Again, the title of our sermon is the Workman's Hammer. We're in part two, Judges Chapter 4. It's a joy to be back in the Book of Judges. Last Lord's Day, we began our exposition of Judges Chapter 4, and the account of Deborah, Barak, and Ja'el, the one that we're calling the Workman's Hammer from Judges Chapter 4. The Lord had given the nation of Israel, now peace under Ehud the judge, if you remember that account from Chapter 3, and Moab subdued under the hand of Israel, under Ehud the judge, and the land had peace for 80 years. However, in Chapter 4, verse 1 now when Ehud was dead, the Bible says the children of Israel again did evil on the side of the Lord. As we began to unpack this passage last week, we look first at the first of four headings, namely point one, the need of the people, the need of the people, and we talked about how that word again, in Chapter 4, verse 1, just leaps off the page at us, the people of Israel, the children of Israel again did evil on the side of the Lord. And we see once more that when the external restraint of the judge is removed, the people then revert back to their sin in rebellion, right? You remove the external restraint, and the people are right back into their sin. And in that condition, we see the utter hopelessness of man to make any real, lasting, thorough, moral reformation. Just not going to happen apart from God's Spirit. It's not going to happen apart from a mighty work of God in the heart of the sinner. We are, as the theologians would say, totally depraved. Every aspect, every faculty corrupted through sin, and it is hopeless to overcome that condition apart from a work of God. The fallen heart is inextricably enslaved to sin. That's the testimony of Scripture. The fallen heart enslaved to sin. So there can be no lasting heart holiness, no real heart holiness, apart from a sovereign and saving work of God. The real bondage then, if you think about that, the real bondage that the Israelites are in, the real oppression that they're under is not really merely an oppression under the Moabites, or in this case, the oppression of Jaban King of Canaan. The real bondage that the Israelites are in is oppression to their sin, is enslavement to their sin, is this repetitive pattern that continues to play out on the pages of judges dealing with their sin and rebellion against God. Their sin and rebellion continues to place them under the righteous wrath and judgment of God. All the nations are in his hands. They're like dust on the scales. So if the Lord wanted to wipe out the Moabites or wipe out the Canaanites in a moment, he could certainly do that. The Lord is using them, it's the tip of the spear so to speak, in his judgment against the sin of Israel. The law of God is not able to produce the heart transformation that we need. We see the law of God represented under the rule of the judge as the judge is raised up, the judge is governing Israel, enforcing the law you could say, applying the law to the people, but when that external strain is removed, they go right back to their sin. External restraints, the law of God cannot produce internal heart holiness. We don't need a mere moral transformation, we need a heart transformation, we need a new heart. And what the law, what the law could not do in that it was weak through the flesh, God did by sending another judge? No, by sending his own son in the likeness of sinful flesh on account of sin. So after the rescue then that the Lord provides under ehood and after the rest that the Israelites enjoyed under the judge, we see the people once again relapse in the sin and rebellion, which is as promised, now followed by retribution, that rescue, that rest, followed by relapse, followed by retribution, God's retributive justice. Look at verse two. So then, the Lord sold them into the hand of Jabin, king of Canaan who reigned in Hazor. Jabin, the word Jabin likely an imperial title or a dynastic title like Pharaoh, or like Caesar, right? There were many Jabens. And if you've read through the book of Joshua, this title may be one that you remember if you read through there, you might have remembered hearing this before. Turn back with me to Joshua chapter 11, just a few pages to the left. Joshua chapter 11. And listen to this from Joshua chapter 11, beginning in verse one. It's interesting, we've run into Jabin, the king of the Canaanites before. Joshua 11 verse one. I came to pass when Jabin, king of Hazor, same name, same title, that imperial or dynastic title, and the same location, Hazor. Came to pass when Jabin, king of Hazor heard these things, that he sent to Jobab, king of Madan, to the king of Shimran, to the king of Akshvah, and to the kings who were from the north in the mountains in the plain south of Chinaroth, in the lowland and in the heights of Dor on the west, to the Canaanites in the east and in the west, the Amorite, the Hittite, the Parasite, the Jebusite in the mountains, and the Hivite below Hermon in the land of Mizpah. And so they went out, they and all their armies with them, as many people as the sand that is on the seashore in multitude with very many horses and chariots. And when all these kings had met together, they came and camped together at the waters of Merim to fight against Israel. Boy it's a who's who of Canaanite or Israelite enemies. They're all gathered together and they're gathered together under Jabin. Jabin's topping the list, king of Hazor, the king over the Canaanites. What happens here to the army and what happens to Jabin from Canaan? Look down at verse 10. So Joshua at verse 10 turned back at that time and he took Hazor and he struck its king, that's King Jabin, right? He struck its king with the sword for Hazor was formerly the head of all those kingdoms and they struck all the people who were in it at the edge of the sword, utterly destroying them. There was none left breathing and then he burned Hazor with fire. So all the cities of those kings and all their kings, Joshua took and struck with the edge of the sword. He utterly destroyed them as Moses, the servant of the Lord had commanded. But as for the cities that stood on their mounds, Israel burned none of them except Hazor only, which Joshua burned. And all the spoil of these cities and the livestock, the children of Israel took his booty for themselves, but they struck every man with the edge of the sword until they had destroyed them and they left none breathing. As the Lord had commanded Moses, his servant, so Moses commanded Joshua and so Joshua did. He left nothing undone of all that the Lord had commanded Moses. Now Joshua, faithful in his day, faithful to the command of Moses, faithful to the command of God to put the Canaanites under the band. And that's exactly what we see in Joshua chapter 11. So what do we see then, considering that now, Joshua had victory over Jabin, king of the Canaanites, king of Hazor. He burned Hazor to the ground and cast out. Not one was left breathing. What do we see then when we go back to Judges chapter four? What is this that we encounter here back in Judges chapter four? So what we see here is the fruit of this new generation's failure to obey God. We see the fruit of their failure. The tragedy they bring on themselves is due their neglect of those things which God has commanded. They neglect duties commanded by God and now they're faced with the same enemy all over again. The Israelites, if you remember, after Joshua takes the land in conquest, that first, that emancipation generation or the inheritance generation goes into the land of Canaan and they take the land under conquest. But as Judges reminds us, they fail to drive out all the Canaanites. And after failing to drive out the Canaanites, the Canaanites then it appears from Judges chapter four, regroup, they rebuild the city, they put another Jabin in place. It's like plug and play in Canaan, right? They put another Jabin in place and now they become the means then that God uses to punish Israel for her sins. It's a tragic, a tragic story, especially of such a great victory under Joshua to now come into Judges chapter four and to fight this enemy all over again to be put under such harsh oppression under the enemy that was driven out at one time. Now not only are the Canaanites back under Jabin, but the Canaanites are stronger than they've ever been. There's been a tremendous strengthening to this army as we'll see. You can think about this, Cancha, on a personal level, right on a personal level. We see this tragedy play out in the history of the nation. What about you or I on a personal level? You go to battle against that sin.  Anything that causes you to sin, you labor, you strive against that sin. The diligence, praying, working against it. And it's like the Lord says, the demon leaves the heart of that one. That one sweeps it clean, clears it out.  And the last state of that one is worse than the first. We have to ensure that nothing gets in through the eye gate, that nothing gets in through the ear gate that would bring that tragedy back upon us. We have to run every last Canaanite sin out of our hearts and minds and give no quarter to the enemy. We have to fight and keep fighting and make sure that that enemy is dead and buried, right? Otherwise it can come back stronger than before. If we presume upon God or if we assume, we become presumptuous in our battle with sin and we think to ourselves, no, I can entertain that or I can entertain that or I'm okay in this area over here and we don't take action to ensure that that area is shored up, that we're fighting strong and that can be a chink in the armor that the enemy uses to take hold again. Here the Canaanites are back, they're back stronger than before. The commander of this army, Jabin's army, was Cicera. And Cicera dwelt in Harisheth Hagoyim. Look at verse three. The Lord has sold them into the hand of Jabin of Canaan who reigned in Hazor. And in verse three, the children of Israel then cried out to the Lord. This is a horrible circumstance that they're in. Causes them great misery. Children of Israel cried out to the Lord for Jabin had 900 chariots of iron and for 20 years he had harshly oppressed the children of Israel. I want you to notice a couple of things about verse three. Joshua had swept the place clean so to speak, right? In Joshua chapter 11. And now that demon, Canaanite, has returned. He brings with him seven other spirits more wicked than himself in the state of Israel is worse now than at the first. Canaanites don't merely regroup in verse three. The Canaanites are stronger than they've ever been. And if you think about it with me, iron chariots would have been like the Blitzkrieg tanks of Germany in World War II, right, this new advanced technology. They mowed over anything in their path, armies couldn't stand before iron chariots and iron chariots would have just decimated any army that stood before them. And Jabin had 900 of them, 900 iron chariots. Israel you could say was under an iron fist. Israel was under a rod of iron, this wicked grip of this wicked king. And apart from it, it shows it highlights in verse three really what's necessary. What's necessary is going to be a miraculous deliverance. No matter what the Israelites would have done for themselves, they couldn't have conquered Jabin king of Canaan, not with 900 chariots, right? Apart from a miraculous deliverance, this text highlights just how hopeless the condition was of the people. We find that in our own lives. Apart from a miraculous intervention of Almighty God in grace and in mercy, we are hopeless against our own sin. We see that pattern repeated in the nation of Israel through the book of the judges, right? Time and time and time again, they're right back to their sin, they're right back to the rebellion. What do they need? They need God providing a full and final deliverance. They need a change of heart, they need a transformation, they need the spirit of God to make them a new in Christ. Here they need a miraculous deliverance. They are hopeless without it, 900 iron chariots. And notice now, this is the first time that Israel's oppression has been described as harsh. Harsh, the word is host cut, refers to violent force, refers to violence, speaks to intensity. Their harsh oppression was intense, exceedingly intense. There's an indication of this intensity in chapter five. Look at chapter five, the song of Deborah. Look down at verse 28. This is their song of celebration. And Deborah, Berek, was singing this song. And look at what she sings in verse 28. The mother of Cicera, a Cicera is the leader of Jabin's army, we know that Cicera in this account is killed by Giel. The mother of Cicera, she's looking through the window, so to speak, she's crying out through the lattice. Why is this chariot so long and coming? Why tarries the clatter of his chariots? Her wisest ladies answered her. Yes, she answered herself. Are they not finding and dividing the spoil to every man, a girl or two? I think with me there, the word for girl or the word there for maiden is rahem. It means womb. To every man, a womb or two. This was an insult. It was a pejorative that the Canaanites used against Israelite women. This is what they thought of Israelite women. No doubt, Deborah sees a bit of talionic justice in the fact that Cicera is dead at the hands of a woman by this point. But notice the men were dividing the spoil, a womb or two, for every man. It's a speaking here of the rape of the Canaanites. The Canaanites raping Israelite women, the spoils of war.  This is the kind of harsh treatment, exceedingly violent, exceedingly intense, harsh treatment that the Israelites were under when under Jabin King of Canaan and the Canaanites. This is the kind of treatment they suffered, right? And they were under this horrible oppression for 20 years, 20 years. Now notice the pattern, 20 years in verse three. Chapter three, verse eight, they served Kushan, Rishithaim for eight years. In chapter three, verse 14, they then served Eglon King of Moab, 18 years. And now in chapter four, verse three, they're harshly oppressed by Jabin for 20 years. What do we see in the pattern? The pattern is increasing, isn't it? It's getting more and more harsh. God's judgment ramping up with the people of Israel reverting back now each time the judge dies as in chapter two, verse 19, reverting, behaving even more corruptly than their fathers. With their behavior, their conduct ramping up, we also see the Lord ramping up his judgments against them. Isn't that as the Lord often does? He ramps up his judgment against them. The chastisements against them are increased. It says though, if you think about it with me, it says though the Israelites are lulled into a false sense of security under the judge. They somehow think that they're in peace. They're under a false sense of peace, a false sense of safety during the rest that the judge gives to the people. And then when the judge dies, that restraint is removed. They foolishly return to their wallowing in the mire, right, as a dog returns to his vomit. They increasingly, after the judge dies, they increasingly stiffen their necks against God. And what does God do? God increasingly turns up the heat. You know, we may believe that we're at peace in the midst of our sin. If you find yourself in an unrepentant pattern of sin, you haven't dealt with that thing, the way that the Lord would have you deal with it. You haven't dealt with it in faithfulness. You haven't cut off and plucked out. You haven't done what is necessary to close the ear gate and to close the eye gate. You haven't taken decisive action against it, as Hebrews says. You haven't strived against that sin to the point of bloodshed. You've not done that. Not only is it liable to be the case, that having somewhat swept clean, that you're going to be overrun by that thing even more seriously than at first, but it's also likely that you'll face the increasing chastisements of God against your sin.  We may think at a time of peace, we may think in a time of arrest where things aren't bad, right? Things are going okay. And we sort of lull ourselves into a sense of security in this sin. And we're not actively engaged in fighting against it. We may think that no harm's gonna come to us. Everything's okay, right? Everything's okay. That false prophet of a heart in your chest seduces you like the false prophets of Israel, prophesying peace, peace. When there is no peace, says the Lord God. You may enjoy a time of rest in your sin. You may enjoy a period of peace in your rebellion. It's what caused Jeremiah to cry out to God. Why does the way of the wicked prosper? It caused Jeremiah to cry out, why does the way of the wicked prosper? If you remember, it causes the psalmist to cry out. Psalm 73, why do the wicked seem to prosper? They're not prospering. Why are those happy who deal so treacherously? Jeremiah asks, we cannot make the foolish error, the foolish mistake of confusing God's forbearance with tolerance. We can't make the mistake of thinking that because God is patient, God is tolerant. Don't confuse his patience with safety. We have to mortify the flesh, mortify that sin. The Puritan, Richard Rogers, commenting on this passage said this. He said, when all things seem quiet and peaceable to us, and when we think that we are safe on every side so that no hurt can befall us, yet if the Lord has a controversy with us, he doth in marvelous manner raise up some great trouble against us. That's a polite way of saying the Lord has controversy with us when he's got to deal with us according to our sin. When the Lord has to deal with us according to our neglect, when he has to deal with us according to our lack of will to fight against that sin, the Lord will raise up some great trouble against us. He says, yay, and that is it, we're out of the very sparks of our former afflictions which were thought to have been quenched long ago and he brings forth a fire and a flame as it were to burn and to consume us. Concerning the day of the Lord, Paul tells the Thessalonians that when many say peace and safety, sudden destruction comes upon them. If you remember that text in 1 Thessalonians chapter five, many say peace and safety and then sudden destruction comes upon them as labor pains upon a pregnant woman and they shall not escape. There's a sense in which God's justice is magnified in the way in which the peaceful, proud or the unholy bold are cast down in a moment. There's a way in which God's justice is exalted, his justice is magnified. It's seen as coming like a flood up on the wicked. There's a sense in which his justice is glorified in the way that the peaceful, proud, the peaceful wicked, the restful sinner is cast down in a moment. They say peace and safety and then sudden destruction comes upon them. They shall not escape. They lay down their head to sleep, believing themselves to be safe on every side. They have a nice glass of warm milk and cover up and in bed and then God's uncompromising justice delivers a tent peg through their skull in a moment if you are continuing an unrepentant sin, if you've not turned from sin to trust Christ alone, then your undoing may come in a moment. You may think to yourself, peace and safety all around. While you continue to harbor this sin, don't think for a moment that you are at peace until you're found in Christ. God's judgment can come in a moment. Paul says that those of us in Christ should watch and be sober. That's the admonition to the Christian, right? That's the work of the Christian, watch and be sober. Paul says, putting on the breastplate of faith and love and putting on the helmet of the hope of salvation, putting on the breastplate of faith and love, the helmet of the hope of salvation. Well, the children of Israel here are under the judgment of God in Judges chapter four. That particular judgment happens to have a name. Its name is Jabin, King of Canaan. And so the children of Israel, verse three, then cry out to the Lord for deliverance. They pray and the Lord gracious and merciful, again gracious and merciful with the children of Israel, he hears their prayer. He's attentive to their prayer while the nations would trust in iron chariots, the Israelites, the people of God trust in the Lord their God, right? And so what does God do then? He raises up a hero. Now in point one, we consider the need of the people. Look with me at point two on your notes and let's now consider the command of the Lord. The command of the Lord, point two, verse four. Now Deborah, a prophetess, the wife of Lapidoth was judging Israel at that time. Now as we'll see in the text, Deborah's a strong leader. Deborah is a faithful leader. She's a woman of great faith. And what do we find her doing in Israel in verse four? This is interesting. Deborah is essentially sitting in the seat of Moses as it were. She, Deborah, the prophetess is judging Israel. Verse five, she would sit under the palm tree of Deborah judging between Rama and Bethel and the mountains of Ephraim. And the children of Israel came up to her for judgment. But Deborah was such an important figure, they named a palm tree after her. This is the palm tree of Deborah. It's a nice palm tree, I'm sure. She was sitting under the palm tree and the people sitting essentially in the seat of Moses judging the people, the people would come up to her for judgment. The Deborah, we can see from verses four and five clearly described as a faithful leader. Someone God uses mightily. Now, not taking anything away from Deborah. Deborah is a faithful, Godly woman judging Israel. But this is amazing that Deborah is sitting in the seat of Moses judging Israel. To say the least, the Israelites, 3,500 years ago, the Israelites would not have been too accustomed to women in positions of leadership. Now that may insult modern day sensibilities and we're happy to do that. We're gonna stick to the Bible in what we think and believe. But about 3,500 years ago is way too early for I am woman, hear me roar, right? That wasn't taking place back then. There's an old saying that Jewish men would wake up each day and pray. They'd pray this, bless our God for not making me a gentile, a slave or a woman. So here we have a very extraordinary circumstance. There's a woman described as a prophetess judging Israel. That's an amazing fact from Judges chapter four. Now, to set the context for that. Keep that thought in your mind. To set the context for that. The Bible gives us some contrast in chapter four. Enter stage left, Baruch verse six. So then Deborah sent and called for Baruch, the son of Abinolim from Kedesh in Naftali. Now, there seems to be a great effort on the part of many commentators to protect the reputation of Baruch here in Judges chapter four. But there are some obvious challenges with that effort to protect Baruch's reputation here. Now first, notice that it's Deborah sitting in the seat judging Israel and not Baruch. They're not sitting under the palm tree of Baruch. They're sitting under the palm tree of Deborah. Notice second that Deborah then repeats a command of God that obviously Baruch has heard before. And it seems to be a command that Baruch should have already acted upon. Look at verse six. So Deborah sent and called for Baruch, the son of Abinolim from Kedesh in Naftali and said to him, has not the Lord God of Israel commanded? In other words, hasn't he already commanded you, Baruch? Go and deploy troops at Mount Tabor.   That command has already gone out to Baruch and here we find it's not been done, right? It's not been done. But third now, notice how Baruch answers Deborah, verse eight. So Baruch then says to her, if you will go with me, then I will go. But if you will not go with me, I will not go. And there's no way around it. That sounds a little faithless, doesn't it? Here's the word of God. Baruch should have said, amen, God, praise you for delivering him into our hands. We'll go right now. But that's not what he did. That's not what he did. Baruch delays obedience to the Lord's command and then Baruch declines leadership. Deborah will only go if you go with us. Baruch is unwilling to carry it out unless he has some reassurance from Deborah here. Now, granted, he's going up against 900 chariots, iron chariots, but what are iron chariots to God? Has it not already been established that God can wipe them out in a moment? He destroys the entire army of Pharaoh burying them in the Red Sea, right? He tears down the walls of Jericho. Listen, these folks have story after story after story from their history of the mighty victory of God. And what does Baruch do here? Baruch doubts. Thousands of them are his dust on the scales. So then, Baruch is rebuked for his unbelief. Look at verse nine. So Deborah said, verse nine, I'll surely go with you. She's a faithful woman, right? A faithful leader. I'll surely go with you. Nevertheless, there will be no glory for you in the journey you are taking for the Lord will sell Cicera into the hand of a woman. This is scandalous. It's astonishing. Far more unusual than Ehud, right? The assassin, the left-handed assassin, far more scandalous, far more unusual than Shamgar, the Gentile, the unusual instrument and the usual way that God delivered his people. Here, the Lord is going to sell the Lord's enemies into the hand of a woman. Baruch appears to be doubting, right? Baruch appears to be faithless. He appears to be indecisive, weak, fearful. Ultimately, the Lord rebukes him through the testimony of Deborah, a woman who is judging Israel. But one of the reasons that Baruch is defended against some well-deserved critique in the book of Judges is because Baruch is mentioned somewhere else in the Bible. Where else is Baruch mentioned? That Baruch is found in the Hall of Faith in Hebrews 11. That's interesting, isn't it? It's not Deborah that's found in the Hall of Faith. It's not Gael that's found in the Hall of Faith. You have other women that are found in the Hall of Faith. The author of Hebrews in chapter 11, verse 32 says this, and what more shall I say? I'm wearing the Hall of Faith, talking about the great exploits of men and women who put their faith and trust in the one true and living God. What more shall I say for the time would fail me to tell of Gideon, Baruch, Samson, and Jephthah? Now think about that company that Baruch is into. Gideon was fearful. Samson was morally compromised. Jephthah's judgment is highly questionable. And then here's Baruch, right? What more shall I say for the time will fail to tell of Gideon and Baruch and Samson and Jephthah also of David and Samuel and the prophets? Who through faith subdued kingdoms, worked righteousness, obtained promises, stopped the mouths of lions, quenched the violence of fire, escaped the edge of the sword, out of weakness were made strong, became valiant in battle, turned to flight the armies of the aliens, women received their dead, raised the life again. Not Deborah, not Gile, Baruch. Notice there are other women there. Rahab is there. Now you go back a few verses and Sarah is there, doubting Sarah is there. And here we find Baruch. What you find in the Hall of Faith is that it's not necessarily great faith on display in the Hall. In that interesting, it's not necessarily great faith that's on display in the Hall, but rather a great God who does great things through sometimes weak faith and even failing faith. In other words, God is the champion of the Hall of Faith, right? God is the champion of Israel at the time of the judges. It's not gonna be Baruch. In its sense, it's not gonna be Deborah. And what does the Lord do to demonstrate his great victory? He gives the Israelites victory at the hand of Jael, a woman, the wife of Hebra the Kenite in her tent, giving Cicera a little milk to drink, lie down, rest your head, right? It's amazing. God is the champion of the Hall of Faith. Now what's going on here in Judges 4 between Baruch and Deborah? Baruch is a picture. Baruch is an example, he's an illustration of the continued decline of the nation of Israel. Baruch becomes a testimony as it were. No matter how this might offend modern misplaced sensibilities, the reason that God raises up Deborah as a prophetess and the reason that God raises up Jael as the true hero of the story is because strong and faithful men in the nation of Israel were nowhere to be found. Now in contrast with the way in which God has ordinarily chosen to lead his people, direct his people through strong and faithful male leadership, male headship, in the absence of faithful male leadership, God raises up strong and faithful women in rebuke. Do you see? I think that's what's going on in Judges 4 here with Baruch. Now there are examples of strong and faithful women all over the pages of scripture, right? All over the pages of scripture, examples of godly women. It has nothing to do whatsoever with a value in the eyes of God. Nothing to do with value has everything to do with what God has said should be, right? God has appointed male leadership in the home. God has appointed male leadership in the nation of Israel at this time. God has appointed male leadership in the church. Paul says in 1 Corinthians chapter 11, verse three, but I want you to know that the head of every man is Christ, the head of woman is man and the head of Christ is God. That can't be said any clear and you can't argue the text, right? However, in the void or in the vacuum left behind in the absence of faithful godly men, the Lord will raise up faithful women. The Lord may raise up faithful women to judge as he did with Deborah or, or in the absence of faithful men in the vacuum left behind by a failure of men to take responsibility for leadership as they should faithless, unbelieving, unscrupulous women will seize power. It's one of the two, right? Think of the dominating Jezebel. Think of the dominating murderous queen of Israel, Athaliah or think of the irrational or domineering rule of a woman in the home when the man doesn't take responsibility for leading as he should. Think of the heartbroken, godly, faithful woman when the man fails to lead as he should in his home. Think of the heartbreak. What a godly, faithful woman desires is godly, faithful leadership, headship as the Lord has designed. The Lord has wired us that way. He has instructed us that way. He calls men, he calls you to take responsibility for your household. He calls you to take responsibility for leadership in your home. He calls you to take responsibility for the spiritual well-being of your home, the spiritual temperature in your home, right? Often when a man fails to lead in the home, it puts the woman in the position of having to bear the load of leadership. And this will cause great grief in the heart of a faithful, godly woman. You've seen faithful, godly women just wither over time under the failure of a godless, leaderless husband when men fail to take responsibility for leadership in the church. Women will assume those roles. When you see women in positions of leadership in the church, just like in Israel, it's an indication that there is something wrong. There's a problem, very wrong. Men, you must take responsibility. Men, you must lead in faith. Leadership, it's a practical, applicable task that's been laid in your lap. You are to lead. You are to serve him in faith. You're to serve him trusting his word. You are to lead faithfully in the godly way, no matter how many chariots or kings this world would bring against you. You're to take responsibility and serve the Lord in faith. Here, it's just an example, one example of what it looks like when that failure takes place. And we see it, don't we? As a part of the decline of Israel, as Israel continues to revert back, behaving more corruptly than their fathers before them, we see God turning up the heat on his retributive justice, giving them more and more severe chastisements for their sin. And we see a further and further decline in the moral and spiritual well-being of the nation. It's a downward spiral, and this is yet one more indication of it. We wanna honor the Lord in our homes, don't we men? Ladies, don't we? We wanna honor the Lord in our church to be faithful. Has nothing to do, right? Has nothing to do with value. Men and women equal on the side of God in that respect. There is neither male nor female, slave nor free, barbarians, hippies and slave are free, right? We have equal value in the eyes of God. Has everything to do with the way that God has said that things should be done, everything to do with the way that God blesses leadership in the home, leadership in the church, and we're to be faithful in that endeavor. They're up against a, what would to them be an unbeatable foe, but the Lord is gonna have his victory. And we're gonna see that next week. All praise, honor and glory to the one who fights our battles for us, amen? Let's pray. Father in heaven, what we thank you, we praise you, and you are the one who goes before us. Lord, help us to trust in you. Help us not to look at the iron chariots of this world arrayed against us. And help us just in faith, obey your word. Help us to be faithful and obeying your word in our home. Help us to be faithful to obeying your word in our church. No matter what the world says, or no matter the ignorance of the wise in this world, no matter what our culture would want to impose, help us Lord, just to be faithful to you, just to be faithful to your word and help us to trust you alone in it, knowing Lord that your ways are right and true and good, and you will bless faithfulness. Help us Lord, strengthen us to that end. Help us to see it clearly. Help us not to be weak and doubting and fearful, but help us to be bold in our Lord and to subdue kingdoms as it were by faith and trust in you, the champion of faith. We praise you and thank you for these many blessings Lord. Thank you for your faithful leadership in Jesus' name we pray, amen.


So our next speaker is Dr. Daniel Bronner, who is a longstanding faculty member in the section of geriatrics in the McLean Center here at the University of Chicago. Dan's research focuses on interdisciplinary approaches to clinical and ethics research with a particular interest in the care of older people. Dan, for example, has used innovative methods from the field of linguistics to develop novel approaches to improving communication of persons with dementia. Currently, Dan is developing a method for evaluating decision-making capacity in persons with dementia based on linguistics theory and discourse analysis. Dan is also writing a book on the history and evolution of cardiac resuscitation and DNR orders. Currently, Dan is co-director of the Ethics Consult Service here at the University of the McLean Center, and today, Dan will speak on the topic the AMA in the cardiac arrest paradigm. Thank you, Mark, for encouraging me to present my work today in this forum. Today, I'm going to talk about a small part of a larger project, as Marshall mentioned, which was occasioned by a series of visits I made to the AMA archives, which are right downtown. Around the time, Mark was asking for titles for talks. So, cardiac arrest CPR, I use that as a, this slide got, somehow got, just being around the PC will make an app work funny. I'm not paranoid. So, cardiac arrest CPR stands, I use it as a metaphor for understanding how a indication procedure gets established. And cardiac arrest in CPR stands as a metaphor for a procedure that is given, that is applied based on very narrow indications, usually involving a single organ, and often does not take other patient factors into consideration. And the cardiac arrest paradigm speaks to as a metaphor for the applications of procedures more generally. So, we see the pervasive application of procedures in medicine today, often based on narrowly defined indications, frequently pertaining to a single organ system. And the problems with this become most obvious at the end of life, but one needn't be dying to get indication procedures that are not helpful and that fit in this model. So, the constellation of indications for procedures constitutes the standard of care as we practice it today. And I use the changing indications for CPR and its various historical incarnations to illustrate the contingent nature of our understanding of medical conditions. Cardiac arrest exists as a diagnosis because of the therapy or potential therapy to treat it. But this model can also be used as a lens to study the constellation of forces that shape the indications for its application. And by extension, the indication procedures that compromise the rest of the standard of care. So, looking at these forces that created sort of the indications for CPR, we have over 200 year history of resuscitation medicine and it's evolving indication that I'm not going to go into today, but that forms a very compelling history. The very nature of the treatment of death has an impact is one of the forces that affected the indication. There's a strong belief system in the CPR project and we've heard a lot today about beliefs. Also the response to the default, which again I'm not going to get into, but the whole way the discourse at the end of life is a very important factor and I think was instrumental in creating CPR as a default. I'll talk a little bit about that later. And also political and economic forces that are not usually talked about that much are also important forces. And that's what I'm going to talk about today a little bit. I'm going to posit that an important force that made CPR for cardiac arrest the default for every patient who died, whether or not it was going to help them, was its presence on this list. This is the revised and greatly expanded, this comes from the revised and greatly expanded second edition of current procedural terminology that was published in 1970 by the AMA, American Medical Association, Burgess Gordon, MD editor. It was a thin volume when it was first published in 1966, providing codes for mostly surgical billable procedures, but by the second edition in 1970 it had grown by 70% and included CPR for cardiac arrest for the first time. It also included a handy form for billing the government in this form of this mock billing form. Anyway, so my visit to the AMA archives, and this is a painting that hangs in the AMA archives that I took a picture of, it was sort of hidden away because apparently our former Dean Madeira did not like it. But it was painted by Stephen DeHanos who was a member of the Social Realism School along with Norman Rockwell, and he did a bunch of Saturday evening post covers. And this was actually a cover for the Medical Times, and it depicts around the time and around the which I'm speaking of, and this is at the convention in 1960. And this is a paper from the 50s that describes how the AMA each year held two large scientific meetings, and I'm assuming that this was one of those meetings. So anyway, we all have a vague notion of the AMA's role in shaping contemporary medicine, but today I'd like to sharpen it just a little bit. And by answering the question, how did CPT come to be? And these two people here, anybody recognize them? Baxter and Whitaker were the first political consulting firm. They were initially hired by the California Medical Association in 1945 to fight then Governor Earl Warren's proposed plan for comprehensive compulsory health insurance for the state of California.  They were then retained by the AMA in 1948 after Truman was elected with the promise of federal health insurance program. And this history is covered very nicely by Jill LaPour actually in a New Yorker article. So anyway, this is one of the papers or actually it's a talk I found in the archive. This is part of the campaign against socialized medicine that had many manifestations. This is a talk by Lewis Bauer, Chairman of the Board of Trustees of the AMA. And he gave it to the National Association of Retail Drugists. It's now called the National Community Pharmacist Association in September of 1949. And it's useful, very useful because it defines what they really meant by socialized medicine. First of all, what is socialized medicine? This is from the beginning of the paper. You can get a variety of definitions depending upon whom you are talking. But I think it's a general rule. We may say that socialized medicine is any plan which the government supports financially by direct or indirect taxation, prescribes the rules and regulations under which medical care will be administered as far as doctors, patients and hospitals are concerned, and when it determines directly or indirectly the fees to be paid for services rendered. This is uncanny in its accuracy of the description of medicine today. But I think it sort of becomes ironic because the AMA I think did a lot to sort of push for medicine to move in a certain direction that I'll be talking about. This is a paper from an interesting journal, The Yale Scientific Magazine, which I don't think is in existence anymore, published in April of 1954, and it's very similar to other papers that the AMA was putting out. Socialized medicine, a case for free Entebuk Prize by George F. Lowell, Secretary General Manager of the AMA. And he talks about, instead of repeating the familiar arguments against socialized medicine, the American Medical Association presents its positive program. It's pointing out the past accomplishments, the present progress, and the future potential of the American medical system. The AMA serves notice that the world's best medical system stands a fair chance of deteriorating under government control. And that really was the big worry at the time. This is a paper, again I found this in the archives, and I found the reference to this in the archives. And this comes from a paper that was published in a journal called Problems of Communism, but was then truncated and published in JAMA the very same year. And that was really, the fear was that US medicine would become more like that in the USSR. So the several factors in this fear were, one was just the loss of sort of economic financial one, the financial worry here. They talk about medical doctors making much less than the workers in the plant in which they took care of them. So the workers were getting 2,000 rubles, and the physicians were only getting 750 to 800 rubles a month. The other fear expressed in this paper, again that was published in JAMA afterwards, is the amount of control by the government. And here we see doctors working for the government in doing health evaluations. And here we see this guy is before entering technical school, he's in the picture of health. But then in the second image we see when he summoned for duty in the provinces, all of a sudden he has medical certificates indicating that he's not healthy anymore. So doctors then becoming sort of workers for the state was one of the worries. And the other worry was the impending bureaucracy and taking patients away, doctors away from their patients. This is actually a time study of two Soviet doctors work in 1953. And you can see listening to and examining patients was only 1.9 minutes per patient. Reading and writing case histories was 2.6 minutes per patient. And then the paperwork in scare quotes was 3.7 minutes per patient, the longest amount of time. And I think this is similar for the second patient. So it's a very interesting look at their fear that medicine was going to become more bureaucratized as it was in the Soviet Union. So this is another treasure from the archive that illustrates another important movement in the AMA that was developing in the 1950s. And this was in the form of the Committee of Medical Practice that was instrumental in sort of creating CPT eventually. But the primary goal for it when it was developed in the 1950s was the inequity between medical and surgical fees. And so the Committee was put together to address this. And you can see here that medical specialists were only making $10,944 whereas surgeons were making $15,000. And a pediatrician again was not making very much. A neurosurgeon was making the most at $24,000. And so the Committee was put together to sort of address this differential. So looking at the introduction to the first CPT, we find an interesting notion here, the relative value studies, which was something that I really didn't know about prior to visiting the archives and which actually turns out to be one of the main goals of this committee, the Committee on Medical Practice. And they have many proceedings. I found a bunch of series of these conference proceedings going through the archives. And this was one of the more telling ones. This was the fourth regional conference on relative value studies.  So this is the opening remarks by Lester Bibler to this fourth conference. And he's like to emphasize that in holding this meeting we are trying to carry out the mandate of AMA delegates first expressed in the 58 clinical session. The purpose of this conference is not to indoctrinate anybody. It is to inform medical professions of an important development in which a number of constituent associations are participating to inform you of the purposes, scope and objectives of relative value studies. So these were meetings in which they were trying to get this idea of relative value studies and the need for them. And he said at the end of his talk here, these last lines, I would suggest as a method of procedure that questions be deferred until after we have heard from Dr. Cox who will conclude the presentation this morning. You will be able to direct your questions and problems to all the speakers in there, boy, avoid any necessary repetition. So this was really a very sort of hot button topic at the time. And these were these relative value studies that were done across the country. And I found one of these surveys in the archives. And you can see here that they were created by the California Medical Association. They were following their model and I'll talk more about that. But basically what they did was they predicted there would be like 1900 items ultimately. But what they did was they took a small representative sample of the procedures that doctors did in their offices and they asked the doctors how much did they charge for these procedures. And they did surveys, every state medical association did a survey of their constituents to find out what the relative values of the procedures that doctors were doing. You can see this for surgery, medicine, fractures. And this was just at the beginning of computer using computers to deal with data and so they were using these punch cards at the time. So this is Francis Cox and he was actually the mastermind of the relative value surveys starting in the early 1950s in California. And he said he starts off with the fundamental premise that no doctor in the nation likes a schedule of fees but if we did not have one and if we didn't have one we'd be better off, this accepted fact. These physicians who object to a concept of the relative values index post the following arguments and you can read the arguments here. You know it's basically controlling what doctors do. But the way he explains it is he goes to the history. And in this history he talks about government really sponsoring medicine since the late 1700s with the creation of the United States Marine Hospitals. And then he goes to the specific state situation that happened in California with a brief historical resume of what happened there in 1910 to 1912 when they initiated workman's compensation. Basically physicians wanted no part of that. He calls it putting their head in the sand. And so they were not involved in creating that at all. And now the physicians have to, every time they want to negotiate a new fee schedule they're obligated to bargain piecemeal for each fee that is approved. So he saw this as problematic especially when he talked about in 1959 the government is already putting in a fair amount of money into the medical enterprise and this was their way of getting physicians to be able to have a say in what was going on. So basically what he says that if we want to continue he concludes with a quote by Lincoln. He says, fellow citizens we cannot escape the history and we of this congress and this administration will be remembered in spite of ourselves. No personal significance nor insignificance can spare one or the other. The fiery trial through which we pass will write us down in honor or dishonor in the pages of our generation. So he's comparing what they're doing to sort of Lincoln talking to the congress in 1862. So he says, yes this I think presents in a succinct fashion as I can the philosophies and reasons I personally believe a relative value study or index if you will should and must be developed by physicians themselves if the private practice of medicine as we know it is to continue. Yes, I just in big words. So this is an example of the relative value studies that came out of California in the 1950s. This is the third edition and basically it laid out what it was that physicians do and compared the relative values. See, it was illegal to set fees. So you couldn't set a fee schedule for physicians. So what the way they got around this was by creating these relative values so that you could compare one service for the other and then you would have a multiplier. Here we see hospital visits. I blew it up here so you can see it better. And also we see consultations. And so this was put into effect basically nationwide with the CPT coming out in 1966 which was just around when Medicare was beginning to pay out. So here you can see how this works. You have a multiplier which then allows you to figure out what your fee service should be here. And interestingly they made the point that you can't compare medical services with surgical services so those were different relative. The relative value didn't translate one to the other which ended up not really helping the medicine get parity. So anyway, so they create the CPT. They don't include the relative value scale with the CPT because each state had their own relative value scale. But basically what it was was a list of conditions that now could be billable to the government. And I don't think that it's really a coincidence that if you look at the evolution of CPR for cardiac arrest that it's not until the early 1970s really that you see the beginning of the default application of CPR for everybody who develops cardiac arrest. I'm not saying here that people were doing CPR to make money that doctors were billing them because they said, oh, you know, this is the way I'm going to become a rich doctor. That's not my intent. I think what happened was it's just being on a list as changed the nature of the procedure and the indication became reified on this list. Also, I think the CPR project required a lot of money to fund. And so the initiation of Medicare in 66 really brought in a fair amount of money. We then see in early 1970s sort of in response to this default, the first order, codified order not to resuscitate which then really seals the default status because everybody who doesn't opt out is opted in. And as I say, the rest is history. Thank you. Thank you, Dan.


Sixty metric tons of cassava starch factory built by the Bayousa State government will be inaugurated soon. Governor Doyer Diri said this during an inspection tour of the factory located at Ebebebebeeri in Sagbama local government area of the state. In order to meet the planned expected production capacity, the governor urged the people of the state to engage in massive cassava farming. Senator Diri, who expressed satisfaction with the level of work done, noted that due to its production capacity, the quantity of cassava produced in the state would not be enough for rich to produce at full capacity. He called on the people to go into cassava farming as it would be a source of revenue generation not only to the state but also to other people.


So, hello everybody. Nice to have you here, why we have strong competition out there. But I hope you will see Susan's point with you on the open stand and how we deal with this deployment of the open stand. It's an early enterprise company, so we're focused on production and environment. So, even if you, the stand as the public said now, I will not do the stand as my presentation, but I will try in my setup installing Susan's open stand cloud within this half an hour. And while I install the stuff in the background, I have different faces where I will tell you a bit about the stack, our vision. And now the step is where we explain a bit how we deal with control and compute clouds, while we realize my ability to serve a stable and reliable platform for even production applications. Further, I will also show you then how we configure the open stack services in a very easy way. To give you a short overview of what I'm going to do, how the setup is done. And Susan's open stack cloud, we have a minimum requirement of nulls, at least when you initial setup the infrastructure. So, we're providing an up and inspiration server that is providing a tool which is called crowbar, compared to all this stuff before, as an example of a tool or all these kind of tools that you can deploy. The approach here is a bit that we discover nodes in the network environment, and then we allocate these nodes and put rows on these nodes. As you see, we have here a control node, that these nodes become stack services, and then we have compute storage nodes, and my simple setup. I have 12 each, and a KVM and a compute node at the home, but you will see we have other opportunities as well. The Chef is our configuration management at the moment, comparable with the soul stack, right? So, this is using cookbook, how to install and configure the programs, like services, databases, entity, HAA, all that stuff. We are using PXE environment, specifically deployment, we can say. We are providing our repositories, either with a local resource or a custom center, all that stuff in the circuit is based on the administration server. So, the first phase that I will do now is deploying this administration node. And I will start now because it will take some minutes. I have a colleague who helps me with the timing. So, I will need to say it's a triggered installation, and I will explain to them all the stuff that works on that. So, I will interrupt and show you how our tool looks like. So, we are choosing installation from scratch, and I will tell you what it does. So, now we can start the timing, and I jump back. I will show you what it's doing. So, actually, it does all the steps that are showing up here. It's doing initial jobs, providing all the open stack services, providing the underlying operating system. Since it's integrated, it's providing some pro bar settings, and then also the proper tools then to use. It's providing Chef Client for this requirement. Almost on each client that the Chef Server will be there. And you also can check the work and all the log files then. So, you have all of you where the installation is. If you have a problem, you can always get the debug information as well then to see what's going on in the installation. So, we let it run now. It will take just a couple of minutes, and I continue with my presentation. So, we go back to the first step. So, as you know, it's a rich tool, right? We have a big community that is providing a lot of nice tools. The call is available to everyone. But when you go into it and want to install it, you can get a bit complicated. How many of you have just used commercial tools? We've used any of them. Yeah, exactly. So, of course, if you try that one, then you have also... My new tool works a bit different than our approach, but that's one of these things. And that's the point from an enterprise class perspective, that we want to provide you with a possibility to get a problem where you can not only develop applications, but also prevention work loads on it. Mission-critical work loads on it. The other thing is when you open source mediums, then you have to find support. When you work in enterprise tomorrow, right? Price solution. So, Susan is providing Susan in this enterprise as the default operating system. And on top, you are getting the open stack solution, this high availability extension all packed in one solution. So, you have good value. So, you get a very pre-built solution, where you only have to focus on your actual work. So, you don't have to spend a lot of effort and knowledge in preparation work in getting the open stack installation done, right? And in the former times, we have proved that we can do that also quite fast. We saw today quite nice solutions, which were really fast, but they maybe have a different approach in terms of maybe, let's say, compatible with different hardware values, because you get an underlying operating system that's reliable. For the hardware, you have to be certified for certain enterprise-class applications. So, it's made a different approach than we do. But, yeah, so we provided this platform, and we do it fast, but fast, that works for enterprises. And that is included by different open stack topics, mostly not open stack topics here. So, we have some pairs. So, these guys put this stack and then have done this stuff in quite a short time, you can say. So, in the beginning, when the open stack showed up in 2012, then it took just a couple of minutes, and if using heat, then they would have done a minus factor with some bonus points. So, they have done fast deployment here as well in Atlanta, when they did a high availability installation, where they really packed cables, and the stuff still worked, services did properly fail, and so on. And then the last time it was full stack, and in the back over, there wasn't even two teams, for instance, winning that competition. I don't know why they don't do it any more probably, because nowadays it goes for seconds, so probably they skip this kind of competition. But at that time, we were quite fast. So, now I have to start, because the base installation I heard is done. So, now we can actually go in our presentation mode. So, now our crowbar is properly prepared. I will just start, to a better instance, one of them will be uncontrolled, and the other one will be a computer. So, the controller is hosting all of the stack services, the computer is the one where you can put your workload on top. The minutes that will show up in this dashboard. So, getting back to the presentation, we talked about rule of the stack. So, how did we get there? That's what we are doing right now. You have two opportunities to install the whole stack from SUSE. One is that you do the stuff more or less manually by downloading operating system, put our configure stuff, the things that takes most time, this is getting very mandatory stuff, that you can provide, for example, the subscription management tool or SUSE manager. And then you have also to configure your network setup. What I installation here, so I actually didn't prepare much, I used actually the admin appliance that you can download yourself on SUSE Studio.com. Currently you have version 5 there, which is the Kilo version, the Liberty version is on my machine, so it's Cloud 6, this is almost like Cloud 6. And when you have downloaded it, the only thing you have to do is create a little instance, for example, if you want to try calling. And you have to take care of the network chase setup. I just used the default, because it's just a better environment. But that's the way how you're very easy to get. My next step was when we started, the first time that I started to install the code, the next step will be to deploy the services on these nodes. So when the nodes are done, then we can do that. The network chase is very important, because you don't lose network chasing. I think you do it in a different way. So that is the definition of your network setup. There are different nodes, depending on how many network parts you have in it, and how much load it goes through your network. We have seen a lot more teaming nodes, so seeing that the teaming is more or less the same, it's either to have an administration network, you have to take separately, or teaming is evolving that way, you can also run all over, all different parts of the network, and your instance network on the same node. Do what is to your app and network separate from the long operation network. Physical network devices, and of course the IP registers you have to adapt to your setup. There are a lot of limitations from our deployment guide, where you can read how to do these things in more detail. Good, let's get back to it. Let's see, so here are the services. So I want to tell one of the nodes should be taking care of the open stack services, and the other one should be the one where I can use for all the KBM workloads, or I can have native Docker workloads. So I go into the nodes, and I have a ball addition, and here I can allocate them on place. So I give these guys a name here. Let's see, I have to make it a bit smaller that I get all the fields in here. So I have an administration node, and then you can check on your records what node it is. So this is for example, like a control node, this is the compute node, so I'm going to give them some names, and I put them in groups, so we have a little better control of them, what they are doing, what they are for. So this is my app node, this is my control node, so I have a couple of names, you can also be a lesson, compute node, and here I can plug them to a compute node, which is higher than my hardware, I can make separate network devices, and I'm about to have Swift, for example, or Zephyr, I can have storage nodes here as well. So I will define it as a control node, and this is a compute node, and so far we haven't done anything more than the apps, we have just preloaded the kernel in, and so on, and now that I have allocated an app here safe, then it will start to install operating system, it will configure the stuff, it will install all the services, fully automated, so you don't have to care about it. Okay? So this will take also a couple of minutes, and when these guys are then allocated, and properly up and running, then we will have a green light for them. So all the stuff that you have seen in the keynotes, the nice presentations, all the fields, how they are interconnected, that's all you don't care, because this is done automatically, here in the background. Any questions so far? Yeah? Yeah, I mean, the production environment recommended, I mean, you can't do that, so you would run a lot of instances where you define that this is a control, and the compute, and so on. You will see later, we have also high availability that we cluster these nodes, but you can't mix the roles of all of these nodes then. So because it's installing the services, it's installing the services, and then you have it there.  And so what we have found out was we have a PXE environment that just started two nodes, they got a set, in and or leaving, all the necessary star stuff to get booted, bootstrapped up, and then in the wild conversion, or so on. So this is a more complex scenario that you can see, so this is a bit of answering also your question. So our focus is that you really position the nodes with their own roles, and you specify control nodes, there are several of them, so I will tell you about high availability. So you can put control nodes, high availability, high availability, and then you have computer nodes, and this is also interesting, because here you have the possibility to have all type of high devices, at least for loading your, or computing your work, and so on. So we have VM, we have Hyper-E, set and taken, and also even bringing a set VM in the game. You will see the old legacy hardware that was used in matrix. And then three kind of storage nodes. So you can, with the APIs, you can also interconnect to bigger values, EMC, Dell, NetApp, we have your storage, so vCenter for example, putting on top is the set, which is our enterprise storage program. So these are the components for a more complex setup scenario. Here is the call address. SQL database we are providing glance. The nice thing that, so the studio called appliance creator, let's say, which is free-away for you. You can build your own images, very easy. It's a graphical listener, it's a browser listener. And then you can all these images into your glance or storage. It's a very nice function. Then you have the identity keystone up here. You can, for example, connect it to an LDAP. Of course the dashboard is there, which we want to get. Then you have the API scheduler and a message queuing protocol. Declone queue nodes. This is where your work also gets processed. So it's important, of course, to have proper CPU and RAM on your machines. Primarily running it on lower services. For Docker, we have the queue nodes. You can even do live migration of VMs if required. Eventually with high availability or if you talked about business continuity, is that required at the process? If you see that picture, you don't want to be able to land at a position or an IT management position. It's easy. What are you doing in such a situation? OpenStack is nice, but it's not natively maybe providing you the tools to have such enterprise environment as it would require for mission-critical applications. SUSE has also supported the H&A project for many, many years. The good thing for us was OpenStack requires high availability so what we did we just integrated it in the OpenStack solution. So now you can really build a high availability platform for your services so you set it up. Very easy setting up, for example, three control zones on the line pacemaker and the nice thing is it's just one more term. We'll see what it is. It's probably our own definition. So it's just one more term where you define what has to be done to set up all services in the cluster. So that's on the one side and on the other side what is new we have also integrated new functionalities for pacemaker removal to keep your compute nodes host high availability. So as soon as you see one of these nodes is going out, you can do migraines that is up and running. So this works not only for cloud-aware applications but you can use this for legacy applications. We get a much wider range of cases for the open stack something. Another good thing is also with this AHA solution especially on the infrastructure side you can very easy maintain the environment. So you can deal with the planned downtime.  And if you are after results recovery so we have also a tool coming with the AHA extension which is called relax and recover. Someone knows that. That's also an integrated tool so you make an image that can very easily bring back a lot of the nodes and you have a very little downtime. Then we have different kind of hypervisors and that's probably also quite interesting when you look on the investment perspective. So we have normally, I would say 80% maybe in the country that using VMware maybe others might use a lot of Microsoft and IBM environments so we thought we won't want to help you in the architecture and the new platform where everybody has to learn Linux and everybody has to use the KVM as hypervisor. So we keep it open. You can keep your results and your knowledge and via the APIs you get the possibility to integrate existing solutions and use these solutions for the self management and for the workers that are based in the cloud. So you do more of this VX role using pure hypervisors and you get a better overview with the service interface here that all the stack provides. So and the other thing is also, I mean if you of course need a certain hypervisor, if you need certain applications that has to be around on the side of the hybrid let it run there because investment is probably good for that but then you don't struggle because you can very easily integrate it here into the cloud environment and any other. And that's the main purpose for us. Everybody is holding open stack code. There are a lot of multi-progress, I mean more than 500 companies missing nowadays over 30,000 to keep the contributing to that. We are part of that as well and as I said, we don't want to lose. Not in. We would take certain products or buy a whole product range from smooths just to get it done. We keep it open that it can work with partners. Here are some on the screen that we work on. So different areas like if you want to have platform as a service, we work with Cloud Foundry and integrate that then you get a proper platform to do your work on partner vendors of course because that's important in the enterprise that software is less is probably working with the features for example, Rust features that one of us are providing. We want to give you an option of your own which storage you want to use, same as that working and then there are tools like job cruiser for building systems or in the area where you see interfaces to manage your instance with your users, your instances and all that kind of stuff. I also pointed to three of Susan products. We have Susan Studio as a manager that's for building images that you can re-deploy in your environment. You have Susan Management for lives like the management so you can easily patch your system in your environment you can patch your infrastructure it's very useful, it's nowadays also using configuration management sold state and last but not least we also have a storage product set based which is Susan Open Susan Open Stack Cloud, yeah that should be Susan Enterprise Storage So that's how we work and how we want to provide you an open-stop stack solution. So let's see we jump back to our setup and we can see the guys are ready to deploy it so if you can go in one of the nodes and then you can see some descriptions and we can also see if they have some outcomes and roles deployed so these are the services that are running here that are required for providing the infrastructure and go in and if you know that you have normally to configure like 7000 parameters in open stack you can do vanilla then we bring you another a bit easier way on to configure all these parameters and therefore we have so-called alternatives which are recipes how to set up the different open stack services I could now go through each of them and configure and show our setup but what I will do is I have prepared something that makes it automatically so I don't have to do the timing difference it's just a couple of minutes so it's going a bit faster and so I will just start it so we hopefully can make this done on time so I just copy a file which is a batch file don't mind ok we can here this is a young file which has all the configuration for my open stack services in tune in because this is a pro bar function you have a pro bar so if I install the whole setup then I can reuse my setup for deploying it on another machine for yeah very easy re-deploy this kind of settings and I can modify the settings of course and when I have these things then I will now import it into the current setup and then it will run into the job automatically you can see how it looks like so it's called pro bar batch build and then something like this so this is at least how it looks like we have not so much time anyhow so it looks after the declines probably because I had a time of error so it's looking for up and down control of the computer and then it's deploying all different origins ok and then it will deploy the stuff on the control mode so I can show you the ones that I wanted to show you and one of them maybe take loba for example so we go to the stack part now we go to the loba it wants us to do it in the right order ok so we create the database stuff so as you see you already know how to do it here is setting the parameters if you are not having these parameters or want to add stuff you can always get the raw code then you can configure it manually and the nice thing is you can then use the nodes that are available and just drag and drop for keeping the service the nice thing is if you have a cluster then you just drag for example a cluster here and put it there and then it will tell you ok or then you will have three nodes in the back end taking care of that service and that's the old thing you have to do for HA then you have the whole interface where you easily can maintain your interfaces so if you would have done everything properly I will show you the last step then when you have everything deployed then you can go into the dashboard and then this is way more of the app and also now with all the more tips for deploy you have your horizon dashboard and then you can log in and then I guess this kind of picture everybody has seen so that's where you want to end up good so that was all from our side I mean I hope you got a bit of insight feel free to test stuff from our web page and if you have questions we have to hurry we are already up there and you can discuss your use cases there thank you very much for your time and your attention


Hi, welcome to Nursing School Explained and this video on some specialized respiratory assessment techniques. These techniques are something that most likely in the clinical setting you will not encounter, but it's nice to know what they are and how they are performed. Now why do we need to know about those? These are some more specialized techniques and they might also help you in case you are more in a rural setting or you decide to go on some medical missions where maybe there is not an x-ray equipment or any of the advanced diagnostic tests available. So when you really are able to fine-tune your assessment techniques with these special tests, then you can assess the patient in a little bit more detail. And these include tactile fremitis, egophany, bronchophony, as well as whispered pectoriloquy. So let's take a look at how those are done. Okay, first we'll look at tactile fremitis which is checking the vibrations underneath the patient's skin and when there is consolidation or anything unusual under the patient's skin it will feel differently. So for the purpose of this video I'm not going to wear gloves but you know to always put on gloves when you assess your patient. So I'm going just like when I check for chest excursion I'm going to place my hands in this kind of a wing fashion on the patient's back and ask him to say 99 and I feel the vibration underneath and then I move my hands down and I ask him to say 99 again and again and again and again and again and I can see I can feel that the vibrations underneath his skin are the same throughout which means that there is no abnormalities. If there was increased fremitis so increased vibration that would mean that there is a density so that could be fluid or underlying pathology and if there was decreased fremitis that could mean that there is fluid around the lungs such as in an pleural effusion or maybe the patient has some emphysema. Now bronchophony is the other test that we'll do and we'll need to auscultate the patient and it's very similar with him saying 99 but in this case I'm going to listen and hear him say 99 through my status scope so go ahead say 99 every every time I touch my stethoscope. Okay. So, a normal finding here is that when I move from the top to the bottom that the sounds that are here become a little bit less distinct or even muffled and that is because on the top here we have the trachea going down breaking off into the bronchi and then into the smaller airways. So the sound is going to be transmitted through the bigger airways a lot louder than through the smaller ones. So as I move from the top to the bottom I'm going to hear the sound of 99 less distinct and a little bit more muffled. If it was the same throughout then that means that there's something abnormal, something going on with the airways, maybe some congestion or some hyperexpansion even such as again an emphysema. The third test that we do is egophany which again I'm going to listen to him while I auscultate and I'm going to ask him to say ee every time. So the letter ee but drawn out. So here we go with the egophany it is normal that again the ee sound is more distinct on the top and then less distinct towards the bottom because again we have the bigger branching off into the smaller airways here. So the sound gets more muffled and more indistinct towards the bottom. If the sound was to sound more like an a on the bottom like the letter a like when you say a and stick out your tongue then that would mean that now it could be some consolidation or some density or some kind of like an underlying pathology like a mass for example. But in this case everything again sounded normal. Now the last test is whispered pectoriloquy which is similar to bronchophony but in this case the patient just whispers 99 rather than actually saying it out loud while I listen to the back. So go ahead and whisper 99 every time I touch my stethoscope to you please. And similarly to bronchophony what the normal finding is that the sounds are more indistinct and faint as I move down but abnormal would be if they would be very clear and distinct throughout the lung fields which again could indicate this consolidation or any kind of underlying pathology. And again these tests are not very commonly used but it's kind of nice to know what they are and what they are used for and again this might be in a setting where you don't necessarily have access to diagnostic equipment such as a chest x-ray or if you find yourself working in a more rural area or you will work in a pulmonary specialty. Thanks for watching this video on nursing school explained and we'll see you soon.