basis is going to be 7,500 and then it's using the straight line mid-month 27.5 I'm going to get to the 261 which now pulls into our expenses for business use and so now that's going to be added here at the 261 so that also gets quite a lot more complicated than just kind of allocating the rent over and like I say it gets a little bit complicated to figure the basis of the home and the out and then to and then to think about what that's going to have on an effect on your basis in the home if you sell the home and that kind of stuff at a future point but that's the general idea okay so now let's go back to the renting situation because it's an easier situation I think and then think about what if we had a loss and then the simplified method so I've changed it now so we're back to like renting instead of owning the home no depreciation we just got the the rent here in our calculation coming out to the 848 that's pulling over to the schedule C on down below so let's say that we had a loss on the schedule C so I'm going to go to the schedule C and say okay let's say that the schedule C is like a break even almost break even but with it before the business home so 120 000 so so now I've got 120 minus the 120 and nothing's happening with regards to the the business use of the home because it's basically restricted it and you can see that over here on the form 8 8 2 6 same form is being populated and calculated but it restricted it and down here on part four carryover of unallowed expenses to 2023 next year operating expenses subtract line 27 from 26 if left since zero so there it is pulling over let's say we had just a little bit of income let's say the income let's add like let's let's let's remove like 200 here and just to nail this point home and go to the schedule C so now you've got this was the income before the home use of the office and now it's allowing you know the 200 here and that's bringing us back down to zero the general idea so you could see what is happening conceptually so now it's limited by the 200 and now the carryover is the 648 all right now this time I forced it to use the simplified method and you can see it comes out to be far worse using the simplified method so if I scroll down I said I just used the simplified method so now we've got the simplified method enter the total square footage of your home we said was the 12,000 and be the part of your home for business use is the 300 used a simplified method and so on which I believe is just taking that 300 times the five dollars and then multiple times well hold on it's being limited let me go back on over here and say let's bring our income back up so we can get a fair comparison here that's not fair that's not fair the way you did it 20,000 okay and then so now we've got our income back on the board okay so there we go so now now the simplified method is the 300 times five right so 300 times the five dollars the 1500 it's not being limited the 300 just being the square footage in essence of the office now this is actually coming out to be higher because we put a we put a square footage of our business use compared to the full the ratio was quite small that we used so you can see you'd want to do both of these methods because because note that you would think that this method because it's for the whole country might work out better if you were in a situation where you were where you're in a lower cost of living place and you have to be under the 300 square foot because if it was over 300 I think it's going to cap it at 300 so for example if I put this at 500 for my business use then it still caps it at 300 right so that's going to be a limitation as well and because there's different cost of livings within the country you would think that it would be likely that if you live in a high cost of living area it might be better to use the actual so now that I've changed this to 500 it limited to 300 let's go back to the other method I'm coming up to 1500 here and if I use the other method it would we would be coming to 1213 so let's just increase that a little bit more let's say it was you know 600 600 and so now we're at the 1395 go back on over and let's say the rent was higher let's say the rent was 35 000 so now we come to 2145 right so so and then if I go back on over and I say okay let's force the other method which is where's the forcer thing where's the forcer thing this method then that would still be capping me at the 1500 so you kind of have to do they try to do the simplified method as if you can just pick the simplified method and go but that actually makes it so you have to do the comparison between the two methods to try to figure out which method is the best now so that's the general idea you can dive into this in a lot more detail to determine you know how to exactly calculate the square foot and special situations like inventory or if you have a separate structure that you that you need to get into you can do more research on that or if you have a daycare facility in particular it goes into a lot more special circumstances in that particular situation or industry which is quite common you know business use a type of business for the business use of the home so you can dive into those in more detail and research them on the iris website iris.gov


People use this passage, touch not the Lord's anointed, do my prophets no harm so forth, and try to apply it to them. One, this was at the time that it was given, time specific for certain people, but in the audience was someone different and truth be told, and I think we forget about this, this was in regards to true prophets, true people that were anointed by God. But this kind of rings hollow, as a matter of fact, kind of suspicious when you hear T.D. Jake say it. When God anoints a person, no matter what they do, be careful about putting your mouth on them, because they belong to God.  Does that even make sense? Touch not what God, well first of all, I know of an example of a person that someone did speak about and this person was truly anointed. Before I get there though, the question that needs to be asked though, the people that you think are anointed and they are really God's prophet says who?  The proof oftentimes is gonna be in the pudding, but even still, are we not allowed to put our mouths on someone else? When God anoints a person, no matter what they do. If that's the case, Paul violates that because Paul does that to Cephas, who is Peter. He says in chapter two, verse 11 of Galatians, he says, but when Cephas came, that's Peter, I opposed him to his face because he stood condemned for prior to coming of certain men from James, he used to eat meat with the Gentiles, but when they came, he began to withdraw and hold himself aloof, fearing the party of a circumcision, that is fearing the Jews, for the rest of the Jews joined him in his hypocrisy with the result that even Barnabas was carried away by their hypocrisy. But when I saw that they were not straightforward about the truth of the gospel, that's what he says, I said to Cephas, in the presence of all, if you are being a Jew, live like the Gentiles and not like the Jews, how is it that you compare the Gentiles to live like the Jews? In other words, he's confronting Peter, he's putting his mouth on him, and this is done publicly, not just for them in a private session, but we have this account in the most public book ever. That is the Bible. So did he violate this? But then notice what Mr. Jake said. God anoints a person, no matter what they do, be careful about putting your mouth on them because they belong to God. No matter what they do. So they can do anything, anything, and we can't say anything about it. We can't deal as Paul says to judge the people inside the church. We can't deal with that, really, because we don't see that in the scriptures. As a matter of fact, what they don't do is what he won't do is give an actual scripture to back up his point. However, the Bible tells us, the Bible tells us, Paul says, so he says, do not participate in the unfruitful needs of darkness. No, so no matter what they do, even if they're unfruitful needs of darkness, Paul says, but instead, even expose them. Jake says, don't. Paul says, dude, let's go with Paul. If there's any bringing down to be done, God will bring them down, not you. Now I will agree with him on that point. The Bible does not call us to bring anyone down, but to expose that person. Now God might use a person to bring another person down, whatever. But our job, if we see a heretic or some heresy, it's not to say, you know, it's my life mentioned mission to bring that person down. No, because we don't see that in the Bible. That will be God's doing. Now he's likely gonna use other men, or he could just use something, a natural disaster. He can use that person's health, what have you. God is not limited to what means he might use, but I'll agree with him on that. It's not our job to bring someone down because we don't see anyone else, but we do see Paul warning people of other people. As a matter of fact, on Paul's deathbed in 2 Timothy 4, he warns about bad teaching, unsound doctrine, and then even calls out people by name such as Alexander. Because if you touch what God has anointed, you become an enemy not of the person, but an enemy of God. Simply calling out someone's sin or calling out someone's error in the scriptures or their heresy. That'd make you the enemy of God. Even if the person is well-meaning, because you're never anointed to do or to commit some sort of heresy. And again, who's determining who the anointed person is? Oftentimes it's the very person that's either called on a sin or the person that has given some sort of gross misrepresentation of the scriptures or heresy that they will come back and say, or their friends might say, don't put your mouth on God's anointed. The Bible says though, we should contend for the faith, earnestly contend for the faith. And so even though that T.D. Jakes has a large following, God has a bigger and better following, a more powerful following. Let's go with what the scriptures say and not with what this person is saying. Amen.