Thank you for staying with us. You're still on to the breakfast on plus TV Africa and right now we stand for a hot topic So we'll be talking about gov. No banks on gov not sanny on building three vocational seats in Kaduna to export skills and Joining us to talk about this is Frank. Yeah. Yeah. He's a technology and media news editor at business D It's on the phone with us. Good morning, Frank. Thank you for joining us Yeah, good morning Thank you for having me and I Left her Are you still in Nigeria, Frank? I am Because now when you hear that someone leaves somewhere is Jack while we're thinking about so it's good to have you here Yeah, thank you very much Gov not sanny building about three cities to you know export skills from Kaduna Let's just have your thoughts on that and then we'll go right in I think it's absolutely sport on for governor to be thinking about Investments in vocational training Whether we like it or not We have a electricity issue in this country We Last last data. I think I checked was a literacy in Nigeria. The rate is around a little over 60% Okay, and then of course the literacy rate is still at around there Above a 30% you know and in Kaduna state for instance as of 2018 the list the literacy rate was 54.6 percent ish you know, so There and then if you then drill down to what really Defines literacy you find that there are different variations of literacy, you know and We we haven't gotten there and I Think that it's about time that we start thinking that Education is Exclusive to just the four walls of a university or maybe to the of a primary school classroom or secondary school classroom or a Certificates even To state that as well We've we've we've so much put a lot of stock in certificates graduate that is is affecting us in Very very The dire way, you know, and what which also our leaders not investing enough in in education I think the UNESCO The court is that was supposed to invest at least maybe about that 20% of our Our our budget on education now we haven't achieved that for many years now if anything I don't even think we've gone up to maybe 10% of our budget in education, you know, so it's been below 10% but then There has been calls that we should start looking at other ways of educating our people, you know First of all is Can we start teaching them in our local languages using local languages? That's that's one idea That's been out there for a very long time, you know, which also I think Inspired the whole idea of our major education, you know, but then also Using vocational trainings, you know, some people don't necessarily have to go to the university Some people don't necessarily have to you know, where the gowns do matriculation and all of that, you know but when you Channel people channel some people their energies into vocational trainings and all that what you find yourself having are technically sound sound people you're able to build skills in a lot of people, you know, and They go out there. They make income. They make revenue. They As in they still do the things that people who went to the university do, you know So I think it's a very very good development At least for cardinal. It's it will help them to reach the gap in education, you know And it will also help them also to reduce maybe security challenges that they are having, you know, poverty poverty have a way of Building security, of course, because when people don't have money don't have what to eat or whatever and all that and have a lot of time On their hands. They are unemployed. They seem to take up to crime That's that has been the order of the day and Kaduna has been one of the state's worst hit in in 2024 alone, we have seen a lot of Violins Mostly in southern Kaduna and all the parts of that state, you know, and all of this all of this is all because some people Feel like they're not being given a lot of attention or Some some some excuses here and there in order, but education is one way that you can take people out out of that cycle of poverty Education is one way you can take them as you can get them engaged and they start thinking positive thoughts thoughts that will Help that state to move on and I think all that governor should also look towards Replicating what is what is about to happen in in Kaduna That's my thoughts so far Yeah Sometimes when when we think about this I just also feel what the point will be if Somebody gains the skills for instance of making shoes that will not be bought by anybody You know because we're talking about building skills be building that Demography of people that will have the necessary necessary skills But not necessarily going to university and having a certificate and all that But we're not talking anything about patronizing Nigerian made whatever it's going to be so I don't know whether it goes beyond just building centers but what about the sensitization of people to to One respect these people not just because they didn't go to school But by the fact that they have the skill and to to patronize the people when they get the skill and begin to produce Whatever they are going to produce. I just use the example of shoes So somebody will not want to buy an abamate shoe will want to buy Italy so the abamate person will have to Maybe label it made in Italy and all that. So doesn't it doesn't don't you think it goes beyond just building centers? I Think I think that people are always going to have the preferences when it comes to What what they buy, you know If if I don't think a particular shoe, let's you shoe again is quality I'm not going to buy just because it was made in Nigeria. I'm gonna buy it because it is quality I'm looking at the value that you're going that a shoe is going to give me over a period of time Do you really think we should call it a matter of preference or a matter of name? You know, like what will the society say?  That's that's one good thing about it then It becomes it becomes an Additional value if you go beyond that to say, I don't just want to make shoes I want to make shoes that people are going to buy now when we go to where many of us go to the market I don't think every everybody Everybody go to the market and start looking for maybe Givenchy start looking for Louis Vuitton or any of these Foreign brand names and all that what they're actually just looking for is something that can last over a period of time Whatever name you give it is not the matter What is it? What's important to them is that can these last me this quality? You know first of all, I think we should address the issue of quality in our local produce If we address the issues of quality in our local produce and all that it is easy for us to come to tell our people Hey, this is working after all. I mean look at what's happening with a I'm some some Online shelves, you know on Instagram and all that most of those things actually made here in Nigeria We're beginning to see bags here make many Nigeria. We're beginning to see tell us In Nigeria who are making a lot of great stuff, you know I even making shoes and people are buying them at very high quality at very high prices You know and those shoes are competing with whatever you import from there Well, it doesn't stop those who want to go outside and go and buy from buying and all that but when you say Buy Nigeria or buy made in Nigeria. No, that it is it is great but Let's be reasonable about it because people are bringing out their hard-earned money To get these things and all that so if you're saying that they should buy something in Nigeria That was made in Nigeria Then you should be able to guarantee them that that thing is quality. That's just that's not the whole idea Yeah, well There's no there's no argument about that. I just wanted to bring that out because for instance when the senators were trying to buy their 60 160 million Naira cars. They said what they wanted was the name They didn't even talk about the quality what they wanted was the name because I know that we have a car manufacturer in Nigeria We've been exporting to other countries and they see the cars as very durable. They're very good But just because it's made in Nigeria and the name is not what it is They went out to buy from other places. I just brought that up. It's not like it's a big issue but the thing is What are the things if you were to advise you would advise the governor To to put in place what kind of skills do you think should be in these centers because it's one thing to establish a center It's another thing to have the relevance skills being lent in those centers That will make life meaningful for these people who are going to learn and the society at large First of all, I don't think that I will tell the governor not to Run that center with government or government appointees first of all because when government runs business in Nigeria It often don't end well So the first thing to do if you have built it Transfide to those to private people who can manage it with the requisite skills With the requisite knowledge with the requisite experience who can manage it properly and hands off Just provide them all that they need to provide the environment for them to try for them to make their recruitment for them to Go into the communities, you know provide the security for them and all of that, you know So that's that that's foundational But if he's going to run it with people his cronies people who helped him win elections and all of that Then it is dead on arrival. It means that it's going to be another dead project in Kaduna state All right So first of all is who are those going to manage these vocational training centers? When you have the right people fixed in those vocational training centers, then you have solved like 30% of the problem those people then Do not have to map out the strategies this And the plan that they wouldn't that they will need or that they would deploy Into the communities because it has to be round it has to be all round So there shouldn't be any form of discrimination It shouldn't be all the people are from southern Kaduna and those who are from northern Kaduna So we're going to give more preference to maybe to northern Kavana Whatever and all that that would that will only arise when it is governor's friends that are running it Because they are only going to take cognizance of the interest of the governor or those who are Around him, you know, but if it gives it to people who are independent who just wants to do their job and Make it count then it becomes inclusive So first of all a second beat has to be inclusive. That's the other thing. It has to be inclusive It has to include everybody and it has to be merit based not cronism so you're not thinking about It seems I'm the director of this center I'm going to bring in all my nephews or my cousins or all my brothers to To come learn skills. No, that's what we're talking about here There has to be there has to be a criteria for selection All right, who are we selecting and then they have to have a number? Okay that okay We have a batch or say of 50 hundred people that we're going to and then you also have to have a plan For after you have trained them what nest are you going to give them a loan to start a business? Are you going to place them in companies around Kaduna State? You know to To get the experience From what they have learned, you know So all those things are very very critical for their success because you're not just turning out people That have skills. That's not that should not be the idea If you want to make them exploitable then you have to give them the kind of skills that will make them attractive to those Who want to get them from outside the country people from outside the country? Don't just take people if you if you want to train software engineers All right, you have to bring in those who all who know software very well to train them Because I mean you just you just went right into what I was going to ask was The fact that the the governor talked about putting them on the international market as well Like they're going to be so employable that people can actually get them You know, it's going to be a good export and that was going to be my question. How are we sure so I come again? My question was how are we sure that this is going to be a good export for the country? But then I'm still scared that isn't that going to still bring about the jack-of-all syndrome whereby? We're training these people and they have to move abroad So what at what is the impact of this is it's going to grow our small businesses here because I think that's what we should be looking at Are they going to grow our small businesses here? And what is going to be the impact of this cities that the governor is trying to build? Yes, so Two ways to look at it. First of all is yeah, we need we need them to be part of the local workforce And and also to help build the local economy in both in Kaduna and also outside Cardinal yet Then the other one is that Jack for me is really is not a problem I mean, we have an FX issue right now and Part of that is that even the Nigerians in diaspora and nuts are no longer willing or hesitant in bringing in Fonds into the country and of course we haven't also set up systems that will attract Investments from these Nigerians living abroad, you know, India has perfected stuff like that You know, they've got this funding if they've got this program that Makes there are people who are outside India to Want to invest inside India, you know, we haven't got that Running yet because we are still thinking, you know, Japan is a problem or whatever and all that because also the leaders here Don't are not responsibly not to to do what they promise to do. All right, so that's one. All right, and then talking about Fuelling Fonelling the the local Businesses here and all that it is it is important. I think it's important Yes, they need to be trained and the local businesses here can give them those experiences that they need It is it is it is absolutely important. All right for them to be trained in that manner But beyond that we need to think globally. We need to use them globally Would they need to be they didn't need to jump really if they are so good if they can be trained so well and Given the right experience so so well that from here in Nigeria, they are aiming for incurrences and Yeah, of course So they can sit on their desk here at home wherever they are, you know that so it will require the kind of technology that you bring To bear. All right. So if you're training them, you're also thinking about how do I put in Technology infrastructures. What are what for instance? What is Godunas? I'm strategy for fiber. I did thinking about how do we Yes, okay We have to wrap it up here Well, it's a bit out of time, but sadly you have to wrap it up here anyways I want to thank you for coming and just you know bringing these valuable contributions. Thank you so much Congratulations to your new place of work. Yes, thank you All right, we're taking to Frank. He's an economic analyst and senior writer writer at tech cabal I've just been talking about the fact that the governor of Kaduna states governor sunny Govna Ubersani had been talking about building cities that will be able to export skills from Nigeria and bacon competes Here and in the international markets. So we'll go on a short break whenever we turn will be looking at our next hot topic Please stay with us


Hey guys, today I'm pretty excited because we're making fluffy pumpkin pancakes. This is based on our oatmeal pancake recipe. Here we go. We'll take one cup of almond milk, one quarter cup of aquafaba. That's the water that comes in cans of chickpeas, water of beans, aquafaba. Three quarters cup of pumpkin puree. One and a half cups of oats. One quarter teaspoon of baking soda.  One quarter teaspoon of cinnamon. One quarter teaspoon of pumpkin spice. And one or two dates, not pictured. We forgot to put them in. We'll put the top on. Blend on variable speed 10 for about 20 seconds until everything is combined and smooth. And then we'll do the pancake thing. Big pan over medium heat. For this first batch, we're making them with walnuts. Now, if you added a date or two, you probably don't need syrup or sweet on their own, especially if you're giving them to kids. But if you're making them as a treat, throw some syrup on there. Next batch, we're adding some chocolate chips. Super duper sweet here. Stack them up real high. Dalsam and syrup. Hey, at least they're 100% plant-based, right? These are really, really good. And guys, you don't need to eat them all. You can throw them in the freezer, warm them up either in the microwave or on the stove. We sometimes throw them in the toaster for our little guy. You can also make these as baked pancakes, just like you would on a pan, but throw them on a cookie sheet in the oven, 350, 10 minutes. Then you don't have to sit over the stove. Kind of a nice little parent hack there. And guys, subscribe to our channel if you haven't already. Hit that bell to get notified. If you appreciate videos like this, hit that thumbs up. Thank you so much for watching and we will see you in the next one.


Hi folks, I was working on the content for Tomorrow when I decided to take a break, browsed Twitter for a little bit, and then it turns out Politico's Twitter account shared this bombshell of an article. Supreme Court has voted to overturn abortion rights draft opinion shows. We hope that Roe and Casey must be overruled, Justice Alito writes, in an initial majority draft circulated inside the court.  Nonetheless, to see it actually take place, I'm a little bit shell shocked, to be honest. Now, keep in mind that this is only a draft. It's possible, theoretically, that one of the justices could have changed their votes, but I don't really think that that is indeed the case. It's also possible that this leak is not authentic, but there's a lot of people who have combed through it were saying it appears as if this is the real deal. And there's a lot of indications that basically confirm, yeah, this is what happened, just somebody leaked it earlier.  And before we dive into the details of the article here, I've got a point to this from SCOTUS blog. It's impossible to overstate the earthquake this will cause inside the court in terms of the destruction of the trust among the justices and staff. This leak is the gravest, most unforgivable sin, as Emma Vicklin points out. Yeah, the leak is the gravest, most unforgivable sin.  I mean, what this means is that abortion is still going to happen in the United States. The difference is that women are just going to get unsafe illegal abortions. And really, when I say that, I've talked about that before, but disproportionately, what we're talking about here is poor women, wealthy women. As always, we'll have access to abortions. They can fly to a blue state. They can fly to a different country if they need to. But we're talking about poor women. Poor women here. So let's dive into the article. The Supreme Court has voted to strike down the landmark Roe v. Wade decision according to an initial draft majority opinion written by Justice Samuel Alito circulated inside the court and obtained by Politico. The draft opinion is a full-throated, unflinching repudiation of the 1973 decision which guaranteed federal constitutional protections of abortion rights and a subsequent 1992 decision. Planned Parenthood v. Casey that largely maintained the right. Roe was egregiously wrong from the start, Alito writes. We hold that Roe and Casey must be overruled, he writes in the document labeled as the opinion of the court. It is time to heed the Constitution and return the issue of abortion to the people's elected representatives. Deliberations on controversial issues have in the past been fluid. Justice can and sometimes do change their votes as draft opinion circulate and major decisions can be subject to multiple drafts and vote trading. Sometimes until just days before the decision is unveiled, the court's holding will not be final until it is published, likely in the next two months. Now we won't get the actual verdict for maybe a month. It could come anytime, really. But I mean if you want to see it, it's right here. Probably not the final draft. It is a draft, but I mean we have no reason to doubt this. Now I've just got to real quick before we get back to the article here. Point out as left flank vets shared on Twitter. This is what the American people think about abortion. 60% want the Supreme Court to uphold Roe v. Wade. 58% oppose legislation to make it harder for clinics to operate. When it comes to whether a woman can have an abortion, 75% of Americans think that it should be left to the woman and her doctor. So what's happening in this country currently is our country has been taken over by a minority of reactionary psychopathic extremists.  So smaller or conservative states have an outsized influence on what happens, right? States like California has the same amount of senators as states like West Virginia.  Now back to the article here. The immediate impact of the ruling as drafted in February would be to end a half century. Jesus, it's been that long. Of federal constitutional protection of abortion rights and allow each state to decide whether to restrict or ban abortion. It's unclear if there have been subsequent changes to the draft. Now real quick, what I want to make clear is that for those of you unaware, this doesn't mean that abortion is banned all across the United States. What this means is that states can enact their own abortion bans as we've kind of been seeing now Republicans want to change that. So they're already saying that in the event they win the House, they will be introducing federal legislation to ban abortions at six weeks. Now that's not going to pass because Biden can easily veto that. But in 2024, assuming Trump gets in and Republicans have the Senate and the House, they're saying we're going to ban abortion in all 50 states. Do you understand how extreme that is and what the implications of that are? And it's not just that they want to ban abortion. If you don't care about this issue, we'll guess what's next. Gay marriage. They have the votes to overturn it now. Any worker rights, they can overturn that. Fuck, they can overturn Brown v. Board of Education if they want to. They can do whatever they want because they have a majority for the foreseeable future. And they are going to ruin this country more so than it's already ruined. So buckle up, folks, because this is only the beginning. No draft decision in the modern history of the court has been disclosed publicly while a case was still pending. The unprecedented revelation is bound to intensify the debate over what was already the most controversial case on the docket this term. The draft opinion offers an extraordinary window into the justice's deliberations in one of the most consequential cases before the court in the last five decades. Some court watchers predicted that the conservative majority would slice away at abortion rights without flatly overturning a 49-year-old president. The draft shows that the court is looking to reject Roe's logic and legal protection. So they're brazen, right? They're not mincing words. They're not allowing states to do more restrictions. They're just saying, Roe's done. Think of how insanely shameless they are. They don't care. They are extremists and they have hijacked our country. A person familiar with the court's deliberations said that four of the other Republican-appointed justices, Clarence Thomas, Neil Gorsuch, Brett Kavanaugh, and Amy Coney Barrett, had voted with Alito in the conference held among the justices after hearing oral arguments in December, and that lineup remains unchanged this week. So the three Democratic-appointed justices, Stephen Breyer, Sonia Sotomayor, and Alina Kagan, are working on one or more dissents according to one person, how Chief Justice Roberts will ultimately vote, and whether he will join an already-written opinion or draft, his own is unclear, because he's going to sit on the fence. Now, speaking of this here, I just want to point out some of these names here. Really interesting that Susan Collins, when she voted for Kavanaugh, this is what she said. I do not believe that Brett Kavanaugh will overturn Roe. He noted that Roe had been reaffirmed 19 years later by Planned Parenthood v. Casey, and that it was precedent on precedent. He said it should be extremely rare that it be overturned, and it should be an example. So you have obviously full confidence. I do. We talked about whether he considered Roe to be settled law. He said that he agreed with what Justice Roberts said at his nomination hearing, in which he said that it was settled law. I could not vote for a judge who had demonstrated hostility to Roe v. Wade because it would indicate a lack of respect for precedent. What Judge Kavanaugh told me, and he's the first Supreme Court nominee that I've interviewed out of six who has told me this, is that he views precedent not just as a legal doctrine, but as rooted in our Constitution, and he reveres our Constitution. I asked him, is it sufficient if five current sitting justices believe that Roe should be overturned? And he said no. I would not support a nominee who demonstrated hostility to Roe v. Wade because that would mean to me that their judicial philosophy did not include a respect for established decisions. Judge Kavanaugh is the first Supreme Court nominee to express the view that precedent is not merely a practice and tradition, but rooted in Article III of our Constitution itself. I will vote to confirm Judge Kavanaugh.  Back to the article here. The document labeled as a first draft of the majority opinion includes a notation that it was circulated among the justices on February 10th. If the Alito draft is adopted, it would rule in favor of Mississippi in the closely watched case over that state's attempt to ban most abortions after 15 weeks of pregnancy. A Supreme Court spokesperson declined to comment or make another representative of the court available to answer questions about the draft document. Politico received a copy of the draft opinions from a person familiar with the court's proceedings in the Mississippi case, along with other details supporting the authenticity of the document. The draft opinion runs 98 pages, including a 31-page appendix of historical state abortion laws. The document is replete with citations to previous court decisions, books, and other authorities, and includes 118 footnotes. The appearances and timing of this draft are consistent with the court practice. I mean, it's 99% likely the actual draft. It's time to like stop pretending as if the Supreme Court is apolitical. It is explicitly political. And until Democrats behave in that way, then things like this will continue to happen. The country will continue to get worse because this is a political institution explicitly so. These are activist judges. Remember when gay marriage was affirmed by the Supreme Court? And we had Ted Cruz and all these Republicans screeching about activist judges? This is what you call activist judges to overturn almost 50 years of precedent where you had this right to an abortion affirmed by two cases. That's activist judges. The disclosure of Alito's draft majority opinion, a rare breach of Supreme Court secrecy and tradition around its deliberations comes as all sides in the abortion bait are girding for the ruling. Let's go to the actual arguments here. So a George W. Bush appointee who joined the court in 2006, Alito argues that the 1973 abortion rights ruling was an ill-conceived and deeply flawed decision that invented a right mentioned nowhere in the Constitution and unwisely sought to wrench the contentious issue away from the political branches of government. Alito's draft ruling would overturn the decision by the New Orleans-based Fifth Circuit Court of Appeals that found the Mississippi law ran afoul of Supreme Court precedent by seeking to effectively ban abortions before viability. Rowe's survey of history range from the constitutionally irrelevant to the plainly incorrect Alito continues adding that its reasoning was exceptionally weak and that the original decision has had damaging consequences. The inescapable conclusion is that a right to abortion is not deeply rooted in the nation's history and traditions. Alito approvingly quotes a broad range of critics of the Rowe decision. He also points the liberal icon such as the late justice Ruth Bader Ginsburg and Harvard law professor Lawrence Tribe who at certain points in their careers took issue with the reasoning in Rowe or its impact on the political process.  Alito's skewering of Rowe and the endorsement of at least four other justices for that unsparing critique is also a measure of the court's right-word turn in recent decades. Rowe was decided 7-2 in 1973 with five Republican appointees joining two justices dominated by Democratic presidents. The overturning of Rowe would almost immediately lead to stricter limits on abortion access and large swaths of the South and Midwest with about half of the state set to immediately impose broad abortion bans. Any state could still legally allow the procedure until Republicans take control of then its ban and then the Supreme Court will reaffirm that and will go two steps backwards. The Constitution does not prohibit the citizens of each state from regulating or prohibiting abortion. The draft concludes Rowe and Casey irrigated that authority. We now overrule those decisions and return that authority to the people and their elected representatives. The draft contains the type of caustic rhetorical flourishes Alito is known for and that has caused Roberts his fellow Bush appointee some discomfort in the past. At times Alito's draft opinion takes an almost mocking tone as it skewers the majority opinion in Rowe written by Justice Harry Blackmon, a Richard Nixon appointee who died in 1990. Rowe expressed the feeling that the 14th Amendment was the provision that did the work but its message seemed to be that the abortion right could be found somewhere in the Constitution that specifying its exact location was not of paramount importance Alito writes. I've got to say that this line is sticking out to me the one where Roberts is really like he's discomforted by the things that Alito says. Okay, well then write the wrong and retire, right? Retire. So there's one more liberal justice, right? You can change that. He's not going to do that though. And even if he were to do that, Joe Manchin and Kirsten Sinema would make sure that they hold that seat open until Republicans take over the Senate whenever that is. 2022-2024, they'll make sure that a liberal is not going to be his replacement. Let's see here. Alito declares that one of the central tenets of Rowe, the viability distinction between fetuses not capable of living outside the womb and those which can make no sense. In several passages he describes doctors and nurses who terminate pregnancies as abortionists. When Roberts voted with liberal jurists in 2020 to block a Louisiana law imposing heavier regulation on abortion clinics, his solo concurrence used the more neutral term, abortion providers. In contrast, Justice Clarence Thomas used the word abortionist 25 times in a solo descent in the same case. So for whatever reason, Alito is virtue signaling and shifting further to the right rhetorically, which is bizarre for a Supreme Court Justice. Alito's use of the phrase egregiously wrong to describe Rowe echoes language Mississippi Solicitor General Scott Stewart used in December in defending his state's ban on abortions after 15 weeks of pregnancy. The phrase was also contained in an opinion Kavanaugh wrote as part of a 2020 ruling that jury convictions and criminal cases must be unanimous. In that opinion, Kavanaugh labeled two well-known Supreme Court decisions egregiously wrong when decided the 1994 ruling upholding the detention of Japanese-Americans during World War II, Korematsu v. United States, and the 18, excuse me, 96th decision that blessed racial segregation under the rubric of separate but equal Plessy v. Ferguson. The High Court has never formally overturned Korematsu but did repudiate the decision in a 2018 ruling by Roberts that upheld then-President Donald Trump's travel ban policy. So, you know, I think that we've got the gist of it, right? It's over. Rowe's over. I'm pretty certain that this is the real deal. I think that most people acknowledge that this is the real deal. So, yeah, here we are in the United States. We're going back to the age where women have to get coat hanger abortions in back alleys because, you know, only blue states will allow abortions for now. Red states will overrule them very quickly. There's a lot of red states that have passed trigger laws, meaning that if Rowe is ever overturned, then immediately abortion becomes illegal in that state like that. But just wait until Republicans take control. Once they have all three branches of Congress, all 50 states, baby, because that's what they are already telling us that they're going to do. And one thing about Republicans that's different than Democrats is that they actually get their agenda carried out. And we've got to say abortion is only the beginning, right? Because they will go for marriage equality next and every other civil right and civil liberty that we've spent decades fighting to achieve. They will undo all of it. And while they take our country back decades when other countries are moving forward, all you're going to hear on mainstream media is how the far left is the problem. The far left is extreme. Yeah.  The far left wants health care. The far right, which is the entire Republican Party and its base, is taking away fundamental civil rights. And if this doesn't shake you to your core, then I don't know what to say, you know? If you don't care about abortion again, it's going to be a different civil right that they go after. Who knows? Maybe they'll try to ban legal weed in states that have legalized it, like my state. There's no limit to the moral depravity of this extremist far right death cult known as the Republican Party and their base. Who votes for this? So yeah, I'll leave that there. I didn't want to wait until tomorrow to talk about this because this is happening right now. And it's just, it's honestly disturbing. It's nauseating. And this country is circling the drain and we're basically down the drain at this point. Like we're falling down the drain as I record this video.  Wow.


Differential expression analysis of single-cell transcriptomics allows scientists to dissect cell-type specific responses to biological perturbations. Here, the authors show that many commonly used methods are biased and can produce false discoveries. This article was authored by Jordan W. Square, Mathieu Gautier, Claudia Cater, and others.


Hi this is Ella from When I Work. Today I'm going to show employees how to set their alert preferences on an Android device so that you can get a reminder for your next shift. Make changes to your alert preferences by tapping the menu button and then select profile and settings. Tap on the icons to enable email or mobile alerts. You can receive alerts by email, mobile, or both. We also have shift reminders. By default you'll get an alert about an upcoming shift two hours before it starts, but you can adjust this number if you'd like between one and 24 hours. Setting your alert preferences can help remind you when you have to work and can greatly improve your timeliness.


Leisure, I wonder if you got one. Yeah. Thanks for helping me. My pleasure. And then this is postoperatively. This is traveled with a chronic six-graded ulnar pre-cis, and that's postoperative photos on the bottom row.  But also, post-barrel, is it really a inflammatory process after a viral infection that causes the six-graded ulnar palsy? Yeah, probably. But you know, kids are always sick, right? So just by, I mean, if you study, do kids have six-graded ulnar palsy after a viral infection? They all do. There's so many viral infections in kids that I've always thought, well, yeah, that's probably what's going on. But I certainly never rely on that without an imaging study, OK? And trauma, definitely, is up there in kids. And if they do have hydrocephalus from a mass or other intracranial disease, they often have other neurologic signs. Differential is Duane syndrome, which we're going to talk about. Just infantile esotropia, and you can't get a child to AB duct their eye because of poor cooperation, and a few other things that I don't want to talk about in detail. Here's a differential. Get an MR, do a pediatric neurologic exam, brief one. You can do it. You know how to do just the basics, but you can always refer them to neurologists as well. If it's idiopathic or post-viral, it tends to resolve over time. And we watch in way, especially if a child is turning their head and still fusing, and often it will resolve. But it often recurs during childhood. It's an entity that we don't really understand. But these are kids whose immune system apparently is causing some post-viral inflammatory pathology at the peripheral sixth screen in there. And then if it's chronic, with sixth screen owner or palsy surgically, you really have two choices. If the lateral has function, but it's reduced function, but it's not a dead muscle and doesn't pull at all.  But if the lateral rectus is dead and doesn't pull at all, then the only way to get abducting force on the eye, getting the eye to turn out away from the nose, is to transpose the vertical recti towards the lateral rectus and use the vertical recti to get an abducting force. And here's a pre-op photo. It's the left eye, and this is post-op. Oh, I apologize, it was bilateral on him. But much worse on the left compared to the right. Okay, so let's take a tangent. Remember I said, don't, you keep hearing this, sorry. No one wants to miss a tumor, right? So you're in your pediatric ophthalmology clinic, you've done a fellowship, or maybe not. Maybe you're just on call.   It looks like abduction is, you know, pretty good. Okay. And, but to kids with acquired non-accommodative comatant esotropias, ever have brain tumors and the answer actually is yes. And they probably have subtle abduction deficits because of hydrocephalus, but you can't detect it. So how are you gonna know? Okay, how are you gonna know? Optic atrophy, nystagmus, those are the two main things. Optic atrophy and nystagmus. An absence of a family history of strabismus. Okay. So esotropia tends to run in families, right? If you have a child whose psychopathic refraction is plus one sphere in both eyes, no family history of strabismus. And, you know, you've got a child with an esotropia, looks comatant, not super cooperative. Don't wanna miss a tumor, right? Look for optic atrophy, look for nystagmus. And I do get an MRI of kids who I feel like I can't get a really good exam to make sure that they have no abduction deficit. And if they have a hint of optic atrophy or are suspected at all, I go ahead and in absence of family history, I just scan them. Because if you don't, those kids, the treatment is surgery. So if you don't, and there have been case series of this following scenario, you operate, they're under corrected, you operate again, they're under corrected, then you scan them, oops. And then there's less happiness in this world at that point. Well, so not missing intracranial pathology with comatant esotropia, that's why we try to measure kids and sidegazes in the clinic. Because in comatant esotropia, due to an abduction deficit, you might pick up when you measure, that you can't see when you do version testing. So if you can, it depends on the child, their age, their level of cooperation. Okay. What was your syndrome? Anyone know what that is? It's a combined six cranial nerve, bilateral six cranial nerve palsy and bilateral seventh cranial nerve palsy can be associated with systemic anomalies. Just throwing it up there so that you recognize his face. That's typically what they look like. I can't smile. Dwayne syndrome. Oh dear.   And the light switch in the kitchen on the ground floor is turning the lights on and off in the upstairs bathroom. And your spouse is up there saying, what are you doing? Okay, that's a miswiring of your new house. Dwayne syndrome is a miswiring of the cranial nerves. It's a cranial disinnovation. So what happens is these kids have hypoplasia of the sixth cranial nerve nucleus and absence or hypoplasia of the peripheral sixth cranial nerve. They have very poor, typically poor lateral rectus function and the bizarre thing is the miswiring. This is so bizarre. The third cranial, the peripheral third cranial nerve innervates the lateral rectus as if the lateral is starving for innervation during development and a branch goes over there. It's really bizarre. So not surprisingly, this disease causes the lateral rectus and the meteor rectus to contract at the same time. Isn't that weird? It's really strange, right? It doesn't make any sense unless you understand the abnormal anatomy of the peripheral third nerve sprouting an extra branch to the lateral rectus. And when you read about Dwayne syndrome, here's how you should think about it. That bilateral, that simultaneous contraction of the medial lateral rectus pulling the globe into the orbit, that unifies all of Dwayne syndrome. So you're gonna read about type one and type two and type three and less abduction, less abduction. They're exotropic. They're esotropic. They have upshoots and downshoots. And you're just gonna be like, okay, I just wanna read about Redna. But this is easy, actually. It's the co-contraction of the lateral medial rectus that unifies all of Dwayne syndrome. You know, if you look at these kids on attempted abduction from the side, from here, you can see the apex of the corneal goes back into the orbit. So when you do peeds and you see a kid with Dwayne syndrome, look at them from the side and have them follow your kids facing this way, have them look that way and look at the right eye. You'll see the globe actually goes back in the eye. I mean, we teach it that the palpibral fissure narrows. And of course that happens, that's easy to see looking face on. But to really understand this, look from the side. And then we're like, oh, okay. This unifies all of Dwayne syndrome. And all these classifications make a heck of a lot more sense. A few mutations are known, have been isolated in a few families, but in general, this is not inherited, can be, they're reported families. So they're the types. Type one, esotropia, type two, exotropia, type three, no stropismus. Okay, if you want to memorize it. But they all have co-contraction. They all have global attraction on attempted abduction. And so this miswiring I talked about, an extra branch of the third dirt going to the lateral rectus. Well, how much innervation goes to the lateral rectus? And how much innervation goes to the media rectus? Well, that varies from patient to patient. And remember there's a tug of war going on. Well, if the resting innervation of those two muscles favors the media rectus, a child will be esotropic and they'll turn their head to point their eyes straight ahead. That's type one. What if the innervation is more to the lateral rectus than the media rectus? Well, their eyes are gonna be out, right? It's gonna be an abduction. They're resting tonus. And so they want to use both eyes together so they'll turn their head. But they'll be exotropic in primary days. If the innervation is roughly equal, they'll have a straight head and straight eyes. But you'll still see the co-contraction. Okay, does that make sense? I try to teach this in a way that really makes sense. It's a springboard to learn the details. And here's a child with type one left Dwayne Center. I shouldn't look into this, right? Here you go. So his co-contraction of the medial lateral rectus is really happening in an abduction. And you can see his palpibrio fissure is narrower here than here. Look at that photo. It's easier to show it in up gaze and left here compared to here. But if you were standing to the side, getting a sagittal view of that eye, you would see the eye pull back in here, okay? So that's, what about this kid? He's a little exotropic, right? He's a little exotropic.  This is type two. And check out his abduction is pretty good, but it's not normal compared to this side. And his abduction, I apologize. His abduction is reduced a bit. His abduction is pretty good, but maybe not perfectly normal. But look at the globe retraction. When his right eye goes into abduction. So this is type two Dwayne Center of his right eye. Does that make sense? Okay. And she has bilateral type one Dwayne Center. Watch this eye. Retraction, you can see narrowing in the palpibrio fissure, and then whoa, it gets nice and big. Here, not that big a difference, but still an abduction deficit. Okay, so this can be bilateral, about 10, 15% of patients are bilateral. There are some other manifestations. An up shoot. Look at this. This is when the resident just comes over and says, I don't know what's going on. And so this happens, we think because the lateral rectus is super tight. Not only getting innervation with abduction, but it's restricted and tight. And it acts as a leash on the globe, and the globe goes whoop. A lot of our rectus kind of slides under the eye, and the eye goes up. And I'm gonna talk about the surgery for that in a moment. Couple other sort of boards things that I don't really care if you know, but you need to know it for boards. More common in females and males, bilateral in about 10, 15%. Usually it's sporadic. Autosomal dominant inheritance is reported in those mutations that I showed earlier are the research papers. It's been reported in association with Golden Hearth syndrome for sure. And usually they don't have amblyopia and they have good stereopsis. Why? Why is that? Well, they like to use both, kids like to use both eyes together. So they turn their head to point both eyes straight instead of allowing strabismus. But what if they allow strabismus? Hang on to that thought. Uh-oh, amblyopia is gonna happen, right? Hang on to that thought. It's one of the indications for surgery for this. So if a little kid starts to not wanna turn their head anymore for their Dwayne syndrome and their esotropic and they start to develop amblyopia, should you operate? Well, you gotta do some amblyopia therapy first, right? Do a psychopathic refraction, see if they need glasses for anisomotropia, significant refractive error. If you do all that and they're still esotropic, then you have to operate. So that's one indication for surgery. But what if they just turn their head? Why operate and when should you operate? Well, think it through. It kinda depends. Depends on a few things. Well, first of all, you don't wanna disrupt binocular visual development in the visual cortex. And isn't that amazing how that happens? Did you know there are ocular dominance columns in the primary visual cortex? Kinda like a pie. Take half a pie and make skinny slices all the way through the half of the pie. And each one of those slices is an ocular dominance column and they alternate right eye, left eye, right eye, left eye, right eye, left eye, right eye, left eye.  It's brain damage. Primary cortical visual development, that gets disrupted by strip isthmus or suturing and eyelid shut, right? That's amblyopia. So you don't want that to happen, right? So if you do surgery and it's not successful and you have to go back and operate again, that takes time. And during that time, there's no binocular visual experience. And amblyopia is gonna start creeping in. And what about stereopsis? Stereopsis is so cool. Imagine that pie with wires spanning over all those slices. Okay, so there are binocular neurons that have dendrites and axons that they span all those pie slices and connect them together. And that's depth perception, okay? That develops during childhood, especially during the first two years of life. So you don't wanna mess that up because we really want stereopsis, right? And kind of like M&Ms, you only got one shot, right? You only got one shot at good stereopsis. My son listens to M&Ms. You don't wanna disrupt that. So should you operate early on a kid with a head turn who has a normal binocular visual experience? No, no, no, no, no, leave it alone, leave it alone. Don't operate right away. Just because a kid has a problem doesn't mean you should be operating, right? You wanna think about the ultimate visual outcome. So I tend to wait. I wait as long as I can, sometimes forever. But forever might be too long for a patient who's always turning their head. Why? Can you live with a head turn your whole life? What would you think of my lecture if I did this all the time? You'd probably say, I'm having trouble concentrating. I keep noticing that he turns his head all the time, right? So that can be cosmetically unacceptable. But even worse, you can get chronic arthritis and highly, chronic arthritis and changes in facially symmetry. And so in the long term, after binocular visual development has happened in a child with a head turn, you can operate and start to help that head turn. I like to wait at least until three or four years of age for binocular visual development. And then after that, I like to get a good exam. And so it's up to the level of cooperation of the kid. So for me, beyond four years of age, and it depends too. There's some other reasons that I'll delay. And the surgeries for this generally recessing muscles, restricted muscles is the way to go to help with the abnormal head position. So for example, a type one, Dwayne syndrome with an esotropic eye, recessing the meteorrectus will help midline the eye. It's not gonna help the eye abduct at all. And in fact, the price of doing that surgery is poorer adduction than you had preoperatively, but the eye's midline and the head's straight. So if you've prevented the arthritis and facially symmetry. There is another approach. Those Arthur Rosenbaum passed away, but he pioneered vertical transposition of the vertical recti to the lateral rectus to try to not only midline the eye, but also improve abduction. And that's where the dragons are lying and waiting because I'll explain that and then tell a quick anecdote. Even after doing this for 20 years, my stress level goes very high when I'm doing transpositions of vertical recti because of induced torsion and induced vertical deviations and not getting the balance right, not getting the eye midline afterwards.  It's just a part of it. And you have to re-operate quickly before Scar sets in typically. You gotta take them right back to the operating room. And here's the anecdote. So I found that as you get older, the bad things in the harder cases get referred to you. It's just a natural progression of things. And so child had this relatively new procedure in the hands of someone who probably didn't have the skill level to make it happen, had a very large vertical deviation, did not re-operate right away, referred to me three months later.  So I referred them down to Arthur Rosenbaum, the person who pioneered this procedure. He actually had stopped operating by then, but a doctor named Dr. Velaz, one of the partners took that on. I think it was five surgeries later. She had straight eyes looking straight ahead, but couldn't move that eye in or out up or down very far. So it was just like, woof. So don't think of, think of the, what's the name of this song my son listens to from Eminem? Just got one shot. Dun, dun, dun, dun, dun, dun, dun, dun, dun. What's the name of this song? The Eight Miles Song. Is that what it's called? The Eight Miles Song? Well, I don't know the name of it, but it's the same song. It's called The Eight Miles Song. Yes. Okay, thanks. You know what I'm talking about. It's just got one shot. And then it's like this big emotional thing. He loves that. But that's kind of true for transposition procedures. They can be reversed, but it's a really big deal. So anyway, I still like a recession of a horizontal recti for DeWayne syndrome to achieve the limited results of a straight head and binocular vision looking straight ahead. Okay, so the next entity is monocular elevation deficiency. Ooh, doesn't tell you a thing about the pathophysiology, that name. Right? What? Oh dear. How do I teach this? So, vertical deviation in little kids. Pretty much you've got fourth cranial nerve peresis, Brown syndrome, monocular elevation deficiency, very rare inferior oblique peresis.   It's really frustrating. And what's fascinating is all the entities have a known pathophysiology, except this one. We don't understand the underlying cause of an inability to elevate the eye. Midline, in abduction and in abduction. Okay, so what we like to say is across the board that I can't go up, all the way across, can't go up. With Brown syndrome, they can't go up looking towards the nose, but they can, in abduction, to distinguish it from Brown syndrome. It can be accompanied by true ptosis, but that's kind of hard to tell when the eye's down because the lid follows the eye because of the fascial connections between the levator and the superior rectus, right? So these kids have to be helped with surgery before you figure out if they have true ptosis or not. This is the so-called pseudotosis. And really, there are two types. There's restrictive, MED and peretic. And restrictive, MED, it just means when you go to the operating room and do four-structions. Now, for those who don't know, four-structions is you got a patient under general anesthesia. There's little or no intervention to the extraocular muscles. And you hold onto the eye and move it around, okay? And if a muscle is tight, like a leash and a dog, you know, the dog's running at your low, okay? When you move the eye, you can't, you feel restriction, it feels tight, okay? And with restrictive MED, the inferior rectus feels tight in the operating room. And if you recess that in these kids, they do well. But there's a peretic type where a nap procedure, transposition of the horizontal recti is helpful. Anyway, let me get back to basics with MED. They have a hypotropia on the affected side. They tend to have a chin-up abnormal head position, not always, kind of like Dwayne syndrome, right? Kids like to use both eyes together.  And so I wait, I wait, I wait. The pie slices are forming. The connections between the slices are forming. I wait, I wait, right? And then eventually operate. But some kids are like, I can't keep doing this. And they just allow the hypotropia, okay? And so they'll develop amblyopia. You have to treat the amblyopia. And glasses, if they need it, always do a psychopathic refraction in kids, looking for anisomotropia. So I'll just touch on the nap transposition. That's just taking the horizontal recti, the meteor rectus and the lateral rectus, and moving them up towards the insertion of the superior rectus. And it gives an elevating force to the eye for peretic MED. This is what it looks like. Can you guys see what's going on? This side can go down, but it doesn't go up. It doesn't go up here. It doesn't go up in abduction. Midline, it doesn't go up, okay? All right, so there's another entity that stops the eye from going up. Now we're moving to Brown syndrome. Oh dear. Antennas and cell phones are internal. When I grew up, antennas were really cool. My mom had a Buick Electro 225. It had a couch in the front. And she drove it. And the three kids were next to her knot and seat belts and lots of sharp things on the dashboard on that. And that car, it had a telescoping antenna that was automatic. This was the AERRA great auto design, if you ask me. You'd hit a button and it would just go zzzzzzzzzz. And you know how those antennas work, right? The telescope out click, click, click, click, click. Well it turns out the superior bleak tendons like that when it goes through the truck layer. Isn't that cool? I think that's really cool.  And Brown syndrome was there's a knot in the rope, bang. It's the, Helveston studied this in cadavers and it's pretty neat. So there's, right in the center, there are tendon fibers with, you know, scant adhesions to neighboring fibers. Kind of like the innermost smallest diameter part of the antenna. And that goes back and forth through the truck layer. And all the layers surrounding it are elastic and they allow it to go back and forth but they stop it from going too far. Does that make sense? So, when this, when the superior oblique contracts, right, it's the intorting down and out muscle, right? Has mainly in torsion, depression, abduction. So when it contracts, the tendon has to go on my left eye, the tendon has to go this way through the truck layer, right? In this direction. And when the inferior oblique contracts, the superior oblique has to relax. So the tendon has to go back the other direction. Cause if my left eye is going up and the oblique's like this, it's gotta do this. Does that make sense? It's gotta do this. If the eye, right? Does everyone know their anatomy? It's pretty complicated. What happens with Brown syndrome is that the telescoping antenna doesn't work in elevation, but it works in down gaze. So maybe that knot in the rope analogy does help a bit. There's a knot in the rope behind the truck layer so it can't elevate the eye. The eye can't elevate. It's restrictive, like a leash on a dog. All the elevators pull up, the eye can't go. Does that make sense? Well, these kids, I'd rather just show you photos. So do kids like to use both eyes together? Uh-huh, uh-huh, right? They like to use both eyes together.  So he's got Brown syndrome right here. So he's gonna wanna keep that eye away from adduction, right? And that's what he does. He's got a left head turn. Does that make sense? So he gets that eye out of the direction where his eye misalignment happens. And he can't elevate the eye in adduction. This eye looks good, good elevation. And look, superior bleak works in depression. So that's Brown syndrome. And why does it happen? What the heck? What's going on? Well, you can have a congenital abnormality of the superior bleak tendon trochlea complex. And just like that kid that I just showed you, but it can be acquired. Here's, you can give someone Brown syndrome by doing orbital surgery. It's the swan incision, the zoonins. I think so. That can happen. So you can give someone Brown syndrome with that. Or just orbital trauma. Poor guy in a car or motorcycle or something. Wow. They end up with Brown syndrome because of scarring at the trochlea. Even inflammatory diseases can cause troubles right up here. Okay? And here's the cool thing. You'll see this at some point in your career, hopefully. Some patients have a knot in the rope that stops the eye from going up, but it's a little knot. It's a small knot. If they pull hard enough, it goes through.  Is that cool? And what's interesting in cases of inflammatory acquired Brown syndrome, steroid injections in that area can help reduce inflammation and the clicking gets better and they can move their eye better. Okay? So Brown syndrome is just a description of some kind of trouble here that can be congenital or acquired. So whether you do surgery for Brown syndrome, well, you know, it has to be a permanent situation, right? You don't want to do surgery for something that's temporary for goodness sakes, right? So the acquired cases generally are not treated surgically unless they're chronic. And obviously from urban surgery or real trauma, that's probably not gonna get better, you know, but the inflammatory ones can, so you can read about it. Don't jump straight to surgery, okay? Okay, so let's talk, you're hearing the same theme again. It's gonna get boring, but you won't forget it. Leave them alone when they're kids. Leave them alone, let them turn their head. They'll develop binocular vision. I think the earliest I've operated on kids for Brown syndrome is five, six years of age. If they adopt an abnormal head position, okay? But I've operated earlier, why? Why did it operate in a two-year-old with Brown syndrome? Because they were like, ah, I don't care. I'm gonna let my eye go down. And they developed amblyopia and we had to move, okay? Does that make sense? Okay. What's the surgery? Well, doing some sort of weakening procedure on the superior bleak tendon at the side of the globe. You know, not in the orbit, you can't get back there, right? But you can't get at the tendon in subtenon space. So that's where we operate. And all of the procedures are to lengthen or, well, cut the tendon in half. And you know, there are a lot of approaches to it. A complete tenotomy of the superior bleak tendon is a good approach. It just let the tendon fly, okay? And there are fascial attachments that surround the tendon. And they tend to keep the tendon some place close together, but it's not quantitative. And in that instance, the chance of superior bleak peresis is significant. As high as 50% even in some series, but as low as 10 in others, you do the math. Maybe the patients with the overcorrection saw a different doctor. And so I've, although I didn't train this way, I started to do a quantitative weakening the superior bleak with first silicone spacers. You know, the retina folks, they use those bands, silicone bands, you just cut one. Cut one to five millimeters, put some sutra in it, sewed on the tendon. Ken Wright was the one that started that. And, but they can erode through the conjunctiva. Stop doing that, only did a few of those and went to just using sutra, just using merciline sutra. And the reason I like this is it can be quantitative in the operating room where you can check your four stuctions based on how far you've separated the tendon. And if it's too much, you can reverse it. If it's not enough, you can let it out a bit and try to equalize the four stuctions between the two eyes. And my results of that have been really nice. I've been really happy. My re-operate is pretty low. And this is the kid pre-op. Look here, here he is, plus dot. So he's like way better. And he does not have a terrible superior bleak peresis. He does have some peresis here. Okay, I'm gonna touch on adults, myasthenia, variable ptosis and variable double vision. As you know, this can be purely ocular or systemic. Disease of the neuromile junction. You know the testing. I'll let the neuro ophthalmologist go into that. And, but we see them if their diplopia is persistent. This is the ice test. This is before the ice. That's after the ice. Nice. You know, I think I was a fellow when the ice test was discovered. Shazam. That's great. I like really simple things in the clinic to make a diagnosis. I just love that. Thyroid eye disease. You guys know what this is about, right? Orbital inflammation of connective tissue in the ocular muscles with replacement of muscle tissue with glycosaminoglycans. The muscles get super tight and start pulling the eyes in bad directions. The severity of muscles affected tends to go in this order. Infiorrectus is the worst. Meteorrectus is second worst. So these patients usually end up with a hypotropion and esotropia, right? But the superior rectus, the lateral rectus can be affected and the superior bleak can be affected too. But usually, they look like this. Okay. Like that. She has an incredibly tight inferior rectus on this side and it's tight on this side as well. Here's your CT. Oh dear. Look at that. Might need an orbital decompression. It's possible in that patient, that's for sure. So eye muscle surgery for their diplopia. You can never make them normal. Just can't make them normal, okay? Their muscles are replaced by fibrous tissue. But you can try to get as large an island of single binocular vision looking straight ahead and in down gaze for driving and reading. That's really what you shoot for. These patients are so happy. Even if you can't restore rotations of the eyes. And here's the teaching point for boards in your practice if you do this. Julie. Recessions, not resections. With rare exceptions to that rule. Okay. You gotta recess. What happens if you resect a restricted muscle? It's more restricted, right? So you end up inducing Duane syndrome if you resect with thyroid disease. But there are some exceptions. I'll just touch on blowout fracture. Okay, so do patients have double vision after blowout fracture? Adults and kids. And the answer is yep, absolutely they do. What's the main pathophysiology of double vision acutely right after a fracture for the first week or two? It's edema, hemorrhage, into the orbital fascial tissues and the muscles. And that can resolve over time. And so you can't jump straight to orbital surgery or eye muscle surgery for these patients with one exception. And that's kids with a green stick fracture with the inferior rectus entrapped. That ain't gettin' better, okay? That's not gonna get better. And they need surgery. And what's really interesting, does anyone know what the ocular cardiac reflex is? I cause it all the time. Does anyone, do you guys know what it is yet? I see unfamiliar faces. You guys aren't nodding, so I assume no. If you pull out an extracurricular muscle, the heart rate goes down. We see that all the time in the operating room with eye muscle surgery, okay? It's a reflex. And it kinda makes sense. If you have a kid in the ER, let's say they have a pulse ox on something to monitor their heart rate, have them look up and the unaffected eye will go up, the other eye won't go up and their heart rate will start to drop because there's tension on that muscle. Okay, and that should tip you off. It's sorta like the ice test. I mean, you can say the heart rate just went down when he looked up, he probably needs surgery. He certainly needs his CT scan. Okay, this is what it looks like.  There's the green stick fracture in the kid. Okay, now it's kind of a big deal to get it done sooner rather than later because muscles can become ischemic when they're trapped in bone and kids. And then after you lift the muscle out, they develop not a hypotropia, hyperotropia because they have a peretic inferior rectus, okay? So orbital surgery, wait at first, except for the indications for immediate surgery from oculoplastic, so I'll let them talk to you about that. Usually it has to do with gigantic floor fractures with obvious enupthalmos that can only get worse as edema and hemorrhage subside. They'll repair early. There's some other indications, but I won't talk, I won't steal their thunder. And once, if there's entrapment, if the orbital surgeons do their job, then we're dealing with double, we can be dealing with double vision that's both restrictive and peretic. And with the restrictive disease, generally you're recessing muscles to reduce restriction. And with peretic disease, you're either doing a resection of a muscle if there's some muscle function, but not normal, or transposition if it's a dead muscle that doesn't pull. Just like six great alert precess. Okay, I'll stop there. It's time to stop. Any questions?