Welcome back to the breakfast and plus CV Africa. We had straight to us a conversation Well, we look at the outbreak of LASA fever the Nigerian government has issued an alert on the LASA fever outbreak That has taken, you know, the lives of 102 persons in a dough Bouchie among all this this morning We're being joined with a public health physician a member of The public health physician of Nigeria Lagos chapter dr. Ghani you jammy you it's good to have you join us this morning Good morning. Nice to see you to have you to this morning. That's all right So with the case right now, let's quickly share your thoughts Do you think that we might just be experiencing a health crisis? We have LASA fever We also have you know the corona virus with different variants among other diseases Can you please tell us what you know the case might be for the Nigerian health sector? Okay. Well, nobody and we say that Realizing the fact that we are currently back there with COVID-19 However, I would like to share my thoughts regarding the fact that LASA fever has been with us for a long time. It is it has become an endemic disease It does occasionally usually during the summer Research have shown that during dry season some are said during rainy season when sometime we just have a spike Dr. Jami Yes, go ahead System People miss it when somebody presented as a facility Attempts people and the virus is been diagnosed after some of them that maybe do not option also The issue has to do with the diagnosis because it mimics that a lot of differentials that is Diagnosis that's associated with the virus like Somebody may assume that somebody presenting with fever Not Well, why because you've described this as Endemic here in Nigeria. Why has it been difficult for Nigeria to deal with LASA fever? It keeps going and coming back and of course we failed to also mention that the Fatality figures with LASA fever fever in Nigeria are staggering We still have not been able to deal with it. So, so what's the biggest challenge? Bigger chance is diagnosis at presentation because most of times the size and symptoms are not specific for LASA fever So a patient can present with symptoms Suggests of malaria or a terrible fever or any fever in us you know, probably the fact that our Infection prevention and control in some facilities are not too impressive and you also agree with me for the fact that You will expect that any point that you'll present fever Or any other maybe Diarrhea vomiting the first thing that's which I know is that is surfacing of malaria or any So usually people don't take caution You find that because dealing with LASA fever will require wearing Equipment and so on. So most of times some people assume it does malaria or the tariff evil So so it takes it to require index of suspicion for somebody to think that a person presenting Actually Fever for instance, let me give you example What happened in a natural state sometimes in November where we lost two of our colleagues What happened was that this woman Delivered and presented with postpartum hemorrhage, you know, bleeding following Anybody would believe that okay, it could be as a result of maybe a Conviction following delivery. I think of the this one was operated on in the B2 a kind of control the place Intiquid was postpartum hemorrhage at the end of the day it was a case of LASA fever So the issue is this is that this part we having the case definition In terms of is he a suspected case for people case is only one we have a confirmation case that somebody may and At times most of time anything will have been done, you know with the patient Vomit is all Secretions and so so before it may be a Suspicious or LASA fever would be made but usually people normally miss it at the beginning because of the nature It doesn't really present you Only occasional where somebody come, you know, I'm a high source of issues or somebody call with bleeding and Fever with other symptoms, but on many occasions only 20% presents with bleeding So this is some of the challenge. So I maybe as we go around the subject what we think we can do Which I believe we are currently doing each other will not be able to achieve the result. Thank you Okay, so Do you think that you know, we have done enough since 2016? I mean when we had this outbreak of LASA fever Do you think we have done enough as a country and what can we do? You know to ensure that we reduce the death rate and of course we improve and prevent all of this Okay, yes, we really don't wear in terms of surveillance But I've said this is a disease whereby you can be specific as to the size of symptoms for Easter Let me give an example. It's a specific case now. It's somebody that may be fever within 32 21 days, which may be Degrees and a both with symptoms such as nausea vomitting, you know diarrhea, the lice body pain, muzzle pain Abnormal bleeding that is bleeding from that. As I've said bleeding, you can only see that in 20% of days So the issue with the only way for which I don't want to stay as part of prevention is for all to have a vaccine for it It's unfortunate that since the discovery of LASA fever since 1969 We're here to get vaccine, but there's a lot of work Currently ongoing, but the only thing we are we advise is especially Relatively in the eye endemic area is for us while I saw eye in this or suspicion Especially if somebody's coming fever, we don't just have this malaria. Actually, there are a kind of a Management protocol with gas to be for instance when you suspect somebody Maybe presented a fever With all those symptoms I just mentioned. Maybe you try to commence and think it as anti-malaria when the person does not respond Within maybe 48 to 12 hours. I've been suspicious whether it is not malaria So but unfortunately before you get to that point of people thinking that in the likelihood of the malaria You'll have freedom with that patient normal contact and so on. I want all that you know All to say is that you don't expect for every patient coming fever a physician should be very All the gadgets, you know, because this is a very high virulent virus I expect it to wear the normal PPE and so on and see, you know These are some of the challenges. So the only way forward as part of this in case we miss This is for us to develop vaccine, which I think the National Center for Disease and Control Nigeria has been in In charge of ensuring that we have a vaccine for it because if you look at it, they've done a lot We have about five centers and so I think the way forward is that is to develop medical vaccine It will go along with a kind of reducing all these miscellaneous which are the end of they get complicated More people involved and so on and so forth. Thank you very much How are transmissible is LASA fever, you know, and of course, what's also the Fatality statistics, how many people get to survive LASA fever and also talk about Nigeria's health care system currently We are still dealing with COVID-19. Do you think we can handle a full outbreak of LASA fever? Is this something we should be worried about? Yeah, okay Case fatality Wanted out to say is that For every Case of LASA fever only about 20% end of getting signs and symptoms 20% And among these the case fatality has been between 10% 15 The only situation about we get high case fatality People that are high risk like pregnant women children people are both 40 years and other people people with Comorbidities, I may be hypertension and other diseases. Those are people that are more in pregnancy The case fatality may reach up to about 50 55% from 45% and above So it's more that's why if a pregnant woman Presented in the hospital with complications and if LASA fever is not diagnosed on time The risk is really higher because in terms of even the outcome of pregnancy the woman or so So these are some of the The issue as a regards to that we don't pray for us to have a kind of company tell me because it will be a company It's already the our assistance already over stretch So having this adulting will not be healthy for the assistant So the best thing that we need to do as quick as possible nipping the board and I think the AC this is doing a lot of work and I promise it even the states they now the capacity No, so I do that as you can about you have the isolation center where they are taking care of them So the only thing that is that since we are witnessing a kind of spike in this in cases of LASA fever I think now in where that such are not being you know discovered or Established what we need is that for every fever we need to very careful as regards to how we manage anybody present Especially if they are coming from high endemic areas like Nassar Rawa, Bainway State, Tarraba So now we're but it was all used to know as one of the Endemic area I body have been now we are witnessing things like that. So at this moment I think about for the COVID-19 which will normally, you know, this Come suspicious point the temperature of about 18 degrees and above. I think with the current situation I think we also need to rule out fever especially on explained fever with all without beating We need to add a high index of suspicions and we need to work in transfer Infection prevention and control in IFA. We don't just assume everybody call me with fever Is this a highly transmissible infection From person to person Yeah, okay, you say For person to person is more because usually, you know Very carry out that infection is Is is rats. We have a class of virus called mastomins Especially that is mermaid rat. That is why you see them all in the in the urine in their feces That is in that dropping. So that is there actually to resolve of that virus But usually when there is man interface with rats I thought you know, not coming out food very well With the urine or with the droppings or try to make it as a meal, you know, all team for them and so on And so anything that will make us to have a contact with any of the droppings I can actually cause an infection in women, but it seems that man to man, you know true Maybe Bring our secretions and so on can actually, you know, post a more risk as that's a Transmission of last a fever. That is why if there is any case of loss of blood at his babies in their facility At times it can lead to a lot a very very You know, pretty So that is why it's actually my left for man to man Man to man. Yes. Thank you. Okay. Can you kindly take us through? The preventives are there measures that can be taken to ensure that this doesn't happen I mean for COVID-19 we're being asked to, you know, wear the nose masks wash your hands and Just constantly respect the social distancing and the malaria You'll be asked to clear the bushes and clean the quarters So are there things that, you know, persons can actually engage in practices to ensure that we don't get to this point Where they contract or the contact, you know this fever Okay, since at this moment we are having Outbreak in some selected states The first thing that will start based on our level of prevention light is at the primary level Immunity we need to eat well Because immunity also play a role. This is a viral infection Good nutrition and try that we eat well I don't like the normal COVID will normally encourage people to also eat well, you know good It's helping building our immunity Then I did also this level or in terms of prevention We need to ensure that we cover our Our food anything that is edible. We need to cover it But we don't expose our, you know, foodstuff at home. We should learn to cover them because of Counter with rats. Then another thing that We need to do is that for those that aren't rats all those hunters and so on at this point in time We need to they need to desist from it In the rural areas, they need to stop speaking a real food item on or by the roadside or the an open surface where that can be Contact with with with rats. Then another Thing I would like to also say So that's what I that we should avoid making direct contact with maybe touching maybe when you cure rats You know, somebody you don't be able to pick it all those things are higher in terms of the practices Then another that we need to do is Our mental sanitation very key because by telling our home is clean It's gone wherever reduce contact a little movement of right to our homes as well So proper environmental housekeeping is also very very very important at this point in time Then another thing is at the facility level. We need to have a high index of suspicion at this Point Send in anybody that call if you want to ask money, especially if the we're having about a temperature about 30 degrees and above We need to because it's not cases of master people that present with beating So we need to avoid that in case of situation in situ that effectively our Special provision and control our protection is I appear to be more relatively severe because I had making contact with a Dissecretion of an infected person. We could be blood to be urine That's also we need to be at the effort to need to be very that idea suspiciously to be there So that the moment maybe We institute the appropriate, you know, investigation if it's my weekly to our normal I don't want to go into the test so that people They know what to do in terms of trying to ask today when I As quick as possible with proper official provision and control to see whether that person's money So that And then that can come out in the calm, you know, present with Fever in our in our setting so after which And again if there's suspicions of money that because that can be money that will last of your way Together so in the case somebody is not in responding based on the protocol of instituting a standard medication for malaria that should be I That should also serve as a pointer to something then they can take the patient sample and you know, you know Send the sample to appropriate Diagnosis centers. We have about five. We are one federal medical center of war We have one in the Iroha specialty teaching hospital. We have another one in legal university teaching hospital Those are there. So there we have any abuja the SEDC laboratory Facility reference laboratory in in abuja. Then we have one in a point that is in federal teaching hospital So usually we have a protocol that is we call that's what's going to get a Disease surveillance and response Starts changing we have in the country. So usually there is an alert Processes of reporting when there's ideas of suspicion from the hospital of particular government to the state So they know the right thing to do. We have all the structures of ground at all level But they will inform the national the state to be involved and all the appropriate, you know Alerts and incident Response will be put in place to ensure that other people are you know are prevented from getting contact for those who would already You know Thank you. So in terms of isolation and making sure that properly treated we have all those Protocols are grinding you want you to ensure that we take care of that. Thank you. All right There's a public health physician and member of the association of public health physicians of Nigeria Legacy chapter dr. Ghani you jam you. Thank you very much for your time and for speaking with us this morning It's important information concerning lasafi vine. I think everyone should be aware Thank you once again Absolutely, and of course a big story there for me would be that bush midsellers need to be checkmated I Guess it's something we're not saying but this is what we call it a wrap Thank you so much for being part of the conversation The show would definitely return tomorrow and the time again is seven o'clock In the meantime, you can be sad on any part of the conversation. It's all right to follow us on Facebook Instagram what plus TV Africa and do not forget to subscribe to a YouTube channel Is it plus TV Africa and plus TV Africa lifestyle? I am messy before do have a great day, and I am a soggy along


I was 20 years old, like I've been new about the game, but I've been like, you know, breaking on boys and breaking on dudes and all that, but actually like activating my horn and hitting a concrete, hitting the concrete, going to a red light district, actually selling my body. I was 20 years old. It was June 1st, 1985. And I know when you said, um, you started out in this lifestyle, what you started out seeing was your brothers, right? So how old were you when you decided that you wanted to do this?  Is that what? Pimp. Okay. The first pimp. How old were you when you actually did that? And how did you? I was 20. You were 20? I was 20 years old.  I was 20 years old. It was June 1st, 1985. You know the exact date. I know. It was a Saturday night in San Francisco and it was lit. But you said one of your brothers were sort of like protected because in the story you told, you said that whenever he was coming to the house, y'all would run inside and put on like longer pants and stuff like that. That's when I was a teenager. When you were a teenager. So I was 20. I'm grown. Right. I would think that he was 17. So 20. I'm grown.  You know, I'm grown, grown. I had a baby. Oh, okay. You know what I'm saying? My brother's cross country. Okay. They're doing their own thing and I decided to get down with the get down. So like when I was younger, yeah, we were scared of our brother. You know what I'm saying? Like strict, like do right in school, do this, do that. But I'm a 20 year old woman working at the post office, sorting mail.  Okay. And I just went, it started on the weekend and it just was like full blown. Once you get that money. How much money did you make that first time? The first night, I made $500 and I was with a white girl named Kim. She had blue eyes and a blonde hair and this Italian girl named Terry. But like I said before in one of my interviews, I don't think that my night would have turned out that spectacular had I been by myself or with some other black girls. And that's not knocking black girls. I'm saying white girls can get in places where other people can't. And then I'm with, I'm a cute black girl and I'm with the Italian girl and a blonde girl. We looking like a girl group. You know what I'm saying? Are Charlie's angels. And it was no eye denying us. You know what I'm saying? Anybody, any trick to see this, you know, they giving us what we wanted. How did you choose your pimp? How did I choose my pimp? Because you, you ended up with them. So you ended up with their pimp. No, no, no. No. So you just walked out on the track and be like, this is what I want to do that night. You didn't have a pimp that night. No, I wanted, I wanted, no, I didn't. Okay. So you did not have a pimp? No, I went out with them and I turned out, but they did have a man, but he was like a dope boy. Oh, yeah. So I was out there when I was out there on the track, I ran into a real pimp.  He wasn't selling dope. He was straight getting it from the womb.


Welcome to Grand Rounds for Ophthalmology and it's great to start our year out by talking about the Moran Corps and the Eccles Health Sciences Library, a resource for your practice and for your scholarship for the coming year. So I want to acknowledge all the people on the library committee, Brian Jones, Griffin you're going to hear from, Mary-Elle Young, Nico, Branquillo, Becca Genture, Rachel Jacoby, William Barlow, Jeff Petty, and then all of the staff for Moran and Brady, Barbara Curris, Elaine Peterson, Ethan Peterson, Elizabeth Neff, Lindsay Dunino, and then our tremendous Eccles Health Sciences Library partners, which is Christy Jarvis and Nancy Lombardo, and you're going to be hearing a lot from Christy today about all the new resources that take place in the library. I'm not sure why this. So we're going to start out with Christy giving us an update on the library and then we're going to be doing an overview of Moran Corps and I think you're going to be very pleased about all the new things that we have in the Moran Corps currently. Now Christy has been with us for many, many years on the library committee. She's the associate director of scholarly communications at Eccles Health Sciences Library. She's the person I've been working with to ensure that we have licenses to books, journals, databases, tools for teaching, education, and patient care. And we go through every single journal in ophthalmology, every late summer, early fall, and decide how we're going to move forward with it. And we ask Christy to come every year because there are so many new things happening and publishing and in scholarship and you need to stay up to date with this information. So Christy, I'm going to turn it over to you. I really appreciate you inviting me back again. As Dr. DeRee mentioned, every year I'm invited to come and speak to you about library resources. And for the past couple of years, I have focused on resources in terms of books, databases, and journals. And I'm going to touch on those briefly at the end. But I really wanted to spend some time today talking about the people resources, the people in the Eccles Health Sciences Library, who we are, what we do. And what I'm hoping that you take away from this part of my presentation is having learned at least one thing that the library can do that will make your life easier. Okay, I doubt people come here very often to say I'm here to make your life easier and I'm not selling you anything. There's just resources that are available that I want you to know about. So the Eccles Library, who are we? These are some of my colleagues that work in the CRED team, which is the Clinical Research and Education Support. So a very talented group of people. Some of the things that we do, some of the roles that we play, you may not be aware of. Obviously, we're librarians. We are educators. We do a lot of instruction across the health sciences, schools and colleges teaching evidence-based practice. We are researchers ourselves. We undertake our own research projects. We are lit-searchers and we are experts at finding information. So what is it that we do? I have a feeling that some of these slides may be somewhat surprising to you. The first thing I'm going to talk about what it is that the library does is improve patient care. I've thrown up some statistics from a study that we've done recently that involved 118 hospitals and about 17,000 providers that for a year had librarians performing clinical searches. And throughout the course of that one-year study, 50% of the providers in the study changed the advice given to patients and families. So you're talking about 7,000, no, what's half of 17,000? 8,500 physicians changed the information that they gave to patients and family based on having an information expert undertake the clinical search. 30% of them influenced the choice of treatment or choice of drug therapy. 25% impacted their diagnosis or changed the choice of tests. So when you consider how large of a provider population that is and the number of patients that they see, there is a huge ripple effect on patients. And there is a growing body of literature that supports this idea and it is becoming compelling enough that the library is having conversations with CMIO of the hospital who sometime in the coming year you are likely to see embedded within Epic an option to have a clinical librarian perform information searches to improve patient care. So that's just something to keep an eye on that you may not be aware that the library is already involved in this type of work and it's likely to expand. And that there are people that can help you track down the information you need for patient care. This is just a slide in case you're interested in reading a bunch of articles about this later and as a good librarian, I have to show my references. Another thing that we do is provide tailored search results. Now, if I were a gambling person, I would put all my money on the fact that these are the two resources that you search most frequently. Is that true? Yes. Okay. How many of you think that PubMed is an exhaustive resource? Oh, good. No hands. Okay. It's not. But do you know what it is that it is searching? And perhaps more importantly, do you know what resources it is not searching? Maybe not. Librarians do. Up to date, same thing. Very robust resource, not exhaustive. There is a lot of information contained in the world of biomedical literature that is not found in either of these resources. The library currently provides access to 350 databases. I don't expect you to know what is in each of them, let alone the nuances of how to effectively search each one. That's what the library is for. We spend a lot of our time swimming in this world. You don't. I work with people who are, quite frankly, much better librarians than you are. For the same reason, you're a much better ophthalmologist than we are. That's what you spend your time doing. You train to do it. You do it all the time. And you just become familiar with patterns. So what I want you to take away from this is PubMed at up to date are phenomenal places to start your search. They may not be the place that you want to end your search. In addition to these just few databases that I picked out to highlight, and that universe of another 300 plus, those are only going to find resources that are controlled by commercial publishers. Beyond that, there's a whole other universe of great literature. I worked with providers and found that the information they were looking for was buried in a data table on a clinical trial. You're not going to find that by searching any of these resources. So librarians can help you figure out what place to search that's most likely to contain the information that you're looking for. And quite frankly, that's not the best use of your time. Your job is to take the research findings and apply them in clinical practice. But the amount of time that you may want to spend digging up that research finding, there are people who can do that faster and more effectively than you can. So that's one way that I would like to you stress that the library can help make your life easier. Something else that the library can help you do is facilitate research and publishing. The library can help you find source materials for systematic reviews. And the library has a team of people that can actually help you throughout many stages of an entire systematic re-process. They can help you find source material for grant proposals, IACOC and IRB proposals, and help you manage, store, and share your research data. On the publishing side, we can help recommend publications that are appropriate for your topic and likely to be interested in what it is that you are writing about. And find reputable journals to publish your work in, manage your citations, and help you avoid predatory publishers. So when I put this slide together, I was thinking about which one of these things I wanted to spend a few minutes diving into. I'm not going to dive into most of them. And I've decided I'm going to talk a little bit about predatory publishers. And the reason for that is over the past year, the library has probably fielded 50 questions from researchers across the health sciences who have either been duped into publishing with a predatory publisher or have concern about being duped into publishing with a predatory publisher. So very quickly, what is a predatory publisher? There's not an agreed upon definition. Here are some samples. What they all have in common is exploiting. These are unethical publishers who are trying to exploit all of your work for financial gain and not for the benefit of the scientific community. Oh, I forgot there's an important part of this. Predatory publishers are better talked about with a pirate hat on. So and I have an eye patch, but I didn't have time to put that on. Just imagine I'm wearing one. So predatory publishers are exploiting your work. And really what they are exploiting is the open access publishing model where open access publishing charges you for services that they provide. Predatory publishers charge you and they don't provide the services. So open access publishing for those that aren't as familiar with it flips the model of instead of having users pay to read the content, you pay to publish the content and then everyone can read it. And you pay to publish. And for that fee, the publisher provides certain services like editorial fees, peer reviewing, archiving, indexing and retraction services. Predatory publishers don't provide any of those, all of which are problematic. But the one that I'm going to focus on is what happens when they don't apply any peer review. So I hopefully don't have to convince anyone in this room of the value of peer review, but it exists to ensure the quality of the research to spot errors before they're published. And so what do you think happens when publishers just skip this process? Here are some famous examples of predatory publishers that have published things that clearly did not go through peer review. There's the Homogenous Configurations by Margaret Simpson, Kim Jong-fun and Edna Crabapple. There was the paper that was submitted by the Center for Research and Applied Phrenology or Crap and my favorite Pinkerton LeBrain and Orson G. Wells, who published Cuckoo for Coco Puffs that was accepted by 17 medical journals. So I have had more several researchers, let me say, that have said to me, well, Christy, I don't really care or why should I care if a publisher is not putting my manuscript through peer review? I know that my paper on diabetic retinopathy is founded on robust research and it's legitimate. That may be true. But do you want it to appear in a journal next to Cuckoo for Coco Puffs? Probably not. It undermines the legitimacy of your paper. So why are they a problem? Well, ask yourself why it is that you publish. Most people don't publish for the love of writing up their research. They publish to enhance their reputation, you recognize for the work, increase visibility. They're also a problem because if you submit a paper to a predatory publisher and it gets published, by which I mean just uploaded to the web, you now cannot submit it to a more legitimate journal to be published. It's already been published. So you're you're narrowing your options for having it included in a more legitimate publication. It can negatively impact your academic career and it perpetuates bad science. So there are a lot of reasons to try and stay away from predatory publishers. There are some red flags, the big one being once you've been in academia for a. Not even very long period of time, predatory publishers will have scraped your email address from the web and you will start getting overly flattering. I mean, disgustingly flattering emails.  Yeah, I cut them all out and hang them on my fridge so my husband can see how amazing I am. Everyone knows I'm steamed and, you know, eminent in my field. Most publishers do not need to solicit submissions. They may solicit a particular editorial or review on a topic that they know you're an expert on. But just submitting or just soliciting submissions rarely needs to happen. Most publishers have the volume of submissions has doubled in the past five years for most publishers. They're they're drowning in manuscripts. They're not really going to come to you begging for you to submit. So just those overly solicitous flattering emails are a huge red flag. There are lots of others. They tend to have very broad scopes, no legitimate archimer indexing policy, lots of things. There is a checklist that I'm not going to go through. Other than to say that these are some of the things that the library looks at is the transparency, the fees, the copyright policy, the peer review policy, the quality of the website and the publication, the indexing. And then a lot of it is just judgment calls. Once you have been seeing lots of patients with a similar condition, you develop a sort of pattern recognition. There's something that just sticks out that doesn't look right. The same thing is true for those of us that spend way, way more time than we'd like to in the publishing world. There are a lot of things that just right off the bat don't feel right. But if you have suspicions, suspicions, you have concerns, you want some advice or guidance, ask a librarian. This is something that the library does a lot of is stirring people away from predatory publishers. So that is hopefully something that you will take away from this as ask the library to help you with so you don't get sucked into publishing with a predatory journal. Unfortunately, if you do get sucked in, it is extremely difficult to do anything about it, just like there are predatory publishers who will list people's names. There was a publisher once that I called someone on the editorial board to ask about her experience with the publisher. And she's like, I didn't know I was on the editorial board.  So that is something the library can help you with so that you keep your record of scholarship in legitimate channels. To just point out, a lot of them will have almost the same name. Oh, yeah, yes, they will have just a slight wording change. Yeah. Yes. Yes. How do you? Is there any way of having them stop sent you? No, there's not. There is actually a team of researchers, I think in Toronto, two or three years ago, who took on the task of I think they did it for 18 months or two years. They went through every unsubscribed blocking option. And I can't remember how much I should have included this like, but they calculated the number of hours they spent doing that. And at the end of the whole study, they reduced the amount of spam email they were getting by a whopping 17 percent. So it really wasn't worth the effort that they put into it. The predatory self-touchers are pretty persistent.  They will, I mean, they're they're pretty adept at getting into your inbox. The only thing I can say is just make liberal use of your delete key. Unfortunately, was there someone else that? OK, I am going to talk quickly about a couple of key resources beyond just the people in the library. Um, full text in PubMed. I talk about this every year because it's so important. I have found that when we do the library does a lot of instruction with students and trainees, the finding the literature part, being able to search PubMed, being able to search the databases to find the literature is a fairly straightforward process. But then there's the finding the full text, which is a whole another whole another issue. So the two things that I want to stress for those, particularly who are new here, is that there is no full text in PubMed. PubMed is a citation database. There are publishers that will put links to their website to get content.  It will only cost you $90. So the way you can get access to all of the content that the library subscribes to through PubMed is one of two ways. You can either use the link to PubMed that you can find on the library's website or is included in this slide. You'll notice in the URL it has that you Utah live at the end. That takes you to a interface of PubMed that has all the library's resources linked to it. So that's one way you can see what you have full text access to. The other one is if you if you like to sign into PubMed using your my NCBI account, you want to go into your my NCBI preferences and choose the Eccles Health Sciences Library as your outside tool. And then if you use your NCBI account when you log into PubMed, that will also bring in all of the library's full text. So very important. If you are in PubMed, this is just showing where the link to the library's PubMed is on our homepage. You will know that you are accessing the library's resources in PubMed. If you see that find it swirly icon next to every abstract in PubMed. It'll be next to every abstract, whether we have the full text or not. But that's going to help you find all the places that the library has full text. OK, so if you click on that little swirly find it button in PubMed, it takes you to our catalog where you will see a list with hyperlinks of all of the places that we have full text access to that article. Very common for us to have five or six places where we have access to that same article. The reason that may be important is that maybe else of your website is down, but we have it through some other aggregator. If we don't have it, when you click on that find it link, it brings you to the catalog and it tells you no full text available. And then down here at the bottom where it says additional services, you can request an article. So you could order the article with your interlibrary loan, which does not cost you anything. You click on that request an article. You pick the library that you're affiliated with. You log into Iliad, which is separate from your university ID and password.  The citation information of the article you were just looking at is pre-populated, you order it and it's sent to you and about. So our interlibrary loan department says within 24 hours to be honest, they're usually in six hours or less, sometimes even faster than that. So any questions about full text in PubMed? Any issues, complaints people are having accessing full text? This is really very helpful. I don't know how many of you have used this, but very, very helpful because we don't subscribe to every single journal week. When we look at journals, we look to see how many people are using the journal. And then if there's only one or two for the year, we may not subscribe to that journal, but you library loan to get the article. Yeah, and the key is to do it through the University of Utah website to get a PubMed rather than go and PubMed directly. Yes, because if you just go to generic PubMed, you'll find the citations. And instead of that, find it link next to it. So you can see underneath my arrow, it says full text Elsevier. The publisher will put their link there and send you to the publisher's website. If we subscribe to that journal directly from the publisher and you happen to be on the university's network, maybe you'll get full text. Those are a lot of ifs. If you go through the library's portal, you'll see all the places that we could get it. You know, if you're not on the network, when you try and access it, it will ask you to log in so it verifies that you're part of the university. And then it will take you to the article. The other thing is that there are lots and lots and lots of journals that we subscribe to not in a one on one relationship with the publisher. There are lots of packages that are aggregated. So if you just, you know, Google search the journal article name and just go to the journal website, I heard this all the time, but how can you not have retina? Well, we probably do, but it may not be at the retina website. It may be on a third party aggregator platform that if you went through PubMed or if you went through the library's catalog will take you to the right place. So just because you go to the publisher's website and you can't get an article doesn't mean that the library doesn't have access. The best way, honestly, is to search in PubMed and follow that link. Is there, you said that there was another way to go to NCBI and add the eclipses. Can you show us where that is, or is it? OK, so if you have my NCBI account, so it just want to click on the where it says settings. And settings is a whole long thing. It's where you can pick, you know, your highlighting options and all of that. It's like halfway to maybe two thirds of the way down that long list. It says outside tool and it's just a drop down of and you can scroll down it and you will find I think it says University of Utah, Eccles Health Sciences Library.  OK, OK. So new resources open up. You better do the easy proxy. Yeah, yep. OK, so I like to throw this in here because I really, really hope that sometimes you're not here. Sometimes you're at home, sometimes you're on vacation. You're not on the university's network. So all of our publishers grant access to their resources based on your IP address. That's a whole thing in publishing that is evolving and may like may change in the future. But for now, it's your IP address that is what lets the publisher either say, you're not affiliated with anyone who pays for content. You can't get in or open the gates. You have access. So when you are on campus on a computer that is connected to the university's network. So sometimes I have people say, well, Kristi, I'm on campus. And I'm like, yes, but you're using your phone that is connected to a cell tower somewhere. The publisher doesn't know that you're physically standing on campus.  When you're not here or when you're not on the network, you have to use a remote access method. It's a way of letting the publisher know, yes, I am part of the University of Utah. So everything that we pay for, please let me have access to. So one method is to use the Easy Proxy server, which you can access on the library's homepage and scattered throughout our website is this little key that says off campus access. If you click on that, you'll be prompted for this lovely screen to put in your unit and password. And then it will always after you have signed in, route you right back to where you were. And you will see in the address bar that easyproxy.lib.utah.edu. That is a that is associated with an IP address that now when you go to a publisher site, they're like, yes, that is a University of Utah IP. Please come on in. You will stay signed into that proxy server for as long as your web browser session stays open. If you close it, you have to sign back in. So so that is one option. Another option is to download the VPN software onto your device. You can get this from the Office of Software Licensing.  So two different ways to go about it. I will tell you that most of the library's resources, if you access them either from our website or from the catalog or from PubMed, if you are off campus or off the university network, we have embedded the proxy prompt. So it will often, if you try and get to the article, it will say, oh, are you part of the University of Utah? And if you put in your unit and password, then it passes you on. So we've tried to embed that as many places as we're able so that in case you forget, it gives you a little a little prompt. Okay, a couple of new resources. The one that I wanted to highlight is the library recently added JAMA evidence. It has the online copies of users guide to the medical literature, rational clinical examination, care of the close of life. It has a massive library of podcasts that are all about evidence-based medicine. So if you're someone that likes to listen to audio, it's a great, great collection. And then I threw up a picture, one of the other really useful resources on JAMA evidence, I think, particularly for trainees and early career people and some mid or late. This is always good to focus on improving your critical appraisal skills. There is a library of critical appraisal worksheets that if you are trying to strengthen your skills in critical analysis, as you are reading studies, there are worksheets for different types of studies, different types of publications that prompt you with questions that over time are things that will become second nature to you, that you will just start asking yourself when you are reading articles. But they're a really good training tool to get you into the habit of becoming a critical reader and being able to analyze and appraise the literature. So I wanted to mention that. How do you get them? So JAMA evidence is on the library's home page. There is, it's not very large, but above all, it says you use a pointer so we can see the mouse pointer. Oh, no, I got it. OK, so right here where it also advances the slide. There's lots of buttons on this. Use the mouse one. Can I even show the mouse on here? You just have to move the mouse and it'll come away. No. And it's not this much. Use the old fashioned way and go up to this screen. OK. Finger where it says research databases. OK, if you click on that, that is an alphabetical A to Z list of all of them. And when I said we have 300 databases, that's the list of all of them. If you go under J, there is a link for JAMA evidence. I don't need to be that. And so if you click on that, if you're off the network, it will prompt your unit password and then it lets you into JAMA evidence. So the there are a couple of tools in JAMA evidence that you are able to use, but you have to create a free My Access account first. There are lots of slides. If you are teaching any evidence based practice, you do not have to create slides from scratch. There is a beautiful library of slides you can download and use. And then there is also this library of critical approach to work sheets. And you can you can select one that you want and you can fill it out online or you can download it and print it out and just have it next to you while you're reading. The podcasts, you can also from JAMA evidence, click on the JAMA evidence based practice podcast and you can either pick ones you want to listen to or just like any podcast. You can subscribe. You can subscribe to it and get new. I think they released new episodes twice a week, I think is how often they do it. OK, so that's JAMA evidence. And then I just quickly wanted to talk about some of the reasons you might want to physically come to the library. I know I know everything is done virtually in the in the cloud. But there is some interesting and useful, I think, tools that are physically located in the library. The first one is we have a virtual reality sandbox. If you're interested in talking to some of our staff, if you have an idea for a virtual reality project that you want to explore, there are people that can help you with that. There is also a one button audio video studio. So if you are interested in lecture capture or if you want to record a podcast, we've had people come in to record patient education videos. I've been told that it is truly as simple as pushing one button. But there are staff that can help you as well. It's set up with microphones and cameras and backdrops and all that. So you're welcome to come. The what the studio is something you probably want to contact the library and make a reservation. You don't have to. But just that way you can ensure that it's available when you come over. Why else you might want to use the library? We have treadmill, desks and bikes. So I'm a person that tends to come in pretty early. I'm usually in the library at about five in the morning. And it's amazing how many providers also come in that early and catch up by email and do some reading while they're getting some exercise in. We also have free yoga during lunch on Wednesdays and Fridays. This is partly, I think, to try and counter. So the library, like most health sciences departments, is on board with the university's wellness initiative. But the library also fairly recently for health sciences, students and trainees, so residents and fellows, this applies to you, is open 24 seven. So on the one hand, we felt like we were trying to say, yes, you should take care of your health and have a balanced life. But we're going to be open around the clock. So so we added treadmill, desks and yoga, I think, so we didn't feel so guilty about it.  It does have security cameras and as a guard. So it's a fairly quiet and safe place. If you really have to study it for a clock in the morning, which I hope you don't, you should go home and see your family. OK, last thing is getting help. This is just access information for the library. Library hours. We are staffed Monday through Friday, 7 a.m. to 7 p.m. Saturday, 10 to 6 and Sunday, we're not staffed. Like I said, if you're a trainee, though, the building is open 24 seven and the Bloomberg library here is open 24 hours as well. So you have access to that. Does anyone have any questions before I turn things over to Griffin and the Moran Corps? Oh, sorry. So you're talking about clinical questions and indeed there may be a link that's going to be occurring in our electronic medical record. Typically, how long does that take to get a reply back? Because often that's the one issue is the timeliness. Yeah, so when the link for a request goes live and epic, my understanding is that there's going to be a like a tearing system in terms of priority. Like I'm in with a patient right now versus this patient has just left. They're coming back in two weeks and I need to, you know, get more information before I see them again. So I don't have a definitive answer to that yet. Partly it depends on my understanding is that Dr. Hightower wants to roll out the service to a limited group first and then see how scalable it is and to see how many staff might be needed to meet the demands. If most of the demands are for more or less immediate response, then it will probably will be scaled up more slowly so that staff can have a chance to get causes. So it's it's obviously evolving. Yes, one of the things is that a lot of us if we do any editorial review work or an editorial boards and the rest, it's so pervasive for us in ophthalmology that Elsevier is involved and so on. And we get immediate access to Scopus. How how good do you feel Scopus is as far as so Scopus is very good just like up to date and other tools, though. You have to understand the I mean, it's not comprehensive. So the content that it has is high quality and very reliable. It's just it doesn't have everything.   What do you do? Do you stop? No, I call the library and she gets a gold star. I mean, do you find a colleague? Do you I have just seen this library resource. If you go to the reference, I have asked for lots of things and I usually get it within 24 to 48 hours or something like that. And and it's really helpful. Right. I mean, sometimes the the amount of time it takes depends on how far down the rabbit hole we're going to have to go. I mean, like I said, I have helped providers find information that was, you know, buried in the data the data table of a clinical trial registry. I mean, there are places in the great literature. So the great literature is anything that is out there in the biomedical literature that is not controlled by a commercial publisher and there's tons of it. So the library is probably more quickly than you are able to identify three or four likely places, but then you may be digging for a while. So sometimes the response rate depends on how how far how obscure it is. Yeah. More questions. Now, occasionally there are times where you're doing research and you're not even really crystal clear on the question. And so it's helpful in other places. I've met with librarians just to help me kind of think of other things I should be looking at. Yeah, I find my question. Is that is that possible? Yeah, yeah. So the question has to do with how do you even know if you're asking the right question? How do you clarify the question to get the information that you may not even know that you need? So that is part of a conversation to have with a librarian to help you define the question. So the Married at Eccles Libraries jointly have an evidence synthesis team that does a lot of systematic reviews, scoping reviews, meta-analyses, that type of thing, and has a I don't know if I call it a method of practice to try and get at that very question. How do you how do you create a good research question? You know that. Yeah, it does. And sometimes, you know, I can give an example. We were trying to develop certain different images that would help patients post sclerobuckle surgery for retinal detachment to find what they were seeing, because many times they had good visual acuity, but they weren't happy. Right. And we didn't have enough like terms in our language to be able to describe some of the things that our visual system does. So, you know, this was at another place I was, but we would come out with a librarian who came up with searches that were totally different than ones that we had thought of. Yeah. And I was wondering if that was here as well. Yes, yeah. Search, search. It's strategy, no, search strategies. Yeah, yeah. Search strategies and keywords and systematic reviews. I mean, this is a resource that all of us in academia need. I mean, if we're going to be performing scholarly publishing or reviews or whatever, it's really helpful. Right, I wish that there were a simple, straightforward Google search or everything in the biomedical literature, but there's not and I don't think there ever will be. So, at least for now, having a team of librarians who are expert information navigators, I think is helpful and hopefully a huge time saver for you. Last question before we, I want to, Christy, Christy is our resource. She's our ambassador from the Eccles Hills Sciences Library to the Bloomberg Library. She attends all of our meetings, works with the library committee. So, she's the go-to person for journals and information. This is... Right, or basically, you can ask me anything and if I'm not the right person, I'll connect you with someone who is. So, thank you, Christy. Thank you, guys. All right. Thank you. So, I want to mention Nancy Lombardo. As you know, she is head of digital publishing at the Eccles Hills Sciences Library and she is the person who I worked with to establish the novel library, the Neuro-Ophthalmology Virtual Education Library and then we tapped into her expertise to get the Moran Core going. She won a Merit Award from NANOS, the North American Neuro-Ophthalmology Society and an award from the Medical Library Association for all her work. She's working on Work-Life Balance this week and has to be on a river trip. But I want to introduce Griffin Jardine who really stepped into the role as editor-in-chief of the Moran Core so I'm going to have, let Griffin give you an update on what has happened with Moran Core over this last year. Christy, that was a great presentation. I didn't have a costume today but I did decide to dye my hair an exotic color to make it more interesting, so. So Moran Core, I think everyone's here is pretty familiar with it. I want to just review just some basics and then talk about some changes we're making and hopefully have a little discussion with everyone here just about any ideas you've had, you have from the presentation or from working with this resource but as we just heard a collaboration between us and the Eccles Health Sciences Library and it's really meant to highlight all the great work that we're doing here and put it into a format that is accessible to trainees and ophthalmologists around the world. I think what's made it initially so successful and I actually was talking to Dermatology who was also looking to do something similar in their department and they, you know so much of ophthalmology is de-identified pictures. I mean the picture of a retina has no identifying features so we're really unique in being able to do this. Dermatology essentially couldn't make almost any progress in it but what we've been able to do is use this as a capturing tool and I have to give a shout out to Ethan. I think Ethan's here, is he here? So Ethan and then also Christy and Nancy for recording lectures, recording grand rounds, getting them posted and organized on the website. I mean it's actually an enormous amount of work so without us as a department having to do much differently besides just let this capturing tool work we've put a ton of the information, lectures, high quality didactics here for you know, especially anybody learning ophthalmology around the world to have access to. The, this is the homepage, a couple of changes we've made recently in the last year. We restructured some of the buttons down here. This resident lectures button is new and I think. And then the general ophthalmology. Oh yeah, and I'll get to that. Yeah, I'm sorry I didn't say that but. So now when you go to the resident lecture button you have this list of by division all the lectures that we're already giving. So this is essentially a lecture series for a residency program and some developing country that just doesn't have this sort of material. And it's got every lecture that you know, as you give for an example, the, you know our fantastic ophthalmic pathology lectures by Liliana and Nick now are kind of organized and we've got the year so you can see how up to date they are. And this is, I just think a great resource. The, I'll come back to this as kind of some ways that we can use it for the future. And then the, looking at this, the side panel on that main website, some other new things. This basic ophthalmology review. In the last couple of years we've, it's pretty much completed. We've got a resource now for either medical students, you know, early ophthalmologists in training or non-ophthalmologists. I don't know if, does anyone in your head a non-ophthalmologist like an emergency medicine doctor or primary care doctor ask him how to use a tonal pen or how to do motility testing? I think these are common questions that we get and they are all on here. And on this basic ophthalmology review, basic diseases and then basic eye exam techniques. Ultra sound, again, just another way to capture the great work we have. Dr. Harry, who has just such a resource here, we're capturing what he's doing and then some other kind of catch-all topics that we cover in Grand Rounds. So going back to the basic ophthalmology review. So, you know, intraocular pressure, there's actually a video here that walks you through what our medical students did who was rotating through a couple of years ago on what the numbers mean on the tonal pen, how you do it. I believe Chris Baer is the patient who gave his eye to donate for research and then project. So we've got just organized by exam and then anatomical approach to eye disease on topics. I think there was, I was at a primary care doctor appointment and I actually told him about this resource because they were asking about how to have, there's just such a, there's not really great resources for non-ophthalmologist about the eye. I think almost all the educational materials that we put out as a field are targeted towards ophthalmologists and that's been a big issue in ophthalmology is that we're kind of losing, we're losing the battle in teaching all of our other colleagues about basic eye diseases. Here's an example submission on the direct ophthalmoscope that also has a video that walks you through how to use it. So, there you go, there's our wonderful training there. So, and then a number of videos have been put out. I wanted to highlight this one. Did I see Judith here? Yeah, so Judith, this video on the neuro-ophthalmology exam is our number one with over half a million views. So when you type in on YouTube, the neuro-ophthalmology exam, this website is linked to our Moran, or the Moran Core website is, we give YouTube open access to all of our videos. And what's interesting, just typing in neuro-ophthalmology exam, look at this, the top four hits, three of them come off the Moran Core, which is in YouTube, getting to be the first video to come up actually is pretty complicated and it is a function of popularity. That's the right word. I mean, that's getting a lot of views, but pretty exciting. So, we can't help ourselves, but go over the statistics. The numbers are amazing.  I mean, yeah, it's amazing. 163 countries this last year have accessed this. New user numbers? Yeah, staying the same. Every year, we're almost 90% new people looking at it. The page views went from 6,000 to 75,000. And this is for the Moran Core website, the YouTube statistics. This is when we opened it up. So, all the videos were exclusively accessed through Moran Core, and then we opened up the YouTube channel so that they could be searched in YouTube. And it went from 70,000 in one quarter to 2.6 million in terms of watch time of minutes. So, almost 10 million minutes in 2018. If you look at this, the numbers are actually a little bit down. We think that's probably a function of putting all this information out there, but then not having as much new content in order to stay relevant in YouTube. You kind of have to keep putting up new videos. And so, just a little plug for putting your surgical videos and other things that you're doing on the Moran Core to kind of keep this momentum going. What's pretty unique too, you think about the attention span of the 2019 average individual. And our average view duration is somewhere between four, six, seven minutes, which is, I think that's keeping people on the website for a reasonable amount of time, or keeping people's attention in these videos. So, here you can see just essentially any country that's from the white countries are the ones that people haven't viewed it. So, it's quite worldwide in terms of people accessing the website. So, I'll skip over these, but this slide is just to make a point that you can do all sorts of different formats. You can do an image report, which is so much of our imaging department, or so much of the purpose of this was to capture all the wonderful work that our imaging department has done. I have to thank Jim too, who's really given a lot of his images to this website and just showcasing that fantastic work. But case reports, surgical videos, grand rounds, resin lectures, we are trying to have all of these captured in the website. So, kind of last couple of key points here. Hopefully it's not a surprise to you if your name is on this list. The editorial board, we've decided that it's gonna take a big team effort to get each of these subsections populated. So, we have each section has an editor, and Ms. Megan here, Megan C. So, I'm trying to meet with each of these editors over the next year or so, and Megan and I met and she looked at her website, or at her specific subsection and made a number of changes. I'm just curious, Megan, if you could share your experience or thoughts on how you felt like your role as an editor was what you've been able to do? So, mainly it's just organizing things because the content, due to Kathleen's amazing work, was pretty much already there, but I changed and made a core section to where residents and students can look at core videos that are on topics like the copia or rizumos, and then they can watch those and then go to something like a flipped classroom. So, where they get the content before and then they go to a lecture and it's more going over cases. So, they've already had the material and then they can apply it to a lecture. So, that's kind of the first thing I did and then it's going through and filling in each subsection with appropriate videos. Yeah, and it's, I mean, you've already, significantly enhanced that section and making it more succinct and concise and to the point as well as just organized. So, thank you, Megan. So, we're hoping to kind of do this with you, section. This is just an example of an ophthalmology showing you, you know, on the exam here, you just see all these videos, all these have to and what a great resource that is. I may, just as we're short on time, skip through some of the publication process, just to keep one so, you know, everything's peer reviewed. So, we all, we kind of peer review every submission. We have all the links on the website that give you the template of how to fill it out and I could help you answer any specific questions of how to submit work. The, you know, the students, especially medical students are assigned a submission and I was in clinic just yesterday with a medical student who was looking for a submission and David Dries overheard our conversation and said, well, I've got surgical videos, traction testing on a strabismus case, pre and post strabismus photos that I would, I think would be a great resource. So, he just handed them to the student who's gonna write them up. Ethan is so helpful in putting together and editing videos. So, with utilizing a student who needs the publication for being competitive to apply to ophthalmology, it was a very easy process to get this written up and I think everybody benefits. So, our future goals are, we just want these section editors to play a bigger role in getting this populated. The resource is only as good as its content and we still have a long way to go before we really actually have all the sections populated. We're also trying to clean it up so it's really just clinically relevant. As David Myers here, I don't think he, David went through optics and really trimmed and went through everything that he thought would be just clinically relevant because it was originally outlined based on the VCSC which has some information that may be not be as pertinent to this website if we're trying to just stay to what's kind of high yield. We're also kind of a mini spoiler alert. The resident lectures were, there's a committee meeting to restructure how we do resident lectures and the new movement is flip classroom and having content available online and then the in-person time is mostly case-based interaction and discussion. If you're delivering a lecture but there's no interaction, it's just a delivery of content that can be viewed online or before the actual interactive time together where you can use that for more of a discussion but right of course it's a great way to actually transition and pivot into that model. And then we're just looking to just populate anything that you have, if we can get it submitted and package peer reviewed and submitted, it's gonna be just a real amazing resource for the international work that we're doing. Again, this is I think where maybe what some of the biggest benefit is is to the places that we're trying to create centers of excellence.  Any questions or ideas or thoughts? I wish I had seen this before, June 13th because we had such fabulous lectures content was amazing. for the pediatric breadth of meeting and it was, you know, a lot of people didn't go. We do have the keynotes that were video recorded but if we had been able to video record lectures from experts throughout the world, I mean it would have probably been one of the, you know, richest source of pediatric retina in the world. And so my question is, if we have like some kind of meeting like this in the future, do we have resources where we, Moran could do that? Because we didn't really have the ability to video record everything for the meeting. At least I don't think that was the case. So we only ended up doing the keynotes. What a great thought. I think that would be, I mean you just have to get permission for whoever's presenting. And then Ethan, our A.B. specialist, I exciting across my mind either that would have been just a phenomenal thing to do. We've got the equipment and the rest. I mean, it wouldn't have been a big deal and it is a lost opportunity. I'm like you and kick it myself. I should have also thought about that. And I would just say if Moran can't do it for whatever reason, we've got the Eccles Health Sciences Library. They record all the cram sessions. They record a lot of lectures on campus and off campus. And so there are some resources for future meetings that we should consider. The biggest problem is the guest lecturer may or may not allow you to record them. And we do have to get permission from, when you have people come from the outside, you need permission from them to be able to record them and put it online. But I mean, I think this is if, if somebody has a meeting that's upcoming and you know, we can always look backward and say, oh my, but let's look forward and say, great, next meeting you have, Amy, which I'm sure you'll have another one. Let's try to get all that recorded. And other people who host meetings, we should be able to record those. Get those keynotes up there there for sure. Yeah, well, that's a great idea. Let's work with the conference center about that. But another thing, like we have two tremendous ophthalmologists coming as benning lecturers. So Mark Humayun, who developed a computer chip to be able to restore vision. And Jean Bennett, who basically is in the science for gene therapy in anything, ophthalmology, but anything, she was sort of the first or spearheaded a lot of the work done for the first gene therapy treatment. They are coming. I didn't know if we're able to somehow record or link with that, maybe potentially to the plan. So the short answers, I'm sure we can. The longer maybe there may be some intricacies, but it's better to start looking at that now and later or scramble at the last second. That definitely needs to be worked on now. Yeah, I think we have a lot of designate lecturers that we potentially can implement as a part of the invitation haven't come. Just a form to explain them, the process of recording and posting on our website and how they feel about it and trying to get a provision form ahead of time. I think it'd be a great idea. Any other thoughts or questions? Yeah, I'm going to try to meet with all the section editors. So if you can't be available when I contact you about that. And then again, I think students, this is the summer season. We have a lot of rotating students who are looking for ran core submissions. It's a requirement on the rotation. So anything that you've recorded or an interesting case that you've seen or if we've got good images, try to catch a student and see if you can partner with them in getting it submitted. These are really bright, eager and energetic people who are capable students who really are great at writing these up. And then also we want to do it for our own work as well as utilizing what we're doing. So, okay, thanks everybody. Do you have anything else? Thank you. No, I just want to thank everybody, but we love your ideas because it's your ideas that help us do a better job on the library committee. And the library committee is a really fun committee.  That's where Pirate has. That's right. Yeah, yeah, exactly. Thank you.


The stomach is an amazing organ. It varies in size from person to person but can contain up to two litres of food and liquid. The stomach is one of the organs in the digestive system. It is essentially a bag of muscle where food is kept for up to two hours whilst various things happen to it. As discussed in the earlier video, what is digestion? There are two types of digestion that occur in the human body. Both types of digestion, mechanical and chemical, occur in the stomach. The innermost tissue in the stomach is called the mucosa. This layer contains cells that secrete something called gastric juice into the stomach. This isn't the kind of juice that I would have with my breakfast in the morning. It contains mucous, digestive enzymes and hydrochloric acid. The enzymes are used to chemically break down the food. The main enzyme released is called pepsin and it breaks down protein in the food into amino acids. A lot of people think that the stomach acid is also used to break down food but in fact it's actually there to protect us from infection. There are lots of nasty bacteria and fungi that can grow in food and you don't want these bacteria to be absorbed into the blood in the small intestine along with the food. This can make you very sick and is called food poisoning which will involve the nasty food being ejected by either one or both ends of the body. Therefore the acid which is pH 1 and very strong kills a lot of these microorganisms and keep us healthy. The stomach has a layer of mucous lining which stops the cells being damaged. However if the acid comes up, the esophagus, it can feel like a burning sensation. This is called acid reflux. The stomach also mechanically breaks down food due to it being made of muscle. This muscle is folded in order to increase the contact it has with the food as it mixes and churns the food around like a cement mixer. This muscular contraction is called peristalsis. This makes the food smaller but also increases the surface area for the stomach acid and enzymes to work more effectively. Food is now called chyme and is released into the small intestine for the next stage of digestion. When the food moves on to the next stage of digestion in the intestine, alkali from the pancreas is added to neutralise the acid and stop damage to cells. So there you have it, the stomach, a bag of muscle filled with acidic juice. Lovely!


Welcome, traders, to another tick mill earning season preview with me, Patrick Mundley, before we jump into today's report, as always want to adhere to the risk disclaimer. Most pertinent to today's presentation is the fact that views and opinions expressed by me are solely mine, and they're not indicative or representative of those held by tick mill UK or tick mill Europe. Okay, so let's jump into today's report and we are looking at Microsoft. Microsoft are set to announce earnings after the close of trade in New York today. In terms of the earnings per share forecast, we're looking for $2.24 on revenue of $51.02 billion. For the business out of three business divisions, the intelligent cloud department has become Microsoft's gold mine contributing 40% of the group's total revenue with sound and solid growth momentum. In the previous quarter, the cloud services revenue increased 18% while whole groups revenue only added 2% for the to be reported quarterly earnings Microsoft anticipated revenues from the intelligent cloud will keep increasing at a pace between 17 and 20% to a range of 21.7 to $22 billion. However, Microsoft also flagged that Azure, the cloud's computing platform that switches one of the most, the main engines of the cloud business would slow down its growing speed by four or five percentage points to near 30% in the fiscal third quarter down from 46% in the same period last year. The trend in global personal computing industry has accelerated in the past year so did Microsoft's PC business in the six months ended December 31st the revenue from PC related businesses was down 11% year over year, while in the last three months the yearly downfall rates speeded up to 19%. First quarter of this year has marked the fifth consecutive quarter of global PC sales decline. As such, it's not difficult to see that this is a hard to stop slide will further falter the demand for all the product line under the umbrella of personal computing. This used to be the proud king of the PC, the PC division projected that this sector's revenue for Q3 will be between 11.9 and 12.3 billion indicating a 14 to 17% decline from the same quarter last year. Battlefield for artificial intelligence race has been set up and the smoke is getting intense Microsoft seemingly led the way for now thanks to its shared commitment with open AI to build a generative AI systems that GPT has convinced the world in 2023 that AI will become a topping layer of technology and prompt a new generation of platform shift. Clearly all tech giants are not hesitated to go all in in the AI race and are ready to thrive in this new age Microsoft despite racing inches ahead now is facing fierce competition in its age old rivals alphabet Google's parent company unveiled a similar AI function in March for Gmail which is now used by 1.8 billion people around the world Apple disclosed a 48 45% of its M&A targets are now AI related compared to Microsoft's 23% in terms of bright minds meta has employed 23.5% of staff with AI skills while Microsoft's ratio is about 21.8% Additionally, the ticket to the AI race is very costly Microsoft has boosted its R&D investment in the previous quarter by 18% 6.8 billion, which saw its net margins fall from 36% to 30% in the September The next major wave of computing is being born Microsoft is not shy of its ambition to be the king of the new wave. The challenge being all its old foes are obviously thinking the same. Let's jump in and take a look at some of these statistical trading patterns around Microsoft earnings. Microsoft shares have moved higher in the immediate aftermath of earnings seven out of 12 previous reports on average stock has moved up 0.2% in the first day after trading based on the previous 12 earnings releases Microsoft is more likely to trade higher one day after earnings for an average game 0.2% on average the stock has moved higher by 2.4% On week after earnings from the analyst community out of the 49 analysts giving a racing on the stock over the past quarter 33 are a strong buy seven are a buy eight are a hold only one strong sell terms of price targets on the lower end we have that 212 level upper end is 335 and the average is 298 from an order flow and sentiment perspective that be noticeable buying 14605 contracts of the $300 call expiring on Friday options order flow sentiment in general has been bullish investor sentiment going into companies earnings has 65% bullish and expecting to be predicted move post earnings announcement is 4.7% that's an average of the actual earnings move in recent quarters of 3.4% So with all that said let's pull up the chart and see if we can identify any near term trading opportunities in the stock. So, given the setup I'm pretty pretty bullish Microsoft at the moment, there are two key areas that I'm going to pay attention to, as we head into the earnings, any breach closing breach of that 292 level, I want to engage on the long side. My target is actually initially going to be this 308 level which is a weekly equality objective versus the swing structure here in the swing low we have in place at 246 gives us a 308 on the upside 3, 314 is the yearly R1 pivot another magnet if we can get through the 300 level. And remember, we've got decent buying in that $300 call for Friday expiration. So, like I say, any move through 292 on a closing basis, I want to be engaged on the long side talking 308 and then onto that 314 area. Let's have some trend channel resistance coming in here on the four hour chart in around 312. Equally, any pullback into these, these prior highs here at the 275 level, also weekly projected range sport 273. Again, I watch for bullish reversal patterns there to engage on the long side same upside objectives that 308 and then 314 in extension at this stage, so I could close through 264 263 to suggest a bearish and bearish development that will obviously come with downside surprise in terms of the earnings, and then I can see as pulling back to monthly projected range for 248 and 245 as the next key sport levels below but for now, like I say I'm constructive and bullish. As always traders plan the trade trade the plan, and most importantly, manage your risk until next time. Thanks very much.


With how long I've been playing Dragon Ball Z Infinite World on the hardest difficulty, you would think that I would have already gone through my worst experience, but you'd be wrong. That's actually this video that you're watching right now. For whatever reason, I guess the game developers thought that Vegeta's part of the Cell Saga should be absolutely impossible to play through, but that wasn't going to stop me from attempting it on Z difficulty anyway. Why do you want to fight an android? What is this? Tra- Oh, tough training with Vegeta? Oh, it's another training one, only on Z difficulty, which means it's probably gonna be really tough. The only rhythm one I've ever had to do on these, I did on stream and I literally had to cheat in order to win. It was that impossible. A hundred times gravity? Yeah, let's get some training in. How tough are these gonna be? All right, let me see if I got it. Let me see if I got it. R2. Ah, ah, ah. Oh, oh, damn, damn. There we go, hold on. Ooh! Damn. Okay, these are tough. These are tough. Hold on, hold on, hold on. Oh, oh, I got those. Oh, I got combos, combos. Yeah, Frieza's never gonna embarrass me again. Damn, this is really hard. I'm sorry, Vegeta Square. Square at one, right hook, left hook. Keep it up, Vegeta, keep it up. There we go, back in it, back in it, back in it. Damn! Come on. All right, pick your energy back up. Nice. Yeah, all right, we finished strong. That's all that matters. All that matters is we finished with hard. Prepare yourself, and you too, Kakarot. Yeah! The Android's gonna get it. Goku gonna get it. Ooh, not gonna get it, bro. Oof. That's Vegeta head. I don't think Vegeta's training is gonna go too well on that one. All right, it's a battle with Z-Rank 18. Don't get my arm broken. Don't get my arm broken. Don't get my arm broken. In fact, let's show off the fruits of my training. Woo! Oh my God!  Ha ha ha ha! Damn! Damn! Ain't no goddamn way! Ain't no goddamn way I just saw that. Let's go. Nope. No, nah, I'm not getting my arm broken. Ain't gonna happen. Oh, no. Oh, no. My arm. I can feel my arm about to break. All right, OK, we're almost down to health bar number four. This is a whole boss fight, dude. This is insane. No, don't get that out of here. You're not doing that ever again. No, why is the Android 18 kinda saucy in this game? Did you see that? I'll do that again. I will literally. OK, you're good. Oh, get off of me.  Nope, nope. 18 is kind of saucy in this game. No, no! Hold on, Vegeta, hold on. Oh, she tried to combo it twice? You should. What? Oh my god. No, wait, damn, damn! Nope. I don't know if Vegeta's charged combos, man. Damn, 18 is so cool in this game.  Oh my god! She's not even playing this. No shot. I thought she did it again. Oh my god! There's just no way.    No, no! Don't even try it. So Deadly Dance isn't even her ultimate, by the way. I didn't even know that. I thought Deadly Dance was like a mix of an ultimate.  I want to know if an android can feel fear. Brokey Blast, I dare you. Yes. Tell me. Damn it, you're lucky I didn't have enough key for Big Bang Attacker. That would have went terrible for you. Oh wait, I kind of win in. I'm kind of win in. Get your hands off of me.  All right, let me charge. Let me charge, let me charge, let me charge. Let me do my thing, let me do my thing. Ow. Oh, she tried to hit the ultimate on me again. Tell me, can an android experience fear? Yeah. Welcome to Super Vegeta's Big Bang Attacker. And I won. Get out of here, 18. You lose. Oh, yes. Welcome to oblivion. Welcome to oblivion. Damn. At best, we're like an anti-hero, I guess. Oh my god, you have so much health left. Tell me, what will you do if I do it again? Energy field. You think a barrier will work? OK, take another Galagon. Damn, how about another one then? Yeah. It was only a matter of time until I caught you slipping. Oh no. Who are you talking to? Damn, you got a brother? Defense, defense. I panicked, I panicked. I still want on defense, so block it. My arm. Oh, I dodged it. I'm out of there, I'm out of there, I'm out of there.  You're trying to take my arm.  Oh, did you see how close she came to breaking my arm? Did you see how close she got to breaking my arm?   She was trying to break that arm. Vegeta had the moves though. Oh, Vegeta had the moves, let's go. Oh no.  It's so saucy.   You're insane, 18, stay back. Yeah. Damn it, the grabs, OK, that's fine. Grab me if you have to, but throw me a Key Blast. Throw me a bone, throw me a bone, throw me a bone.  I'm too good at the game, I don't know. Get out of there, get out of there, get the key back. She's doing back flips for some reason. Nah, nah. That's all I got to say to that is nah. Nah, let's go big deeps. Let's go. Nah, you ain't breaking my arm today. You ain't breaking my arm today. That much I can tell you, this battle ends here. I'm getting out of here with a fully intact arm. No, no, no, no, no, no, no, no. Oh god, deadly dance. I'm in the red, I'm in the red, I'm in the red. Deadly dance again? It's too much deadly dancing. No.  Knock me out of, oh.  What's the matter? Not feeling so good? I'm a Super Saiyan. You can't hurt me.  God, Z difficulty does not play around. Just focus up, focus up, focus up. Ugh, hey, I want to know something. Can you experience fear? I got a lot of questions on my mind about you, Andrewites. Super Vegeta's big bang attack. Oh, you didn't. Wait, did you win that? God, dammit. You're lucky I can't add on the extra big bang attack. Perfectly blocked. If only Future Gohan would have known about that technique, man. Oh, damn. Deadly dance. God, this move is cheap. Whoa, did you try to go deadly dance into the ultimate? That would have been bad. That would have been not great at all. Oh no, I'm out of Super Saiyan. My arm. Knock it off me.  Hey, you were looking the wrong way. My arm. Protect the arm at all costs. Defense. Go defense. Max. No, no, no, no, no, no. My arm. Vegeta dodged it. Still going. But why is 18 the coolest character in this game? Oh my god, that ultimate. I'm actually crying. Freeze frame it on Vegeta's face.  His arm is broken. And it ripped me out of Super Saiyan. No, no, no. No ultimate. It's not anymore. Get up, Vegeta.  I've been embarrassed enough for one day. All right, I really should have gone Super Saiyan from the start, but I kind of messed up my input. So this is this I have to do. This is just as good. This is just as good where we're going to be fine. Got Max key. I'm a Super Saiyan now.   Fire key blast. Yeah. Yeah, try that again. Try that again. I am so tired of you and your key blast. Oh, it's free. It's 18.  Fire key blast, fire key blast, fire key blast. Big mistake. Tell me, does an Android ever see patterns? Now I'm actually just going to finish you with the big bang. I've had enough of playing around nice. Gallant gun. Oh, that was awkward. Ha ha. 18. Do something else. All right, this puts us in a decent spot, though. I wish he was a little closer to stun. She's going to grab me again. I'm out of stamina. Oh, the dirt tastes not so great. Oh my god. No, no, no. If I defend it, we fully dodge it. You're not taking my arm again. They took my arm. They took my arm. They took my arm. They took my arm. Oh my god. Damn it. Stop. I'm already dead. I can't believe this video is going to be all 8 Android 18. I thought it was good. I thought I was going to get up to Super Saiyan 2 versus self. That was a dream. I didn't expect Z18 to put me through the work like this. Oh, deadly dance. Here we go again. The amount of times I've been deadly danced on. Oh, grab me. Big mistake. Don't ever do that. Don't ever in your life think you got that.  Don't even, you're not taking my arm again. I'm dodging it this time for sure. Please dodge it, Vegeta. That is a dodge right there, baby. Don't even try it. No. No, I'm not going to stay still. I've seen what you do to the people that don't sit.  Four key blast. Big mistake. Yeah. God, don't grab me. OK, I need a key. I need a lot of key. What I need to do now is I need to stun them, go into Big Bang, and that's when I win. OK, focus, focus, focus. We can maybe still win this. It's just going to be pretty much next to impossible. I don't know what to do. I don't know what the best play here is. Go for full key, maybe. That's unfortunate. That's unfortunate. She charges like a little itty-bitty, though. Look at her. She tried to excel dance me again. Deadly dance, man. Do I ever get to play Z18? If I ever get to play Z18, that bot better be scared, because I'm going to go crazy. Yes. Finally, some decent damage. Yes, more decent damage. All right, now we charge. Now we charge, now we charge. Let me charge, 18. Don't don't even think about it. We have to hurry up and get the stun here. We can go into Big Bang. If she key blasts, we might be able to Big Bang and win this thing. If I dodged it. The one time in my life, I needed that so much. Deadly dance. No, no. Nothing about this situation is good anymore. Teleport Vegeta. Amit. That was supposed to be it. I saw a chance for a stun. That's why I didn't reset. I saw a chance for a stun into a Big Bang. I got greedy. I got greedy. That's all I can say, really. Ah, she tricked me. Is there a reason you have combos like that, man? Just let me charge. Let me get the Super Saiyan. It's literally not even fair if I'm not a Super Saiyan. Like, that's the power level of that gap. Yeah. Finally, you respected my wish to become a Super Saiyan. It's a damn shame I missed the button. Deadly dance. Yeah, OK, you're good.   It's not even fair. OK, OK. It's not the worst situation to be in, right? Because if I teleport this, maybe we get some damage. Anime, anime. Eventually there has to be a winner of anime. And it's going to be me, baby. It's going to be me. It's going to be me. I watched World Dragon Ball Z. I've seen the anime. Let's go. There we go. There we go. Get some damage and get the good numbers in. There we go. More good damage. Give me a stun so I can follow that up with even more damage. Oh, god. Anime, anime. It's all I can do. That's literally all I can do. Everything else is just too risky. I'm so close to getting knocked out of Super Saiyan for money. Don't stop me. Don't stop me. Don't stop me. Don't stop me. Don't stop me. Don't stop me. Don't stop me. Keep it last. Damn it. Give me a stun. Damn it. I did that wrong. I did that wrong. Deadly dance. Come on. There's got to be a way I can win this. There is not. There might be. There might be one way we win this. Yeah, maybe in a million years maybe. Canceled your ultimate into a grab. Guard break into deadly dance. I'm getting sauced. Hold on. I need a break. I need a break.  All right. She's just willing to put way more resources into the opening than I am.  Just to get deadly dance thought again. If I would have blocked that, that would have been huge for how many times? How many times can I get deadly dance in one match? OK, I'll take it. Look, I'll get grabbed at this point. The grab doesn't do that much damage. It does like 168 or whatever. And usually it sets me up for something good, but I'd mess that up. Here we go, baby. That's what I'm talking about. That's supposed to follow up into another teleport. You wouldn't know, by the way, I haven't ever gotten it to work, but it's supposed to. OK, now let me teleport. Let me teleport. Good deeps, good deeps. We love to see the damage. OK, that's fine. Look, look, that's fine. Do what you've got to do, man. Do what you've got to do, but give me something. You didn't give me anything? That's just a go next. That's a go next. Unfortunate, unfortunate, but it is what it is. I think that was really good. I think that's pretty good. This might be our best opener yet. Really good opening statement. Oh, we're showing we're not joking around anymore. We're not a joke. This is a good match for us. I hate when I run into that. That's so embarrassing. Give me a Key Blast, give me a Key Blast. Give it to me, give it to me, give it to me, give it to me, give it to me, give it to me. I needed that. Love to see that. We're actually on even help bars. What? No. Yes, I'm going to go for it. Big bang. Ah, I got grabbed, I got grabbed. It's fine, it's fine, it's fine. We can work with this, we can work with this. Key Blast. Give me the, yes. I've been trying to catch you boys all day. Give me another Key Blast. Just give it to me.  The game was, the game knew it was that bad that it didn't even want me to kill them. Oh, wait, could I have just run? Did I have to fight? Oh no. Was there a time limit? Was I driving myself crazy trying to do a time?  Oh no. Okay, me and Trunks are trading. No, me and Trunks are trading because of that. Here's what we're not going to do is we're not just going to allow that to happen. I've got to take my anger out on somebody. Trunks, get to the hyperbolic time chamber. Even in trading, there is no mercy. I'll do my best. Let's go.  Wait, this is the difficulty. There's no way I win.  He blocked that? Block it. No. It's impossible. I don't have enough time. No. That's embarrassing. That's embarrassing. It's so hard. All right, I got a slight lead. I got a slight lead. I can't make it in time. I can't make it in time. It's so hard. Damn it. No, no, no, no, no. I'm beating Trunks on Z.  Come on. This is the last thing in the video. Take one of these. We don't even have the lead. My defense has been bad, huh? I can't. I can't.  I'm cooked. I got a grip though. I got a handle on my controller. I can play this. I can play this. I missed it. I missed my golden opportunity. Block that. I ain't running anywhere. I didn't make it in time. What does it look like when he does that? He just goes for the combo piece. Damn. Okay, okay, okay. Come on. I can do this. Just hopefully my hands hold out. Got him. Slightly. We've got a slight lead on Trunks. I wasn't even close. I wasn't even close.  I can't. I can't. I can't hit L2 that fast. I'm right handed.  Okay, Trunks. Okay, I can't, dude.  I can't keep up with him. Ah! Ah! This is actually tiring in real life. This is tiring in real life. I don't know how they made a game that does this. The training is so real. I couldn't do it in time, man. I've gotta switch my grip. Might be top five's hardest missions I've ever seen in a video game ever, but that's just me, I guess. Ah! I just, my finger slows down on that part so much. I have to switch to my thumb. All right, I'm gonna cheat. I'm gonna cheat. I'm gonna cheat. I've decided.  I can't make it. I can't make it. Okay, I still have a pretty huge lead, though. I can't make it. I'm still alive. I've done so well that I lived through two knees. Come on. Come on. Come on. Come on. No! No!  I blocked one. When it was all on the line, I blocked two.  But now it's my turn. Now it's my turn. I got two big attempts to fight back. Two big attempts to fight back. Just don't drop any inputs. No! When it was all on the line, I blocked two and then choked the rest. I'm not blocking that. I'll tell you that right now. Okay, I'm going to retry. I'm going to give my arm a minute's break and then editors show this whole next attempt uncut because I'm going to focus and not say a single word. Oh, we got two attempts. We got two attempts. Finish him off. We got one more attempt.  I'm gonna do this.  Oh, gosh. Let me fix my wrist.  Come here.   Oh, that was so bad. That was so bad. That was, that was so bad.  I feel sick.  I am so tired. Like, physically, I am the most tired I've ever been after a video. Like, this video was like this. I'm just beating you like, this is the actual training session with Trunks that I could not, it is not even close. It is not even comparable to what me and Trunks just went through. Also, Trunks, what are you doing not being a Super Saiyan right now? What was the training we did even for? God, damn it. At least fire a key blast at me, man. Let me teleport. Thank you. God, I'm sorry. That's my fault. I probably sound exhausted, dude. I'm so, I don't know how long that was, but I clicked so many buttons. Trunks, don't, Trunks. Where are you getting these combos from?  You know what, Trunks? No, Trunks.  Trunks. I hate Trunks now. Dude, I was so hyped when I got that Trunks mission before. And now, now look at me, dude. I just, I absolutely cannot stand the guy. Can't stand this motherfucker, dude. Ah, just go down, Trunks.  But this was, this is tough. This is a tough one. Like, this video was tough.  I will tell you that. Definitely work with a little something, something here. We're definitely working with something. Wait, you know what, Trunks?  How about this? How about this, Trunks? Well, you take one of these and then what happened in my, what happened in my Samurai? What happened in my Samurai? What happened in my Samurai? What happened in my Samurai? What happened, you, Trunks, what happened? What, why am I dead? What is happening? What, Trunks? Trunks, please. I'm sorry, I'm sorry. Dah, dah, dah, dah, dah. No! I'm losing, I'm losing, I'm losing, I'm losing. I know I did not just see that. My eyes gotta be messed. This is the worst Infinite World video. Yep. That just did it. That just, that did it. That pushed me over the edge. This is worse than Omega Shenron. This Vegeta Arc that I've been on.   Ah, Trunks, I don't even consider this training anymore. You've gotta go, man. You've gotta go. Keep watching me. All right, you've gotta go, Trunks. You've gotta go. Get out of my game!  The Vegeta arc is over. Z-Rank! God, who cares? My hands are broken. I'm so tired. I wanna go home. I'm leaving. All right, that's the end of the video. Oh, my God. There's a Vegeta versus Self-Fight, isn't there? There is. There's gonna be. And I... I'll see you guys in the next video. Ha ha ha ha!