Our medical students, University of Utah will be kicking kicking it off. It's nice to see some suits and ties out there And and if you are a medical student not wearing a suit and tie, that is also very acceptable as well Our residents will be doing our introductions today. I believe it may be our 11 and dr. 11. I apologize if I'm mistaken Can can Ariana be unmuted? I just made her co-host so she can Okay, we've had a little change of schedule here, so let me Yeah organized Okay, I think that we have all University of Utah students this morning at our first Presentation will be Michael Sawyer. There's a fourth-year medical student presenting a nine-year-old female with corneal vascularization Go for it Michael Immuted how's that? Good perfect Good morning, everybody It is a pleasure to be here. I'm really excited for this presentation I have loved this ophthalmology rotation so far and it's just been a lot of fun The faculty have been excellent and it really is an honor to be at the Moran eye center It's also been a privilege to work with Sam and Taylor on this Rotation so far and I'm excited to hear their presentations this morning as well So I am presenting today on a nine-year-old female with corneal vascularization. This is a girl who came into our clinic My my Slides are not here we go. This is a girl who claim into our clinic as an outside optometry referral She has coronal opacities and coronal vascularization and she also has a three-year history of recurrence styes and blepharitis Mom reports that she's had some pain in her eyelids and swelling in her eyelids as well as eye crustiness And she's had a pretty significant decrease in her vision on in both eyes Some significant negatives through her histories that she does not get Cold sores or Lee and she does not have a history of glasses or contact lenses No surgical history and she also does not have any known recent trauma They've tried antibiotic eye drops for previously not sure which kind and they're trying to wash her lids daily at the moment On base eye exam her right eye is 2100 vision her left eye is 2,400 vision both eyes improve to Roughly's 2070 with pinhole. We're able to refract her right eye to 2080 with the negative point 75 sphere and The left eye we don't have any improvement With refraction for distal visual cutie. The rest of her exam is pretty normal No other No other abnormalities in the base eye exam Here's a slit lamp exam photo of her right eye Starting externally. We don't see any active signs of Currents die. However, looking at the eyelid margins. Would you see some mybilma and gland dysfunction here? mainly on the upper eyelid going to the country Tyva it is hyperemic and On the corner we see some opacities Some punctate keratitis Which we can see in the glare of the cornea and definitely some vascularization Mainly on the lower half of the cornea Here's another view of the same eye just to help us appreciate the opacities with the light at a different angle as well So appreciate the vascularization a little bit better looking at the left eye externally the lid does not have any Currents dies that we can see But there is again some mybilma and gland dysfunction I've indicated with the arrows here because it can be hard to see over the internet and Both on the upper and lower eyelid. We have a hyperemic country Tyva and as well as Corneal vascularization with opacities here looking at the nasal cornea. There might be a flictenol there that we see too Here's a slit lamp at a different angle here And this I thought was helpful because it shows that the vascularization May extend down into the stromal layer of the cornea on that nasal side in this area so differential diagnosis we have a Ninety-old patient with corneal vascularization and opacities Can be pretty wide. I split the differential into four main categories. I'm sure that there's a variety of ways to do this But we felt that from her history and physical exam that blepharoceridoconjunctivitis was the most likely diagnosis and decided to treat for that So we decided to treat right away since her significantly was impaired and She was given erythromycin drops in both eyes every night as well as toberdex four times a day and then just standard treatment for dry eye and Encouraging her to have eyelid scrubs on a daily basis. We scheduled a follow-up for three weeks in three weeks They come back mom has Noted some subjective improvement Her eyelids are not quite as crusty anymore, and they're pretty compliant with the treatment However, the patient is pretty resistant to the wait minutes at times Visual acuity has improved to 2050 bilaterally and her pressure is still looking pretty good at follow-up So lamp exam here's the right eye We see some very significant improvement a lot less vascularization and there was a few weeks ago still some opacities that look like they could be obstructing the visual axis and a little bit of vascularization still on the temporal cornea here the conjunctiva is Less distressed and it seems a few weeks ago as well Here's the right eye again just with the light a different angle to help us appreciate the opacities a little bit better Again, so pretty improved from last time Looking at the left eye we have Maybe some mild my boomy and gland dysfunction here in the upper eyelid that I've indicated with an arrow the Conjunctiva is looking better less inflamed and then the cornea does still have quite a few opacities Vascularization is quite a bit down although still present and if you were to see this slit lamp in person You'd be able to appreciate that this vessel here on the central cornea is still functioning and patent Based on the fact that we see red blood cells of flowing through This vessel which for me as a medical student seeing that for the first time was pretty exciting Not something that I get to see on a daily basis at this point in my training. So I Really love this slit lamp exam here Here's the same eye just with a light a different angle to help us see those opacities pretty well So our assessment is that the patient was Responding well to treatment her pressure looks good. She's tolerating the steroids well So we decided to continue the same treatment and have the patient follow up in six weeks This patient has blepharoceratoconjunctivitis Which is pretty common in pediatric ophthalmology clinics this review from Will's eye hospital in Philadelphia Showed that over a five-year period Blepharoceratoconjunctivitis, which I'll just call BKC turn out. It's a pretty big mouthful But it was actually the most common referral diagnosis for patients in their clinic so I The reason I chose this case out of all the cases I could have chosen Is because for me is someone who's relatively new to the field of ophthalmology It was really exciting to see a patient go from being essentially legally blind to being an almost driving vision within just a few weeks and On top of that the really fascinating physical exam findings seeing the coronal vascularization It's the cells running through the vessels made this a very memorable case for me and As I've told some people if this is considered a more common And routine case and ophthalmology than by all means this is a pretty exciting field So I think BKC is really worth talking about for a variety of reasons One being that coronal vascularization is not an uncommon thing It's estimated that there are about 1.4 million cases of coronal vascularization seen per year in clinics About 20% of coronal transplant specimens have some sort of vascularization on them And then with BKC as we've seen patients can have pretty rapid response to treatment However left untreated you can have very detrimental outcomes So it's absolutely crucial to have a timely and proper treatment for this condition, especially in children Where they can develop really deleterious complications if if it's left alone for too long we'll be talking about those in a second but BKC Essentially comes down to the stability of the tear film lipid layer and that can be caused by either mybomine gland dysfunction or by bacterial lipases in an infection that can further destabilize the lipid layer And our patient we saw probably saw a combination of both of these Pathophysiology is going on Once you have a destabilized tear film you get evaporative dry eye which causes inflammation Leading to vascularization in places where we don't want it and so that leads to the treatment We want to treat the underlying cause of the inflammation as well as the inflammation itself something I found interesting is that although BKC can be a fairly routine presentation in the clinic and there is a lot of research about the treatments for BKC There's not actually a standardized like official treatment regimen for the condition Here we see I just put the titles of two cocker reviews about BKC that done by similar groups of authors and Out of all the literature they reviewed they actually found that between these two studies only one study actually fit inclusion criteria for their study and Mainly because most studies don't have a proper Control treatment arm and other ones mixed children and adults in their treatments. And so they weren't actually able to make any Recommendations for treatment of BKC that being said the consensus is pretty wide throughout the field that topical steroids and topical antibiotics along with treatment with for dry eye is Pretty widely accepted So some additional treatments that are less common but Plausible is that for patients who are steroid responders or otherwise intolerant steroids a calcineur inhibitor could be used as a steroid sparing agent and As a treatment for sty something that's become more popular in the last few years is hypochlorous acid spray or the brand name Avenova. This is something that patients can buy over-the-counter and a lot of people tend to like it And then research is Showing increasing support for essential fatty acids in the diet They can have an anti-inflammatory effect and may help with dry eye and chronic blepharitis So recommending flax seed oil is certainly a possibility in a patient like this Similar presentations common things being common. We don't want to forget about HSV keratitis This is especially important since one of the main stages of treatment for BKC steroids We could obviously make HSV a lot worse by treating for BKC if it were concurrent or if it were the actual cause of this patient symptoms on the other hand some providers Maybe hesitant to treat for BKC out of concern that there is keratitis present So a good way to get around this is with concurrent steroids and acyclovir Basically treating each condition at once We decided not to give this patient acyclovir simply because her history and exam Were very indicative of BKC. We weren't as worried about keratitis However, based on my reading, I don't think it would be frowned upon To give a patient prophylactic acyclovir if they were in this situation So some important complications, especially in pediatric patients With the corneal involvement we can develop an irregular astigmatism Another cause of this is simply because of the eyelid issues with chronic chelasia Can also cause an irregular astigmatism And then with the obstruction of visual axis or with the astigmatism Pediatric patients commonly develop amblyopia from this condition And that's definitely something that we need to keep an eye out for this patient And of course for walking a fine line between Managing the inflammation in this patient's eye, but also making sure her eye pressure Doesn't get too high. So that's another important reason for regular follow-up With that in mind some considerations we have for this patient is to have corneal topography in the future To make sure to see whether this patient develops an astigmatism and of course keep her pressures in check Another thing to consider as we saw from the follow-up is that most children don't like things going in their eyes And that can lead to really difficult compliance in children. So although this is a very treatable condition Some patients may have deleterious outcomes simply because they're refusing treatment despite the best being parents Prognosis in BKC as I've hinted can be pretty good. Um, this is a study in 2007 by A group of researchers who Found that on average their patients ended up with 20 20 vision at the end of the study that being said 30 30 percent of patients did not have improvements in visual acuity And over half of the patients did develop amblyopia that required ongoing treatment So I think this shows that BKC while it is Um a relatively routine presentation in pediatric ophthalmology clinics does require Really prompt treatment and it's something that Either with misdiagnosis or delayed diagnosis can lead to really bad outcomes And uh I just really love this case. Um You know, they they say when at this point in my academic career When you're thinking about specialties Uh, think about the the common standard even mundane things about a specialty and imagine yourself doing that on a daily basis Um, and boy if this is uh an example of that in ophthalmology, then this is a pretty exciting field Uh, the zebras of every field I think are are fascinating and exciting Uh, but it's also nice to admire the glamorous beautiful horses Right in front of us and for me that was an example of that. So, uh, this was just a good opportunity to reflect on that Thank you so much for listening to my presentation special. Thanks to everyone on this slide Uh, I couldn't have Prepared this presentation without any of these uh people. So thank you. I'd be happy to answer any questions Thank you, michael This is dr. Olson, uh a few comments uh The corny has evolved to be fairly resistant to vascularization for obvious reasons because Uh vascularization is obviously bad for vision and bad for survival Yes, so uh, there is that there's a system that's been worked out and uh part of inflammation Is uh, almost always up regulation of vegef and it doesn't take much of that for cornyas To be vascularized, but there's a system called flip two Which uh, uh resist that So, uh, a couple of things with kids that are important as it's obvious that that when you breach that system, it can it can go Dramatically fast. I mean I I've I've seen cases where it was just early neovascularization They were lost to follow-up and a month later the cornyas were hugely vascularized So that's one reason why you got to get on top of kids very very fast And once they are vascularized you can look carefully and you'll see these ghost vessels that are still there And that's true for all of the different conditions, you know Zoster herpes you know Leuetic and interstitial keratitis and it takes very little New inflammation those open-ups you really got to watch these kids carefully and of course The secondary effect if you've got vascularized cornyas is that you'll end up getting scarring a lot of that white deeper stuff Is just you know, true scarring in the cornyas. It's now an altered architecture And so that's something that also needs to be watched very carefully, but The other side is is that um, it because kids are hard to check and they're hard to do with pressure We see an awful lot of kids who not only have steroid glaucoma and dexamethasone has been well shown to be the one most likely to lead to steroid you know, glaucoma but Easily lead to cataracts and we often see these in more of the allergic conditions Where people have been treated and they're not getting good control steroids are extremely effective For this condition and and then all of a sudden the next thing you know, you've got You know, you've got a steroid induced cataract, which is a Not reversible at that particular point and that can be a real problem So there even though we deal with blepharoconjunctivitis so commonly in adults and many of the things are going to be very very similar Kids are quite different. So I think you you raise those points But it's it's always a shame to let it get to the point where you know, you've got pretty profound Vascularization, but those are some of the things to think about with this tough condition Thank you, Dr. Olson All right, we'll save additional questions or comments until the end of the presentations to make sure that each presenter has Enough time. So thank you so much Michael. Our next presenter is Samuel Wilkinson another fourth year medical student Who will be presenting ocular syphilis as our speakers speak. You can also place questions in the chat Okay, good morning. Can everyone hear me? Okay Yes, you're good. All right, perfect. Well, good morning, everyone And thank you for the opportunity to be here. My name is Sam Wilkinson And I'm a fourth year medical student here at the University of Utah Today, we're going to present a case of ocular syphilis seen in Dr. Law Rochelle's uveitis clinic This particular patient was a 64 year old female with no significant ocular history Who presented to the brand triage clinic with two months of a worsting black spot in the center of her vision of her left eye She also reported intermittent flashing lights as well as blurred vision in her left eye That did not have any symptoms in her right eye Her past ocular and medical history is non-contributory Her family history is significant for a father who lost vision from age-related macular degeneration And no family history of autoimmune disease Social history is significant for a history of incarceration, but otherwise low risk Current positives and negatives from review of systems includes hip pain and muscle aches Patient also reported occasional urinary urgency and diarrhea Patient denies any rash or genital sores Vision in the affected eye was decreased to 2200 without improving with binhole And pupils and pressure were normal The right eye had a cataract, but was otherwise normal The affected eye had findings of mild anterior chamber reactivity with posterior sneaky eye and a few pigmented cells in the vitreous Here's an optosphoto of the right eye As you can see here the right eye is significant for a small nevus Just outside the super temp super temporal arcade And this is an optosphoto of the left eye It is remarkable for a placoid yellowish lesion in the posterior pole Notably on our fundus exam. There was a cluster of punched out spots inferiorly that cannot be visualized with this image Here we see a fundus autochoresis imaging of the left eye And in that same location on the posterior pole, there's this placoid hyperintensity The top image here is a macro CT from the right eye As you can see it is normal and the bottom image shows the left eye Right here. There's loss of the ellipsoid zone See here as well as retinal pigment epithelium irregularities It's in here and here Next we have fluorescein angiography of the left eye This image is of the earlier arteriovanus phase. Initially it is relatively normal But if we move forward to a later phase it shows hyper fluorescence in the area of the placoid lesion As well as staining of the overlying vessels And weight leakage peripherally Here we have a mid phase icg of the left eye These are there are a few hypo fluoresce spots In the posterior pole At this point we describe this as a subacute unilateral pan uveitis Due to the anterior chamber reactivity Pigmented vitreous cell and macular lesion Our differential at this point was placoid syphilis Versus non-infectious or inflammatory posterior uveitis An initial laboratory workup returned two days later With a positive RPR titer and positive FDA ABS No other abnormalities were found on lab work Patient was admitted to the hospital for IV penicillin Infectious disease consult and a neurosyphilis workup Due to the ocular involvement She completed a two week course of IV penicillin A lumbar puncture was remarkable for elevated white blood cells And notably the VDRL of the CSF was negative Regardless this is still treated as neurosyphilis due to ocular involvement Additionally the elevated white blood cells do raise suspicion And notably she was HIV negative Patient had to follow up ophthalmology appointment one month after the initial presentation And had that follow up her exam Her visual acuity improved from 2200 to 2050 And here are opto-color photos of the left eye from the initial visit on the left And then right next to it is the one month follow up As you can see the placoid lesion that we originally saw Is resolving This difference in color between the photographs is just an artifact And this is fundus autofluorescence of the left eye Similarly there's near resolution of the hyper fluorescent Placoid lesion seen here as well And an OCT of the left eye shows that the photoreceptors have returned And there's been some normalization of the retinal pigment epithelium So the final diagnosis is acute syphilitic posterior placoid choreo retinitis Or ASPPC Patient will follow up with ophthalmology as well as infectious disease to ensure Definitive treatment of this patient's syphilis As syphilis can present in the eye in a wide variety of ways Of all the presentations uveitis is the most common This particular presentation of ASPPC was first described by dr. Donald gas in 1990 And the key clinical findings of ASPPC are a yellowish placoid lesion within the macula Patchy disruption of the ellipsoid zone And a hyper reflective nodule lesions in the retinal pigment epithelium Is more commonly seen in immunocompromised individuals Although still possible in immunocompetent patients as seen in today's case In uveitis patients with suspected ASPPC The workup should include a high specificity test such as FDA ABS And non-specific tests such as RPR and BDRL Are negative in about one third of ocular syphilis cases The prognosis is variable Spontaneous resolution is possible However, loss of retinal function is also possible when left untreated Patients do respond well to treatment as seen in today's case Treatment typically includes IV penicillin G 24 million units daily for 10 to 14 days And syphilis has been rising the past decade The U.S. has had the highest number of new syphilis cases since 1991 So this is an important diagnosis to keep in in your mind with any uveitis patient But especially with these characteristic findings I just want to say a special thank you to Dr. La Rochelle For help on this presentation as well as for all of her mentorship And for introducing me to clinical ophthalmology And a thank you to Dr. Abigail Jevarage for helping me obtain some of these photos And if there are any questions, happy to answer those Great. Thank you, Sam. We probably do have time for one question before we move on if someone has one Otherwise as you're thinking of questions and putting them in the chat Our third presenter is Taylor Brady A fourth year medical student who will be presenting an otherwise healthy newborn with an anterior segment lesion Thank you, Ariana I think back up here So, um, appreciate the time. I'm going to talk about an otherwise healthy Newborn with an anterior segment lesion Michael and Sam. Thank you for your presentations. They were great I have no disclosures for this presentation. So let's jump into it Just to first cover the patient specifically she's now two years old but Presented at two months old. She was otherwise healthy Born at full term She had this irregular iris border in her left eye that you can see here in this image This clear kind of inferior nasal lesion with a tropion uba that you can see here She also had lens coloboma Which you can't see in this particular image because it's posterior to the iris Didn't have any pertinent family history and our Initial differential diagnosis includes a ciliary body or iris cyst or neoplasm Or a coloboma phpv aniridia Trauma or nat Or potentially a juvenile xanthogranuloma This was concerning. So she was sent for An e way and ultrasound. Here's actually an a scan and a b scan Similar to what our patient received She at primary children's got an a and b scan with With dr. Harry and unfortunately we went over there to retrieve those images and the The ultrasound machine at primary children's is broken. So we weren't able to pull them off But this is a very similar presentation in another patient You see in the a scan this increased signaling Behind the cornea in the iris suggesting location of this lesion, which is in the ciliary body And in the b scan you can see the location actually located in the ciliary body It's important to know that this particular b scan is taken at a very steep angle So it makes the posterior chamber Look a lot more shallow than it actually is And if you look at the lesion closely, you can note that there's the solid consistency of the mass And when you compare that to other ciliary body gross, they're typically more cystic in nature and appearance And so that's something to note when you see these types of presentations This was concerning for medullo epithelioma And so this patient was referred to ocular oncology dr. Jonathan kim Who's a great ocular oncologist at usc? He actually diagnosed her with medullo epithelioma after his own ultrasound and examiner anesthesia And that's actually the best method to diagnose these tumors. We don't want to biopsy at them Because there's a large risk of re of seeding or causing a hemorrhage Now our patient had a fairly typical presentation for medullo epithelioma when it does show up The typical presentation includes a lens coloboma, which you can see in this image here And this actually arises interestingly because of congenital absence of the zonule in the area of the ciliary body where the tumor is located And the tumor actually is typically Inferotemporal although in our particular patient. It was infero nasal You can see a clear to flesh tone mass arising from the ciliary body There's often small clear cysts that are present within the mass And sort of like retinoblastoma. It can also have these calcifications depending on Any embryonic tissue that's contained in the tumor and and kind of depending on its histopathologic characteristics It's often covered in the cyclic membrane There can be secondary glaucoma resulting from Incl closure, there can be lens subluxation if the mass is actually pressing into the lens and ectropion uva as we can see in our patient They can also have leukocorio, which is one of the main reasons It's important to differentiate these tumors from retinoblastoma And you know, one of the concerns is that oftentimes patients undergo a workup for Cataract or glaucoma something else that's secondary to the medullo epithelioma And they get treated for that. Maybe there's even been cases of people having surgery for glaucoma surgery for On the vitreous surgery for cataracts Things like that and then having a medullo epithelioma found incidentally during the surgery Here's an image that shows leukocoria in a five-year-old female with medullo epithelioma You can also note with this arrow the neobascularization of the neoplastic cyclic membrane. So that's that's a good image And here's a growth gross pathology specimen It's a example of a large medullo epithelioma after enucleation and you can notice the lens subluxation And then all this retinal detachment that's happened. So this can be an incredibly morbid disease Histopathology, I think is really interesting in these tumors They typically arise from the non-pigmented epithelium of the ciliary body And they're classified into teratoid versus non-teratoid and also benign versus malignant The majority of them are malignant or have malignant potential regardless of whether they're teratoid or non-teratoid And they're classification there The non-teratoid here or there another another name An older nomenclature you may know them as is a dictioma It has this characteristic kind of net like proliferation of these neoplastic cells And then the teratoid medullo epitheliomas can have a bunch of diverse cell origin seed here is actually a really distinct focus of highland cartilage That you can see within those tumors. There's a couple other examples here Couple other histology images and these are both from teratoid medullo epitheliomas as well The image on the left resembles skeletal muscle And and malignancies that can be found in in skeletal muscles such as a rhabdomyosarcoma And the image on the on the right resembles neural or brain tissue Some of the complications of malignant Medullo epithelioma can include extra ocular extension and orbital invasion Which typically cause significantly increased morbidity for these patients regional lymph node extension does occur and is Most common if there's extra ocular extension Distant metastases are pretty rare cns extension is also really rare But if we encounter a patient that has this metastases or cns extension that is Almost always fatal unfortunately So in discussing this presentation with dr. Dardeen something that he brought up and I think is a really really Prudent way to approach these cases And and applies to most of general oncology as well Is to take kind of this stepwise approach You know, we're mostly Foremost concerned about the patient and their survival We want them to be able to live secondly, we want to preserve their eye And then we want to preserve their vision and you know in a lot of pediatric tumors intraocular tumors The fourth step here is to preserve their binocularity if we can so we approach this in a stepwise fashion And I think this is a great method of thinking through the treatment of these tumors So for preservation of life, I think it's appropriate to kind of compare medullo epithelioma to retinoblastoma Which is a tumor we're all much more familiar with From an epidemiologic standpoint medullo epithelioma is incredibly rare I spoke with dr. Hoffman and dr. Harry Dr. Hoffman says he's seen maybe five to six cases of this in his career. Dr. Harry said he's seen about 12 of them Whereas with retinoblastoma There's two to 300 new cases per year in the united states Medullo epithelioma Manifests in the first decade of life almost always and retinoblastoma before the age of five For metastatic risk medullo epithelioma has a low metastatic risk, but the challenge is that it's uncommon And there's often a delay in diagnosis because well for a couple of reasons one is we're just not looking for it as much The other is that it's It's easy to miss if you know if it's in the ciliary body, it's posterior to the iris. It can be difficult to see there But when it's caught early, it is really it does have a lower metastatic risk In contrast retinoblastoma has a higher metastatic risk, but you know family medicine doctors Pediatricians, we're all trained to look for this And catch it really easy really early when we see leukocoria in a in a kid Um, and so it's typically caught early Survival rates are are pretty similar in a recent study for medullo epithelioma on medullo epithelioma post a nucleation There was a 90 to 95 5 year survival if the extension was just in the globe And with retinoblastoma it was 96 5 year 5 year survival There's some risk for other cancers in medullo epithelioma. Most of these are non hereditary but there is a 5% risk of a specific genetic mutation That contributes to several other tumors or cancers that can happen In that patient's life, but that's pretty rare. It's a rare rare mutation in an already rare cancer And then of course we know about germline rb1 mutations associated with pineal and bone tumors and patients with retinoblastoma So the next step in that stepwise approach is preservation of the eye. So the big question is can we avoid a nucleation? With medullo epithelioma sometimes we can but it's really important to catch it early if we want to give the patient a chance Unfortunately a nucleation is still currently the standard of care for advanced medullo epithelioma because it's often caught so late If it's large, if there's glaucoma, if there's significant global involvement Almost always have to have a nucleation And if there's any orbital involvement you need to get even more more bed and move on to exentration Which can be often for these patients Luckily in our patient, she had this relatively small lesion. It was about three clock hours It was no no significant involvement of the globe. It wasn't causing any other complications Like glaucoma or Wendt subluxation And she was able to be treated with plaque radiotherapy Placement of the plaque for her with Dr. Kim was an inferior nasal area In proximity to her tumor And this patient is a great example of how early detection can contribute to preservation of the eye and avoidance of the nucleation So some complications she had with plaque radiotherapy With plaque radiotherapy, she had two muscles moved in order to have the plaque placed And her inferior rectus of the left eye was not resuscitated to the insertion She developed worsening strabismus over time and keep in mind this is two years ago that she started she was uh diagnosed Um, she also developed a radiation induced cataract in that same eye She started to develop amyliopia. Their thought is that this is a multifactorial cause, you know, she's got a tuner She's got strabismus. She's got a cataract. She's been undergoing radiation Her parents have been patching her two to three hours a day for the past two years But unfortunately hasn't been incredibly effective to this point She's also developed this strabismus, which is exacerbated by the surgery she's had Exasperated by the plaque radiotherapy and the movement of those muscles She's had to undergo two strabismus surgeries with dr. Jardine And the question about what caused the strabismus is is Is difficult to quantify unfortunately and and also the question how much is it actually contributing to her amyliopia at this point Is it a congenital cause? Is there a sensor? Is it a sensory cause because of her cataract? Because of the radiation or their their permanent damage to the muscles that's causing it and My thought and our thought is that it's most likely max multifactorial as well So here's an image that you can see of this eye During our most recent eua. You can actually make out the cataract here faintly And you can see that it's more of this flesh toned. It's it's it looks like it's evolved I'm not sure if this is because of evolution of the tumor or because of Just the the differences in the camera differences in the in the picture quality But the measurements are actually about the same here and the main thing to do With these particular tumors is to ensure that they're not continuing to grow And the measurements have been the same. They've been stable. And so that's the main goal Especially with this patient Next steps for her are cataract surgery And you know, that's concerning looking at that tumor. We're going to enter the eye with that Neovascularization. It's that's quite a worry. It's something that Dr. Jardin and I have talked quite a bit about There's a big worry for a neovascular hemorrhage within her orbit Considering also doing some of Aston treatment in our anterior chamber before the operation And then the other thing is to monitor these for reoccurrence It's unfortunate, but oftentimes people who have Local resection or other Non and nucleation surgeries for these tumors end up needing an enucleation anyway because of recurrence So that's something we really need to watch Thank you for the time. I feel very You know, I feel very lucky that I actually got to see a patient with such a rare cancer that Is not often seen in just the last couple weeks A special thank you to dr. Jardin dr. Harry dr. Hoffman and dr Who have helped me out so much with this. Thank you for your time Great. Thank you. Taylor. We did have a question come into the chat The question is whether a scan or b scan is more helpful or whether it's a combination in cases like these Taylor, you're welcome to answer and I think we also have dr. Harry in here as well Yeah, so dr. Harry could probably answer this better than me But I think that a combination of the two is typically the way that the air these are diagnosed Can you hear me? Am I unmuted? Okay. Very nice presentation. Taylor Um, yeah, the question a and b scan a scan is really superior in the poster segment for melanomas Anything posteriorly it really is more information in the b scan. I use them both But I depend on the a scan more the anterior segment is different just because of Angle usually size of trimmer or smaller. You don't get internal reflectivity Patterns as well. So I depend more on the b scan the anterior segment And unfortunately because the machine was sent out for repair. Like you said, we didn't have the images from this case, but The immersion high frequency ultrasound is very helpful too This case shows a regular 10 megahertz b scan that The picture you show is just a regular 10 megahertz. You can see the tumor but to really see detail the high frequency machine is better But for residents going into practice if you have access to an ultrasound machine without the high frequency You can still use the 10 megahertz.  You can put a tonal pen cover on the tip You can use a cut a glove tip off and use that To make an immersion and visualize the enter segment But that's pretty important and just one comment about Dictiomas they can be masquerade kinds of lesions. I saw a case years ago with paul's emerman We thought was par's planitis But as we looked at it Again carefully with immersion ultrasound. It was a tumor ended up being a dictioma. So they can fool you sometimes So anyway, very nice job on the presentation Great. Thank you. I think that's it for today. Great job to all of the medical students I think that they're still in their rotations for a little while. So say hi and if you have questions, let them know Thanks, everybody


From the SiliconANGLE Media Office in Boston, Massachusetts, it's theCUBE. Now, here's your host, Dave Vellante. Hi everybody, Dave Vellante here, coming at you from our East Coast studios in Marlboro, Massachusetts, just outside of Boston. What I wanted to do is give you a little recap of 2017 and what's happening and give you an update on SiliconANGLE Media. So as many of you know, SiliconANGLE Media Inc. comprises three brands, theCUBE, which most of you know is, we call it sometimes the ESPN of tech. It's our live and on-demand video broadcasting element. And of course, we have the research arm, which is Wikibon and wikibon.com. And then SiliconANGLE is our news site. And so I wanted to just, as I say, recap what went down in 2017, some of the things that you may not know about. Last February, February 1st, actually we opened a new studio in Palo Alto, California. It's at 989 Commercial Street. You should check it out. It's sort of near the Mountain View line, but it's in Palo Alto, it's a great location. We have a large studio there. And throughout the year in 2017, we held events, we had launches. But most importantly, John Furrier, my business partner, was really running editorial content programs out of that studio. So every Thursday, Furrier has high level key guests come in, CEOs, VCs, end customers, and they just riff on what's going on in the industry and what's happening. It's been an absolutely awesome resource for us and really encourage you guys to go check it out. We did 135 show days last year. The Cube is run by our general manager, Jeff Frick. And 135 show days, meaning we broadcast live at 135 days at events last year, which is just incredible. It was our first year. We ever did anything in China. And we did the Alibaba Conference, the Cloud Show there that was very exciting. We did a number of shows in Europe. And of course, all the big shows in the United States as well. We launched three websites last year. The cube.net is the latest one. You know, a lot of times we talk about data-driven media. If you go to the cube.net and check it out, you'll see something called the Cube Alumni Database. And the alumni database contains virtually everybody who's ever been on the cube. So you can search, CIOs, CEOs, developers, bloggers, analysts, all the folks that have been on the cube you can see. And we've got a profile page on each one of those. So we're collecting all that data. SiliconAngle.com, we launched a new website, SiliconAngle is run by Rob Hoef, who's our editor in chief. Rob was the Silicon Valley bureau chief for business week for the better part of a decade. He's really proud to have Rob on. He's been on for the last couple of years and just doing a great job with that site. And then wikibon.com is run by Peter Burris. He's our chief research officer. He's been with us now for the better part of two years and he's got that team cranking on all kinds of research in cloud and AI and data orientation, the edge and infrastructure for emerging applications like AI. One of the areas we're most excited about that we launched in 2017 was a new capability called Clipper. So we have this tool called Video Clipper. As you know, John Furrier and I when we met we had this vision for data-driven media and innovation. And we launched this tool we call Video Clipper that was developed by Kent Libby and his team, one of our newer executives that we brought in last year on the product side. What Video Clipper does is we transcribe every video now that we do, we'll transcribe this video. And then we synchronize the transcript with the video and we're able to then search, video, highlight text, the paragraph, let's say, push a button and boom, we've got a clip and that clip is ready to be shared throughout various social media platforms like Twitter and LinkedIn and Facebook and the like. And so very, very excited about that tool. You're going to be hearing more about that. We don't sell it as a separate tool. We integrate it as part of our offerings and got some new offerings that we're bringing to customers in 2018. One of the other really exciting things in 2017, we brought on a new Chief Revenue Officer. His name is Greg Thirio and I'm going to introduce you to him today. Greg Thirio is with me here in studio. Greg, it's great to see you. Thanks for spending some time with us. Thank you, Dave. Thanks for the opportunity. I've never been more excited. Let me tell you a little bit about myself. I live in Concord, Massachusetts right around the studio here. And I came from the IT industry. I've been there for a long time. I used to be at a small systems integrator, kind of the size of Silicon Angle media, building client server computing, got certified in Novel. And then I jumped into sales. I worked most recently at Forrester Research and was there for almost 18 years, two decades, building the sales capabilities. Always wrapped around the customers but I am thrilled to be here today. So, Novel, when our network goes down, can you help us fix that? It was about 20 years ago but you know the history with Novel. So yeah, another Utah company that just didn't somehow didn't make it. But for a while there, they were a little monopoly. So you've been in the business now for a couple of decades. Maybe think about what's happened over the last 20 years. What kind of changes have you seen? Share with us your perspectives. I've never seen so much disruption from client server to social computing to AI. Now it's digital disruption in everything. And you hear about this all the time in the news that companies are becoming software companies. Look around the corner. GE is now GE digital and they're trying to reinvent themselves. Very, very exciting times. AI, machine learning, autonomous computing. And then right around the corner there's blockchain. I mean, that's the big, the big buzz these days. Also there's the autonomous vehicles and I'll give you a quick story. About two years ago, my son was born and I was fortunate enough to have a breakfast with the CTO of Tesla. And I asked him, hey, he was born, what's going to happen in 16 years? And JB said to me quite candidly, he said, if your son is driving a car that's not autonomous, it won't be safe and he won't need a license. So things are happening at an epic speed. I don't know if these predictions will be true but it is Tesla. Won't need a license. You know, it's funny. I mean, I don't know how you feel about it but when I turned 16 it was like one of the most exciting days of a young person's life. You know, you wonder what the sort of social implication of that is if you don't need a license and I don't know maybe they can start driving at 14 or 13 or, you know, whatever. But you know what I'm saying? That was a really exciting time. We couldn't wait to get our permits and you know, dad, can I drive you to the dump? Right? Self-driving cars and self-driving refrigerators. I mean, it's moving fast and at an epic speed right now. Well, everything, and again, you take that business. It's all about the data. And I said in my intro, we always talk about, you know, data-driven media. We got so much data. You talk about digital transformation. You know, philosophy is digital means data. Right. And you talked about GE. You're seeing all these companies now getting disrupted because, you know, digital allows people to move so fast it allows companies like Apple to get into financial services and you're seeing Amazon become a content company and it's really all around the data, isn't it? Absolutely.  What attracted you to SiliconANGLE Media? I think it was the fact that I jumped on a plane and went out to Palo Alto and met with your general managers. I think the innovation and the speed, the speed around, it's in your DNA. And then you took social computing, combined it with, you know, really computing power. And then I saw the video clipper tool. It's the fastest application I've ever seen to clip video. And that innovation, the speed really attracted me to the company, to build really powerful content. Yeah, it's been quite a ride since I met John Furrier in 2010. And, you know, John at the time said, Dave, whatever we do, we have to innovate. We have to continue to invest in R&D.  So we're very excited about that. Share with us your philosophy. What can we expect from Greg Terry? Sure, I appreciate that. Well, I'm happy to be here. I actually blogged on LinkedIn over the weekend about my transition here.  But my philosophy on business is to really be customer focused, to hire the right people, train and coach, and build a different mindset, which I call the growth mindset, that the sales rep of the future is being disrupted right now, just like every other function. And that is absolutely pivotal. I think the buyers changed, Dave, faster in two years than the past 100 years. The buyer is in control. You have to build systems, processes and technologies wrapped around how do you help the customer be successful to drive growth? And then that's the biggest, biggest shift going on right now.  So social selling and things like that. I want to bring that kind of discipline and processes to Silicon angle media. Well, what about social selling? You know, a lot of people will, when social media really started to come into play, a lot of people say, well, we sell to IT people and IT people, they don't have time to go on Twitter. They don't do Facebook. They don't, what's your perspective? Has that changed? And you know, what about that? It's changed faster than I could have ever believed. And buyers buy differently, but they also need to see a different presence in social. That's Twitter. That's LinkedIn. And that's also, you have to be on the phone. You have to be in front of customers, but it absolutely is pivotal that the new, let's call it a digital rep, needs to understand the tools to listen. Listen to the customer first and foremost. And it's a new channel, but it's a channel here for a long time. Again, it's disrupting sales at an epic pace. So what are your priorities, you know, looking out, let's say near term, midterm, long term? To wrap my hand around the customer base that we have to innovate with them, with the team we build, and also to build a collaborative culture. I'm really into culture and the ability to kind of gamify the culture, grow the business, accelerate the business, and also develop the team that we build. I mean, the aspirations to where do they want to be in a couple of years will help build the business. And that's a global business as well. Well, so of course, a lot of the action in the tech business is out in Silicon Valley. You and I are based here in the East Coast. What can we expect in terms of your presence in Silicon Valley? I'll be on a plane a lot. I don't mind that at all. I mean, it's a flat country right now. So I'll be on a plane, but also the heat is in Boston, New York, Chicago, but the valley's where it's at. So I'm going to be jumping on a plane in two weeks to meet with the team. I can't wait. Well, we're excited, Greg, to have an executive of your caliber join our team. Thank you. Congratulations. Appreciate it. And I look forward to many, many years of productive growth and adding value for our clients with you. Likewise, thank you. All right, you're welcome. Thanks for watching everybody. This is Dave Vellante with Greg Theriault. We'll see you next time.


A half-day meeting between Prime Minister Hon. Alan Chastney, Minister for Agriculture and Fisheries Hon. Ezekiel Joseph and representatives of the fishing sector has resulted in an amicable and unanimous position on the sector's role in helping protecting the nation's borders amid community spread of COVID-19. The meeting was convened to discuss the one-week suspension of fishing licenses as government-refined protocols for the sector. Acknowledging the importance of the fishing sector, its contribution to the local economy and food security, government has decided to allow fishers to resume their trade, however only between the hours of 4 a.m. and 7 p.m. daily. Captains or owners of fishing vessels must share information on the vessel with the marine police.  No more than three people are allowed on board a vessel. We are going to continue revisiting the protocols that were set in April and in addition to that we are going to reduce on the hours that they are allowed to go to sea for the next three weeks, whilst we look at more medium to long-term solutions. Operations manager of Goodwill Fishermen's Cooperative Society, KG Anna Tussier-Charlie says the meeting was productive on many fronts. Most of the issues we were confronted with as a fisherfolk with the news of the week suspension I think were adequately able to exploit at the meeting and what we are most happy about is that our fisherfolk will be able to resume work in about a day so we're very happy about about that news. The statutory instrument containing the measures will be published on Wednesday 4th November 2020. The measures come into effect Thursday 5th November 2020.


Okay, we're back live here at HP Discover in Germany. I'm John Furrier with SiliconANGLE.com and my co-host Dave Vellante and I are here with Biri Singh, SVP and general manager of HP Cloud Services and Cloud Systems. No, Converge Cloud and Cloud Services. Converge Cloud and Cloud Services. Welcome to theCUBE. Thank you, thanks for having me, John. Great to have you on. We met in Palo Alto for a short briefing. I know you had run all these executive meetings, but the cloud was emerging. You were behind a lot of the OpenStack and the cloud project and since then you've launched the cloud. Okay, when we met it was months ago and HP's got cloud everywhere. They've had cloud system out there but talk about the cloud offering right now and let's set the table for the cloud. So cloud is a big global term. It's generic, but it's not generic and HP's a little different nuances. So can you lay out what cloud is with HP? Let's talk about HP Converge Cloud, which is really the... So if you look at it from the standpoint of Converge Cloud, what we've done there is actually pulled together private cloud, our public cloud offering and our managed hosted offering and put that together under the banner of HP Converge Cloud. And really what it's dealing with is the idea of hybrid delivery. So we're pulling together a set of solutions under each one of those respective areas that together allow us to offer customers and partners. We think one of the most comprehensive solutions for dealing with not just hybrid delivery but also wrapping it with things like a very secure environment, SLAs. And the whole thesis is what's it going to take to get enterprise production workloads onto the cloud? So is that the buzz that we were seeing this morning about enterprise grade for consumer cloud prices? There was some buzz going around. Was that the Converge Clouds at cloud system? That's part of it. So cloud system is our private cloud offering. HP Public Cloud is our public cloud offering. And then our managed cloud business with enterprise services is essentially our ES led consulting where we essentially stand up clouds for our customers. Got it, okay, got it. So how's the reaction, because you guys went into beta and now they're the product. So we started working on the public cloud about a year and a half ago. We, in the summer of 2011, committed to OpenStack. Put a full weight of HP behind it. It's been fantastic. We're one of the, I think most significant players in OpenStack, but not just in terms of sort of showing up. We've actually demonstrated and executed and stood up one of the largest public clouds, you know, using OpenStack in a fairly tight way. So in the fall of 2011, we went up in private beta. In May, 2000 of this year, we stood up our public beta service and we just went GA with compute. So now we have compute, storage, CDN, both block storage, object storage in general availability within SLA backing it. And really why I want to emphasize that is it's our thesis that ultimately to get enterprises off the sort of dev test and just playing around for shadow IT of using cloud, you really need a true enterprise grade service quality. And then standing behind an SLA is really important. So, you know, in seven months we went from beta to GA. We think it's the early innings of now being able to go after full blown production workloads, not just dev test, but dev test to production. And I think it's important. And if you look at what we've executed on relative to the rest of the industry, where other players took anywhere from 12 to 22 months to put their service into play and some haven't even exited beta yet, we think we've made some progress. So we've been busy, but it's been a good busy. So what? You mentioned your commitment to OpenStack and you sort of said you were really committed to OpenStack. I know a number of people have joined OpenStack, but it's almost, you get the feeling of, okay, hey, we're into, we're open. Yeah. So talk about that a little bit in terms of that commitment. So HP's got a pretty strong tradition in OpenSource because we put a lot of wood behind OpenStack. The way I think about it, in OpenSource communities code speaks, right? And you have to be able to look at what each vendor and each member is doing, not just the large companies, but even some of the smaller and even individual developers. And committers and the idea of committing is important. So we've aspired to make a difference there. We're one of the significant sponsors. We leveraged our understanding of sort of how to do foundation work to get stand up the OpenStack foundation. So I think we've done some decent work around governance, but quite frankly, also leverage what we think is an incredible stack of technology that the community is sort of centered around. And I say community in a broad sense. But I think we've leveraged it. We're one of the only vendors that has stood up a public cloud on OpenStack, but also now have a private cloud implementation and the idea is to bring that together in a hybrid solution. So there's a lot of weight in your shoulders with that commitment that you're making to OpenStack. Is OpenStack ready for prime time? We think it is. It's like any open source project, it's only as good as the ecosystem around it. And if you look at the players, there's some serious players that are sort of geared up. And I think we're going to see a lot of activity just in the last three months. There's been tremendous, tremendous milestones within OpenStack. And we think that's going to continue in 2013. The credibility of OpenStack definitely has turned because at the beginning, we were critical of OpenStack being kind of like, back in my glory days as a youth land manager, remember the whole, everyone was jumping in these standards bodies and it goes nowhere because it's just him marketing ploy or infighting. And then when Citrix dropped out, you saw an interesting shift, like in Nasira and the guys in the SDN area, you got some heavy duty tech guys going in there, looking at it as a playground and some good stuff came out. So the Nasira stuff was interesting. You called it a Hail Mary against Amazon, but it looks like the past got completed. Well, it became a developer environment. It really became kind of a playground to get some stuff out there. And you guys going in that speaks volumes. My question is, is that if you look at what OpenStack is doing right now, it's becoming kind of this third option as a way to kind of get some independence. You got AWS out there. You got Rackspace and all the Rackspace does play in OpenStack. But at AWS, the trend was, we're going to put SSD and AWS. We have Netflix as kind of their showcase customer. And then recently, the signal from NetApp to do storage in there, it's pretty interesting. So given those kind of market signals, HP has their own cloud. You have an amazing announcement from three-par team here at Storage Group. How do you cobble in the greatness and the awesomeness of some of those other products into your cloud? Well, I think at the end of the day, you have the HP storage announcement, which I agree, fantastic. It's catering to a very specific demand in the market for enterprise that we've seen. And I think you're going to see HP always continue to deliver. That's part of the Converge infrastructure portfolio, which we essentially coined three plus years ago. The entire industry's followed it. Similarly, we've taken Converge Cloud in a similar theme and said, we believe there's a certain way cloud technologies will be used and cloud solutions will come to manifest, vis-a-vis hybrid. So our investment in OpenStack is in parallel to follow that. The storage piece follows what we're doing in Converge infrastructure. For HP Cloud, we're using Converge infrastructure to power the cloud, if you will. We're using HP software solutions. We've built our own with OpenStack. We've brought in a healthy dose of the enterprise services piece of it. So I think it's coming together to essentially help customers move from traditional IT models to now incorporating cloud models. I think that's really how it's in. The beautiful cloud was obviously buy as you go, rent versus buying kind of thing, economics were supposedly good, but really it's about on-demand and utility-based like electricity, if you will. How are you seeing the demand? Now that the on-premise has gotten in more advanced with solid state, we see some innovation, like you said, three-part caters to the audience. On-premise has been good. Public cloud, obviously it's public cloud, but the hybrid really has emerged as a nice little gateway between the two. Not a lot of people are throwing their weight into the public cloud because of security and data issues. So this new ground, the hybrid, was the focus. So how do you see those three things playing out? Obviously you're doing all three, right? So you're rolling out all three. Do you have any particular preference? Let's make a point first. Our view on public cloud has been we're building an enterprise-grade public cloud with service quality of an SLA, a secure cloud, the notion of customer service to deal with the very notion of production workloads.  There has not been two-data robust offering dealing with what enterprise departments are. We think we've delivered the early innings on that. When you combine the notion of cloud system and private cloud, we've been in that market for two plus years. I think we've done a very admirable job there. But pulling this together is the notion of hybrid delivery. Customers have hybrid clouds, right? We don't have a hybrid cloud. HP doesn't have a hybrid cloud. We don't have hybrid delivery. Customers have hybrid environments, hybrid clouds, they expect us to manage for them. So our goal is to really line up public cloud. That's a connection. It's not a hybrid cloud, right? Basically make them interoperable in terms of service quality, in terms of moving workloads across the environments on-premise to your public cloud environment, and third, keeping it open and making sure our customers have choice, because all the other vendors' solutions are largely fairly locked in.  That's not been our approach. So customers actually federating applications in that hybrid model? Absolutely. I mean, one of our announces today is, you can now go with our HP Cloud Workload Migration Service. You can literally take a Linux or Windows app and with our partner, push button deploy to the cloud. So you're now seeing a real world example of workloads being moving from an on-premise environment to a secure public cloud. Over time, we'll see other clouds get federated, but we need to see other clouds actually adopt the same level of SLA, the same level of sort of requirements. Hypervisor support, all the hypervisor support. How about federating between one of your customers' private clouds, which have the robustness, and your cloud? Do you expect that in the near or mid-term? Yes, I think you'll actually see us being very active there. We just did our workload migration service, which can take any on-premise application, Linux, Windows, through three great partners, AppZero, Clicker, and GigaSpaces, and I've implemented that as a service. We think that's going to be a massive solution for our customers. Yeah, okay, and so, am I correct though, you're not seeing that today? That's sort of a near-term or a mid-term, or are you actually seeing federated apps today? No, we're actually seeing that today. We announced that solution to deal with the demand. But do you have customers actually federating apps in between their private cloud and your public cloud? Yes, we do. Yeah, okay. What's the use case for that? So you can take anything from, take DevTest, you've got an application, you've seen it in production, you now want to scale it. You want to basically move it into a production environment, keep it running on the public cloud while you basically cloudify your on-premise environment, which was a traditional monolithic structure. So while you essentially, you can't afford to have that application go down. So have it run securely in the public cloud while you essentially refactor your on-premise model into a cloud model. Do you agree that's rare in the industry in terms of providers being able to do that and actually having customers doing that? You're really the first, and I've been looking for months. I think you're the first, and I said, yes, we're doing that today. And I've talked to probably 20 cloud service providers in the last two weeks, and that's that very same question. The answer is consistently, we think it's coming. You're the first to have said yes. Why do you think that is? Well, I mean, HP's got some breadth and depth in terms of customers. Like I said, a lot of the folks you've probably spoken to are coming at it from a lens of either, it's a pure private cloud view or it's a pure public cloud view. When you couple the notion that says large enterprises want to adopt all the mobile stuff, all the web 2.0 cloud-enabled social networking apps, they want to take advantage of the bring your own device phenomena, there's a lot of new age web 2.0 distributed mobile apps that are looking to sort of get deployed in what we call new cloud infrastructures. There's also traditional applications that essentially need to get moved on. We've responded to that need. I mean, our pipeline tells us there's a healthy need for that. That's why we're all the solution now. I would love to follow up with you on that and talk to some of your folks about it and learn more. That would be great. I appreciate it. So my final question is we got to wrap up here is marketplace. Since we talked, a lot has changed for you in terms of the scope of your offering and the success. A lot's happening in the marketplace, specifically in the platform as a service and infrastructure as a service business. And then yesterday, VMware, Cloud Foundry, Vfabric, Green Plum, Cetus and Pivotal get popped out of VMware our spring sources in there too. Merits is leading that charge. So you're seeing the maturation of an app environment, right, app developer environment. And you know, my angle on that is obviously two DNAs of VMware. We have the plumbers, the infrastructure guys doing the virtualization side and then you had the developers floundering. Little bit different opportunity. So I can see that. Actually, I think it's a good move for them but I want to get your take on it. Why are they doing it? What's the dynamic? What's changing the platform as a service market? What are some of the key dynamics that are happening? Well, I'll defer to VMware and EMC to comment on why they think they're doing it. My take on it is I think it validates our model in HPE Cloud Services, which was we designed our cloud services to have infrastructure through cloud, not virtualization to cloud, which isn't true cloud. True infrastructure is in a service with an integrated platform stack. So we're building platform as a service. We did it with Cloud Foundry. We've leveraged other models on it. We think what the future of that is people want a secure place to build and run workloads and applications. That's what the CIO wants. Then they in turn want tools that are modern, modern tools with databases, service analytics, all of the sort of different language and frameworks. They want that for their developers, whether it's a startup or an enterprise developer, along with their IT ops model, completely tied in and say, we're not giving you a set of tools and environment, a management environment to manage all of your workloads. So to me, the EMC VMware announcement, I think is great for the industry. I think it actually validates the fact that they probably needed to focus more and from our standpoint, this is what we set out to do two years ago. True Cloud, we love True Cloud. This is a no-cloud-washing zone. Yeah, yeah, this is good. No, I think it's awesome. I totally agree with you. HB Cloud Service is definitely a no-cloud-washing zone. You can soundbite on that last segment. This is, to me, I totally agree with you. To me, what I'm most excited about, what you guys are doing, what that's happening with those guys is, it's good for their business and all the people involved. So, I mean, the spring source guys are jumping ship left and right. You know, they're losing talent. There's all kinds of things going on there, but it's good for DevOps. It validates what I saw as a stall on DevOps. So, DevOps had this great momentum, kind of stalled a little bit, big data sucked the oxygen out of the room with a dupe and a lot of things going on there, but this absolutely, to me, legitimizes DevOps as a bona fide category of market. And I think that is ultimately still early build-out days, but the ability to move workloads seamlessly just at push of a button and it programmatically is the future. So, congratulations. Barry Singh with HP, senior vice president, Converge Cloud and Cloud Services. So, he's now in charge of all that greatness over there. Congratulations. The cloud wars begin, true cloud will be the definition that we will look at. And we love it here at HP Discover, extracting all the signal from the noise. This is SiliconANGLE theCUBE. We'll be right back after this short break. Thank you.


So if we have 11, we need to lock it in. I currently have a lot of people, 8 at least. What's up everybody, I'm the Mangus, you are awesome and I have some Dante gameplay from Aetherial's last stress test. If you want to try the game out for yourself, they're having a free weekend starting on January 21st. Dante is Aetherial's ADC and he plays a bit like Twin Blast from Paragon, but his ult is just a straight up Murdox knight.  Dante's Q is called Go Long. It's a straight line skill shot that pierces through targets. His E is a grenade that deals damage and slows enemies.  His movement ability is a quick roll in the direction of movement. His ultimate called Say Hello To, kind of a bit of a tribute to Scarface there. It's a long range snipe that can hit anyone anywhere on the map.  Dante's risk reward ability allows you to fire 10 rapid shots. His pistol is then overheat and you can't basic attack or use abilities for a brief period of time.  This does get faster and it deals more damage as you level it up. He also has a passive that gives you a attack speed that stacks three times as long as you're hitting the same target. All right, now that you know what Dante do, let's get into the gameplay. I think Ron's right click is not useless, but nobody really uses it. Yeah, it's useful in some cases, but. Did he just steal that kill? Yeah, I did. Oh, I got it, sick. Oh, did you? No, I don't know if I got it. I don't know if I got it. No, I didn't get it. I was going to say, pretty sure I got that. That was my passive kill. Oh, was it? Actually, I think I still get it. But I'm going to make you feel bad about it. Let's assume it doesn't. Oh, well, no, I don't feel bad. I'm the ADC. I get all the kills. I feel like we're starting to become friends, and then you just throw it away for nothing. You came into this lane to give me a kill, and I took it. Yeah, she saw me move. It's like, OK, I'm not going in. I hit her pretty hard with my Q. I'm just mad I lost fire over him. Oh, man.    I can't wait to see you get Dante sniped here. Yeah, he hit you. Don't for it, bros. And I thought Final Fantasy Qs were bad. Oh, no. So I'm sitting here looking through Leah's kit. How does she fly? I can't figure it out. Like, what if she's flying?  It's her class ability. It's just her class ability. Huh, because I just played a whole game and had no clue how to do it. I would say that Leah is significantly worse without that. So that's a brilliant idea. Wouldn't it be cool if this character with bird wings could fly?  Yeah, it was like, I was sitting here. I was reading through the ability of, like, none of these abilities.  Oh, wait, no, we have minions. Oh, yeah, 100%. This is how crack-headed about this. This is incorrect. Like, imagine they're going to make a character with wings and then it's like an archmage, archmage. Yeah, because the one thing I remember them talking about is if a character has it, they'll use it. I believe that's what they said. Something like that. Oh, god. Oh, while flying, can you, like, fly from mid lane to one of the side lanes?  I wish I could answer that, my friend. But I played a whole game. I played a whole hour game and never flew once. So I wish I could tell you. Man, if I still had my prime, so I would definitely call it to you, but I said we'd be back. Thank you, guys, so much for the follow. Thank you, guys. You're on streaming. I didn't see who it was, let's see. I was infected already in Zambia, so thank you, guys.  Nope. Yep. He's in the unknown.    Do I have two of these? And again, no issues. Again, no issues. I don't know what you're talking about. Apparently, apparently, I suppose it's very hard to kill. 20 minutes. I mean, did you do it? No, I got, like, I don't need it. I got ganked twice. I mean, he tried to sell all the Angus mob in the game. Yeah, but he got ganked twice or two. Well, that didn't real. This is an after post. You can deploy a Leia that will come and haunt you. I'm going to be fired. Wow, this new patch is wild. This is a boggess patch, bro. Hey, don't have to buff Atropos, but an Atropos just nerfs you. I should be farming anyways, bro. I only love their team. It's going to be a thrush. It's going to be a thrush. Yeah, but then you do the same accent. You just say, let me see your clash of souls. Hello, guys. Can I ask you how I joined the game? Undyinggames.com. And you can make an account. And then there should be a download link. If you just Google ethereal clash of souls, it should pull up the website as well. Yeah, I bought the website. Oh, yes, there should be a my account section and then you make an account. Have you done that yet? Oh, my God. I was just a crit. Great. I actually have not downloaded since it has not been key related. Fumo, do you know what to do here? Tommy, you're going to make me count first. Yeah, I thought he said he just did. Then I think under account management and then above the overview. There's a blue link that should appear near the very top of the page, like underneath the menu, but above all of the very specific stuff that's on the account page. It's surprisingly subtle. Oh, yeah, I did it.  I know. I know it wasn't going to do anything but scare her. I was hoping that she would try and fly afterwards and then fall to her doom.  There's a layer around. This is a trap. That stat at the bottom left of your icons, is that crit chance 50%? I saw Yonex. I believe so.  What's upside? Oh, what upside? How's it going, Yonex? We're actually about to get a custom lobby going. We need to reserve one place for a man named Mark Atlas, though. So if we have 11, we need to log it in. I currently have 10 people, 8 at least. Now, you don't get this. You don't get this, Mangus. Come on. Come on. Come on. You're going to get body-bought too here. Damn. I have him. It's right. I don't have him in theory yet. Now, Antropos? Now we have three people taking it? Or two, because, oh my god. You can walk through that rock. Hey, Mangus, go right through this rock. Hey, hey. I can hide inside there. You see that, Kai? My immersion is broken. I can crouch inside my ultimate and just hide in there.  We need a burster. She's going to try to alt this as she comes in. Oh, I'm going to die here. All right, I'm pulling this thing. That's her kit. Nice, we got it. Good stuff. I don't know who this Leia is, but she's been a nuisance the whole game. Yeah, she's good. You last game. Oh, thank you. I'm blushing. You guys are so sure it's a feature. You guys are so sure it's a feature. You guys trying to get a custom match going? Pretty much, yeah. Oh, what's up, Splatoon? How are you doing, man? Yeah, we're getting custom set up. We have 11 spots to fill, and then one other. We're a homie that will be coming after this game. First come, first server. Yeah, until that dual spot. So thank you, Gucci. OK, I'm good, all right. Bro, I thought she was a pretty interesting character. Just like the survivability and the slows and stuff. Oh, do we call infinitely spamming shield to get 75% shield survivability? Yeah, that's what that is. Hawkeye. I had more kills with her than I played with the jungle. I played Leia. No, man. I mean, I was talking about when Marina shields look invincible. Yeah, yeah. And then I had to order it in my lane too. According to Skifter, that is purely visual. So you're still dealing damage to the health. It just looks like she still has shields. OK, well, I'm going to save my mana again. Oh, Marina all came out, so now I have 20 frames. Yes. Good game. Ain't no paper to take away. So who is this Leia? Time to see. Raleos. Definitely sounds like an eSports name. Yeah, he was very good. Yeah, he was bobbing and weaving when I was trying to shoot his EES. Yeah. Oh, you're strong. Oh, Alpha Esports team incoming. I was watching that guy the other day. He was a pretty good Talos too. And man, goose. Special shout out to channel members FullishBloodHunter, Jelly KneesMeal, Mixed for Men, Stunt, Farith, and Raven.


From San Francisco, it's theCUBE. Covering Girls in Tech Catalyst Conference, brought to you by Girls in Tech. Hey, welcome back everybody. Jeff Frick here with theCUBE. We're in downtown San Francisco at the Girls in Tech Catalyst event. Really great event, about 700 people a couple of days and it's just a single track, a lot of presentations, about 20 minute presentations by a bunch of female leaders telling their story. How do they get where they got? What advice could they give? And there's men, women here that they just brought in, I think a busload of students. So it's a really great event. We're excited to be here. And we're psyched for our next guest. She's Rashmi Kumar, the SVP supply chain and procurement for McKesson. Welcome. Hi, thank you, Jeff. Absolutely. So you said you hadn't been to this event before. You keep trying to come, but things don't keep getting in the way. So what do you think now that you're here? Absolutely, I'm so glad to be here. I'm so thankful to McKesson for being the lead sponsor of the event. I'm really excited to see the energy here. Yeah. So did McKesson become the lead sponsor? Because that's a really nice statement on the company to really get involved in something like Girls in Tech. Yeah, so McKesson is a company which is sitting at the intersection of healthcare. Guess what? It's something on which our lives depend on. But this is the industry which is most behind in technology. So we want to do everything to grow technology talent across the country in this space to enable better healthcare for our patients. Right. And it's interesting. We talked before we turned the cameras on that there's still a huge talent gap. You know, it's funny because we go to a lot of shows and they talk about the machines are taking all the jobs and there's not going to be jobs for people. But in fact, there's still a ton of jobs. There's still a ton of opportunity in tech. We still don't have enough people. So we have to bring in women. We have to bring in other folks to help fill all these great opportunities. Yeah, absolutely. Means when we talk about machine and AI, we are not talking about pure AI taking away the job. It'll be enabling human being to do better job and will improve our quality of life. So who will build those machines though? You need technologists. We need technologists who will build that machine. And we are here to kind of grow ourselves and grow our people sitting where I am at SVP of supply chain role. All the commerce is moving from storefront to e-commerce. That is run by programs and technologies. And there are jobs and warehouses for people to enable the e-commerce. But how do we build those platforms that enable our patients to get, say, their medication at their doorsteps and not have to go run from pharmacy to pharmacy to find it? And we need technologists for it. So it's interesting because supply chains have been optimized for a long time in early days of tech innovation where it was ERP and SAP. So what lessons can you tell from procurement that now we see it in more kind of customer facing and direct to consumer tech involvement? Because you still have people. There's a lot of automation in procurement but you still have a lot of things for people to do. Yeah, so as the supply chain was more business we were focused on the customer experience of, say, pharmacist or the experience of a person who was working on the warehouse floor. And we didn't worry about it. The gray screens, green screens, whatever we put. Now you think about an autonomous car or you think about a drone delivering medicine. You need to give the interaction to every person which enables them to consume those services.  When machines will run the cars and we don't have to drive it, how I interact with it, somebody needs to define it and then tweak it and grow it. That's also another point about all technology and digital product. You can pivot and change and bring in new functionality. Satisfy human consumerization of technology is changing human needs to interact with technology as well. And we need all kinds of people from all backgrounds because diversity brings in diverse thinking which brings in better products. Yeah, it does. It's the right thing to do but it actually delivers much better results and bottom line. So you're here, you're running a workshop today. So tell us a little bit about the workshop that you're running. Yeah, so the workshop, my topic is make your pitch perfect which is around the old topic of elevator pitch. But because it's girls in tech conference, we women want to be 200% sure that we are good to do a job and we don't kind of branch out to highlight the work that we are doing already which could get us in that next position. So how as a professional we should interact with not only our managers and peers but other leaders within the company, maybe other leaders across my industry as well as in technology and impress them with what I can do so that we leave a lasting impression on the person's mind. And when he or she is looking for a role, for a person for a role, they think of the girls who are here training these two days. So this is just kind of icing on the cake. So what are some of the tips and tricks for the people that didn't make the conference that you helped them with? Are there some kind of common errors that people make over and over and over that you're trying to tell them a lot to do? Or there are a couple little guideposts that you can help them to get their pitch down? Is it the timing? Is it the focus? Is it the way it's structured? What are some of the things you share with them? Absolutely, so HBR did an article on elevator pitch for elevator pitch. So that means that we leave a lot of interactions on the table because when we are riding an elevator, riding a train, or just sitting at a bar, we don't take the opportunity to open up that conversation. So we'll be focusing on that a little bit. And then also talking about as you define your elevator pitch, think about your own passion, your own skill, and where does it fit with some companies or some projects need? At that intersection lies the sweet spot for that person and how they hone in, how they really practice it and have it handy and available to say it when the time comes. So that's the main gist of the workshop. Well, it's an interesting concept too because we go to a lot of conferences and one of the great values of conferences, if you're exhibiting, is you get to practice your pitch with a whole bunch of people over a really short period of time and hone it. So it's an interesting concept to take advantage of those opportunities, maybe if they're not even great ones, but just to get the reps in, just to see what resonates, what do people listen to, what do they grab? Right, so they will do a practice. Right, right. Think about what's their skill, what they're passionate about and what is the place where they want to go meet and see the intersection. Maybe the places they're thinking of might not fit their passion and skill, but they're just enamored with that place. So it also kind of gives them some toolbox to think ahead of time around how to plan their careers. All right, well, important work and again, thank you for your sponsorship of the conference, it's really important and it's a great statement on McKesson. Thank you. All right, she's Rashmi Hum Jeff. We are at Girls in Tech Catalyst 2018, downtown San Francisco. Thanks for watching.


Why do people procrastinate uncertainty? Yeah, fear and uncertainty. So the thing you want to do with the customers, you want to raise their certainty, not reduce it. Yes. You definitely don't want to challenge it. You want to raise it. Because when I raise somebody's certainty, then I make a decision. Do you think that's just giving them more information? Because that's what people go. In room. In room to breathe, right? Room to breathe and room to move around, right? And maybe it means you need to follow up. Like, we have a program that says follow up. You're not going to close everybody no matter what you do.


What's up everybody, JZM for Jaspyscasebreak.com 2022 Bowman Draft Baseball Super Jumbo Edition just sold out. Quick little two box break, random teams number three, and again guys, there are two combo teams, all-card ship. Philly's Marlins together, A's Astros, and you can find five prospect autographs per box. So there's the names, and then of course, Philly's Marlins, Astros A's. There you go. Let's roll the dice and see what you guys match up. Up with five out of five, 10 times, good luck. One, two, three, four, five, six, seven, eight, nine, 10. Daniel down to Dave. 10 times here, one, two, three, four, five, six, seven, eight, nine, 10. Boston Red Sox down to the Cleveland Guardians. There we go. So Daniel D, you have the Red Sox, Chris B. Butch Holtz, sorry. There's gonna be two Chris B's in here. Tigers, Richard, T with the Pirates, Adam Cumberham, Rangers, Adam Ewald, Giants, Josh, Lucas, Reyes, Brent, Yankees, Matthew. Orioles, Jordan, last one, Mojopadres, Chris Butch Holtz, sorry about that. Cardinals, Paul, Royals, Jose, Mariners, Brent Dodgers, Matthew Brewers, John, Schwartz, Mets, Eugene, Astros, Ace Combo, Richard T. Phillies, Marlins Combo, Josh Lucas, Rockies, Chris Butler, Twins, Ryan, Rids, Eric, Braves, Cuppermen Nationals, Butler, you have Cubs and Angels, Jose with the White Sox, Dave with the Diamondbacks, Matthew with the Blue Jays, and then Dave with the Cleveland Guardians. All right, if anybody wants to make any trades, trade window will be open for a quick minutes. One minuto. Braves and Rangers just continue to go ham, but what do they do to now? Storms saying Rays and Rockies are available if anybody's interested. All right, sorry about that, guys. I guess no trades then. Braves signed Sean Murphy, Six-Year Deal, signed a Valdee, Rangers did, huh. How come I didn't get no alerts today? Did I turn off my alerts? I'm sorry, my wife is telling us something from the call we were expecting. Oh, wait, this is yesterday, Rex. The Valdee deal was like 24 hours ago. All right, looks like Alan Murdoch got the Padres, so let me quickly put that in there too, and I can repost up the next five-star. Yeah, I guess I had my alerts turned off when I went to Mexico. I have to turn on my notifications again for Yahoo Sports. I kind of really turned off all my notifications for everything when I left. It's like the first time in a while. All right, so I posted up number 13, number 13, five-star. If you guys want to start doing that, boom. All right, sorry about that, guys. Or not, super, super back to the busy. What happened to my sheet? Oh, it's out of paper. Oh, I guess it is out of paper. I don't really know how that's gonna go. I mean, I guess his injury just hasn't healed it, right? His leg. The Giant's one was interesting though, right? I mean, Giant's one, he hadn't really signed anything or did he sign? Then he did his physical, and then they were kind of like, I don't know. But for the Met's one, did he sign everything on paper already, or does the contract potentially get avoided if he didn't pass this physical? All right, we'll go through the paper at the end, just like we have for Jumbo Cermak. Having cross, and that might be a variation, I believe? Yeah, that ends in 46. So there you go, a little variation. Justin Boyd, first auto. All right, we got Blake Barkhalter. The 99, the next auto should be right here. Dylan Delecia, blue to 150. Yeah, well, I'm assuming he agreed in principle, verbally, with the Met's, because my thing is that if he signed an actual contract, and then they did a physical, then that'd be kind of weird and dumb on the Met's part. So I assume they verbally agreed, and then obviously doing a physical now, they figured that, you know, hey, we don't like the scans either. It wasn't just the Giants.  I mean, there's always like, avoidable things in contracts, so it's not like Korea pulled a fast one on them, you know? Unless we met with that desperate, and they're just like, I don't care if you're injured or not, we're still gonna sign you. Robbie Snelling, and we got a Nathan Martorella. Yeah, I think I've seen that one too. I mean, the way the Met's are spending all their money, I don't think they would mind cheating either, honestly, if they get some of a ring.  Ain't trying to be ain't cheating. Brady House paper, and Chase De Lauder. The Guardians. Last pack here, and then we'll go through all the paper base. And Cade Doughty, for 150. $100. All right, so let's go to the next box. The Denser Guzmum and Landon Sims for the Diamondbacks, which is Dave Casey. And Zach Maxwell for the Cincinnati Reds. So 50 gold. And Jimmy Crooks for the St. Louis. Cardinals to 150, Blue Wave. Cardinals to Chris Butchholz. Luis Mesa. And we got Jacob Mizorowski. Actually not my dear apparent, the lauder. The last autograph here is gonna be Chase Midroth for the Boston Red Sox. I did see a couple holidays and those players here in the paper so let's just quickly pull those ones out. And then we're pretty much done, guys. So remember, everything does ship though, so we're only sleeving up those main three prospects to top out everything first, paper wise, everything like that. So I guess what I could do is just pull them out as I see them and then we're gonna have to go over all of them but I've not seen him like twice. So there's one, two, three, four, five, six, seven, eight, nine, 10. Thank you guys. Next one's in the store, Fresh Case, JasperysCaseBrace.com, guys.