We're in the home stretch here in terms of wrapping up the open session. Next in line is a council-initiated discussion. I'll just point out we have a couple of announcements to make. I have to go over the MOU, the Memorandum of Understanding, and then read the chant of the Conflict of Interest document to you. So bear in mind we have the few other things left to do. The council-initiated discussion will be led by Eric. Generally when we ask of the council, what are the items that you're thinking about? We've been driving this agenda so far. What are the items that are hot in your mind? We sometimes ask the council if they want to hear reports from us at May or September or subsequent council rounds. So we're as open. And either topics you want to talk about now or you want to plant seeds of things that we didn't cover at this open session you'd like to hear about at future council meetings. I'll just say as a new member that I'm very impressed with the spectrum and the breadth of the kinds of applications that you are looking for and your funding.  And I just find it very impressive. At the risk of sounding like, what do you call it, a plant or a sycophant or something? I'm not sure what it is. Happy camper. Happy camper. Comments, questions, requests, thoughts. You can also sleep on it and give us something tomorrow morning if you'd rather. Do you want to say if we're, I mean, one thing really anticipated in May council, going to be a particularly busy one or not as busy? I mean, partially it helps to frame how many things we can squeeze in to a council meeting. I forgot. We have maybe four RFAs coming, so there'll be more to do. But it really is very helpful for us to hear from you of things you want updates about because especially months in advance, because it's time to prepare for it and think it through. So, yeah, Howard. This might be heresy, but it seems like the list of... Seems like the list of approved clearances is greater than can ever be actually put out there to be funded. So things we've cleared in the past, there's too many of them. Is there just program handle that, or does something that comes back to us to unclear some... First of all, but give us a little more detail. What do you mean by that? There's documents we've looked at before that looked at the past council meetings and concepts that have been cleared, but are not yet RFAs out on the street. It seems like there are more cleared concepts than can hope to be funded in the current environment. I just unclear how... I used the word clear to me at times, but how does one deal with that? What is our responsibility to help you have fewer of those on the books? Let me take a first pass at that, and I'm I'm I'm Terri and Jeff, who are the program division directors of... They're sort of often in these conversations about these priorities, especially their new roles as division directors. First thing to remind you that this council's advice previously when there were healthy discussions around things that we should or should not be doing, came to the conclusion that it probably was better to err on the side of approving some concepts. As long as we wouldn't be angry with council at the other end of it when they actually saw what came... If there was debate around whether the time was right for something or not, as long as we were comfortable getting the feedback by the time you actually looked at the grants to say, you know what, you originally penciled in $3 million of stuff for this RFA, but we only think there's $2 million worth funding it.  So by definition, that might mean that we will let more out theoretically out of the gates than we actually could fund. I think the second thing playing into your question may also reflect some of our budget projections, which have, because of the current circumstance we find ourselves in, are extremely conservative. So while you think that all these things can't be funded, those are based on big assumptions, based on possibilities that may or may not come to pass. And if they don't come to pass, actually we will be very comfortable. But it's all based on assumptions not only for this year, but for next year. So I don't think it's as bad as you think it might be, but there will be some challenges. I mean, there will be challenges. I wasn't necessarily thinking, it was, I wasn't trying to quantitate badness, but rather, just wasn't sure about the process. I think we would all be delighted to not have to declare whatever the word is concept. So I just wasn't sure what it was. No, we don't see you having to declare anything, but we do see the, and again, and I think there's going to be some things that'll be coming up that you'll, where we will want your feedback about the set of grants that come in on RFA. And just because we've penciled in X number of dollars, if you don't think there's X number of dollars worth of good stuff to fund, we will want to hear that from you because we all decide collectively it was better to do that than to be too conservative up front. Terry and Jeff, do you want to add anything to that? I'll add one thing. Because I think last year there was a case where there had been an approved concept clearance, but the RFA had never been issued. So it's the opposite of the problem you're suggesting where we're not sure how good the things that'll come in, but we'll take a look. In that case, there was interest in a concept clearance, but there was a decision made at the program level or internally that we don't have the funds to request proposals in that area. And I think that it would be useful to hear if there's any things in that situation right now where it's come up by council. Council has been enthusiastic, but program feels like there's not funds to support an actual RFA. And so I'm just going to say we are working out the processes to do this internally. We were really making it up as we were going a year and a half ago. That was the first time we went through that kind of exercise. I think we have the process improved a little bit now. And that's among the information that we plan to bring to you every council round. Are there any things like that right now? Approved clearances that have not made it to RFA? There's one example that I think you're thinking of. But that just meant we didn't have money last fiscal year. But it's back, but it's on the list and it's in draft and it's going to go out. And it's on the list potentially for next year. And I think that that example was one of the reasons that in discussions with you the decision was made to delay the final decision until you really see what the, so the decision at that point we were more working under the lines of if we clear something for $5 million, we basically got to keep $5 million on the books. Instead of being willing to put more on the books and then make the decision at the time of the applications. Okay, are there questions, comments, thoughts, requests? Okay, seeing none. Okay, so back to the agenda. Under announcements, an item of interest. There are two reports that were sent to NHGRI. They're available on our website for the council open session. Versus from the American College of Medical Genetics and Genomics, it's their report to the council. There are several items of interest. I'll draw your attention to their position statement on public disclosure of clinically relevant genome variants. And the second is the quarterly report from the National Society of Genetic Counselors. So it's time to go through the Memorandum of Understanding. And Monica, you wanna come up and have a seat on the side? No, she can be on the, you can be at that chair in case you need to use the microphone. So the Memorandum of Understanding for those new members of the council in the simplest terms, and I probably do a disservice to what the document really represents. But it's basically a description of how we're gonna conduct business with you. What things we are required to report to you, what actions we can take with your consent and without your consent or your knowledge. It's all spelled out in the MOU. I'm not gonna sit here and read it to you. There are two changes that have been made to the MOU and those I will draw to your attention. Again, I don't think you'll be surprised by these because you've already seen an example of the first. The first change is the requirement to conduct special counsel review of any application where the principal investigator, if he or she receives that award, would then have more than $1 million a year in direct costs from any number of active current grants. So that's been added to the MOU that we are now obligated to bring those to council and to have that review be conducted. The second issue is the matter of the expedited council concurrence. This is an NIH wide, or ECC, we're now calling it. This is an NIH wide phenomenon. It allows the institute to bring certain application types to a subset of the council, members of the council. In the case of NHGRI, it's SBIR and STTR applications. The current members of the ECC committee, I guess we'll informally call them that, are Didi and Jim, and we will conscript someone from the new incoming class. So there'll be three council members. So we will bring these applications to this subcommittee about one month before each council meeting, and they essentially perform the same process that's done in a full and open council meeting. We give a report to you. There is a report in the ECB that shows you the list of applications. Fundamentally, what ECC does is it allows us, if we want to make an accelerated award, we can basically get started early on those applications. Any questions about the ECC process or any other aspect of the MOU? Great. I think we're down then to the conflict of interest statement, which I am obligated to read to you. There is a document in your, did you get folders? Or just, yes, okay. There is a conflict of interest document in your folder. You might want to do it at this time, or as we break between the open and closed session, please sign it. Comfort will come around and collect it from you. This will certify that in the review of applications conducted by the National Advisory Council for the Human Genome Research on February 11, 12, 2013, I absented myself and did not participate in the discussion of nor vote on any application in which I, or to my knowledge, my spouse, minor child, or close professional associate has a financial interest, nor on any application from an organization or institution where I am an employee, consultant, officer, director, or trustee, or am negotiating for employment or otherwise have a financial interest. In council actions in which we voted on a block of applications without discussing any individual one, the so-called unblock vote, me an example. My vote did not apply to any application from any institution fulfilling the criteria in the preceding paragraph, or that which I just read to you. So, at this point, I think we're ready to close the open session of council and we'll turn off the cameras. You can run to the bathroom for five or ten minutes and then let's re-adjourn to deal with a couple of applications before we quit for the day, okay?


You may be seated our sermon title this morning is faith in progress faith in progress and we are in John chapter 4 Verses 43 through 54 and this is a glorious chapter of Scripture from the beginning of John until now We've just seen so many truths expanded to us and explained to us from the Scripture And it's just been a blessing studying this and now we come to the end of chapter 4 And we have another account here of the Lord Jesus Christ now with the nobleman from Capernaum whose son is sick as we Examine the account of Scripture through John's Gospel. John's Gospel is about believing John's Gospel is about revealing the Lord Jesus Christ for who he is and then presenting to us a Pathway if you will to faith. How is it that we are to believe? What art to we believe? How are we to believe? How do we come to Christ in faith with each passing account with each passing? Conversation we are to learn more and more and more about what that looks like How we are to believe upon the Lord Jesus Christ as the Christ as the Son of God and how in believing in his name We're to have eternal life We're to believe that he is the Christ the Son of God and that believing we might have life in his name That's John's purpose for writing the Gospel So now today as we come to this account of Jesus Christ and the nobleman with a sick son from Capernaum Again, we look at what it means to believe today We see in the heart of a desperate father a desperate father who has come to the end of his rope over his sick son and Now in coming to Christ for his son to be healed comes face to face with his own Desperate need of a savior and we're gonna see this work of faith and this man's heart in progress as the Lord Graciously leads him to salvation and we're gonna see that in several ways as we walk through this passage point one on your notes We're gonna see first that we must honor him. We must honor him honor the Lord Jesus Christ We see that in verses 43 through 45 Not just for what you can get from him Not just for what can be obtained through him, but for who he is and all that he has done for us We must honor him the Lord Jesus Christ Secondly, we're gonna believe in him verses 46 through 48 believe in him our faith is not in works our Faith is not in heaven Our faith is not in health wealth and prosperity Our faith is not in some genie in a bottle our faith is not even in our own believing It is though in the one in whom we are to believe our faith is to be in Christ in the person and work of the Lord Jesus Christ, but thirdly we're to trust in him. We see that in verses 49 and 50 Might be better to be said we need to entrust ourselves to him We trust him for all that he is and all that he's done and we entrust ourselves Fully to him everything that we are to all that he is We're to place our future our destiny our lives in his hands in his lap so to speak And then fourthly we're to live for him verses 51 through 54 while trusting While believing we simply devote ourselves to him Commit ourselves to him and we'll see this in the progress of faith in this nobleman from Capernaum let's take point one on your notes were to honor him We see that in verses 43 through 45 where the Bible says now after the two days He departed from there and went to Galilee for Jesus himself testified that a prophet has no honor in his own country So when he came to Galilee the Galileans received him having seen all the things he did in Jerusalem at the feast For they had also gone to the feast Now if we remember from our last week's study of Jesus Christ and the explanation of his encounter with a woman at the well in John chapter 4 verses 27 through 42 Jesus evangelizes witnesses to the woman at the well He announces to her who he is and he opens her eyes This is a wonderful account and that woman of Samaria becomes a wonderful very compelling Witness to the other Samaritans who lived in the village of Sychar and they said to the woman in verse 42 After having come out and heard Jesus speak they said now we believe not because of what you said For we ourselves have heard him and we know that this is indeed the Christ the savior of the world Think about it for a moment now. He performed no miracle. He did no signs and wonders He simply preached to the people of Samaria. He taught them for two days and After hearing him they believe because of his word They believe because of his word This would have been now a joyful time if you can imagine the Lord Jesus Christ his disciples the woman at the well Witnessing the people of the village coming out being saved. We see the Samaritans coming to faith in the Lord This would have been a joyful time. They were being forgiven, right? They were being pardoned from their sin made right with God after having been outcast Samaritans so there would have been a lot of rejoicing together in the work of the Lord seeing people saved and Seeing Christ Honored in the eyes of the Samaritans as the Messiah This is Jesus the Christ the Son of God and he was honored in the eyes of the Samaritans as the savior of the world Now Jesus after those two days Continues his original journey. He was headed out for Galilee so he continues his original journey toward his country of Galilee and After the honor that he received in Samaria Jesus makes a very interesting statement in verse 44. He says a prophet has no honor in his own country That saying is not unlike a saying that we have today the saying is familiarity breeds contempt Have you heard that before? It's a it carries the same kind of sense that familiarity breeds contempt here a prophet has no honor in his own country When he says his own country many look at this passage and believe that he's speaking about Jerusalem or Judea Did he get any honor in Jerusalem when he was there? No, he went there were many who plotted to kill him But he was performing miracles performing signs at the week of Passover the week of the festival in Jerusalem He didn't get any honor there either if you flip back one page look at John chapter 2 and Remember how the people responded to him look at verse 23 Here John says now when he was in Jerusalem at the Passover during the feast Listen to this many believed in his name when they saw the signs which he did But Jesus did not commit himself to them because he knew all men and he had no need that anyone should testify of man For he knew what was in man Jesus knew their heart. He knew what they were like. He knew what was in their heart And he didn't commit himself to them because they didn't honor him as the Christ They believed the miracles it says there they saw the miracles they believed but they didn't honor the Lord Jesus Christ For who he was or what he came to do they didn't honor him as the Messiah They just believed because of the miracles they saw that a miracle fake superficial kind of faith That was in Jerusalem Now the Lord is headed to Galilee and the Lord Jesus is from Galilee. Where's he from? From Nazareth right a little town in Galilee So Galilee is the Lord's country and with Galilee in view as he makes his journey north Jesus makes this statement that a prophet has no honor in his own country Jesus makes a similar statement in other places right think about it Luke chapter 4 Jesus was being rejected in Nazareth when in verse 24 He says that a prophet is not accepted in his home country in Mark chapter 6 He was in Nazareth in Galilee When he said a prophet is not without honor except in his own country among his own relatives and in his own house And many of you can say amen to that right when you came to Christ you may have thought to yourself man A Christian is without honor around his family around his friends around his co-workers They're going to feel like nobody will listen to you Many of you have experienced that very thing This same statement recorded by Jesus in Matthew chapter 13 verse 57 when the Lord there was very clearly speaking about Galilee So clearly here in verse 44 John chapter 4 the Lord has Galilee in mind He's thinking Galilee when he says a prophet has no honor in his own country now that presents some difficulties in Observing and interpreting the text if you look at verse 45 Where it sounds like the Galileans here honor him verse 45 says so when he came to Galilee The Galilee Galileans received him they welcomed him They welcomed him but listen to this Having seen all the things he did in Jerusalem at the feast for they also had gone to the feast So when you consider the Lord statement and put these together when you consider the Lord statement in verse 44 And then you consider our context revealed here by the Lord in verse 48 That the Galileans won't believe without seeing signs and wonders Here's the issue those in Jerusalem Here the Galileans won't believe unless they see signs and wonders. It's the same Form of rejection all over again. They will not honor Jesus as the Christ the Son of God They simply believe because of the miracles Now, how are we to understand this? This miracle seeking Sign-seeking superficial kind of acceptance is Dishonoring to the Lord Jesus Christ a Prophet is without honor in his own country when they do not accept him for who he is But only because of the miracles that he performs So to have a miracle seeking sign-seeking experience seeking kind of superficial faith is Dishonoring to the Lord Jesus Christ The Lord of glory Here was nothing more than a circus show to them just a side show a curiosity He was like those and just like those in Jerusalem who saw the signs and believed in John chapter 2 They believed the miracles, but did not honor Jesus as the Christ the Son of God that word honor Means they're to reverence to respect. It is to be worthy of Respect it is to be valued to be treasured to be in a state of being respected They didn't value Christ they simply saw him as a curiosity Saw him for what he could do right? Odd by the miracles, but he himself wasn't treasured as the Messiah I contrast this with the few days before with the Samaritans. How did the Samaritans react to him the Samaritan? Samaritans highly honored him the two days that he was there He simply gave them his word and they soaked it in loved his word urged him to stay with them They believed him at his word although he performed no miracles and did no signs and they Trusted his word trusting him alone as the savior of the world. That is honoring to the Lord. Amen So here the Galileans welcomed him, but it was only a shallow superficial even conditional Kind of honor kind of welcome kind of acceptance. They weren't really interested in him now in that listen in That is a brazen Rejection of the Lord Jesus Christ They drew near to him with their mouths, right? They honored him with their lips But their hearts were far from him This is still if you think about it another example of the prologue John chapter 1 verse 11 where he says he came to his own These Galileans and his own received him not. This is just another Rejection here in his own country Another rejection of the Lord Jesus Christ Those Galileans and others like those in Jerusalem in John chapter 2 were consumers. They weren't worshipers They were Onlookers they were not followers in chapter 6 We're gonna see that they follow him because of the signs that he did and because of the food The bread that he provided when he himself is the bread of life They don't value him for who he is They don't follow him out of Gratefulness for the salvation that he offers for the salvation that he brings they simply follow him. They're devoted to him Because of the works that he's doing The miracles that he's performing They're not devoted to him who alone is able to meet our greatest need, right? the height of Dishonor the height of dishonor is to reject who he is By only accepting him for what he can do for you The height of dishonor is to reject who he is by only accepting him for what he can do for you for what you can get out Of it, you know, what's in it for me kind of thinking many won't submit to him to live for him as Lord But they'll use him as a get out of hell free card Right, we know people like that Christ isn't precious to them. Isn't there a treasure? They're just in it in Christianity so to speak for only what they can get out of the deal You think about it that is the fundamental basis the foundation for the health wealth and prosperity gospel Which is a wicked false Garbage gospel it is no gospel The word of faith Nonsense that treats the Lord Jesus Christ is a genie out in a bottle you rub the bottle you get Jesus to do what you want to What don't want you want him to do for you? And so you say you believe it's a bunch of garbage It is not the gospel Many are not compelled to live in a way that is pleasing to him because to them the Lord Jesus Christ is simply a License to sin and a free pass to get into heaven Maybe you remember when you were lost. Maybe you heard the gospel and Being lost hearing the gospel you thought to yourself.  I want to have heaven But you have no thought or no concern for whether or not Jesus Christ is gonna be there when you get there, right? Because Jesus Christ isn't precious to you.  Remember the example of Eli, right with his two sons I want you to see that with me go with me to 1st Samuel chapter 2 1st Samuel chapter 2 and let's look at the example of Eli and his two sons. How did God?  They were called sons of the devil and By Eli's neglect in dealing with their wickedness Eli was shown to have honored his sons More than honoring the Lord God, right? I want you to see this his sons were committing immorality with the women who came to worship at the tabernacle of meeting He was sleeping with them when they came to worship the Lord his sons were stealing Taking for themselves From the sacrifices that people were bringing to the temple to worship the Lord They were skimming off the top if you will taking what they weren't entitled to Taking because they weren't satisfied with the provision that God had given them as priests So look at what the Lord says in chapter 2 verse 29 God says why do you kick at my sacrifice in my offering which I have commanded in my dwelling place and Honor your sons more than me to make yourselves fat with the best of all the offerings of Israel my people Therefore the Lord God of Israel says I said indeed that your house in the house of your father would walk before me forever But now the Lord says far be it from me for those who honor me I will honor and those who despise me shall be lightly esteemed now He describes those who do not honor him as those who despise him That's the truth if you're not honoring the Lord Jesus Christ you're despising him You're despising him, but look at how the Lord defines Lightly esteemed.  This shall be a sign that to you This is lightly esteemed right this shall be a sign to you that will come upon your two sons on Haphne and Phineas in one day. They shall die both of them Now you think to yourself How then does the Lord define honor when the Lord says honor me here Eli is to honor the Lord by upholding righteousness and in that honoring the Lord more than he's honoring his sons by Condoning their wickedness and look at how the Lord defines those who honor him verse 35 He says then I will raise up for myself a faithful priest. They're faithful I'll raise up for myself a faithful priest and listen to this Who shall do according to what is in my heart and in my mind there it is if you want to honor God above all honor God above your job honor God above your family with your commanded to do Honor God among your sons and daughters honor honor God among anything you've got going on in any other part of your life Here's how you do it. You shall do according to what is in his heart and in his mind That's honoring the Lord God to honor the Lord is to devote yourself Heart soul mind and strength to him is to devote yourself to him to do according to what is in his heart and in his mind Listen to the words of the Lord in Isaiah chapter 58 and again defining What is the Lord's honor Isaiah chapter 58 verse 13 and here regarding the Sabbath? He says you are to call the Sabbath a delight The holy day of the Lord Honorable and you shall honor him it says now. How how do we honor him? Listen by not doing your own ways Nor finding your own pleasure nor speaking your own words Then he says you shall delight yourself in the Lord This is not just drawing near to the Lord with our mouths, right? This is not just honoring him with our lips. This is honoring him with our hearts This is doing what is in his heart and in his mind Delighting ourselves in him speaking his words and all of that reflects a heart that's near to him Reflects his heart his mind and that's what honors the Lord if you've come to faith in Christ You're to honor the Lord with your life You're to honor him by doing what is in his heart and in his mind speaking his words Delighting yourself in all that he is and all that he's done If you're here today, and you've never turned from your own way You are rejecting the Lord in dishonor You're here today, and you've never turned from your own ways to follow Christ in faith Listen, there is nothing more dishonorable to the Lord than unbelief There's nothing more dishonorable to the Lord than unbelief and following your own ways Those Samaritans think about those Samaritans for a moment. They honored the Lord They honored the Lord by believing his word by bowing to his authority by trusting themselves to him and by trusting him that he was all in all trusting him for his promises his promises to forgive them Whatever their sin to make them right with God to clothe them in his righteousness that they might inherit heaven They just trusted him and in that they lived for him, and they honored him They honor the Lord Jesus Christ were to honor the Lord secondly on your notes We're to believe in him and notice the progress here. We're to honor the Lord We honor the Lord through believing him believing in him verses 46 through 48 back in John chapter 4 listen to verse 46 So Jesus came again to Cana of Galilee Where he had made the water wine? There was a certain nobleman whose son was sick at Capernaum And when he heard that Jesus had come out of Judea into Galilee He went to him and implored him to come down and heal his son for he was at the point of death Then Jesus said to him unless you people see signs and wonders you will by no means believe The thing about this nobleman for a minute in many ways this nobleman from Capernaum Came to Jesus in the same dishonorable way that many others had come to him In fact in verse 48 Jesus says before him and the other Galilean standing around He says unless you people and he uses the plural there unless you people this man and the other Galileans Unless you people see signs and wonders you'll by no means believe However, there's something different about the circumstances of this nobleman and we're gonna see that his life Was about to change and he's described here as a nobleman and the word there means someone who is in the service of a king So we know that this person this nobleman was probably in the service of Herod Antipas who is a tetrarch of that area a tetrarch was a governor But in the area in which he ruled he was often called a king So here the word is used for one who is in the service of a king Now being in the service of a king would have come with perks He was a nobleman. He's described as a nobleman and the perks He would have been reasonably wealthy in the service of the king We know from verse 51 that he had servants so that shows that he was reasonably wealthy in The service of the king he would have been used to getting what he wanted, right? He would have been used to being an authority Commanding those around him telling someone to jump and then answering how high right?  Think about that for a moment if you don't have kids think about that person You love more than anyone else in this life and think about that person at the point of death think about your child Laying in a hospital bed at the point of dying His life was becoming unraveled around him Think about this wealthy man doing everything he can to save his son Using every possible resource that was at his disposal by this point He's probably already gone to Heron. Maybe you've even used or consulted Heron's physicians to try to heal him Mom and dad are at the end of their rope. It is becoming frantic. They are in desperation and His son is at the point of death The whole household would have been going under losing hope beginning to despair He's used to being in control and now his entire life is out of control There's nothing that he can do. There's a sense of hopelessness a sense of helplessness His world is falling apart and his son is gonna die But then He hears the rumors People from Galilee begin to come back from Jerusalem and he hears the rumors of this miracle worker who showed up at Passover Performing miracles and healing people and in desperation at the end of his rope. He thinks Maybe this miracle work. This is Jesus And save my son And so now he's come to Galilee even now to Cana To plead with the Lord to save his son at this point. He doesn't dare send a servant This is way too desperate a situation way to dire a circumstance. He goes himself And in despair for his son's life. He pleads with the Lord He left at sunrise that morning the crack of dawn and at the seventh hour of the day He came to Cana, which would have been about one o'clock and he pleaded with Jesus to come back with him The word there literally means that he began asking which he meant meant he continued to ask He asked and asked and asked begging the Lord to come to Capernaum to heal his son now at this point in The heart of this grieving father in his heart and mind his only concern his only thought Was for his sick son From the reports that he heard From the testimony of those who had come back from Jerusalem. He chose to believe that the Lord Jesus could heal his son He trusted in the news of his power in a sense. He trusted he had faith in the miracle, right? Wasn't yet saving faith in the Son of God Now at first you consider that circumstance and how his heart must have been broken how grieved he was At first the Lord's response in verse 48 seems Strident maybe even harsh Considering the man's circumstances Jesus says to the man and to everyone else standing there He says unless you people see signs and wonders you will by no means believe Now this was certainly certainly a rebuke of the people a rebuke of the Galileans There's also in this isn't there a criticism of the nobleman Listen the last we think that the Lord Jesus Christ is strident or harsh here something that is Far more important than the miracle that Jesus Christ is about to do is the soul of this man And the Lord Jesus Christ isn't gonna leave him half way to saving faith He or his household and he's gonna bring him all the way to saving faith But Jesus says to the man everyone else standing there unless you people see signs and wonders you'll by no means believe As far as this nobleman is concerned This criticism and what the Lord is going to do next is meant to press him beyond faith in a miracle to faith in the miracle worker himself meant to press him beyond the miracle to faith in Christ Listen the criticism of the nobleman is this right think about it all That moved him to come to the Lord Jesus Christ was his miracles He's not interested at this point in the Lord Jesus Christ himself, but only in what he can get from him Jesus is basically saying listen if I didn't perform miracles you wouldn't be standing here before me asking me to heal your son It's his weak misplaced so-called faith That engenders the criticism from the Lord and that faith needs to be moved on it needs to make Progress toward genuine saving faith in Christ himself from believing in miracles to believing in the Lord right from in a sense here think about it from honoring his son more than honoring Christ I May seem harsh in the circumstances, but that's the truth of the matter He's not honoring the Lord in this he is honoring his son by seeking a miracle And it's got to move beyond that to honoring the Lord for who he is and all that he's done and the salvation that Christ offers That's going to take progress in faith. It's gonna take the progress of his faith. I Think about this for a moment and look at the contrast the contrast between the nobleman here and The other Galileans, okay the people the Galileans generally those in Jerusalem and Judea even Ask the Lord for a sign ask the Lord for a miracle for Jesus to prove himself to them That's why they're asking for it Do you see the difference there between what the man is doing and what they're doing? The reason the man is asking for the miracle and the reason that they are seeking the miracle right in Mark chapter 8 verse 11 Describes the Pharisees coming out and beginning to dispute with Christ seeking from him a sign from heaven Listen testing him, but Jesus sighed deeply in his spirit It says there in verse 12 and said why does this generation seek a sign assuredly? I say to you no sign shall be given to this generation As Jesus reluctant to do miracles No, Jesus is not reluctant that he does miracles all over the place It's the reason for which he does it that is the point make the connection here Jesus said that he would perform miracles But that performance of miracles is for the purpose of a testing to the people of Who he was and to point them to believe that he was the Christ the son of God the Messiah Jesus was not reluctant to give evidence of who he was through miracles. However The miracles that these people wanted Were thought by them simply to prop up their superficial Self-indulgent hypocritical and misplaced so-called faith Their request of a miracle here. It's extremely Dishonorable to the Lord. It's like give me a show Perform for me so that I'll believe you Extremely dishonorable and Jesus knows what's in their heart. He knows what's in their heart People today are absolutely no different People today absolutely no different think about it one They're looking for anything besides Christ to put their faith in They look for anything besides Christ to put their faith in a miracle makes no demand on your life a Miracle doesn't convict you over sin and demand that you change Many trust that they are saved because they speak in tongues Many trust that they are saved because of some quote-unquote miraculous experience that they've had I remember Witnessing to a man at the door. I'm talking to him his live-in girlfriend walks behind him. I said is that your wife? He says no, that's my girlfriend She's in her underwear. She's walking behind him and yet that man in Unrepentant sin hardened in his heart living in his sin Thought that he was saved because he once spoke in tongues in a prayer circle and believed that he saw the Lord release him from a demon They seek signs and wonders to put their faith in but they won't put their faith in the Lord Jesus Christ Who will change their heart? Who will grant them repentance to turn from their sin? They would rather live in their sin many think they're saved because God speaks to them, right? They have a sense of God's presence. I know he's been with me all the while They're living completely in their sin living like a devil at home Yet they believe that they're saved because they feel him or they sense him They put their faith in a miracle or faith in an experience because they can live however. They want to live with no change Think about this Many people will not take the Lord Jesus Christ at his word. They will believe just about anything besides the word of God The word of God brings conviction over their sin the word of God brings a life transformation and People will believe just about anything but that to ease their guilty conscience and allow them to live However, they want to live and keep their sin Most people listen no exaggeration Most people believe today that they are saved Because they have put their faith put their belief put their trust in some silly Ritualistic little prayer that is nowhere in the word of God And they will believe that thing more than they will believe the word of God when it says turn from your sin and trust Christ alone It's just not in there. There are about 15 million people Who will believe choose to believe that some? serial polygamist Stuck his head in a hat Translated some plates that no one else has ever seen and they will rest their Eternity in the hands of that wacko before they will believe what the word of God clearly says why? because they can have their sin and reject Christ They would believe garbage like that.   How do you walk after him? You take heed according to his word. That's right You fear him and listen to what he says keep his commandments we find those in the word of God and obey his voice we hear the word of God when we read the word of God out loud right You shall serve him.  Entice you from the way in which the Lord your God commanded you to walk And so you shall put away the evil from your midst Always it's going back to the word of God back to the word of God back to the word of God Taking Christ for all that he is and trusting in his word Listen to mark chapter 13, and this is regarding the end times listen in verse 19 Bible says for in those days there will be tribulation and listen. This is a Strong argument against a millennialism Listen, there's days there will be tribulation such as has not been seen since the beginning of the creation Wow, that's pretty serious tribulation because that flood thing was pretty serious, right? So it's going to be worse than that Which God created until this time Nor ever shall be many think that this is speaking of 8070 the bible clearly says there's going to be such a tribulation That has never been seen before nor shall ever be 87 70s already been seen. There's something coming that is worse than 8070 This is an argument for premillennialism, but now listen verse 20 Unless the Lord has shortened those days No flesh would be saved, but for the elect's sake whom he chose he shortened the days Then if anyone says to you look here's the christ or look he's there Do not believe it for false christs and false prophets will rise and what? Show signs and wonders to deceive if possible even the elect But he says take heed see I have told you all things beforehand It's back to the word of God right back to what he's told us Don't put your faith in signs and wonders When Someone genuinely comes to faith in christ. It's not about all that stuff It's not about the experiences. It's trust at the deepest possible level. It's not just about miracles experiences It's not at that point really even about getting out of hell, right?  It's not in the bible to save you So back in john chapter 4 Jesus and john chapter 4 didn't want this nobleman to stay halfway down the road to saving faith Him or his household he wanted him to be saved So for the sake of this man's soul And in tremendous wisdom. I want you to see what the lord does here. It is just brilliant just so much with it's Just astounding wisdom from the lord listen to how jesus does this Jesus addresses his remark, you know, you people won't believe unless you see signs or wonders He addresses his remark not directly to the man Right not directly to the man. He's not going to crush this man who's grieved over his son So he doesn't crush the man. He addresses it to the people He does that to rebuke the people are they worthy of a rebuke? Yes, they want him to prove himself with a miracle. They're coming in a very dishonoring way So they earn the rebuke from the lord But what is a rebuke to the people here? Is a challenge To this man. I think about it for a moment He knows in his own heart That his motivation is not to test the lord His motivation is to see his son saved So in his heart, he is desperate to see his son saved And now this word from the lord Challenges the nobleman to press on beyond miracle faith and put his faith in the lord jesus christ Jesus christ with this statement now Inserts himself Between the man and the miracle that he came for Puts himself as a prerequisite if you will to the miracle This man is going to have to believe the lord jesus christ in order to see the lord jesus christ save his son Jesus is saying listen believe in me the lord jesus christ is not saying it's not just about a miracle Put your hope in me. Don't hope in the miracle. Put your hope in me And so far, um, we've seen how this man Like many dishonored the lord through misplaced faith in the miracle And now he's seeing that lord is worthy to be honored for who he is This nobleman is about to be asked now to trust christ in earnest without the miracle look at point three on your notes We're not just to honor him not just to believe in him We're to trust in him verses 49 and 50 trust in him Verse 49 the nobleman said to him sir sir come down before my child dies And jesus said to him go your way your son lives So the man believed the word that jesus spoke to him and went his way So the nobleman Takes the criticism right he takes the rebuke and he's he's humbled by it He's humbled by it and he calls jesus christ here sir. So word kuryas means lord He calls jesus christ lord. He's humbled He calls jesus christ lord, but his faith is still in progress here in order to heal his son Jesus still has to come down to capernaum. He's not all the way there yet But his pride is crushed and he persists He doesn't hesitate at the rebuke because this is life and death to his son. He now needs christ He now senses his real need for him think about it for a moment He's not coming any longer with a mindset that i'm going to employ christ to perform this miracle He's not sensing that he needs to employ christ anymore. He's coming And treating christ for his grace and his mercy christ comes heal my son I need grace and mercy from you. He's gone from seeing christ is nothing more than a miracle worker to now I need you christ. Please i need your grace and i need your mercy. My son's gonna die Jesus again just graciously graciously condescends to lead this nobleman onto genuine saving faith in himself christ puts himself in a position Where he's going to have to this nobleman gonna have to trust christ apart from any miracle He simply says go your way your son lives This man was in a desperate situation, but the lord jesus christ is going to save on his own terms It's not that he gave the answer. I'm going to come down with you. He simply says go your way puts the man in a position of having to trust the word of christ Without a miracle. He's simply going to have to trust christ All of his hope now is in the word of christ all of his faith In the word of christ the life of his son Wrapped up irrevocably in the word of christ Is his word enough amen it's enough Blessed are those who have not seen and yet believe So how did this nobleman respond? How would you respond? How would you respond your loved one in a hospital bed? Maybe the doctor comes in the room now go your way He's gonna live. How would you respond to the lord here? This nobleman had to place all of his hope Place him himself the real life of his son In the hands of this man the christ the son of god was going to have to believe him according to his word And he trusted him Do you know that um in this at that moment The man didn't race back to capernaum. It's interesting to think about that In trusting the lord jesus christ trusting his word he could have made it one o'clock in the afternoon He could have made it back to capernaum But he didn't He trusted the word of christ and he stayed there that night In capernaum he met his servants on the road back to capernaum the next morning Imagine what that night was like for him. He trusted the word of christ And so he stayed there Got rest that night probably slept Thinking about what awaited him when he got home in other words. He lived according to christ's word And trusted himself to him to live for him point four on your notes We're to live for the lord jesus christ. We believe him We honor him. We trust him and then we live for him verse 51 says and he was going down His servants met him told him saying your son lives interesting. They use the same words that the lord jesus christ uses Verse 52 that he inquired of them the hour when he got better. They said to him yesterday at the seventh hour the fever left him So the father knew that it was about the same hour in which jesus said to him your son lives And he himself believed and his whole household This again is the second sign jesus did when he had come out of judia into galley So the nobleman trusts christ and he goes about his business in light of that trust he lives for christ in this new reality Get some rest in capernaum And then he heads off for home the next morning No doubt believing christ as he is going and thinking about his son what awaits him at home when he gets there The lord knows our faith Is often weak right? Lord knows that we often struggle that we're prone to wander And As we walk and live for him We're not always going to believe as we should and believe perfectly But we are to walk in faith and live for him As we walk in faith Trusting his word as we live for him God is gracious To affirm our faith to confirm our faith to grow our faith and to mature our faith Lord is gracious to strengthen our faith. So this is what happens. Listen. He's on the road His servants meet him use the same words that jesus did he used to tell him that his son lives He inquires about the hour to remove all doubt sure enough. What a coincidence. It's a seventh hour, right Lord did that work? So on the testimony of unbiased witnesses and on the confirmation of providence This nobleman's faith is bolstered right wouldn't yours be his faith is strengthened his faith is bolstered This is the grace of god to him when your faith is grown that way when you experience the grace of god And your faith is strengthened. That's the grace of god to you to grow your faith This is the grace of god to him our faith grows through experiences of the lord's grace to us There are times when our faith may be weak, but in the lord we are to pursue a strengthened and fruitful faith Every time we trust christ Every time you trust christ in adversity We find out that his grace is sufficient for our need don't we? And in that our grace is grown. It's just like the muscles Just like your muscles, right?  Well your faith muscle Has to be worked out to grow You exercise faith in the gym of life using the weight of god's word And your faith is going to grow Your faith is going to grow strong So this noble nobleman now Christ to him is more than just a worker of miracles christ to him is the miracle He is the miracle How do you think he might respond the next time that the going gets tough? Now after facing this adversity and the lord confirming himself to him You think if he gets back to Capernaum and you know hered finds out he's been gone for a couple of days and so hered fires him He's like, whoa, it's me. I've lost my job. What am I gonna do? No, no not this guy His faith in the lord has been confirmed. It's been affirmed. He's gonna trust the lord jesus christ As you would expect from a man who genuine believes his whole household immediately hears about jesus and they all believe Much like the samaritans believed at the preaching of the woman had the well Then they heard themselves from christ in the same way that cornelius and his household believed Lydia and her household believed The Philippian jailer and his household believed christmas and his household believed When someone's saved others are gonna hear about it. They're gonna believe too I want you to think about something for a moment. The nobleman Was faced with the fact here that he was unacceptable He was faced with the fact from the lord that he was unacceptable that he didn't deserve anything from the lord He didn't deserve anything from the lord You and I and if you're here today, you're outside of christ You and I are in the same helpless condition We are apart from christ unacceptable We don't deserve anything from the lord What we most need we cannot do for ourselves Now if you believe that to be true If you believe that to be true Then literally all you can do Is to simply leave that which dishonors him behind And to come to christ trusting in his word That if you come john six says he will by no means cast you out That's faith Listen to it again. The nobleman here was faced with the fact that he was unacceptable He realized in short order that he deserved nothing from the lord You and I are in that same helpless condition The most The thing that we most need we cannot do for ourselves Now if you believe that to be true And the bible attests that it is Then literally all that you can do is simply to leave that which dishonors him behind and come to christ Trusting his promise that if you will come he will by no means cast you out That's faith Trust his word to you today if you're not if you're here and you're not in christ If you've never turned from all that which dishonors him Turn from that trust christ cling to his word hold to his promises Sometimes just seems hard to believe doesn't it you mean if I just believe yes if you just believe If I just trust him for yes if you will trust him the lord will forgive you and cleanse you and pardon you Make you right with god clothe you in his righteousness Place you in the heavenlies with christ make you a child of his Adopt you into his family put you in his kingdom give you an inheritance in heaven If you'll just believe him at his word trust him at his word believe him You can do that today. You can do that now And listen if anyone else told you that we wouldn't believe would we?  You're not exempt from trials Think about it now comfort As much as a blessing as it is Difficulty is far better if it points you to christ As much of a blessing as ease is Difficulty is far better if it conforms you to christ amen And this time of trial this difficulty the difficulty for this man From capernaum Is so that The genuineness of our faith listen, which is much more precious than gold which perishes May be found to praise Honor and glory at the revelation of our lord jesus christ whom having not seen You love Though now you do not see him Yet believing you rejoice with joy inexpressible and full of glory Receiving the end of your faith the salvation of your souls. Amen Let's put our faith in christ. Let's pray just a couple of moments in silent prayer and ask the lord to Apply these truths to your heart. Let's pray Father in heaven god, we worship you and praise you for your glorious Word your glorious promises to us Thank you lord for offering salvation Granting repentance and faith that leads to life And praise you and worship you for these things god Please lord help us to apply these truths to our hearts to our minds that we might live My faith in you according to your word for your glory and for our good. We love you lord in jesus name. Amen


Going on everyone Sam here with late in sports cars ripping two boxes of 23 tops chrome MLS for Steven M It's good luck here Steven. Let's do it buddy. Here we go See it buddy big messy This all good Brandon. Oh, yeah Mender Garcia that is Christian rolled in to 125 Seattle Sounders Aqualaba Green and 99s Kip Keller for awesome FC Color-match pitch prodigy Sebastian for area Green Lava to 99 is Raul Rudy s Rui Diaz for Seattle Sounders green Is Lucho Costa diamond Derby diamonds that is Christian rolled in Seattle Sounders see Kate Cowell That is a Sheridan Shaqiri flashbacks to 199 is Lothar Mathaus. I'm a Matao is Yeah, I think so Jesse it should We've got a Couple more it's probably I would assume it will Jesse I would assume so very toward the very end The 25 miles Robinson for Atlanta if not if it doesn't go Jesse Derby diamonds Sebastian Blanco it will a hundred percent go tomorrow after a group breaks over 100% will go tomorrow if it doesn't go tonight. I will do my best to get there though That is Jonathan Osaria to 125 and Owen Wolf You the Hawks really did blow it 23 point lead To 199 Ben Bender Charlotte FC Time to tear it down that was Costa Leon Flotch to 199 for Philadelphia Union Yeah, no problem Jesse like I said, I will do my best to get to it because that's easy that takes 30 seconds to do so Kucho for Columbus crew Barra Cooley Juan Juana Trios no fifth. Yeah, it's what are you knocking people? It's a passion for area I didn't understand how they weren't fighting each other. It's like there's three dudes here. What's going on? Why aren't they fighting each other?  Yeah, I was thinking I was like I'm gonna report this dude for teaming Cheating Raul Rue Diaz Seattle Sounder's refractor when Dempsey flashbacks Joseph Martinez in Miami Derby Diamonds Efron Alvarez imagine if you won one of those games, that'd be pretty impressive. Yeah Matai Akim Akimaboni DC United on the green auto to 99 That's on that. I mean this guy's going crazy Who is True Now I agree with that Max numeral dose for you buddy Let's see it Steven or Farson you send I'm out to 99 camera in Harper, New York Red Bulls refractor. That is a who's Jesus for area There you go Luna rookie Diego Rubio, that is a Kim Keller gold auto for Austin FC Nice one there 31 50 Congrats Steven not too shabby Portland timbers One Mosquera That is to 125 keep Keller Austin FC again. It's prodigies steep a buick That is to 199 Juan Jose Peruta Jason Russell Rowe rookie Derby Diamonds Blue Wave to 199 Ryan Gald Jordan Morris Christian Rolden to 99 They're in yuppie Casper prison Bilco Green to 99 Willie Agata for Sporting Kansas City Kai Wagner or Wagner that is a mini diamonds of Roman Salantano and gold mini diamonds to 50 Evander for the Portland timbers If Marcina's the guard on Thor Halson for Orlando City at FC Orlando City that is to 199 Matai Akim Boney Daggard Thor Halson James Stanz NYC FC It's prodigies Benjah Kramashi for Inter Miami Remain to foe that is Owen Wolf Derby Diamonds and Ramiro Enrique for Orlando City. Don't do it for your break there Steven. Thanks again for your support as always buddy Get him right out to my man


Hey everybody excited another great week as we celebrate a whole lot of great things. We're investing in our city again as we continue to invest in equipment, technology, training, opportunities to grow and provide better service to our community. We also have a public hearing, have lots of zoning issues and others so we look forward to everybody being part of that process and getting through it. We also will be passing Joe Taylor as a memorial to Joe Taylor our former council member two blocks of Washington Street in honor of him in downtown which is very appropriate for him. I know he wouldn't want it but we feel it's it's the right thing to do and it's important that his legacy doesn't get lost as time continues to move on. And we look forward for you to continue to be involved. Stay tuned lots of budget stuff happening and you need to be involved because these are your tax dollars.


The Lagos residents have been charged to take ownership of projects undertaken by governments in their areas as to go a long way in tackling the issue of abandoned projects. This charge was given by the Inspired Youth Network during their citizens engagement town hall meeting with stakeholders on addressing public requests from the 2024 budget of Lagos state. Details in this report. How do we have the energy to send back what we know of Lagos? To ensure that young persons, especially young women, have access to democratic public responsive services. Over time, the stakeholders have monitored the implementation of budgets and are here to discuss the findings from their track ends on abandoned government projects in Oshodi's solo local government area. The idea is for the community to take actions towards the completion of the project. Great budget for all of this. Let budget that you have created be used for the completion of this project. And we have one in Okorodu currently. The one where the Okorodu is a vocational centre as big as Okorodu is. We only have one or two vocational centres being managed by the Lagos State Minister of Women Affairs and Poverty alleviation. Now this is another vocational centre that can complement the effort of the one Lagos State government is currently running. If we have a large number of people going to one vocational centre, we will not have good effective training and learning, or effective learning in all these vocational centres. The idea was to go monitor the projects that was going on in Ido-Urufi streets in Agopa last week and we found that constructions were not really ongoing the way it should be. And this was causing some issues leading to drainage problems. And of course all of this can also result in diseases and displacement of people. So we tried to bring up these issues to the limelight to let people know that there is actually a budget allocated for this particular construction and they need to demand for accountability so that the right things are being done. The town hall meeting also aims at educating relevant stakeholders to be involved in the budgeting process and ensure good governance. As government is advised to meet with the people halfway in this discourse. From all of our engagement so far, from exception, you could see that the major challenge there is that most, the majority of the persons in Lagos do not really have a better understanding about budgets, processes and the rest. So that's why we're doing all of this to see how we can educate the citizens to allow them to be a part of the process to actually drive a change in their society. It's good that organisations like these are coming up with such engagement in order to know what their resources are meant and are useful. And you know, if we do not accommodate such programmes like this, going forward we may not be able to achieve anything. This is more like helping government to lessen their work and all of their burden. So you know, I think it's something we have to also encourage and actually listen to them. And that's one of the reasons why I find it like I have to be here today. In order to urge the government to look into the abandoned project and ensure their completion, as it would not cost anything more since they have been budgeted for in the first instance. Hello. Hope you enjoyed the news. Please do subscribe to our YouTube channel and don't forget to hit the notification button so you get notified about fresh news updates.


Hobby every EFL teacher needs to try when teaching English abroad, pick up a new drawing or painting style. Being able to draw well is a great asset for an EFL teacher. Whilst bad drawings on the board can often elicit a good range of vocabulary in a fun way, sometimes you will want to draw well. A simple pencil kit can easily fit into a day bag, and sketching what you see whilst having a coffee break is an easy way to practice. But again, the internet has loads of resources for you to learn from. Similar to the musical instruments mentioned above, each region of the world also has its unique drawing or painting style. Check your local YMCA or culture center for art classes. Thanks so much for watching. We are ITTT the leading provider for TEFL and TESOL training courses. If you like this video, please subscribe by clicking that button down here and click on any of the videos here on the left for more interesting teaching tips for getting certified to teach English abroad and online.


Well, it's another week in Victoria and it's actually mild conditions across the state. We'll see this week rain or moisture in the systems, which you'll see it to be fairly humid but certainly not extreme fire danger. The highest fire danger this week is likely to be very high and that's only in a couple of northern districts on only certain days and that'll be driven by temperature. We'll see temperatures in the 30s but certainly not extreme temperatures. We won't see extreme winds and it won't be super dry. One of the things to really note about the weather is what's happening in Central Australia. I often talk about it but one of those things is it drives, Central Australia drives our weather systems and particularly when we get that hot dry windy weather. At the moment Central Australia is in the mid 30s so it's not high, it needs to be in the 40s or even the high 40s before we start to see extreme fire weather come into the state. We think that'll be the case for probably the next seven to ten days so for the rest of January we don't believe that there'll be excessive fire danger indexes across anywhere in the state. So I suppose that's a bit of a message out there to say just be careful with fire but we're certainly not at the top end of any threat about fire at this time. With very high fire danger ratings you can still have a fire that can do damage so just be aware of that but we're certainly not in the excessive areas and we certainly won't see excessive rain. That's it for this week, enjoy the week it'll be a mild, nice week in Victoria, thank you.


Okay, so we'll just go over the answers and then through the Jeopardy game we'll kind of review more in depth a lot of this stuff but all right number one besides the CNS findings what other systemic findings of tuberous sclerosis are potentially life-threatening or is potentially life-threatening. Yeah, B, so cardiac grab to myoma. Perfect. What non-CNS cutaneous or ocular manifestations are not associated with ataxiatlantric atasia? C. We're really killing it. Lim-length discrepancy is not associated with ataxiatlantric atasia. That's not a standardized question. It's a not. C. Ataxiatlantric atasia is kind of hard because it does have a lot of different manifestations so with ataxiatlantric atasia you have a mutation in a gene that helps like maintain many different things so including like telomere length you have angiogenesis glucose metabolism so many different things so these kids who get this have like a like a really low life expectancy how long do you think they live if you throw us in the first after 20 years 25 years is like the expectancy for these kids and when they get um cancers uh age when they're younger than 20 usually get hematological malignancies solid organ cancer is a little bit more common in adults so they have a much more increased risk of breast cancer in this population about five times the risk in general population and then they have thymocypoplasia and also like um IgG IgG IgM IgA abnormally all kinds of um infection risk um including especially like pulmonary infections is usually what they die of and so there's a lot of different findings here and we'll go over even more of them but it's it's one of those things where it's just like you're not really sure and they have increased risk of mortality because the cancer it's usually ataxiatlantric among the okay number number three was maybe a little confusing so but what are the diagnostic criteria for neurofibromatosis one just the parentheses abbreviated version just meant you don't have to be really specific about it but does anybody have a list or a good mnemonic to remember yeah so bone bony abnormalities there's seven there's three that affect the orbit or the eye you think of what else you just said one that's actually that's that's actually I don't include iris iris yeah so these nodules how many others do you have to have two two neurofibromas right so yeah neurofibromas is another one catholic spots yeah it's like five or seven or something right there six okay say it again yeah axillary freckling optic pathway glioma yes optic pathway glioma and then there's one more what are the criteria really um it's uh like someone in your family yeah relative perfect so kind of a mnemonic i've seen before is calborn so cal b or n so the c is oh sorry the c is cathol a a is axillary freckling l is least nodules b is bony abnormalities including especially sphenoid bone dysplasia o is optic pathway glioma r is relative and then n is neurofibroma more right yeah so i guess i just have to remember it based on like what's in the eye first like any hallucinodules optic pathway glioma or uh plexiform neurofibroma and then i think of all other things so that's three things that affect the eye and then you have a sphenoid wing dysplasia or long bone abnormalities there's two things that affect the skin either axillary freckling or inguinal freckling or cafe or lay spots and then you have a relative so like skin i found them just gotta try harder okay all right what are the renal and adrenal masses associated with fontanipulin now good and then there's one more renal cell nailed it and then last one what faking mitosis presents with uh race most angioma or retinal AVM yeah okay so next we're going to go over some cranial nerve seven actually i'm not going to go over the anatomy because you guys had this review sheet i wanted to give this to you so you have an idea maybe like one way to approach trying to understand or learn anatomy it took me a long time to like put it all together because it feels like the bcsc has some information and then you have to look up your own sources and things like that to really understand anatomy and especially the clinical anatomy so i'm going to scroll through this but we'll go to the actual questions um the quiz question is not the worksheet i'm filling in the blank about the anatomy you guys all have a copy of this yeah or you can put up on a computer and bring this kind of news together okay the most common cause of damage to the upper motor neuron of the facial nerve is so when you have um when you see uh cranial nerve seven palsy and we know that it's due to an upper motor neuron lesion rather than the lower motor neuron lesion what is the most likely cause going to be a stroke and near plasma or infection stroke yeah stroke is the most common um and these are all from the bcsc in like main points i guess uh this so if there's a stroke to the left paracentral gyrus um it would result in what facial muscle deficit so if you have an upper motor neuron stroke would you have upper face lower face which side would be affected if if there's a stroke on the left side we're right so why is it lower right yeah so you have um uh yeah let's blow up a picture here so okay so could you explain this mic basically you have dual innervation and so unless you stroke out the lower motor neuron you're still gonna have innervation from like it's a lateral side to that upper upper right so the upper motor neuron um provides yes uh input into the uh the lower motor neuron cell body here in the ponds um and both of them do the both upper motor neurons do and then with the lower motor neuron there's only only goes to one side so you have dual innervation from upper motor neuron for the upper face and then for the lower motor it only comes from the contralateral side one here for nuclear a right cranial nerve seven nuclear or in for nucleation would result in what facial muscle deficit so if you had the other issue so not upper motor neuron issue but more like a lower motor neuron issue so um right side for lower motor on affects the same side upper and lower so if you know that someone can't raise their brow you know they have like a male or seven palsy having facial weakness they can't raise their brow um and their lower face is weakened it's almost like the lower motor neuron condition rather than upper motor neuron okay this is trying to have like some questions we had in med school actually damage to the nerve that supplies the stapedius can result in what kind of hearing problem can you hear too well like too any noises or too little too much too much dip it's almost like hyperacusis because what does the state bees do dampen sounds yeah it's a stapedia supplies the state bees muscle and muscle supplies the the bone with the more stability and dampens the sound um so you have all these conditions decreased hearing dry mouth decreased taste hearing impairment I stag must vertical taxia you have involved in multiple cranial nerves five uh six and eight as well and cerebellar signs kind of like pointing towards a certain region in the brain could be affected here what do you guys think see a dry mouth decreased taste hearing impairment those things could be what cranial nerve or decreased hearing all these things and then um stag was in vertigo and ataxia can happen from cranial nerve eight or cerebellar issues right and if you have five and six also involved in addition to other cerebellar signs kind of think this is a lot of real estate in a very important area called the cerebral apontine angle um what what two tumors could affect that area yeah because you know well what you get in an obscene or other one that's what you think about in the meningioma yeah so those are the two main things that we see in that area um Bell's Palsis Diagnostic Exclusion but what do you if someone if your patient comes to you and says well why does this happen to me why do I have Bell's Palsis what do you know about it like what can you say probably viral could be viral no autoimmune right why are autoimmune inflammation of the nerve temporarily um and what do you use to treat it acutely yeah steroids and then some people do antivirals but that's not necessarily particularly any guidelines what's the term used to describe the co-contraction of face facial muscles after incomplete recovery from a Bell's Palsis so you might see like yeah in kinesis right you also see that in other cranial nerve Palsis too you can see in cranial nerve three what is a pattern of facial apresis would you what pattern would you expect in Bell's Palsis it's kind of like same side or same session yeah so you know a lot of upper and lower face all right um let's go around and have maybe you guys read some of these so Jeff do you want to read the next one number one um what tick-borne illness can result in bilateral or unilateral cranial nerve seven Palsis um this could be line what's the bug that comes in right generate this one sure so this is a hd of cranial seven is called uh is there a Ramsey hunt and diagnosed for vesicles found along the course of iteration of the cluster regular nerve which includes what structures are we talking about like which nerves so um so auricular nerves uh actually supposed to auricular nerve supplies certain structures on our head with innervation like sensory innervation and when I scroll back up here so you can see exactly where it is so somewhere in that posterior auricular that gives you a clue yeah yeah so you're going for pina extra ulterior right yeah so you can look in the ear and he's and I mean if there's obvious vesicles you can see these you can see them getting better over time um and you have the muscular innervation too as well to muscles around the ear and the occipitalis most commonly affected cranial nerve and sarcoidosis is cranial nerve seven due to infatuation of the parotid gland the second most commonly affected is cranial nerve eight um so actually found cranial nerve two okay I didn't see it here I found like a range for eight and then two was sort of in that right yeah it's not very common to have other ones and cranial nerve involvement anyway in sarcoidosis it's pretty weird to have nervous sarcoidosis right but um I found two as the most second most common so you can get vision loss and not do neuropathy from this um which childhood disorders characterized by bilateral facial paralysis chronic facial swelling and legal placata furring of the tongue um Melkerson rosin balsam yeah right so what are they um what what what part of their face usually gets swollen like do you guys see any pictures look it up see what it looks like the classic that you can get a cheek or their lips actually that seems to get um affected it's really weird that it's on the caps because there's only like hundreds of people affected with this that have been reported it's not even so uncommon but is that it's actually yeah yeah it was on there yeah let's go over a few more things real quick and then we'll move on to debris um all right so let's do this as a team so the rest of you guys who haven't answered the question yet um on the board uh you guys want to go through this together and kind of fill in the blanks to shout it out so for um blood for spasm by not essential blood for spasm versus hemifacial spasm it's important to know the distinction and there's often also other conditions that cause um muscle contraction type uh presentations that will go over as well that affect cranial nerve seven so what muscles are involved in uh blood for spasm versus hemifacial spasm where you have like hemifacial spasm which is like cranial nerve seven muscles so it's like these are the whole upper and lower yes yeah great um and as far as laterality which which what is uh blood for spasm and hemifacial spasm so blood for spasms usually well hemifacial spasm as it says as the name is yep so what where is the pathology or pathophysiology of buffer spasm like what do we think causes it yeah so it could be we don't really know this is currently I think it could even be like extra pair middle maybe or it could be like stress because it's like stress related sometimes with some people um there are other conditions that can like dry eye right can also be one of the things that can cause blood for spasm people's helping to control that will help as well so maybe the surface of that is can be listed here how about for hemifacial spasm you know the seventh nerve typically yeah and what's compressing it usually like a I think the book says like a dolicoactatic vessel which is what does that mean uh it's just a weird ship vessel I guess yeah so dolicoactatic it's like this twisty dilated vessels like this tortuous vessel that's dilated sort of from uh from hypertension just that's interesting so let me kind of tell you that we should probably see we should probably do some imaging to see what's going on there because what else could be there not a vessel but yeah it could be an aneurysm it could be a tumor or something else that is compressing the nerve there um in the in the brainstem so uh which one is present during sleep yeah hemifacial spasm yeah um what would you do as part of the work up other than imaging for hemifacial spasm yeah I mean we do it yeah open MRI and I mean what type of imaging sorry yeah spasm imaging um and then for spuffer spasm what work up would you do like what kind of questions would you ask the patient you know it's isn't that one of the things to like um I think it's more in kids like with glaucoma like they could have like blood for a spasm that could be a sign of it or no am I thinking of something else I think I'm sure there's some kids who have that I don't I don't think that's commonly seen in kids as much yeah I think like sensitivity I don't know is it's like yeah yeah like they congenital I'm not talking about like for yeah um we can uh we can also ask about like you know maybe caffeine intake stress things like that anything else going on in their lives that could be related to the timing of onset what would you do for like what are like one or two medications for each of these that you could try medication surgery for hemivacial yeah you do surgery um real quick for medication for left first spasm oh there's sorry yeah I'm like out of here at all artificial tears artificial tears yes I thought 41 um okay so what surgery would you do for left first spasm you asked her to take the muscles and how much really it's pretty surprising um so if you what are the what are the three components of our obruculars uh if you had a list of the three parts of our obruculars in orbital yeah so um so if you have if you have all three components you would think that you maybe leave a lot of it but actually you take out the majority of it and people just usually live a strip of the pre-tarsal muscle apparently so a lot of it's gone these are varieties of that surgery um your patients have to order yeah so sometimes they'll probably leave more of the pain on how severe it is too there's a lot of plastic student because I've never seen that surgery but it's really the last resort it's quite a uh in face changing people look very different after surgery but it's very mechanic very effective I have one patient who's had that by a different surgeon and she still needs Botox but a lot of them they're good but they've cost have chronic tryout and what surgery can you do for any patients spasm it's sponge sponge where in between where like the nerve is and whatever it is it's compared the weird vessel that Chris said yeah who does that yeah all right so for the last I'm going to give you guys I'm just going to give you that I don't want to take too much time because I want to do everything but um I'm going to show you one video and I'm not going to go over these questions I'm a facial malchem is another bit different and I want you to tell me how this these these movements are different from left first as the sort of the seventh nerve but in this case probably due to brainstem involvement this is a patient with multiple sclerosis and what you can see are continuous undulating fasciculation like contractions in the distribution of the seventh nerve now this disorder is different than the benign obicularis myocardia which I think all of you this one's more like undulating it's different from spasm it's like it's fast you know it's not continuous like this it's more like undulating it's rip and also lovers as well compared to this where are we looking at right now well yeah this is the all of a sudden although you can get myocardia without having to be the whole face yep you can have you can have just like what you can have like a certain extrafiler muscle probably myocardia or even this individual muscles as well in the face right so in this condition with the space you have multiple sclerosis or sometimes adults or kids who have haunting gliomas you can have and then I will just send this rest this out to you and we'll move on do you get at both point of the last few questions is that for six and seven um with uh facial myocardia and this spastic you know lateral facial contracture these conditions anytime you have these conditions it's really important to consider that it could be something malignant and consider really consider getting next part we're gonna go over if they come in oh why don't we do um okay so it's Jeff and I'm sorry tell me Trevor Trevor why don't we do trying to do like a pgy three and two in each class and then we'll split up Trevor Ali and Jeff okay that's why we have three teams yeah sounds good we are two here I know I was well I guess all right so Marshall or Ariana need to move away from Brad pgy two and a three right so either you or Ariana need to go over there all right then Chris okay so Rachel's coming here so Ariana you go over there okay so so the way that we're gonna do this um is just everybody's gonna answer every question so just write down your answer on the whiteboard and then we'll just hold it up so there are there is a lot of repeat information but it's kind of coming out from different angles so just also pay attention because one question might give you the answer to a later question and there there is basically one benefit to choosing the question so if you get it right so kind of try and pay attention to like who put their board up first but um because there is a double jeopardy question so only that person can double their money whoa all right so we'll just start Brad why don't your team go pick first like a boss I knew you would be I should have said this category is kind of the harder question all right so quickly and we first I think you were definitely there is no question about that all right that was quick that's quick that's right so NF1 is the most common and then just for kind of by way of information those are the incidents it's just it's it's it's it's it's I everyone got it we have team names oh man is winning okay our team name is team like a boss we're gonna be team like their boss all teams got like their boss I believe you were first so but but they held their thing up first I know it's like it's the only way anyway can we still get the first one I'm going to just use one benefit in choosing double jeopardy but let's do okay ready and you have to answer no penalty for answering incorrectly so I just want everybody to answer I will point out that it says these chromosomes oh oh oh so there's two correct you got 10 more seconds guess I should put one this one in like a boss all right five seconds okay okay all right this is a tough one six oh god that was close yeah so kind of two jump question right so what's the condition so tuberous sclerosis and then chromosome nine and 16 and just in in a few charts actually in bcsc it specifically talks about how these genes are also so tsc one is also called hammerton tsc two is called tuber and and then just I tried to full pictures I tried to get them from bcsc just because I guess that's where they always talk about the unwolf right bro yeah which is like not it's not what yeah that's true all right uh so back to like their boss since everybody got wrong and keep it do ocular findings for 300 ataxia tell good so ataxia telegenitasia yeah also known as so I really like how strong I've talked about this there's so many systemic symptoms systemic things that can go on with like or ataxia telegenitages so just another example so super nuclear gaze palsies so these kids like they have ocular apraxia or variation of that sort of they can initiate movements so what can they do to help all right I think it was I think that was me what was it okay great like like like their boss I'm like I see you Dr. Warner's keeping tracks so watch it all right go ahead like their boss again it names for 400 400 oh and the one daily double so only you guys can double your money but everybody else still answers so 800 for you 400 for you guys all right you guys have 600 everyone has 600 points okay you're ready and we still have to get it fastest though if we want to right okay no if you get it right you get it okay but if you want to pick again all right here we go so specifically the less common name if you list both I guess that'll work all right 15 seconds how many how much did you guys waste here what is it double yeah it's worth double because we're not chasing away we're not taking away points I'm making it up as we go okay all right five seconds you've seen the oh yeah all right time's up team winning what did you say I saw what it says as long as you want to keep it all right here we go oh nice I'm getting tired of this ataxi I told you there's repeat information but repetition right repetition all right so again I mean it's all these a lot of systemic things so and Strav already mentioned that respiratory infection is a common cause of mortality and these younger patients who die with ataxi atlantication all right like their boss let's do sorry so name the that's maybe a little confusing name the neurocutaneous disease not the finding but I think that says it's very close angiom is that okay maybe it's just someone else right don't give it to Chris all right so everybody got it right that's right so wyburn mason or race most angioma there anyway there's yeah uh just as a side note because this is not considered an inherited disease it's most common sporadic mutation as well as sturch weather so this just bonus tidbit thing that's not sturch weather correct no it's just that that's also a non-inherited all right like their boss okay let's do miscellaneous for 400 eight ten seconds a little bigger getting old all right we're good so again the wyburn mason race most so so due to the intracranial arterial venous malformations just they can have spontaneous rupture and intracranial hemorrhage this is the same condition that um Kamansky talked about at that last deputy game with retina he has number one what are you talking about um the reason why this disease uh became as popular in ophthalmic literature apparently is because at wills there was a patient with wyburn mason who had who's getting dental work done had an avm in the mouth and then it ruptured blood to death all right like her boss let's do alternative names for 200 10 seconds all right five seconds all right anything team winning live up to your name winning winning winning okay this is this is what i'm talking about oh Ben hang on now we'll take that oh yeah i couldn't remember what it was so do they get points if they wrote the other name uh so what's so von hebel lindau is kind of i guess the more common name i i would say but it's actually also known as retinal cerebellar angiomatosis so that specific lesion what are what are we talking about with the description album you do bless right oh sorry yeah retinal hemangioblastoma a couple pictures all right like a boss uh 200 we have to raise it up right i mean do we don't get points if we get there's no benefit if we didn't get no everybody gets points if you get right oh you're all getting points oh yeah i didn't know this i know it's been a while since you have been first so all right that was they all got it um also known as encephalofacial angiomatosis but sturge wearer syndrome and i think this so this picture is from bcsc yeah like a boss let's do uh genetics for 200 you have to tell okay okay they they told me that that's the top ones i crossed out yeah yeah thank you thank you extra points for writing big thank you i know you're struggling out there but all right good so 22 so i think he's too good yeah so nf2 22 like a boss on a roll um let's go for our did we do for 100 ocular no all right ocular fight so what's the lesion sorry what's the name of the lesion okay can you be more specific than that okay all right so we'll still take it but we're just like that's what we meant is like being more specific okay all right uh team winning all right team winning like a boss for 500 all right here we go like a boss 500 okay we had it reviewed that was we already reviewed this but that's good all right uh team like a boss all right here we go a lot of growing on this one i need multiple choice i don't want to pay out just think about all the things that this condition has and like three you think might work you're gonna get all three that's why this is like boss was it was that it probably was in a mixture yeah there is a lot to repeat all right let's do that sure i don't think anyone got them all i'd like to tell you faces i'm just trying to read it yeah read it sorry what it's actually astrocytic hamertoma and intracranial lesion okay so i don't yeah i don't think anyone got them all i think you guys but uh adnoma sebacea did was that on your seizure hamertoma oh hamertoma okay all right so yeah so the classic triad so cognitive impairment seizures and then facial angio fibromas also also called adnoma sebacea so it's like these these triads sort of came about when all we had was like we can look at the patient and see what they have right all right uh everybody had nobody got it so were you guys last yeah fine you gotta keep track of that mark or T wait yeah good so NF1 right where the where the lesion is and what the shape of it is is the left eye. And it's known as a, like a, what is it? The tram tracks is a meningeal one, right? Yeah. So you can have that glioma, it's an optic pathway glioma that this patient has. These can go all the way back. So I, I always would get the two mixed up, like tram track and fusiform. This is maybe like a result, but so I actually think it's really helpful to, I think, turn off, to think about what part of the optic nerve it's affecting. And then that's why it looks like that, right? Because as the meningioma it's affecting the, the meninges are like the dural sheets. So you get this, you know, thickening of the outside. So it's going to look like that tram track. Whereas this is kind of the glial cells of the optic nerve. So it's just going to blow it up. That picture, is this really asymmetric temporal lobes? I don't know if that's the, it's called out on that slide, but it looks like the right spheroid wing is different than the left. Yeah. It can be very lumpy, like fully. Okay. Thanks. All right. Um, let's go for, let's do genetics for 100. Brad knows what it is. I just heard a big sigh. Okay. Five seconds. Pick a number between, all right. 11. No half credit for one on that one. It's the gene for this. The gene that's mutated. ATM. And I, the only way I can remember this is actually, I looked at like why do they have telling dictages? And it's actually because again, the ATM genes associated with like angiogenesis. So these people have dysregulation of the hypoxia inducible factor, HIF1 and VEGF actually. So those are, there's extra levels of hypoxia inducible factor and VEGF floating around. And they have telling dictations of their congenital vessels and also their skin, their superficial skin. You can also see those vessels. If that helps to remember, just, I feel like anything helps with these things. No, so back to you guys.  I like it. I will forever. Do they, do they usually know? Like, do they usually have family members like that? Like, are they aware of that? Yeah. It's, so are we going to go over inheritance? I actually, I don't think I have questions on inheritance. Yeah. So what do you think the inheritance pattern is? It's recessive. It's recessive. Yeah. I was a little recessive actually. So yeah, you can have family members with it. But usually, part of the inheritance. Whereas most of these neuro-facumatoses are what? How are they inherited? Dom dom. Well, I do. There is one question on genetics, but we didn't spoil it. All right. You told us we had to pay attention. I mean, I don't always. So I wrote it down right here. So Robin, what are you thinking about? This is the list of elements. Okay. So Tuber Sclerosis is right, but the less common name is Bornville Disease. Bornville. And then just, just to go over some of these findings. So ash leaf spots, facial angiofibromas, or adenomysibatium, chagrin patch, and then angolfibromas. What's their intracranial lesion? Our tumors have to calcify tumors. Oh yeah. Okay. What is it? You didn't mention the, mentioned the vodka? It's their, um, right there. I know, right? Thank you. I'm just here to admit about facial or uh. What are the tumors there? I can do a good picture of a seizure. I mean, they're like. They're like. They're like talking. Yeah. She's talking in a parody. You know, like. Oh my god. Brachemole. Brachemole. And it's also a sub-pandamole, uh. That's what it is. Yeah. They asked that. And then it's going to be calcified. Wait, wait, wait. What lesion? Yeah. I'm sorry. What's the, what's in your stuff with this one? Astrocele. So Rachel just said. Calcified. That's okay. They don't have to be calcified though. So the ones that look like the mulberry lesions, those are the ones that are typically calcified. If they're non-calcified, then they tend to be a little more flat. And then they're often associated right around, they're often placed like right around the optic. Are you going to set this up, by the way? These are really good. Uh, we'll, we'll put it in box. Proprietary. Yeah. Well. Yeah, we can put it in box. Me and some of them up real quick. And then can we review what the votes try out? Vote try out is again real quick. This one. Seizures. Seizures. Proprietary seizures in the facial and different from us. Nailin. All right. Oh yeah. Team winning. Lurries. Lurries. Short-term ratio. Short-term ratio. Team winning. Team winning. Team winning. We had a points update here. Team winning. Like your boss has... Team winning. Yeah. Yeah. 1,950. Like a boss has 3,350. Wait, sorry, sorry. What? You ready, Brad? Yeah. Like their boss has 3,950. Like a boss has 3,350. And winning has 2,500. Yeah. Winning. Yeah. You're insane. That's not... So we're like... We're like...       Dang it. I'm trying not to make it. I'm trying not to make it. I'm trying not to make it. This is getting real. All right. Um... I think it was... Okay. Yeah, we got it. Let's team winning. Alternate in age 500. Okay. Here we go. Let's do a jump there quick. No, I want the alternate in age 500. I saw it. It's awesome. It's awesome. It's awesome. Yeah. I remember that. I'm pretty sure. Okay. Five seconds. Just to start. Mike cheated. You know, we were talking about why we're Mason. We're going to give the three-person name. Yeah, yeah. Yay! So you're right. It's the last one. It's the last three-person... Yep. There's another one. Blank. Blank. Blank. So it's Bonet de Chamblank. What? Long syndrome. Blank. Oh, Blank! I got Blank right. But we're taking Wyburn Mason. But Strav pointed out that there is an even lesser well-known name. Although I couldn't find it in the neuro-BCSC, so I don't know if it's in the Pied section. Anyway. We're supposed to name them. Everyone just tries to get their freaking name on everything. We're names. But we're taking Wyburn Mason. Like an arm, an arm, an arm. Blank. All right. Team winning. So we're going to get them too. Sorry. We want Miscellaneous for $500. Yeah. Yeah.  Because even though... Yay! Oh, shoot. I haven't been putting what are. Okay. We'll just go to Final Jeopardy. It's a day or two. Sorry.   Oh, but we only have a couple of them. Weager, right? What's that? We have to Weager, right? Yes, you have to Weager. But only Weager. Yeah, but I didn't give a topic, but you need to Weager. I don't remember. I have to look at the question. Oh, no. I do remember. The topic is treatment. Treatment? Yes. Treatments for fakeomatosis. Okay. We're wagering everything. Okay. What's the price? There's no price. A potential pie is the price. Yes. It goes towards the pie. What do we have? What are our points? Oh, what are your points? You guys, Winning has 3,000. Like a boss has 3,850. How much are you guys wagering? I gave a half credit for there was one that was like partially in order. Making this up as we're going after work. We have a viral video. All right. Are you ready? Wagering everything. All but 254. 256. Okay. All right. Here's the question. I didn't. It was 0. Okay. No, no, it wasn't 0. No, there's one. Okay, all right. It was 0 and how much? Anyway, let's just do the question. All right, guys. Ooh. Wagered everything. That is correct though. Weird. Nice. Yes. Good job. So double your money. Unfortunately, team like their boss wagered everything but 25 cents. So I think they still came out on the top. You guys did great though. Awesome comeback though. Say for what it is. Say for what it is. Say for what it is. Say for what it is. We're going to talk about same role then. We're going to talk about same role then. We're going to talk about same role then. We're going to talk about same role then. And up here. Up here. Up here. Up here. At least we're waiting for the right amount. Have your quiz then. And can you show evidence that you completed the worksheet? Evidence? Evidence.