Hi, I'm Zor. Welcome to Unisor Education. We continue talking about limits, limits of the functions in this particular case. Sequences we have already covered. So these are limits of the functions. This lecture, as you know, is part of the course of Advanced Mathematics for teenagers and high school students. It's presented on Unisor.com. I do recommend you to watch this lecture from this website because it has notes, very detailed notes for each lecture, including this one. Also registered students can take exams, and this is a very good way to check how you basically master the material. The site is free, so. All right. Now, today I'm going to talk about two definitions which I have presented in the previous lecture. Two definitions of the concept of a function limit. Now, first of all, there are certain historical motivations for having these two separate definitions. Let me just remind you very briefly what they are. So if you have a function, let's have it graphically. This is my function. Now, this is some particular value, R, and we are talking about function converging to some value, A, as X converges to R. So let's just take, for instance, X1, X2, X3, etc. They are all converging to the R. And these are corresponding values of f at X1, f at X2, etc. And this is supposed to be A. So as X converges to R, function is converging to the value A. That is basically illustration of what the function limit actually is. And I have suggested two different definitions. One definition is the following. If for any sequence X1, X2, X3, etc., converging to R, any, any is a very, very important words right now. So if for any such sequence of arguments converging to R, corresponding any, this is the mathematical symbol for for any. If for any, the corresponding value of the function is a sequence which is converging to A, then A is a limit of the function f at X, at point, at point R. And this limit is equal to A. Another definition, now by the way, the good thing about this definition is that it's very I would say human-like. It's nature. I mean you see immediately that well, the X is moving towards R, f is supposed to move towards A and that seems to be corresponding to our intuitive understanding of what actually the limit is. And this important detail about any sequence which converges to R should really cause the corresponding sequence of the function values to converge to A. This is a very important thing because sometimes you can have functions and I give you an example that if you go by rational numbers, for instance, to the towards R function might take the value, let's say, 0, on irrational it takes the value 1. So it looks like there is no limit basically in this case. But nevertheless you have argument converging either by rational or by irrational numbers to the same R. So if and we cannot obviously say that in that particular case function has a limit, but if for any sequence converging to R of the arguments, my functions converge to A, then we can say that the function has a limit and its limit is equal to A. Another, oh yes, that's the positive thing. I forgot what negative. What's negative about this particular definition? Well, the negative is that how can I check that the function really has the limit based on this definition? Well, I have to go through all the different sequences of argument converging to R. But how can I check for all the sequences? It's impossible. There is an infinite number of sequences, obviously, which are converged to R. So I can't really constructively check the existence of the limit. I cannot prove that function has a limit because I cannot really exhaust all the sequences of the arguments which are converging to R. So there is another definition. It's not as human-like. It's not as natural as far as, you know, what we intuitively think about this. However, it's perfectly correct and it's equivalent to this one. And this is an equivalency, which I'm going to prove today. So let me remind you the second one. Now the second one is if I would like to be as close on my function as possible to the value a. So for any degree of closeness, epsilon, positive. However small, there should be, there should exist. So for any epsilon should exist delta, such that as soon as my argument is within delta from limit point, immediately following from this, my function would be close to the limit than this particular value epsilon. This is not as obvious as this one. However, it's also correct. And let me just try to explain it a little bit more over and beyond whatever I did in the previous lecture. Now this signifies the closeness of the argument to the R. Any kind of argument as long as it's within delta neighborhood as we are saying. So within very, very small. So for any delta, for any epsilon neighborhood of a, so if I would like my function to be from a minus epsilon to a plus epsilon somewhere here. There is always such a range of argument where this is true. And then I can make this smaller by vertical. So epsilon gets smaller. And then for a smaller, I still have to find an delta neighborhood of my R where all the values of the functions will be within this smaller neighborhood. So no matter how small a neighborhood I do, I would like to really be, I would like to be as close to a as possible, measuring is, measuring it by epsilon. For any measure, I will find certain degree of closeness to the R. So whenever my argument is very close to the R, my function will be within this narrow interval around A. So this is my other definition. And today I'm going to prove that these definitions are equivalent, which means if this function has limit A as X goes to R, according to one definition, then it's actually the same limit with the same condition according to another definition. And vice versa. So that's what I'm going to prove right now. Okay? All right. Now before starting this proof, I would like to mention something very important. I would like to, I would like to recommend you to try to prove it yourself before actually listening to my explanation. Whether you will be successful or unsuccessful doesn't really matter as long as you spend some time thinking about how to prove from one to another or from the other to the first one. It's very, it's very useful exercise for you. And you know, the whole purpose of this course is to basically convince you that this kind of a mathematics is really necessary for for your creativity, for your development of your logical thinking, your analytics, etc. It's not the purpose of just giving a certain amount of information. Nobody needs the proof. I mean, everybody knows that these are two equivalent definitions. So why do we prove it? Well, it's an excellent school of thought for you. So I would rather recommend you to stop this video if you didn't do it before. Stop this video. Go to Explanationonunisor.com of these two theorems. And there are proofs that as well. Don't read the proofs. Try to prove it yourself. Then again, after you spend at least an hour, that's what I would suggest. You can read whatever is written there, then you can listen to me. And when everything is finished, I do recommend you to try again. Just do it by yourself from the memory, whatever you have remembered from my explanation, or from reading the the website. Okay, now I will go. So the first one is, I would like to prove that if my, so my first definition is the following. If my Xn converges to R, and for any such sequence of Xn, if this is any sequence which is converging to R, if from this case, follows that my functions of these arguments represent a sequence which is converging to A, then the limit of the function is A. So let's consider that this function has limit A, which means that this is true. What I would like to prove is that for any epsilon greater than zero, there is such a delta that as long as my X is in delta neighborhood from R, my function would be within epsilon neighborhood of A. So this is given, this is a true statement, and this I have to prove. By the way, sometimes people are saying strictly less here and here. It doesn't really matter for definition. It doesn't really, both are completely equivalent. Alright, so how can I prove that? Alright. Let's assume that this is not true. What does it mean that this is not true? Well, it means that for some particular epsilon, there is no such delta. Right? Now, what does it mean that there is no such delta? It means that whatever value of delta I can choose, doesn't really matter which one. From this, this does not follow. So I chose some particular, so I'm negating this. So from some particular value of epsilon, there is no such delta that this is true. What does it mean that there is no such delta? It means that no matter what kind of delta I choose, if my X would be closer than this delta, my function would not be within this particular epsilon neighborhood. My function would be outside neighborhood. So I choose one particular epsilon. I put it as epsilon zero, it doesn't really matter. So there is no such delta that this is true. Which means that no matter what delta I choose, if this is true, this is false. Alright? Okay, fine. So let's choose delta equals to one, delta first equals to one. And I choose one particular X which is closer than one to R. I find this X1.  Now, I will choose another delta. One half. And choose X2 within one half of the R. Still, now this is f of X1. This is f of X2 also would be greater than epsilon. Delta three, I will choose one third. And X3 is within one third from the R. And I know that my f of X3 is still greater than epsilon, etc. So my delta nth is equal to one nth. I choose Xn which is within one nth from R. And then still my f of Xn. So what do I have right now? I have a sequence of X1, X2, Xn, etc. Which is converging to R. Which is this. It's true, right? Since my difference is less than one, less than two, one half, less than one third, less than one nth. So obviously the difference between Xn and R is infinitesimal. My function is still outside of the epsilon neighborhood around A. So I have actually constructed a sequence of arguments which are going to R. For which values of the functions do not converge to A. Because the difference between them and A is still greater than something. So they do not converge. So it's contradiction with my premise that any sequence, you see, this is what's important about this any. I said that any sequence of the argument which goes to R results in the sequence of arguments of the function which is converging to A. And now I'm explicitly constructing one particular sequence that this is not true. What does it mean? That my initial negation of this leads to the contradiction with my premise. So my initial negation is wrong. Which means that this is true. And that's the proof, basically. That's the end of the proof. There is no such epsilon for which something like this is happening. So for all epsilon, as long as my, there is always some kind of a delta where closeness to the argument to the limit point results in the closeness of the limit point. That's the function. All right? Well, that's one thing. That's the proof from the first definition to the second. Now let's try to do it the other way around. So this is given and this what we have to prove. Right? Okay, fine. We have to prove this for any sequence, right? Sequence of arguments. Well, let's take the sequence of arguments. Any sequence of arguments. Any. I just took any sequence of arguments which is converging to R. Now what happens then? Now I know that my, as long as my sequence converges to R, there is, for any delta, there is always some number N. After which, as long as N greater than N, my X N minus R greater than, less than or equal to delta. Right? That's what it means. Convergence to R means that whatever the degree of closeness I choose after certain number of N, all my members of my sequence will be within the delta neighborhood from R. That's what it means, right? That's basically, that's what given when I'm saying let's take any particular sequence which goes to R. Okay? Now, what I do have to prove is that the corresponding sequence of functions of these X N, that's what I have to prove. Now, what does it mean that I have to prove it? I have to prove that for any epsilon, there is always some number N such that as long as N greater than N or equal from this follows my function minus A would be less than epsilon, right? So, let me choose one particular, one particular value of delta. Now, I have this. Now, for any epsilon, for any epsilon, so I can choose this one. I can find such a delta that this is true, right? Because this is my premise of this particular theory. So, from this epsilon, I can always find delta. Now, from the delta, I can find number N when this is true. So, what happens? It means that no matter what kind of epsilon I choose, no matter what kind of epsilon I choose, based on this, I can find delta. Because that's what basically this definition states. That if the function has limit of A, it means that for any epsilon, there is a delta such that as long as your argument is within delta neighborhood, my function will be within epsilon neighborhood. So, for any epsilon, I can find my delta. Now, from delta, I can find number N because I know that this is converging to R. So, for all these numbers N, my X would be within this neighborhood. So, from this follows this, which means this would be within the epsilon neighborhood. And that's basically it. So, let me just try to maybe say it slightly differently. Because, again, what do I have to prove? I have to prove that for any epsilon, there is some kind of a number when this function would be in the epsilon neighborhood from the A. But for any epsilon, including whatever I choose, I can always find delta. And based on this definition, I can find the delta neighborhood of R, where my argument should be to necessitate this. And since my X is converging to R, I can always, by this delta, I can always find N. After which, all my members, including these ones, would be within delta and this would be within epsilon, therefore. So, that's my proof from this more constructive way, the one which is, I would say, more intuitive but less constructive. Okay, I hope I explained it in a relatively understandable terms. If still it's not exactly what you would prefer, go to thisunisor.com and read the explanation as it is written. The proofs are written over there. If you still do not understand it, send me an email and I'll try to personally explain maybe in writing again something which is not really clear. But in any case, it's very important for you to really think about both proofs because it's excellent exercise in logic. Because here you have some logical statement. For the first proof, I had to negate that statement. And there are a little bit more complicated maybe than you're used to logical considerations here. So, that's why I would like you really to spend some time on this. It's much more useful to spend time thinking about this than to memorize formulas or whatever else. It's very important to understand completely how these both logical conclusions can be derived one from another and backwards. So, these two definitions are equivalent. If you feel comfortable about these proofs, I guarantee that all other things related to derivatives will probably go very, very smoothly for you. Alright, that's it. Thanks very much and good luck.


That's kind of where we are today, closing literally right on the 10-day moving average. So this 392 level for tomorrow's session is gonna be an absolute huge deal. Welcome to Access to Trader, the number one community for those who are committed to taking control of their trading in order to achieve success, profitability, and longevity. Thank you for joining us. Here's Dan Shapiro to help you find your edge, master your process, and own your future. Hey guys, good evening everybody. Welcome to a Monday edition of the AccessToTrader.com Nightly Wrap Up Show, everybody is doing well. So after last week's, nearly 4% on all across the index, is the question was, what was the market gonna do for an encore? And if you guys watched the last week's, last weekend's video, there was kind of a big separation, a big disconnect between the growth stocks that were kind of sold now for the last couple of weeks. All the money was coming out of all these growth names, and the money was flowing into names like Apple, names like Microsoft, a lot of the consumer cyclicals, like we talked about, for example, Colgate Palmolive on the weekend, up again, nothing sexy, but that's where the money flow entered. So the question going into today's session was, number one, can the market continue its last week's dominance? But if you traded last week, you kind of know that the majority of the value from last week was all to the downside, not named Apple, right? Not named Microsoft. So the question it was coming into today, was Apple and Microsoft gonna bring everything else back up that was getting sold, or is everything gonna get sold finally gonna start bringing down Apple and Microsoft, especially Apple has had this really, really parabolic move that we've been talking about, and obviously we highlighted over the weekend. And when you look at the scoreboard today, it's not a big deal, right? When you look at the scoreboard, you see pretty much everything's down 1% all across the board, but it doesn't really represent the weakness, the aggressiveness in continuation of selling all these growth stories. And not even like the stocks like the UPSTs of the world will let it use, even names that had this really huge run over the last couple of years, and we talked about NVIDIA as well. These are the names that are really starting to get into the sweet spot of a lot of aggressive selling pressure. When you start looking at names like NVIDIA, and you start looking at names like a Tesla or a stock like a Netflix, you can see how close they're all coming to the recent Lowe's channel. And if this was a situation of using Apple as a barometer, right? To see kind of the strength and weakness in tech. And the question remains is, well, if the money does continue to come out of Apple, and again, this was the leader going up, well, how are these other stocks going to survive? And that's the million dollar question. The key kind of going into tomorrow is understanding two things. Right now, the NASDAQ 100, after everything that happened is, after everything that happened last week, we saw this 4% move, nearly 4% move in the NASDAQ 100, the queues closed today right at the 10 day moving average. And that's a kind of a big deal. If you've been watching this video or any of the workshops or anything, anything I've done, you know the importance that I put in on the 10 day moving average. It's the birth of the trade. Once you close above the 10 day moving average, that's super bullish. If you close below the 10 day moving average, and it confirms the next day, when you had a problem in your hands, and that's kind of where we are today, closing literally right on the 10 day moving average.  Because if we gap up and start losing that 392 level and start building below, again, if you believe in the theory that stocks trade from supply to supply, then again, you have to believe in the theory that stocks trade to demand, to demand. So if we start losing this 392 level, then we got 387 and then 384, which will be a double dip test to this rising 50 day moving average. That's kind of a big deal. And when you look at all the former runners, well they're already far, they're already far in front of the pack as far as weakness goes. And you could see the bottom channel here on Tesla stopped here perfectly double bottom. You could see the bottom channel here on NVIDIA, right? Very, very close of taking out recent, recent lows. You could tell the bottom kind of starting to form, confirm the five day moving average. We talked about this on the weekend video of Doc, you're trying to see the bottom of the channel here. And the video of course, right? And the video of the mall, you have this double bottom here and this thing confirms it has another 10, 15 points to the next demand zone. So yeah, I mean, the bulls have their work cut out for tomorrow. I think tomorrow, if we gap up and start losing support, it's gonna be a pretty ugly scenario. I think in a weird way that the best thing that can happen to the bulls tomorrow, if we actually gap down below the 10 day moving average on the cues and wash them out, trap some shorts on the bottom of the channel, reclaim the 10 day moving average and start to rally. Because again, if you don't believe in technical analysis and you avoid all these levels where you're gonna be A1 in the cross hairs of what's about to happen next. And nobody wants that, right? It's not about bull versus bears. It's all about being prepared versus the unprepared. And again, I could be wrong every single day, thesis wise, literally wise, even on the wrong side of the market. But as long as I don't jump the gun, as long as I don't preempt the trade and forecast what's about to happen next, it's okay, right? It's okay to be wrong theoretically. Just do not be wrong financially. And the most important part is once you get all this data, right? And that's the data we talk about every single day, collecting via technical analysis. At least it's going to give us a lot more clues going into tomorrow's channel. And if you do your homework today, if you do your really good to diligence today and look at the technology space, you'll see a lot of names that are in the chopping block looking aggressive to the downside. But if you look outside of the tech space and you look at names, how really well a name like Costco held up today after Friday's really big move, the Sumer cyclical like a Colgate Palmava has nothing to do with the technology space holding up well. So there's definitely names that are holding up. But again, our focus, especially from the trading aspect is looking for momentum average to range, especially in technology. And if these stocks do start confirming, especially today's channels on macro on the cues and formally a lot of names that just starting to test out previous week's lows, then you have yourself a big problem. So let's talk about some names that I do like for tomorrow's session. I like this Colgate Palmava, Palmava, we'll get to the pivots in a second. It started taking out Friday's channel, cleared out all the supply and now it has this whole gap to fill. This thing starts getting above all this channel here. Maybe you could start seeing filling a gap here all the way up to 83. This is a name you definitely want to play on dips into rising 60 minutes support. A name like Costco as well. Today was a perfect example of a stock that broke out the previous day and trapped shorts on the bottom of the range. You see this whole 49, 50 level? Again, we'll talk about the pivots in a second. But here's where bulls trap shorts, eager, emotional, not prepared shorts. They're just thinking, well, everything's gonna go down because the market's going down. And here's an example of, again, strong stock dipping into rising 60 minutes support, trapping, and this thing actually went green a couple of times throughout the day and held Friday's gain. So very, very impressive. But if you look at the downside, again, we have to watch Tesla for tomorrow. There was pretty aggressive 900 weekly call buyers coming in and you could see from the December six lows. And the reason why the December six low is so important, this is the lowest candle, right? Defending the 50 day moving average. So if this candle gets validated, right? Or at least confirmed, then you gotta move coming to like 930, 909, and all the way down to fill in this gap, which could be very, very aggressive. They were coming for pretty aggressive short-term expiration of NVIDIA itself. And again, they were coming today for the 290s, the 285s, the 280s, and the 270 weeklies. And the reason why they're saying 270, if it confirms this whole channel here, then you have this rising support here, measured potential 271 on the 50 day moving average. Look at Boeing. They were coming today also for the 190 weeklies, okay? And this is the first close below the 10 day moving average. When it tried to rally back, it got stuffed at the 10 day moving average. So if it starts losing this bottom channel here, you can see here the December 3rd lows were pretty much correlated with today's lows. And if it starts losing that, it has a pocket of all the way to 185 to fill, which could be very aggressive as well. Look at a name like ASAN. Again, here's another example of a stock blowing up into earnings, right? Blowing up at the earnings, dead cat bounce now finally lost its 10, lost its five day moving average. Just things like a day away from confirming earnings lows. And if it does, and if you've kind of been watching this broadcast for a while, you know how much I love these earnings lows confirmation plays. Once they confirm these earnings lows, they're a week, two weeks of literally drifting, drifting lower, and you can get some pretty aggressive moves to the downside, especially if there is continuation of weakness. So some really good value tomorrow to the downside. Again, the bulls are gonna really need to put in some work tomorrow to start reclaiming some macro levels because of that 10 day moving average does get violated, right? And sellers take control, then the 50 day moving average is going to be a retest once again. So let's talk about today's pivots. Again, the weird way today was actually, you know, pretty tamed, at least in the morning, there was definitely some good value in the morning, some dips today, in names like Microsoft that was strong, in names like Costco that was strong, obviously the shorts today really, really fell apart. And that was the most important part, how easily they gave up compared to last Friday when they were still fighting over controls. And obviously when the indexes are up 4%, you know, it's much easier to kind of manipulate the narrative without realizing how ugly it was below the surface. So let's talk about today's action. Snow started off well, right? We talked about two areas, 375 and 378 big areas needs to build. Snow was super thin today, really, really thin. Went from 375 to like 377 change, never confirmed the 378 macro and then all of a sudden like everything else got really, really beat down. CL, 79, 75, 80 needs to build. Here was CL, took out the 79, 75, 80, traded up to like 81 and a quarter within 10 cents of the highs. Really nice move here. I still like this thing going higher. There was actually two areas of Microsoft. The first one was 240, 340, 80s for a dip, right? The first one was 240, 80s for a dip and you can see here why, right? You see this first channel here? Again, rising support. It actually went green on a day and traded all the way up to 340, 370s and they got pretty much rejected at the pre-market highs in the stock, obviously fell apart with everything else. TTT was pretty good. I didn't do this, TTT, I was involved with a whole bunch of other stuff, but TTT is super tight. We talked about this 99 to the upside, 93 to the downside, went to like 90 and changed. So nice little move there. Qualcomm was pretty good today. There was really good call buying coming in, Qualcomm at the open. It took out the 188, took out the 89, went to 91. Actually, it was a pretty good trade considering how weak the market was in the beginning. So it took out this whole 88, took out the 89 and traded all the way up to 91.30. Nice move there, like really, really nice move there on Qualcomm and then you started seeing all the names getting weak, all the names we started talking about on the weekend video, losing their channels, docus earnings bounce was short-lived basically, right? Anything under, it was supposed to be under. 142.50, 142.50, 142.00, if it builds below can start move back to its earnings lows. So here was docus, right? So here was docus. Again, here's a perfect example of losing the five-day moving average, took out the 42, closed right at the lows of 39 and changed. This thing starts confirming this 39 level tomorrow. I do believe there will be a test to the earnings lows and that's when the stock, that's when the trade really starts from the 131 area. NVIDIA got destroyed, absolutely destroyed, 298.50, 298.00, if it builds below can flush more. NVIDIA got, as the kids say, got wrecked. Here was the 298.00, went all the way down to the 280. And now it's staring a macro in the face and this thing loses this 280. You're gonna see a move to the two 50-day moving average. So keep an eye on that. Tesla for experienced traders obviously never got the 10.24 because now we're looking back to the downside. Guys, VRTX continues to look very, very well. Stock is just not going down and it's not going up, but it's not going down. If this thing could finally get above this 209 level, now some of these bios have been holding up. Maybe this thing goes, it's holding up incredibly, incredibly well. It's just a matter of time there. Costco, here's, again, here's a perfect example of stocks trapping, right? Costco for experienced traders only, 549, 550, bounce potential into rising support. Obviously, 562 needs to build and here was Costco. Here was the 60-minute support. You see this whole 549, 550 area? This is where emotional sellers got trapped by technical buyers. And this thing went almost green in the day. Beautiful bounce. I mean, really, really beautiful bounce. Nearly an $8, $9 bounce on Costco. Nice move there. Starbucks still not anywhere close to, here comes Qualcomm, right? Take it on the way up, 191 on deck, and that was supply. 89, 70s coming. I didn't expect 280s to come, but it sold off much more there. Nice bounce, could go green, did go green. NVIDIA, perfect move to the 290 area. And here's it, this was the one that pretty much gave the stamp of approval for the selling in the afternoon. Apple 178.30, 178 for builds below, can confirm the blow off.  I don't want to use that. Had a beautiful majestic run. Bulls did great. It just a near short-term pause. Let's use the word pause, but anyway, 178.30, 178 for builds below can flush. I gave about a dollar move initially and then finally in the afternoon, it gave it up. You could see here, finally gave it up in the afternoon and closed right on the five-day moving average. And guess what, that five-day moving average is obviously gonna be important to Apple for tomorrow as well, for the bulls to defend and obviously to sellers to try to take control. So again, market's a little bit aggressive right now. We are coming up on some key levels. If you are new to technical analysis, dive right in, fall in love with it. The faster you fall in love with technical analysis, the easier mentally you can digest information. It's all about collecting data and making logical choices on the data you collect. Guys, have a great night everybody. God bless and I will see you all tomorrow.


I'd like to introduce Nadine Grunt, our presenter on Midwives from Haiti. Nadine tells me that she was raised on the dairy farm in Ohio, and she's the mother of three and the grandmother of five. Her first nursing degree was from Eastern Menomax College, and she has a master's degree in community health from the University of Virginia. She has a certificate in Midwifery from the Frontier School of Nursing and Midwifery. And after 15 years of full-stope nurse midwifery practice, she's the founder and the executive director of Midwives for Haiti, a six-year organization dedicated to increasing access to skilled care for pregnant women in Haiti. And I'm sure we'll all enjoy her presentation. Nadine, then Mike is going to you. Okay, good morning, good afternoon, good evening to all of you.  I want to tell you a little bit about Midwives for Haiti and our efforts to increase access to skilled care for women in rural Haiti. I think we all notice that all the research has shown that what saves the lives of mothers and babies is access to skilled care. And what skilled care involves has been defined by the WHO and ICM. And so I want to tell you a little bit about our efforts to create skilled birth attendance and an increased access to that care here in Haiti. And for those of you who don't know, Haiti is a country that shares an island with the Dominican Republic and it's just its southeast of Cuba and it is which is south of Florida in the United States. So it's about a two-hour flight from Miami, Florida and it is a largely rural country. In Haiti, the bulk of people live in rural areas and have poor roads, little to no electricity running water, any of the amenities that more developed countries have. The area that we are in is largely rural and in the rural areas, although the statistics show that about 25% of Haitian women deliver in a hospital, in the rural areas, it's probably only 6% to 8% deliver at a hospital. So the reasons for that are the lack of roads, lack of money, cultural beliefs. Their mothers did not deliver in hospital so there are many barriers to care. In rural Haiti, the typical home is made of wood. Where in the cities you'll see more cement homes and a lot of women deliver on dirt floors. The problem all over the world is that women in rural developing countries live miles from hospitals, miles from clinics, and miles from midwives and doctors. So it's very, very difficult to figure out and this is what our task is all over the world. How do we figure out how to get to these women because these are the women that are in the statistics. This is a typical home in Haiti in the city. So even if you're in the city, you may not have the money to get the taxi. Most people do not have vehicles. Not only to get the tax to the taxi, but the bulk of the hospitals are private and require cash. For example, in Port-au-Prince, it'll cost you $600 to $700 to have a vaginal birth at the private hospitals and over a thousand US dollars to have a C-section and that is completely beyond the capability of the bulk of people in even Port-au-Prince. So in Haiti there have been in the past only two kinds of midwives. There are the matrons and the matrons are uneducated, untrained. Sometimes have received short little training programs by the government or other agencies. Most of them cannot read and write and they have an incredible amount of cultural beliefs about childbirth and pregnancy that make it very difficult to educate them. For example, they believe a woman's water breaks through her mouth.  I think we seem to have lost Nadine, but I'm sure she will be back momentarily. And I see we have some new participants have joined us. Why don't you tell us where you're from while we're waiting for Nadine's connection to pop back up. Ah, some of them are still. Excellent. And Penny had asked a question earlier about isn't social distance a barrier as well, especially serving in a country like Haiti? I think that would be the case. She named me having difficulty with her internet connection. I know we had some issues when we were practicing with us, but hopefully she's able to loan out and log back in again. I'll keep an eye on her when she comes in. Oh, I thought she's left the meeting, so maybe that's what she's trying to do is log back in again. Do you want me to just advance the slide so that people can get an idea? There's a lot of it. It's very visual, and maybe she can capture stuff when she comes back in. Why don't we give her, yeah, there we go. And Sarah has shared the website for Midwesters for Haiti as well. So perhaps we can just wait another minute and see what happens. And here's Nadine. Okay, let me just promote her. Okay, Nadine, I advanced a couple of your slides. So we're at your discussion of maternal mortality here if you want to jump in at this point. Just one minute, I have to promote her. And there we go. As soon as you're ready, Nadine. Okay, can you hear me? Yes, we can. Yes, we can. All right, it's good. It's exciting. I advanced two of your slides. So if you want to jump in with your discussion of maternal mortality, that would be great. Okay, so I wanted to explain the two kinds of midwives that are in Haiti. The matrons that are uneducated, and most of them cannot read and write.  And so there's only about 180 of those in the country. The bulk of babies born in Haiti are born with these untrained matrons. Therefore, the deaths per 100,000 births are really high in the highest in the western hemisphere. There are some statistics that show this more like three to 400 per 100,000 births. But many people in Haiti believe the 610 is more accurate. We know for certain that much of the maternal deaths that happen here in rural Haiti never get reported to any agency. So we believe the 610 is much more accurate than the latest statistics that were published. In Haiti, the causes of maternal deaths are most likely to be from hypertension. There's a high degree of chronic hypertension at a very low, very young age. And we're not sure why exactly if it has to do with genetic, long-term malnutrition, but pre-eclampsia and eclampsia are rampant in Haiti. Temerase is the second reason. And like all over the world, infection, obstructed labor and incomplete abortions are the next. So all of you know this that worldwide there are at least 254,000 maternal deaths each year. And I know for certain that probably is much higher because here in Haiti so many of them do not get reported. So one woman dies in birth every one to two minutes, which is the equivalent of two jumbo deaths crashing each day. In Haiti, we've been trying to figure out what we can do to change that statistic. And so we started by trying to train skilled birth attendants. We've had no curriculum when we began six years ago, no materials in Creel, which is the most common language. We started teaching under trees, hospitals, laundry rooms once we were in a hotel courtyard. But as of last year, we finally have an indoor classroom with electricity and ability to get internet and show PowerPoints and videos. This didn't do very, very well with visual learning. We found that the World Health Organization had midwifery education models, but they were in English. The American College of Nurse Midwives had life-saving skills manuals. They were in English. Other organizations such as UNICEF and JPEGO had some materials that they were in English. We have translated the main text, a book for midwives, into Creel. And so that is our main text used for students. We also use where women have no doctor, which is in Creel. And we have since picked up some textbooks in French for our instructors. And we're getting more and more materials translated into French. Some universities are helping us to do that. We decided to build our curriculum around the core abilities of a skilled birth attendant as defined by WHO and ICM. And there's 30-some abilities. I'm not going to read them all to you, but they include everything from assessing individual health status, performing screening tests, identifying abnormal lab tests, educating women in self-care during pregnancy, childbirth and postpartum, identifying illnesses and conditions that put a woman's health and her babies at risk during pregnancy, monitoring maternal and fetal well-being during labor, use of the partogram, managing third stage of labor actively, knowing how to do newborn representation, identifying hemorrhage, postpartum hemorrhage, preeclampsia and eclampsia, and doing first-line management of these emergencies. We also are trained to identify illnesses and conditions that are detrimental to women in the postnatal period and provide advice on family planning. And then the component also is there of us having shared responsibility with the woman and her community in having optimum health. One of the barriers to skilled care in the Central Plateau where we are, and I was going to show you on a map, I'm in Intady, which is YLOP Internet, in a very rural area. And the hospital that we are in serves an area of about 600,000 people. It is very poorly resourced. It's owned by the government. And so therefore it has added to the version of teaching students well. It's very difficult if you have the constraints of food supplies, of poor equipment, lack of trained staff to model care. And so one of our barriers to training skilled birth attendants has been what we have to work with. And as you can see, the delivery beds are one of those problems. We start with women or men who are either an auxiliar or an infaniate diploma. Auxiliers have about 18 months of some basic nursing. Jerry hands on, it's sort of equivalent in the United States of a nurse's age. They can take some vital signs. They can start at ease. Infaniates are different. They have a four-year nursing degree. And depending on the quality of that education, they have a pretty good understanding of some pathophysiology. But what we found is that putting them both in the same class has not been a problem, because both of them lack obstetric knowledge, obstetric background, and the skills needed to be a skilled birth attendant. We use infaniate systems who are the midwives from the university program in Port of Pints. And they're very difficult to find and very difficult to keep. We've lost two teachers to Canada. And that's been the biggest problem with this university program is because they have a nursing background and because they can speak French, one-third of the university-trained midwives have left the country. Most of them are in Canada working as nurses. So it's been difficult for us to find these teachers, but teaching in any language except what the students can understand is way too difficult and takes way too long. We have a ten-month program and most of it is done in this hospital where the people who come are really quite sick because if a pregnancy is deemed normal by the family and her friends, most women are still delivering at home. What we see come into the hospital are very sick women. This is a 17-year-old pregnant woman who arrives in seizures and the instructor and students quickly starting an ID and starting magnesium sulfate and then monitoring her urine output. And this baby did not make it.  So the students are working in very high-risk areas. The next slide shows that one of the issues we're dealing with and struggling with at all times is that people say to us, you're not training midwives, you're training skill birth attendance. And the reason they say that is that per the International Confederation of Midwives, a midwife is educated in a program that's recognized by the country it's in and it fits the framework of the ICM Global Standards for Midwifery Education. We think that we're able to meet the next three. Our students can meet essential competencies for basic midwifery practice and they're learning the scope covering pregnancy, labor birth, postpartum, prevention and detection of complications. And they're doing a lot of counseling and teaching to women in health and communities. But our program is not recognized by him. We do have a contract with the Ministry of Health and the Central Plateau and the Ministry of Health signs are diplomas. But that's for the Central Plateau. Our students work in about 14 different areas of Haiti. Haiti has 10 districts. And what we're making an effort to try to get Central MSCT, which is the health department of the government, to recognize our diploma in every district. But it's really difficult because they are changing their program from the four-year nursing as an entry requirement to a four-year direct entry program. So they currently are still developing a midwifery program and have not completely got that curriculum completed. So at many meetings we're told, well, we'll accept your program if it bridges well with our program, but their program is not developed. So we're still waiting on number one. Therefore, many people say you can't call what you're doing and that you can't call your graduates midwifery. The problem in Haiti, if there's only one accepted midwifery training and it's still in development and that the old four-year nursing program graduates, a third of them have left the country, we have to find a new way to educate midwives because Haitian women can't wait until it'll be four years before we even get graduates from this program in Port-au-Prince. What do Haitian women do in the meantime? What do we call our graduates? Right now our graduates are called either Azuliers or Insaniers with a specialized obstetric training. Now, the people they care for call them midwives and everyone here in inch calls them midwives. We're not sure what they're going to call the graduates of the four-year direct entry program even because they're not going to be Insaniers or Thames, they're not going to have started with the four-year Insaniers degree. When they decide what they're going to call the graduates of the four-year direct entry program, it'll give us some guidance of what we can call ours eventually. So, educating is not enough. We had to get out to where the women are, we started a rural prenatal clinic by going out to 16 villages a month where women come for miles around to get prenatal care. This is done with our deep, which is able to go places there are no roads and through rivers. And we see an estimated 20 to 60 women a day. We've had as high as 90 to 100 turn up in a village for care. So there are four to five midwives to go out because of the intensive work that's involved in seeing this many patients in one day. Every patient has a record and to get blood pressure, weight, a fundal assessment, fetal assessment. Basically, we try to give everything that she would get if she had gotten to the hospital, including HIV and syphilis tests, gonorrhea and chlamydia. HIV is about 2% in rural areas. Syphilis is about 11%. And we're finding gonorrhea is rampant here in the central plateau. We have to use rapid tests. We don't have a lab to take things, take any specimens to. HIV and syphilis, we cannot afford to treat. So we send them to the local hospital and there they get serum testing. And if they are positive, they can get free treatment through partners and health programs in inch or con armor abaly. We do treat the gonorrhea and chlamydia. We treat malaria. Every woman gets worm treatment in the second and third trimester because anemia is a real huge problem. And some of it is caused by poor malnutrition. Some of it by worms.  They all get prenatal vitamins, folic acid, iron. We give calcium when we have it. We get our vitamins from an organization called Vitamin Angels. We purchase a couple thousand dollars worth of medications each month for this mobile clinic program. The midwife does a lot of teaching about how to take medications because patients typically will hoard medications until they feel bad. There's an incredible amount of education needed as to why you need to take your pills on a daily basis. These are three of our five mobile clinic midwives who are really well loved throughout the community. And in our three years of doing mobile clinics have developed a reputation so that people seek them out for advice to their communities, the women in their communities of all ages, even those who are not pregnant, seek out these women for multiple health problems. What we'd like to see all over Haiti, and we think should be the model for all over the world, are rural birth centers where midwives do this kind of care and screen and then have transport to hospitals within 30 minutes to an hour for taking care of emergencies that turn up in obstetrics. We're trying to get a birth center started and hopefully in the next couple years we'll have several sites where we open those. Right now we're the women, most of the women that we take care of in these mobile prenatal clinics they're still going to deliver at home because they don't have access to transportation and the funds to buy transportation. They're fortunate that if they do get to St. Jerry's Hospital because it's a government-owned hospital the care is free. Then we started, because most of the births in rural Haiti are still done by May Crohn we decided we needed to reach out to these caregivers and make them a part of our system. So a year ago we started training May Crohn and May Crohn's been very excited about receiving training. We do a 20-week program that was developed by Management Sciences for Health. It's approved by MSCT, the government and the graduates of this 20-week program get little certificates signed by the Ministry of Health and by Midwives for Haiti. They get badges to wear and they're encouraged to bring their patients to the mobile prenatal clinics and to the hospitals when they notice risk problems. We were totally blown away by the results of doing this in just one rural community. What happened is that we saw an immediate increase in the number of women who came for prenatal care and we saw an increase in the number of women who came to the hospital with their May Crohn for care. The May Crohn are being encouraged to stay with their patients being welcomed so that they feel a part of the system and they feel like they're still taking care of their patients even when they come to the hospital. The patients trust these women because these are women and men because these are who have delivered the babies in their communities for years and years and years. But when these May Crohn say, I learned that when you have a headache and your ankles are swollen that we need to go get your blood pressure taken. They are much more likely to seek help than if they were not referred. This has been a very exciting part of our program and there's now some new research, although at one point funding for training these May Crohn disappeared because WHO felt the research showed that it didn't help at all. There's now some new research that if they're integrated into a system where of midwives and doctors and hospitals, it can make a big difference. We found it really exciting to reach out to these women and men because until Haiti's statistics change, this is still who's going to be doing most of the delivery. So we have to give them tools and knowledge. We not only supply them with a 20-week program, we are keeping each one that we train supplied with clean birth kits. And that has been very exciting for them to have clean razor blades, gloves, a receiving blanket, and a large, clean piece of paper to have the women deliver on these dirt floors in these dirt floor huts. In the meantime, we are working very hard at reaching as many women as we can with the message that they need skilled care. So we do classes both at the hospital and at these rural clinics. We do postpartum care. So what you see in that slide is a young woman who is having her second baby and went home about four hours later. So the midwife did a home visit. This is the father, his first wife died a couple weeks after childbirth. We're not sure of what. And so he is very happy each time this second wife comes home from childbirth and very proud of their baby. They always dress their children with the best things they have when they know someone is coming, but what they may have the next day is nothing. This is a woman who had a severe postpartum hemorrhage treated. She was delivered at a birth center that's run by Heartline in Port-au-Prince. And because of the severity of her postpartum hemorrhage, ended up getting transferred to a local hospital and having a hysterectomy. But the happy news is that because she's got care with skilled people, she was able to go home to this family. The result, as you know, when mothers are not able to go home and when women and mothers die, it means a significant loss for both the family and the community and the chances of children under 5 that that woman has with surviving past the age of 5 is more than 50% reduced. So it's really a tragedy for everyone if these women don't survive. And this is one woman who would not have survived. So birth centers in Haiti, we know there are several. There's one in Cai, which has excellent statistics. It's run by midwives. Four of our graduates are working there. There's one in Port-au-Prince, run by Heartline. There's one in K-Pace, run by Mama Baby. There's one in Fontaracine. There's one in Thomasique. All of these except the ones at Heartline have our graduates working at them. They are within 30 to 60 minutes of referring to a hospital. And we think this is the model that needs to happen in Haiti all over the country and that even more developed countries like the U.S. to develop this model would save lives and save hundreds of dollars. In the meantime, we're graduating about 15 to 20 graduates per year. We have currently 56 graduates working in 14 areas of Haiti. This was class four. Each year, the line of applicants gets very long. Two years ago, we had 67 applicants. Last year, we had 81 applicants. We screened them by looking at their diplomas. They are really a family of diplomas by looking at their past work experience and by giving them a basic competency test, finding out whether they test their reading skills, their math skills, and a little bit of nursing background. Here, back in the United States and in many of your countries, we are well equipped to take care of every obstetric emergency that comes through the door and we have everything ready to take care of a pro-left cord in 15 minutes to stop to... And we rarely see seizures in women because we touch preclampsia so soon. And the question has been asked, is this what we need in every country and is this realistic in every country? What we think and what World Health Organization has proven is that you need these three legs. You need skill birth attendance, which is what we're trying to do. You need transportation so that they can get their patients who are having complications to a well-staffed and equipped medical center. The birth center model is a wonderful model for Haiti and we're hoping to expand on that in the next couple years. Our mobile prenatal clinic midwives are begging us to get out to the villages where the women are delivering because they are very upset when they go out and find out that a perfectly healthy woman that they took care of during her pregnancy died from a postpartum hemorrhage and it's just a statistic that needs to have a solution. So transportation, skilled care, and a place to go, Haiti needs at least 1,200 skilled birth attendants immediately. It currently has less than 200 university chains midwives at the end of this year. We will have 79 graduates who are working and we are hoping to open up a second school in 2014. We hope to find a facility where we can have a better model of care but in the meantime, we know that there are just some basics that are needed to save lives and we can make a difference by what we're doing. I'll take questions now. Raise your hand if you want a mic or just type your question in the chat box, please. Do women, if someone put, do women there always birth in stirrups? At the hospital, yes, quite frequently, which is one of the reasons they don't come in because they're used to breathing, standing or sitting up at home. We have struggled with the lack of beds in this delivery area so that women can change positions and we've been accused of, we've been criticized because some of our patients who we walk as long as possible rather than put them in these positions have delivered on the sidewalk and on the floor and we are in the process of showing the staff that this is very acceptable if you can put down clean paper, clean cloth. I could talk for a day about all the obstacles that we have had at this government-owned hospital to doing care the way that is evidence-based and we're actually kind of tickled when a woman delivers in the antipartum room where there are just beds and we can deliver there but when they're deemed to be in really active labor and close to delivery, they walk down the sidewalk to this room that has these exam tables with spirits in them and so most women are delivering there although our midwives have seen many videos and examples of other ways to do it. One of the things that we have not done before but we're starting this year is we want to get the birth centers that do exist in Haiti which there are about five or six of them involved in our education of our students. For example, we have two students right now in our class that are from Lagunaib, that's the island that's just off of Haiti. They're not going to be delivering at a hospital, they're going to be delivering at a birth center so they need birth center experience so we are working on developing the problem right now is money. How do we house and pay for the room and board of our students at these birth centers while they get birth center experience but we are going to be putting Delana and Fluxelia at a birth center for six weeks in one, hopefully six weeks in three different because we know that what they need is birth center experience not hospital experience and that most of our students are going to be working eventually in birth center setting so we've got to get that, we've got to get out of this hospital with models such poor care in so many ways. Okay, Nadine, there's a question from Carrie Smith about if I interpret it correctly about having students from other countries come to work with you as part of their clinical experience. Have you explored that option with any of the midwifery programs outside of Haiti? We discourage midwifery students because they come with the goal of wanting to catch babies which can take away from the opportunities for our own students. Unless they plan, first of all they have to come with their own preceptor and they have to schedule their time at this local hospital at a time when our students are not there. So we have an agreement with the hospital that we will not have midwifery students teaching midwifery students. We have used them in the classroom. They, students from Philadelphia University, University of Pennsylvania have helped with classroom teaching but they can't be part of the clinical training of our students and they have to be precepted by a... they have to bring their own preceptor. So it's not impossible. We have on two occasions had midwifery students here with their preceptor working at the hospital but it had to be, they worked mainly nice when our students were not in the clinical area. Thank you very much for addressing that. Okay, there's something here from Ella. Go ahead. Okay, a question about Ella, from what kind of practices take place in birth settings that are more in turn with physiologic birth? Do you want to address that for a little bit? Yes, it depends on the birth center. In, for example, at Heartline Birth Center we find that no one delivers in syrup that they deliver, they frequently labor with a sling, labor walking, standing, and deliver on a regular bed. In general, all the birth centers have a lot more freedom to provide physiological birth practices than what we have here at the hospital although we entrain our students that they're, and model to them with the patient other ways of delivering besides flat on your back. So I know that students would love to, students who would like to get experience here and we would like for them to come with the goal of helping us increase our curriculum. We can always put them to work, but they would not be able to be in the hospital setting without a preceptor. So they can come and get an experience of the cultural experience of being in Haiti and being with women in Haiti. They can go on the mobile clinic, they can visit birth centers, but they would not be able to actually catch babies without a preceptor. Someone asked how the three mobile midwives establish such good rapport with the community women, and that's because they're out there every month. And while one of them is taking blood pressures and weighing women and doing fundamental height, the other is talking to the rest of the women. We have some kind of sort of an informal centering pregnancy happening in every village where some subject is discussed, whether it's breastfeeding, signs of preeclampsia, family planning that's available, the signs and symptoms of danger to be watched for. And so over time, these midwives are very loved because they demonstrate that they care very deeply about that these women have safe birth and are really concerned. And frequently say to a woman, you really have too many risks. When you go into labor, you need to have transportation to the hospital as soon as possible.  And they preach this in every village that you need a plan in case there's an emergency. You need money set aside to pay someone. You need to know who you're going to call and you need to have gas fuel to put into that vehicle. Because the delays, we know that one of the problems in rural areas is the delay in seeking care and the time that it takes to get. There's a delay in the decision making. There's a delay in the transportation. And it's the reason that deaths happen in rural areas. Partners in Health, someone asked a question about that. There's a main organization that we have a partnership with because they actually support this hospital with all the medication that is available. And they have the clinics, the HIV, syphilis, STD clinics where people can get free care. Partners in Health also recently built a new hospital in Mirabilis. But the sad thing is that there are no birth centers around it and very few prenatal clinics I think only two in the surrounding one-hour area. So what they're going to be getting is simply self-referral. And we want to partner with them to create more antipartic care and more prenatal care out in the communities around their hospital because they will be much more effective if women are being screened for birth. Okay. Someone said, our birth attendants have little or no access to obstetric drugs. That's true about the MACE home. But not our graduates, our students do have access to obstetrician entomizer possible and know how to use it. And they use active management of Thursdays. Okay, Nadine, this has been fascinating. I'm sure people would love to hear you share more about your experiences. Can we refer them to your website midwivesforhady.org for if they have further questions or want to learn more about your work down there? Yes, and I did not. You can see that we're on Facebook. You can message us through that. www.midwivesforhady.org, the website there, also has some emails of board members and administrative assistants, people that can help answer questions about volunteering, about teaching. We really love to have people who can speak Creole and Sprint, and we know there's many people in the world that can speak Sprint to our midwives. So please access that site to find out more information. Okay, thank you so much. I'm going to wrap up the meeting now. Thank you, everybody.


Okay, well This afternoon I wanted to try in 18 minutes to combine the practical with the profound and To reveal the obvious in the unseen so I was gonna do this session without any slides at all Because I wanted to kind of take you on a journey and then I realized but wait there's some quite pragmatic Concrete things that I want to share with you And so the slides are there to assist you with that but not to distract you from what I'm saying, okay Concretely today I'm gonna talk about a Concept from sociocracy 3.0 and for those of you who don't know what that is It's basically a menu of behavior patterns That you can observe emergent in collaboration over time and persisting Because of their usefulness in certain contexts and to take that out of the Very complicated phrase. I just said for example Delegating influence to people in what we call roles, right? That's a pattern. We do it Everywhere. Yeah, because it's useful. Okay, so that's one example So I wanted to talk about a key concept from S3 So she'll see 3.0, which is drivers Can you raise your hand if you've heard of the concept driver from sociocracy 3.0? So Some of you, okay So I want to just clarify for those who don't know what what we mean by that and also to offer you some insight into how to Describe drivers and that will make more sense as we go. The other thing is on the topic of decision-making Okay, is how do we make and evolve agreements harnessing collective intelligence to achieve the best we possibly can with what we have and then act on that and Learn from it and iterate and evolve things incrementally. There's so much investment into agile operations Yeah, like billions and billions and billions But agile governance agile decision-making at the organizational level applying that same mindset Well, this is a this is an emergent realization among organizations that that might be a valuable thing to do It's kind of like the antidote to waterfall governance So and on top of that, I want to reveal what's underneath all of that like what's under the hood behind these things So let's see how it goes. Okay Driver I stopped. Okay. Good a driver the motive for responding to a situation Okay, when we say driver It's a difficult word because it's like what's that like driving the bus or something It doesn't translate into Swedish and it doesn't even work in English because there isn't actually a word to describe what I'm talking about so to Take you behind what we mean a driver is a combination of perception of something happening in the world in a given context that matters to the person or people perceiving it a Driver perception of something happening in the world might not be true But it's a perception of yeah occurring in a certain context that matters to somebody or a group of people who are perceiving it Okay, and all you do as a human being from birth to death is identify Categorize prioritize drivers and respond accordingly. That's all we do. We're like driver spotting entities, you know, the whole systems set up to do that So why is this a concept we have in S3 well It's a useful concept because if you see something happening that you think matters in a certain context One it's useful for you to be able to understand what that might be and what it might mean and Secondarily if you need to communicate it to others, it's useful to have some way of doing it Yeah, and so we have been exploring with S3 like how do you summarize something like that? How do you summarize this thing happening in a given context that matters or maybe matters? Okay, and You can break down a driver summary into approximately two pieces one is to talk about what's happening like objectively It's okay. The water spilled on the floor. It's like something objective And secondarily to talk about what might be needed. There's water on the floor Maybe it needs removing from the floor for example, yeah And if you take that on another layer of granularity You can also then further break down to what's happening part in terms of the situation So the objective situation that's occurring and the effect or the anticipated effect of that situation on the organization So think of this in it. I often hear people give examples of oh well people aren't taking responsibility It's like So what why does that matter? It's like that doesn't tell me anything, right? It just tells me people aren't taking responsibility. It's not even that objective, right? But if someone says you know what last week 50% of the essential work that needed doing on the back low was not done And the consequence of that was we lost half of our customers this week, right? Now I know what's happening concretely objectively and I know what the effect of that is and why it matters Okay, and that's gonna help me with categorization and prioritization of that situation And anticipated effect because sometimes it hasn't happened yet But you see something happening and you think hmm the consequences of that might be really bad or hmm The consequences of that might be really cool if we interact with that situation in some way and on the other side is What's needed right and when I say what's needed I often hear people arguing well We need to do a and we need to do b right but when you get into those kind of arguments You're too much in the strategy space in the solution space, but if you zoom out a bit and say okay Well, what's the thing that's deficit that were we to do a or b would? Help to change that situation to achieve the kind of impact that we would want to see Yeah, when you zoom out far enough you arrive at that point where the person arguing for a and the person arguing for b says Okay, well I can agree with you on that and that is so important because as human beings We are limited in our perceptions, you know we we we have different facts Right, and and it's good to be humble about that and recognize it and when we're trying to navigate complexity It's like you don't know what's happening really actually you can just see certain things occurring right and you can be more or less Accurate about what those things are so being able to Converse with others and say hey look do you see this too looks approximately like this And I think that's the effect or it could be and what do you think and what do you think is needed and? What kind of impact might we want to make on the current state of the universe so it appears up in a different way tomorrow? Yeah, is a very useful mechanism to have drivers is a is a really useful mechanism, and there's two patterns in S3 one is Describe organizational drivers, and the other one is respond to them according to your priorities so Drivers can be Problem-focused or solution focused and usually you can look at a situation either way Yeah, there's going to be optimists in the room. It's like everything's fine And it's all going to turn out great It's an opportunity and there'll be those who are more pessimistic and say this is a damn big problem And if we don't do something in a minute, we're screwed you know and both are valuable perspectives and how you describe a driver Depends on the context you're in and the impact that you want to have right Sometimes it helps to give an optimist a slap and say yeah well maybe mate But the reality right now is it's not looking good and conversely someone who's more pessimistic to support them in seeing how They could have a better tomorrow so a couple of examples just to make it concrete this is from a Customers of ours, so one is ambiguity on how we contract track time and bill Leads to perception of unfairness by people inside and out Okay, this was a consultancy company and this was what was happening because people were billing in different ways They were charging for things that other people weren't charging for and it created all kinds of problems for this company and relationships with their customers and then What they decided was needed was a common enough approach There was an Deficit of a common enough approach so everybody was doing their own thing That everybody adheres to and forgive me looking at this because I have got it by heart to bring clarity transparency and fairness Yeah, and once they got that clear Yeah, and it was a difficult conversation for them because some people Didn't want to talk about it. Some people didn't know about it Others were so angry about it and by getting back to the basics of what was happening and needed They were able then to interact with that and decide how to proceed. Okay, and what came out of that actually was a Collaborative proposal forming where they came up with some basic constraints that would enable them to evolve a more Transparent way of doing these things together and they were very happy about that Another example. I just wanted to introduce a an opportunity focused driver So we have considerable resources and the potential to further utilize our production capacity This is a manufacturing company in Russia that manufactures chemicals and products for the oil and gas industry And by their own admission, it's like it's a pretty a pretty kind of a how can you put it corrupt? environment to be in and they've got a very progressive founder who just recently gave over 90% of the company shares to itself and Created the first company in Russia to own itself It's not people own companies the company owns itself and people become stewards of the company and has found ways to decentralize authority and Invite people to take full ownership of the system to figure out what else can we do in the world? And so they want to develop new opportunities and innovate to make the best use of what they have Again, it was like unclear for them like what's going on and what the problems and what are the challenges? And we had long conversations to unravel things and we condensed it down into two sentences Yeah, what's happening the situation effect or anticipated if it was needed and the anticipated of Impact of responding to that need not the truth, but a starting point Yeah, not the solution, but the thing needed begin there Decide Experiment fail if you need to evolve and learn not just your decisions, but what you thought was happening and needed So that's driver Now the thing about drivers is When you clarify a driver and you agree it's important the next thing is you need to do something or you need to decide something Yeah, so some drivers that you're responding to in your daily work. It's just stuff needs doing right? It's like oh, this is happening. This is needed Yeah, don't know that need to call James for example It's operational stuff and there's organizing work as well, but on the other side is the governance It's the making decisions that govern future decisions and actions right decisions that constrain What happens to guide the creative flow in the way that you want it to go to create value? And and that's another area that's really challenging for people the decision-making Right because when you need to decide across stakeholders with different perspectives opinions biases preferences Interests and so on yeah, you need some kind of mechanism to arrive at something good enough And we've got autocracy.  Or you've got majority I've said this on this stage before it's the most stupid idea in the world not in itself because like okay We can dot vote or we can see where the majority opinion is but wisdom always emerges through the minority first, right? So if you concede to the majority always you just got a diminishing set of options over time and consensus Consensus by unanimity. It's like we're all gonna agree with everything And we're just gonna spend our whole lives talking and talking and talking and talking and talking and talking and not agreeing anything I was in an elevator going from a workshop. I ran here with my wife and coach co-teacher Lily Lilliana We're going down in the elevator after this workshop on decision-making. It said learn how to make decisions even in Sweden. I Loved it. It was great You remember that you were in the elevator exactly. Yeah. Yeah, because it's like okay Let's be more pluralistic inclusive egalitarian and not get anywhere, you know Because we're just trying to include everybody and everything. Oh, sorry include everything everybody and everything all of the time so Is there an alternative? Supremacy to the individual of the small group doesn't work especially in complex environments Supremacy to the majority doesn't work. You lose the collective intelligence Supremacy to consensus with unanimity doesn't work because the first person who says I block I don't like it and it's not gonna happen. Even if it's unreasonable Becomes the dictator and you're back to autocracy So supremacy to people groups and individuals is a problem in decision-making, right? So I want to introduce the principle of consent. Can you raise your hand if you've come across the principle of consent from a sociocracy point of view Yeah, okay, so let's see if I can define this for you consent the absence of an objection, okay So the principle of consent says raise seek out and Respond to or raise seek out and resolve objections to decisions and actions. Okay, so that begs the question then, okay? What's an objection? so It's an argument We don't teach our kids how to argue we say stop arguing It's like what you did argument like in the sense of Arguing for why something might be the case. Yeah, and being able to do that in a concrete and clear way for people an argument that demonstrates or reveals how an agreement or a proposal or some kind of activity is Leading us to unintended consequences Yeah, if you carry on like that, it's gonna be really bad and here's why or it might be and we don't want to risk it Or an argument that demonstrates that there's a worthwhile way to improve something Yeah, people think of objection like something negative But if you think of it as a gift something that reveals a possible problem like Stop going that way bad things are gonna happen or a possible tool like keep going that way good things might happen And we can improve it. Yeah, this is a more healthy way to think of objections So the question is and well, how do you know if an objection is true? How do you know if the argument is true? And this is the techie bit. I want to try and nail Okay, and I'm gonna run through it and we share the slides afterwards so you can come back to it Okay, so listen to the argument. I'm gonna look at this because I don't even remember how I constructed it So listen to the argument check people understand the argument Reflect everybody. Do you think this argument qualifies as an objection? Does this argument reveal the potential for unintended consequences? we want to avoid or a worthwhile way to improve and Does anybody disagree with this argument totally or partly and this is the question because if you say I've got a Objection and then you just say okay, well you've got an objection So we'll just have to change everything now as a consequence You're missing a point because the person might be a little bit off the rails on their argument Yeah, it could be partly or entirely untrue. So checking to anybody disagree takes us down a layer It's like No fine Qualified seems good enough according to the collective intelligence of the stakeholders involved You've got a point nobody sees a problem with it so we can act on that But sometimes someone says wait, I don't agree with you. I think you're mistaken partly or totally So what do you do about that? Well you fight, right? Okay, fight. Yeah, well another way of doing it. It's kind of fighting but it's saying Let's repeat the process. You disagree. Let's hear your argument Yeah, do people understand the argument? Reflect do you think that argument counts as an objection to the first argument and does anybody disagree with this argument totally and partly Etc etc etc Okay, so you're using the collective intelligence of the people to bring the multiple perspectives to empirically and rigorously Take apart arguments and check that they're robust enough according to the intelligence you have available So it kind of looks like this you've got an argument There's a disagreement you hear it another argument you check and maybe there's a disagreement again and another argument and you check And there's a disagreement again and suddenly you're like three layers of abstraction down and you say oh my god There's another disagreement so your four layers down and and and then somebody disagrees. Well It's a little reassurance in the last 18 years I've experienced never going lower than level four because either you misunderstood an earlier argument or what happens is it comes back up Because the last person says no I disagree with the person who's arguing against me And so a little trick if you're in that situation and you can have the discipline to follow the process then oh sorry You can invite a time box conversation between those two people and say There's something in both of your arguments. Have a conversation and find the both and more argument And then once you've extracted the both and more you come back up the stack again Integrating at every level and finally you want to check Listening to the original argument. Is there anything left of it? And if there is do people understand it? Consider if it still qualifies and does anyone disagree totally or partly and you'll arrive at the point Where there's no more disagreement and you've qualified the objection. Okay, so lastly I just want to move on a little bit because the last thing is okay. Well, we qualify an objection, but then what do you do? Okay, so resolving objections is another pattern from S3 basically you invite the person first to See if they've got any ideas how to change or amend the proposal or the activity according to their argument to resolve the Objection usually a person objecting has a lot to offer in terms of how to constructively evolve something and Then following a very familiar process now check people understand the proposed amendment and Check for any objections to the amendment and if there are Process those possible objections in exactly the same way. I just shared with you in the resolve objections plan So if there's objections propose an amendment to the amendment Check people understand it check for any objections to the amendment to the amendment Etc. Etc. At the end you're going to arrive at a point where Objections have been resolved you zoom out to the whole proposal and you go through the process again and finally you can celebrate some more Because you've achieved a miracle You've made an agreement together where all objections have been heard and integrated into the original proposal And everyone has a sense of peace and reassurance in what it is that you arrived at so The final thing I want to share about that is good enough for now safe enough to try it is the best you can achieve in a moment and It might be completely wrong So evaluate, yeah reflect on outcomes Evolve your agreements incrementally learn through doing and As a way to finish this Maybe with something a little more profound. It's not either or it's both and more I think I said in the talk just now that maybe I didn't last year. Maybe Ken Wilber saying nobody's smart enough to be a hundred percent wrong now, of course We can be mistaken, but what he meant by that was there's something of wisdom in everybody, right? And so what amazes me about Intentionally proceeding with consent decision-making is it says we're going to suspend our biases and our opinions We're going to fully show up with our perspective and what we believe to be true And we're going to rigorously listen to others as well We're going to hold the tension between apparently polarized and irreconcilable opposites and in the creative space that emerges Give birth to holes that are greater than the sum of their parts And that's my presentation to you


So, the tumor microenvironment of pancreatic tumors tends to be what we describe as nutrient poor. So, the cancer cells have less access than many normal cells to the sugars and other important nutrients that help cells proliferate. So, because of that, pancreatic cancer cells have developed these sort of alternative adaptive mechanisms that allow them to take up nutrients differently from their environment and also use them differently once they get into the cell. One of these processes is autophagy, which some people might have heard of as self-eating. So, this is when the cell actually breaks down things that are already inside the cell, whether they're organelles or proteins, and uses the fuel that they generate from those to help them proliferate. And sort of where we went with our story is that we found this pathway called mitophagy. So this is a form of autophagy where specifically the mitochondria are broken down and then recycled for their different parts. We found that this pathway seems to be one of the ways that pancreatic cancer cells adapts to those low-nutrient environments. So, one of the things that we hope to do now is sort of see how we can harness our understanding of this altered sugar metabolism and also changes in mitochondrial dynamics into a therapeutic strategy for patients.


Hello, hello, hi How's surface world good everything's fine great How are you? Tired, but in a good way busy Unit trenches still unit trench. I'm worried About you. I heard there was a storm coming. I told you I Need time because as far as I can see you're just treading water We're upping the extraction rate maximum output. I don't expect you to understand You're not the only one who's suffering. I need you with me here now I will be promise


Hi, welcome to Nursing School Explained in this video on hypovolemic shock. Now, a hypovolemic shock is basically a loss of intrabascular volume. And that can be a loss of volume, so of basically the fluid, or it can be loss of blood, or it can be a combination of the two. So if we're just using losing fluid, this can be due to vomiting or diarrhea or maybe a heat stroke, extreme dehydration, and so forth. But we can also lose blood or blood components from, let's say, a GI bleed or any kind of massive hemorrhage from a trauma or any kind of other injury. Now, those of fluid losses to the outside, they completely leave the body. But then there's also third spacing, such as in burns, or maybe even patients with ascites who have third spacing in their abdomen. And that would basically be lost to the extravascular space, where it's still, where the fluids may still remain inside the body, but they are now out of the intrabascular space. And whenever we think about loss of intrabascular space, we have to talk about cardiac output and stroke volume. So, physiologically, if we now have decreased volume, we're going to have decreased stroke volume, which then leads to decreased cardiac output, which decreases the blood pressure, which means that our organs are not being perfused. The body is going to hold on to every drop of fluid, and therefore we have decreased human output, and then eventually we'll have impaired cellular metabolism.


Sergeant Alvin C. York, he made a talk, there was a huge crowd and I was standing on the bench in the back of the room and I kept asking my mother, where is he? I was expecting a giant of a man because they said he'd done so much. When he stood up to make his talk, she said there he is and I said, my God, that little war frat, he couldn't have done all the things that they said he'd done. He was strict. He had a set of rules that you'd followed and I mean he enjoyed life, he wasn't abusive, wasn't mean or anything, but I imagine the strictness came from his training and then he had five or six years of being in the military. Well, everybody here just thought he was a farmer and he did a little something in the moor but he never would talk about it. I knew from my childhood that he was a war hero. I would hear that in my family as I was growing up that he was a war hero and that's all that was said. I didn't realize all that he had done. I have learned more about what he'd done after he's passed away than I did the whole entire 58 years I lived with him. He didn't talk about it. My dad was not a boastful individual. He didn't want to brag on anything that he'd done, he kept that internally and so that says a lot about his character. He liked to work behind the scenes and no doubt that's probably part of what earned him the merits in the war is he done, as he said, he done what had to be done. The action was January 24th in 1945 near Hussain, France and winter and a deep snow and the Americans and allies were, had been moving the Germans back and they made what they considered the final stand. He had been in a hospital because he had suffered a severe hip injury which actually left him with a permanent disability for the rest of his life. He slipped out of the hospital because he was going to send him home and he hitched a ride back up to the front. They were pushing the Germans back over across the Rhine River and his battalion was always in the front. There were Germans coming in with tanks and in great numbers and Colonel Ramsey was trying to decide how to counter this. They knew these tanks were coming but they didn't know where they're coming from or what. And Colonel Ramsey says, you know, if we don't find where those tanks are, they're going to wipe us out, Garland Connard. I said, I'll go find them. He said he would go out and he picked up a spool of telephone wire and they ran about 400 yards through the American forces and it was in the, in the forest and out in front of the American lines. Zero weather in the snow and got in a small ditch and then when the tank started coming, he started calling artillery in. They kept advancing in and got within, I think maybe five or ten yards of his position. He actually called in artillery on his own position. For three hours, he called artillery in, destroyed the six tanks, killed 50 of the German infantry and wounded another 100 until they retreated. So he saved his battalion by doing that because they could not have stood up, had the river to back and the tanks in the front. And he was willing, obviously, to give up his life to save the battalion that was behind him. To tell you the truth, these escapades that he done that caused him to merit the Medal of Honor, I didn't know those laughter he has deceased. After these people started, we had no idea that he'd done that because he wouldn't talk about it. He didn't want people to think that what he'd done during service was to be bragged about. General Ramsey contacted him numerous times to try to get him to apply for the Medal of Honor, but he wouldn't do it because that was the way he felt. He didn't ever want to apply for that in his young days, but as he got older, you know, he wished he had. When I told Richard that he could go ahead and apply for the Medal, I looked at Murl and he was looking at me so straight with tears in his eyes and crying. And I know that he wanted him to do it too. Now, my dad was honest. He didn't want to draw attention. He didn't have a lot of education, so he didn't make a large farmer. He just, you know, raised me and cared for us with the farm that he had. His impression was always do what you say you're going to do. If you say you can do it, do everything you can to do it. If you promise something, fulfill your promise. I feel like that Murl would have liked for all the veterans to know that he did what he felt like he had to do, and he was proud of it. I'm proud of what he did, and I hope I can take care of that medal the way it's supposed to be taken care of. He was Clinton County's hero, and he's my hero. Always has been. Always will be.


Next of kin is really like a solid master craft of horror and mystery. And it's Australian too, right?


Child Diana utilizes a shortcut after getting absolutely bodied by a tree branch. How embarrassing that you didn't see that coming quick silver She grabs a spear sprints her heart out steadies her aim, and she's gone Pulled away from the event again.  What she utilized a Mario Kart shortcut. Suddenly, that's illegal This kid is half the size of the other contestants with not even 50% of the experience What is she supposed to do throw the kid a freaking bone?