Hello. Welcome to my session today. Today, we're going to be taking a look at securing the continuous integration and delivery infrastructure for the Tinkerbell project. My name is David McKay and I am a Senior Developer Advocate for Equatics Metal. I am also a CNCF Ambassador and I do quite a lot of live streaming. You can find my streams at rockhold.live. My goal with streaming is to provide educational resources for all of us to learn the vast cloud native landscape together. And today I want to introduce you to Tinkerbell, a bare metal provisioning system open sourced by Equinix Metal, now a CNCF sandbox project that aims to solve some challenges that have been difficult for a long time. And that is commoditising bare metal, which is no easy task. So before we dive right in, let me just shrink myself down. So Tinkerbell isn't your run-of-the-mill project. When we're working directly with a metal, there are a lot of things that are a little bit harder than working with a virtual machine. First, Tinkerbell has to run an in-memory operating system that can handle partitioning disks, encrypting disks, writing and installing operating systems through container-based workflows. There's multiple microservices that are responsible for understanding which bare metal devices are coming online through MAC address identification. There is IPEXA for building the operating systems and streaming the operating systems over the network. And of course there's IP address management too, DHCP. And while you can use traditional CI systems, you definitely have to provide your own runners. So in order to build out our continuous integration and delivery system for the Tinkerbell project, we need access to some metal. Personally, I work for Equinix Metal, and Equinix Metal do donate a substantial amount of infrastructure and inventory to the Cloud Data Foundation for projects like this. My go-to tool for spinning up brand new machines on any cloud provider of choice is Pulumi. And there are a few reasons I want to talk about Pulumi for this session. One, Pulumi very graciously gave us free access to Pulumi Cloud for the Tinkerbell project. This comes with a whole bunch of benefits. From the security side, it meant that we could commoditize access through their RBAC system. It also meant we could take advantage of their secrets management as well. Something that Pulumi does really well is allow us to really adhere and adopt GitOps by having everything that we need including secrets in the repository and pushed. They are of course encrypted using the Pulumi Cloud backend. However, if you want to use Pulumi and you want to stick to the open source, you can use any cloud KMS as a backend as well. This is our actual production stack file which is open source on github.com. You can see we have AWS credentials here and we also have our Equinix Metal credentials. Next, we can't just spin up metal and magically do something right. We have to go through some provisioning stage so we need some software on the devices too. My go-to tool for this is SaltStack. Again, focusing on the security reasons of why I'm using SaltStack is one, there's no SSH as a transport protocol. SaltStack uses zero MQ based messaging to pass messages which the minions are subscribing to from the master and executing those days. Salt also has a concept of pillars which allows us to have secret information available on the SaltMaster node and selectively distributing the keys that we want to each individual machine or minion based on a whole bunch of grains and parameters. One thing about the messaging system here is that it simplifies all of our network policies. The minions only have to be able to speak to the SaltMaster. We're not opening up ports for the SaltMaster to reach all of our minions and that's a big win too. And the way that we're consuming SaltStack or provisioning SaltStack on these machines is leveraging the Loomis secret store. Writing the secrets that we need to cloud in it and then they'll come available to Salt. And the secrets being stored in pillars means that we can selectively distribute them based on grain data to each of the minions. So the minions only get the secrets that we allow them to see. And it's worth pointing out that while Tinkerbell was open sourced by Equinex Metal and a majority of the team comes from Equinex Metal that it is a CNCF sandbox project. This means that we're using hardware not on our Equinex Metal accounts but on our CNCF accounts. It also means that any maintainer or contributor regardless of where they are employed should be able to have the same amount of access. We want to protect against the bus factor of course as well. So we need to commoditize the access to the machines. And for that I'm falling back on one of my other favorite tools, Teleport. Teleport allows us to disable OpenSSH. We don't need to rely on giving people access to the machines by reaching out and getting their SSH keys or scraping them from GitHub. We don't need to add everybody to the project on Equinex Metal. We can use Teleport's SSH server which is backed by GitHub SSO and restrict access to these machines based on a group that we create within the Tinkerbell organization on GitHub. So in order to give people access to the runners or to the saltmaster itself we just have to add them to a group on GitHub. And that's pretty cool. We're keeping Teleport secure by only allowing private IPv4 access for other nodes to join the cluster. And again the tokens are all stored in the Pulumi store and are encrypted by Pulumi and distributed via cloud in it to SaltStack to the runners as needed. So what does that all look like? Okay, so first you can see all of the code to provision this infrastructure and the applications running on top of the machines at github.com slash tinkerbell slash infrastructure. We have the Pulumi directory which is responsible for running the Pulumi app provisioning the bare metal, writing everything that we need to cloud in it and bootstrap the salt setup. From there salt takes over and installs everything else that we need on itself and the runner devices. Using Pulumi's cloud we have access to see when Pulumi commands were run against a stack. We can just click on Tinkerbell infrastructure production. We can see the outputs. We can see the configuration used including secrets although they are nicely sophisticated. And what else is cool is that we have the activity view that shows us every time someone ran the Pulumi stack so we've got really good visibility and to when any of these secrets were accessed the state was changed and nodes were spun up. Now in order to get access to the machines we can browse to teleport.tinkerbell.org There is only one option to log in and add us through github. I click the magic button and I now have access to all of the machines within the infrastructure. I think what is really cool about teleport as our SSH means is that we can have the ability to see active sessions and in fact we can even join them if they were in progress and see what the people are typing or doing or whatever. And the sessions are also recorded but let's take a look at that.  Back over here you can click on active sessions and we can see that I have an SSH session in progress and I have a join button which if I type echo hello I can see both of my terminals. Very very cool. Let's end both of these sessions. Refresh and that will end in just a moment hopefully it shows up here and now our session is gone. We can go to our audit log, we can see that sessions were started we can see the single sign on from github we can see that someone joined a session and we can see the user disconnected. We can come back here and click play on our recorded session and see all of those commands that were executed. We got the salt, we have the salt, test up ping followed by our echo. Thank you for watching this session. I hope you get as much value out of Pulumi, Solstack, and Teleport as I, the Tinkerbell, and Echo Next Mail. Have a great day.


a very good evening aspirants welcome to hindu news analysis brought to you by shankara is academy today's date is 13th of june 2022 the list of articles we are going to discuss today is displayed on the screen you can go through it now let's start our discussion now look at this text and context article it talks about cryptocurrency what the article basically says is that the high price of the cryptocurrency is based on the belief that in the future the cryptocurrency will replace the fiat currency like the US dollar but what the author of this article argues is that the government all around the world would take every step necessary to stop this this is the basic essence of the article now let us see this in detail first think about this why does anything acquire monetary value see a commodity or asset acquiesce monetary value based on its use value or exchange value take petrol for example see the money value of petrol has various factors associated with it but the primary factor why petrol is valuable is because of its use value we need petrol for transportation and without petrol any economy will stand still next take stocks in a company for example although the stock does not have any use value they have a exchange value we can easily exchange the stocks for cash and we can expect future returns from it so as I already mentioned for any item to have a money value they must possess either use value or exchange value now let us take cryptocurrency see any invention or discovery must have a need or necessity right we know that the Wright brothers invented aeroplanes because from time immemorial humanity wanted to conquer the skies now what necessitated the creation of cryptocurrency see all over the world the central banks have moved away from the proportional reserve system and taken up the minimum reserve system take India for example here RBI has to maintain a minimum reserve of rupees 515 crore and with this minimum reserve RBI in theory can print indefinite amount of money so world over the central banks post the adoption of the minimum reserve system started printing money out of thin air now what happens when money supply increases it causes inflation and what happens when there is inflation the amount of wealth you hold declines in value so naturally investors were looking for alternative assets whose supply cannot be cranked up as easily to protect their wealth from inflation on the side note just remember that this act of protecting your wealth from investing in safe assets is called hedging okay a hedge is an investment that protects you from risk now coming back so investors were looking for assets whose supply cannot be increased by the whims and fancies of the government right this is where the private cryptocurrency comes into play their main selling point is that only a limited amount of cryptocurrency can be mined this led to a speculative mass hysteria money started pouring in see we know that bitcoin is on a downward trend right even now one bitcoin is trading from 19 lakh 93000 rupee but when the cryptocurrency market was bullish some year back the bitcoin was trading at 45 lakh rupee okay see does cryptocurrency have any use value it is a big no does cryptocurrency have any exchange value it is questionable whether they possess any exchange value in the real world the most the cryptocurrency can do is that it can help you buy very few goods and services that is with most economies around the world banning the use of cryptocurrency as a medium of exchange they can only be used on the dark web so why does the value of cryptocurrency keep appreciating it is because of scarcity we already know that only a limited amount of cryptocurrency can be mined and this scarcity is one of the main reasons that is pushing up its price the next reason is that the investors are bidding up the price of bitcoin because they foresee a future in which private cryptocurrency are widely accepted as money let us take the second reason in the future will private cryptocurrency become the main medium of exchange here economist fried rich hayek in its book that denationalization of money mentioned that competition between currencies to cater to the demands of customer would ensure that fiat currency that is the currency like us dollar or rupee that are printed indiscriminately simply go out of use this is what the government fears it will do everything within its power to prevent such a scenario from happening but why the monopoly that governments and central banks possess over the issuance or printing of money is at the root of their power and influence it is only by using this power during difficult times the governments fund their budget deficits it also allows central banks to manipulate the money supply to manage aggregate demand and inflation in the economy and if cryptocurrencies like bitcoin are going to challenge fiat currencies like the us dollar as a medium of exchange they would essentially be challenging the authority of the government to print and spend the money just think about it will the government in any way want to lose its power definitely no right so according to the author of this article the government will allow cryptocurrencies to exist only as long as these currencies remain a speculative asset and not a medium of exchange that is like in india the cryptocurrency exchanges will continue to exist as long as they do not try to become a medium of exchange and challenge the government's authority so that is all regarding this discussion and this article discussion we saw the need for cryptocurrency then we saw why any item or commodity has a monetary value then we saw about the fundamental flaw with cryptocurrency and then we ended the discussion by seeing why the government will take steps to prevent cryptocurrency from becoming a medium of exchange so with these learned points let's move on to next news article discussion look at this text and context article it talks about the FATF and pakistan's position on its gray list here FATF is the abbreviation of financial action task force see FATF is the news because its plenary session is about to start from june 14th and pakistan is hoping to get its name removed from the FATF's gray list this is the crux of the news article given here in this context let us know what is FATF and then we will discuss in detail of how pakistan is aiming to get itself removed from the FATF gray list okay before that the syllabus relevant to this article is highlighted here for your reference you can go through it first of all what is this FATF see the FATF or the financial action task force is an international watchdog for financial crimes such as money laundering and terror financing it was established at the g7 submit of 1989 in paris this is to address loopholes in the global financial system this was mainly spoken or brought into light after member countries raised concerns about growing money laundering activities note that the FATF also added terror financing as a main focus area see this was done after the september 11 terror attack on the united states okay this was later broadened to include restricting the funding of weapons of mass destruction see the FATF currently has 39 members and the decision making body of the FATF is known as plenary it meets three times in a year its meetings are even attended by observer organizations such as world bank and some officers of united nations and some regional development banks okay now what is the work of this FATF firstly the FATF sets standards or recommendations for countries this is to plug the holes in their financial systems so it tries to make the countries less vulnerable to illegal financial activities secondly the FATF conducts regular peer reviewed evaluations this is called mutual evaluations of countries this is done to check their performance on the standards prescribed by it see the reviews are carried out by FATF and FATF styled regional bodies then they release the report called mutual evaluation reports okay thirdly the FATF draws up time bound action plans this is for the countries that don't perform well on certain standards see the recommendations range from assessing risks of crime to setting up legislatures then the recommendations also include investigative and judicial mechanisms all these are done to counter the cases of money laundering and terror funding okay see after the end of every plenary meeting FATF comes out with two list of countries we know that these two lists are gray list and black lists but these words gray and black list do not exist in the official FATF lexicon okay note that the gray countries are designated as jurisdictions under increased monitoring these countries work with the FATF to counter criminal financial activities whereas the black list countries are called high risk jurisdictions these are subject to call for action these nations have huge deficiencies in their anti money laundering and counter terrorist financial regiments okay just look at this image to know the 23 gray listed countries you can see Pakistan is one of the gray listed countries okay see regarding these gray listed countries the FATF does not tell other members to carry out two diligence mechanism they simply ask them to consider the risk such gray listed country possesses okay but coming to the black listed countries the FATF calls on members and non-members to apply enhanced due diligence like in most cases members are told to apply counter measures such as sanctions and we know that currently North Korea and Iran are on the black list see not only these when countries are listed by FATF under these lists it is hard to get aid from organizations like the IMF Asian Development Banks and the European Union it may also affect the country's capital inflows foreign direct investments and portfolio investments etc okay now coming to the main part of a discussion that is why Pakistan is on the gray list see Pakistan was retained on the gray list in March this is because it was yet to address concerns on the front of terror financing investigations and prosecutions but Pakistan claims that it has taken several measures to counter terrorism like prosecution of Masood Azhar and arrest of about 300 other designated terrorists and the seizure of more than 1,000 properties owned by terror groups okay this is the Pakistan's claim now why is Pakistan trying to get out of this gray list see as I already said getting enlisted in the gray or black list makes the fundraising procedures from organizations like IMF difficult in Pakistan's case they are struggling to get bailout money from IMF here bailout is the general term for extending financial support to a company or a country facing a potential bankruptcy threat it can take the form of loans cash bonds or stock purchases a bailout may or may not require reimbursement and is often accompanied by greater government oversee and regulations okay so to raise fund from international organizations Pakistan is trying to get out of this gray list so that's all regarding this discussion in this article discussion we saw about FATF gray list and black list and the countries in these lists we saw that North Korea and Iran are on the black list then we saw about one of the gray listed countries which is Pakistan that is trying to get out of this gray list with all these learned points let's move on to next news article discussion now look at this news article this news article mentions about the legislative council election that is about to be held in Karnataka this is about the news article in this context let us see about legislative council from exam perspective see legislative council is also known as Vidhan Parishad it is the upper house of the state assembly it is presided by the chairman and deputy chairman okay but remember not all states have legislative councils the states having both a legislative assembly and legislative councils are called bicameral here note that only Andhra Pradesh, Bihar, Maharashtra, Karnataka, Telangana and Uttar Pradesh have constituted legislative councils this non-uniformity exists because some states believe that existence of legislative councils delays legislative process and they think it as an expensive institution and one inference can be made from this that is a legislative council can be created or abolished it can be created where it does not exist and can be abolished where it already exists this is provided by the constitution under article 169 now what is the procedure involved as per the constitution parliament has the power to abolish or create a legislative council by law but this will happen only if the legislative assembly of the concerned state passes a resolution to that effect this resolution must be passed by the state assembly by a special majority special majority means a majority of total membership of the assembly and a majority of not less than two-third of the members of the assembly present an outing now we will see some of the features of legislative councils see it is a continuing chamber or it is a permanent body and is not subjective dissolution like legislative assembly and it checks the defective and ill-considered legislation made by the assembly this is done by making provision for revision and rethought then it also facilitates representation of eminent professionals and experts who cannot face direct elections see the governor nominates one six members of the council to provide representation to such people okay note that the composition of legislative council is as per article 171 cross one the maximum strength of the council is fixed at one-third of the total strength of the assembly and the minimum strength is 40 this means the size of the council depends on the size of the assembly of a concerned state but remember even though the constitution has fixed the minimum and maximum limits the actual strength of the council is fixed by the parliament now these members are indirectly elected in accordance with the system of proportional representation by means of a single transferable out and the tenure of the members is six years but one-third of the legislative council members retire on the expiration of every second year these vacant seats are filled by fresh elections and nominations by governor at the beginning of every third year with this let us see how the MLCs are elected see one-third of the MLCs are elected by the state MLAs then the next one-third of the MLCs are elected by the electorates consisting of members of municipalities district boards and other local authorities in that state then one-twelfth of the MLCs are elected by an electorate consisting of teacher and then another one-twelfth of the MLCs are elected by registered graduates then the balance one-sixth of the MLCs are nominated by the governor from among those who have distinguished themselves in literature science art cooperative movement and social service so that is all regarding this discussion in this discussion we saw about the legislative council how they can be created the bicameral states in india the composition of legislative councils the features of legislative councils and finally we saw how the members of legislative councils that is MLCs are elected with this let us control this discussion and take up next news article take a look at this article it talks about a petition filed by a class 6 student in by Parmanand Vidya Mandir in delhi she was told by the school that her name had been struck up the roles over non-payment of fees since june 2021 so she challenged the certain provisions of the delhi school education rules 1973 but the delhi high court said that rte act guarantees the right to education however it nowhere provided that the said right can be unconditionally enforced against a private unaided school and this is the crux of the news article given here in this context let us learn more about rte act see the right of children to free and compulsory education act 2009 is an act to provide for free and compulsory education to all children of the age of 6 to 14 years okay now let us see some of the key features of this act firstly no child should be liable to pay any kind of fee or charges or expenses and a child with disability also have the same rights to free and compulsory elementary education and secondly if a child above the age of 6 years is not admitted to school then he or she should be admitted in a class appropriate to his or her age and have a right to receive special training and thirdly the child has a right to transfer from one school to another when there is no provision for completion of elementary education in this case the headmaster in charge in the first school should issue the transfer certificate without any delay for the implementation of this act the government and local authority should establish a school if it is not there already within 3 years from the commencement of the act and also note that the central and state governments have concurrent responsibility for providing funds for carrying out the provision of this act okay so the financial burden is shared by both the center and states so far we have seen some of the features of this act and now we will see some of the duties of the government see it is the duty of the government to provide free elementary education to every child of the age of 6 to 14 years and they have to ensure compulsory admission attendance and completion of elementary education and it is also the duty of the government to ensure availability of the neighborhood school and they must ensure the child belonging to weakest section and the child belonging to disadvantaged group are not discriminated against and the government should provide infrastructure including school building teaching staff and learning equipment and they should ensure the timely prescribing of curriculum and course of study and finally they should provide training facility for teachers like the duties of the government there is also some other duties for local authorities as well it is more or less same as the duties of the government now let us see them see it is the duty of every parent or guardian to admit his or her child to an elementary education and the appropriate government must make necessary arrangement for providing free preschool education for children with a view to prepare the children above the age of 3 years for elementary education and note that the age of a child should be determined on the basis of the birth certificate issued in accordance with the provisions of the births, deaths and marriage registration act of 1886 and at the same time no child should be denied admission in a school for lack of age proof and these are some of the important provisions of the act. We will see the remaining provisions some other day so that is all regarding this discussion in this discussion we saw about the key features of RTE act the duties of the government and the local authorities with these learned points let us move on to next news article discussion. See this article here it talks about the type 1 diabetes it is said that India has the highest number of incident and prevalent cases of type 1 diabetes in the world as per recent estimates from the International Diabetes Federation and as per the article the ICMR has now published a comprehensive document providing advice on care of diabetes in children, adolescents and adults with type 1 diabetes and this is about the article given here in this context let us learn about the types of diabetes first of all what is diabetes see diabetes is a chronic disease that occurs when the pancreas is no longer able to make insulin or when the body cannot make good use of the insulin it produces so what is insulin then insulin is a hormone made by the pancreas that acts like a key to let glucose from the food we eat it passes from the bloodstream into the cells in the body to produce energy all carbohydrate foods are broken down into glucose in the blood and insulin helps glucose get into the cells and know that not being able to produce insulin or use it effectively leads to raised glucose levels in the blood and this condition is known as hyperglyemia with this basics let us see about the types of diabetes firstly type 1 diabetes see type 1 diabetes is caused by an autoimmune reaction where the body's different system attacks the cell that produce insulin as a result the body produces very little or no insulin the exact cause of this are not yet known but they are linked to a combination of genetic and environmental conditions know that type 1 diabetes can affect people at any age but usually it develops in children or young adults people with type 1 diabetes need daily injections of insulin to control their blood glucose levels if people with type 1 diabetes do not have access to insulin they will die and around 10 percent of all people with diabetes have type 1 diabetes now coming to the next type which is type 2 diabetes see type 2 diabetes is the most common type of diabetes accounting for around 90 percentage of all diabetes cases it is generally characterized by insulin resistance where the body does not fully respond to insulin and because insulin cannot work properly blood glucose levels keep rising releasing more insulin for some people with type 2 diabetes this can eventually exhaust the pancreas resulting in the body producing less and less insulin causing even higher blood sugar levels and know that type 2 diabetes is most commonly diagnosed in older adults but it is increasingly seen in children adolescents and younger adults due to rising levels of obesity physical inactivity and poor diet and the cornerstone of type 2 diabetes management is a healthy diet increased physical activity and maintaining a healthy body weight oral medication and insulin are also frequently prescribed to help control blood glucose levels and finally let us see about gestational diabetes see gestational diabetes is caused by insulin blocking hormones that are produced during pregnancy if one has gestational diabetes the baby could be at higher risk for health problems gestational diabetes usually goes away after the baby is born but increases the risk for type 2 diabetes later in life the newly born baby is more likely to have obesity as a child or teen and more likely to develop type 2 diabetes later in life too okay so these are the three major types of diabetes which are type 1 diabetes type 2 diabetes and gestational diabetes so that is all regarding this news article discussion now we will move on to next news article look at this news article this article here says that india is negotiating the purchase of additional chinook heavy lift helicopters and apache attack helicopters see both these helicopters has the origin in united states see it also says that the f a 18 ef super hornet fighter jet has distinct advantages in terms of capability over the competitor french rafael jet to operate from the indian navies aircraft carriers and this is the crux of the article given here in this context let us learn about chinook and apache choppers okay first let us see about apache choppers see the ah 64 apache is the world's most advanced multi role combat helicopter the ah 64 e is an advanced multi mission helicopter with the latest technology insertions maintaining its standings as the world's best attack helicopter and it is the only available compact helicopter with the spectrum of capabilities for virtually any mission requirements including greater thrust and lift joint digital operability improved survivability and cognitive decision aiding this helicopter is the latest version of the ah 64 the ah 64 e version 6 is a lethal survivable and agile system providing the range maneuverability and performance needed by ground forces it has a number of improvements and upgrades including more powerful engines upgraded transmission and other improvements this attack helicopter is operated by a crew of two including pilot and gunner see there are numerous features to protect the crew and increase survivability of the helicopter the airframe is designed to withstand hits from the guns of up to 12.7 mm caliber and the rotor blades can withstand hits from 23 mm guns see the crew members are seated on crash resistance seats the ah 64 e has infrared suppressing exhaust system and is equipped with flare dispenses both these features combined reduce the chance of being hit by enemy air defense missiles both crew members use various sophisticated sensors and systems for the detection and attack of targets and know that the Indian Air Force had signed a multi-billion dollar contract with the US government and Boeing limited in September 2015 for 23 Apache helicopters having seen about Apache now let us see Chinook see the CH-47 Chinook is an advanced multi-mission helicopter that will provide the Indian Air Force with unmatched strategic airlift capability across the full spectrum of combat and humanitarian missions the Chinook has unsurpassed ability to deliver heavy payloads to high altitudes and is eminently suitable for operations in the high Himalayas know that the CH-47F is an advanced multi-mission helicopter for the US Army and other international defense forces it contains a fully integrated digital cockpit management system common aviation architecture cockpit and advanced cargo handling capabilities so that they supplement the aircraft's mission performance and handling characteristics and also the CH-47F helicopter tactically transports forces and associated equipment and provides routine aerial sustainment of man-over forces secondary missions that the Chinook executes to support soldiers and commanders include medical evacuation search and rescue parachute drops disaster relief and aircraft recovery the Chinook is the helicopter of choice for humanitarian disaster relief operations in missions such as transportation of relief supplies and mass evacuation of refugees so that is all regarding this news article and this news article discussion we saw in detail about Apache helicopters and Chinook choppers so with these learned points let us move on to next part of our news article discussion which is preliminary practice questions discussion today we have four practice prelims questions I will solve first two questions and the remaining two questions will be a quiz question for you okay look at the first question consider the following statements regarding RTE Act 2009 if children above six years are not admitted then they are eligible for free education only for remaining years till the age of 14 statement 2 the age of child is determined based on the birth certificate but if there is a lack of age proof then the child shall not be denied admissions we have to find the correct statement here see statement 1 it is incorrect this we saw in our discussion right if a child above six years is not admitted to school then he or she shall be admitted in a class appropriate to his or her age and they have a right to receive special training that is in this case the child have the right to free education until it completes the elementary education even after 14 years of age okay regarding statement 2 it is correct this also we saw in the discussion the age of the child shall be determined on the basis of birth certificate issued in accordance with the provisions of the births deaths and marriages registration act 1886 and at the same time no child should be denied admission in a school for lack of age proof okay so here our correct answer will be option B2 only look at the second question that is regarding diabetes consider the following statements regarding type 1 diabetes this type of diabetes is diagnosed only in older adults statement 2 type 1 diabetes is caused by insulin resistance when the body does not fully respond to insulin now we have to find the correct statement here see the first statement it is incorrect because type 1 diabetes can affect people at any age but usually develops in children or adults and regarding statement 2 it is also incorrect because type 1 diabetes is caused by an autoimmune reaction that the body's different system attacks the cells that produce insulin and this statement is the cause of type 2 diabetes see type 2 diabetes only is caused by insulin resistance so both statements are incorrect so our answer will be option D neither one nor two look at these two questions these two questions or quiz question for you find the answer and post it in the comment section the main questions based on today's discussion is displayed on the screen write the answer and post that also in the comment section if you like the video hit the like button post your comments and share the video with your friends and don't forget to subscribe Shankar IAS Academy YouTube channel thanks for watching


What's going on guys Preston here from x trades and today we are going to be talking about contracts selection or contract expiry selection based upon chart and How long you expect it to take for your play to? Hate your profit take so let's go ahead and get started. I'm gonna be using the Apple chart here but So let's say I'm just gonna go by like time frames depending on try to hit on like what every time frame Like the usual ones that people would trade on so starting off on a smaller time frame with the one hour Let's say you're looking at this hourly chart for Apple here back in late May and You're pretty much just we've gone through This one cycle of okay. We kind of got support figured out here We got resistance right here kind of like a profit take area in the middle right here. So We're going just one to two day swings Maybe like weeklies But yeah, so let's say you're looking at this chart right here And you pretty much want to continue trading this channel You're seeing this you're seeing the bounce off support. You're seeing a little bit of resistance here around 126 and then ultimate ultimate resistance 12775 so what you're gonna want to do is pretty much you're gonna be trading weeklies so If we're I got it pretty much pulled up here So we're looking at around in May sometime around there. So you would want to be trading Either like two weeks out. It's a monthly sometimes those will get better volume and Open interest you can see here back in around that time In this area like 120s There's pretty much Yeah, so we're looking at 126 12775 and we were near the Bottom of the channel here. You can see 123. This is like On-demand so it's pretty much live From that day May 12th 2021 of when we were around this area so Anyways going back to here. You can see there's some volume because we're near the bottom of that channel So there's some volume picking up here for like the 126 127 strike price so What these people are looking for and what you would be looking for is that you're trading a weekly you expect like one hold one Three days maybe so you're just getting that weekly contract and you're looking for the bounce-off support to get up to here nothing big scheme Just profit take one right here in the middle profit take two with Maybe leave some runners, but I would assume like just all out here and it's pretty much a first sell here And then runners to sell here but That's from like an hourly standpoint. You're trading weeklies You can't really get a good grasp of like the long term to where you're trading like monthlies or leaps so carrying on let's say we're looking at the daily chart here zoom out and Let me turn off on demand because at this point we're getting to where we are today so let's say you were looking at the daily chart here and you would actually be able to notice that Here is where we were in what I was just showing on the hourly chart. You can see we're kind of forming a base here Haven't been down here since early April and so kind of expecting this to hold this this support is Fairly notorious. Maybe we got some we're slipping under here, but It comes back and so that's what you're seeing here on the daily and on the multiple tests got a couple daily candles that Hit it bounce off And so you're seeing this on the daily chart and you think oh like this thing's gonna pop soon Like for sure and you're in at this point around like mid-may late-may getting into June And so you think okay like this could this could base for which base would be if it just like stayed in this channel But it's like loading up for that pop But you're you're expecting like the big the big pop then you'd be looking at Maybe a monthly, but I would go with like something in at this point. We're in like early or late May so you'd be looking at like August maybe and Pretty much like it's gonna cost you extra premium at this point we're in July, so it's a little cheaper, but Back then it would have been more expensive and I guess we could pull it up. So let's see We were in let's go back to on-demand here and then So that's let's go here And then we're looking at so we're pretty much looking at August Just to play it safe, you know because July 16th now would be Pushing it with we just got to all-time high and you're expecting like all right Like we're gonna break out. It's gonna go far and you're putting in some good premium like a good amount Or for your account size like you're getting a good position in there Then you're gonna want to look at three months out two months out if you're expecting something good to happen And so we're looking here at May 26th I'm in on the West Coast, so This is two hours into the trading day and you can see that There's there's some good open interest volume is what it would be usually for more of like a leap Contract is about three months out at this point. So we're seeing you could get what a 130 Strike price call for Apple on this day at five for about 495 $495 per contract and you're around like 127. So we're right at This resistance right around here like we're pretty much getting up there. So you're you're watching it you think it's gonna break out and You get in and so that was the 130 strike price in August 20th 130 you're looking at 500 and we're down here. So now let's say like you you got in because you know that that's gonna happen now when we looking at 130 now you're at 1615 per contract and so that just shows how I mean one Looking at a bigger time frame, whether it's like the weekly chart daily chart or even The four-hour chart it can help you like notice these big moves. Whereas if you're just on the hourly chart not necessarily looking at like this stuff on the right, but you know like You can kind of tell there's something but for here. It's you're just looking at Like channel trading and you're trading weeklies, which are fine Definitely like some big moves can can make you some some good money, but you want to look for The the bigger moves. I'm sure all of us do So that's pretty much what we're looking at here for daily Weekly is where you can kind of see bigger trends Where's the chart? So weekly we could see here that we're kind of in a up and then now it's sort of Flagging in a way you could say yeah, you could say that we're we're sort of flagging and so at this point You could go like pretty far out with the weekly and we're looking at some far-out contracts And if you're looking at a weekly chart like each one of these candles is a week And so your expiry is not gonna be you're not gonna be playing a weekly because you're basically playing one of these candles You can't take a trade based off of that. And so You would want to go a good like Like six months out or so we're looking at I mean not not getting into January Although there's nothing wrong with it if you see like this this kind of chart You're like, all right, like we got a little trend going on here Something like that and then we got obviously the This right here, so it's like an ascending triangle kind of and so this breakout is gonna be all-time high one and two It's gonna get some good momentum going because it's Apple and we Even in the chat room we're talking about just waiting for this breakout for a while And so you would go with an expiry like if we're in we're in July 11th now so maybe like looking at September or October and looking at like a 160 kind of contract so you can see yeah We got some good volume there a good open interest and then if we're looking at September It's a little closer. So maybe like a 155 Kind of contract. So there we go 27,000 They are still a good volume on the 160s for sure So people are people are noticing and that's just what you want to be looking for so our To summarize what I just talked about you're looking at hourly is going to be like weeklies Short shorter term kind of like lotto plays not necessarily like not necessarily that but those smaller shorter term Like let's get a good move play and then when you're looking at the Daily chart four-hour chart you're gonna be trading monthlies because you have better data and You can like see a breakout coming you can see a base and see that okay Like I think we're gonna break out here And then when you're looking at a weekly you get stuff like this where it's like an overall just the long-term trend is About to break out and it's gonna be big, but you don't know when it'll break out because we could Reject this resistance go back down to the trend line and get back up.  So you're gonna want to be protected with far out the expiration dates


Gweithio, ein bod wedi bod yn ymddangos i gael ddatblygu'r ysgolwyddon sy'n cael ei wneud o'r sgolwyddon yn ei byw. Ac mae'n defnyddio'r ysgolwyddon o'r ffrindiau ei ddesig o'r ffordd, ac mae'n ddweud o'r ffordd o'r ysgolwyddon yn ymddangos i ddweud o'r oeddau ydw i'r cyfnodol yn ddweudio'r clywed o'r llei. Ysgolwyddon yma yn ddweud o'r ddweud i'r ddeu gyffredigol yn ymgyrcholwyddon, yn rydyn i wneud maen nhw'n dilyn ni i gynnig iawn i'ch gymryd ymddangosau cymdeithasol hynhygoel a'i'n mythdoed yn gallu iawn i'ch gondol yma, i'ch wneud i'ch byw gyngorol beth ond am y bwyllai a'ch oedd o gofynnodd cyfrionnol i'r cyfrannu lleoliog feddwl, i'ch ddysgol yn dweud o'r cyfrannu lleoliog. Rhywodol wedi'u gweithio'rjm er amlwg, mae'r cyfrannu, a dyna'r ysgolion gyda'r ysgolion gyda'r northgrath George's Street i'w ddweud yn y cyfrifio. Mae'r cyfrifio'r gael, wrth gwrs, y dyfodol y riliogatio'r perthynau i gyfrifio'r ffordd yn y ffwrdd yn y dyfodol. First, a fawr maes o'r llyfr i gyfrifio'r ysgolion gyda'r ysgolion. I will begin with a short context setting for our current transport policy and in particular what we refer to as smarter travel. Secondly then a look at the impact that the fiscal crisis has had on our policy. Thirdly I want to focus in particular on the key role of vehicle technology in delivering the emission reductions that we need in transport and finally I am going to try and place smarter travel in the context of wider government policies across various sectors. So to begin with the background context to smarter travel and current transport policy. Well smarter travel is the title of the Sustainable Transport Policy for Ireland which was published by the previous government in 2009. While some of its key proposals are now on hold because the money for the necessary investment is simply not available in current circumstances. The underlying principles had broad acceptance right across the political spectrum and are also to be found in the current programme for government. Now as a mere civil servant I am going to steer very carefully clear of the political debate on what priority we should be giving to enshrining emission reductions in domestic legislation but a factual position that should be borne in mind is that our emission reduction targets do actually already have the force of law. The bottom line is that our reduction targets for overall national emissions are binding under EU law irrespective of whether and when the world as a whole agrees on new targets and there are very very punitive potential sanctions for Ireland if we fail to meet those reduction targets and as will have been very clear to you from what you've heard so far today we have very little chance of achieving those reductions in the medium term if we don't deliver a significant reduction in transport emissions. This has been masked a little bit by the economic downturn because transport emissions have traditionally been very closely coupled with economic activity but when economic growth resumes so too will the growth in transport emissions unless technological change and our policies result in a new trajectory. Now the first presentation of the afternoon after lunch may not be the best time to look at statistics so I limit myself to a few key ones. The transport sector is the third largest contributor to greenhouse gas emissions in Ireland at 19% of the national total in 2010 but as everybody here is aware and was highlighted in Laura's presentation this morning the more significant percentage is transport share in our emissions outside the emission trading sector since that from now on is what will provide the basis on which our national performance will be assessed. The emission trading sector will look after itself and Brussels will look after it we have to look after the non trading sector. Transport share in the non trading sector in 2010 was a little over 26%. CO2 emissions from transport were on a growth trajectory over the period 1990 to 2007 increasing by 156% in that period with the road freight sector accounting for over 23% of transport CO2 emissions in 2007 while the private car contributed over 37%. Now since then the years 2008 to 2010 saw significant reductions in transport emissions but mainly due to the economic downturn with freight activity in particular being very much reduced over the period. Specific policy measures taken to address demand and to encourage energy efficient vehicle purchasing patterns have also had some effect so greenhouse gas emissions for the transport sector in 2010 were down to 11.61 megatons from a peak of 14.29 in 2007 and that's a drop of 19% however the 2010 figure is still 127% higher than that of 1990. From 1996 to 2006 road freight vehicle kilometres increased by 115% they've since fallen by over 40% from that figure but the vast majority of that is due to the reduction of that reduction is due to the downturn in the construction sector with much lesser reductions in vehicle kilometres in other sectors of the economy. Ireland's plans for economic recovery include a concerted effort at building further on our exports and not just in agri food. With this in mind it's interesting to note that the value of exports returned to pre-recession levels by 2010 and increased further by from 89 billion to 93 billion in 2011. A growing export-led economy is likely to see an increase in freight emissions. The number of private cars per thousand adults while it increased by 73% over the period from 1990 to 2009 is still below the EU-15 and UK averages so undoubtedly there's potential growth there as well. In other words there's absolutely no doubt that the underlying trend in transport emissions will return to growth unless there is a shift change. The good news is that the combined effect of technological change and policy development can bring about the shift change that we need. I'm just going to look quickly at what the Department of Transport as it was at the time set out to do in smarter travel. The purpose of smarter travel was to provide a plan to make Ireland's transport system sustainable by 2020 and it contained a total of 49 measures which can be broadly grouped under four key headings. Firstly there were actions to reduce the distance travelled by private car and encourage smarter travel and these include focusing population and employment growth predominantly in larger urban areas. This entails the development of better and workable linkages between the spatial and physical planning systems and the transport agenda aiming for a future in which investment in new public facilities such as schools, community centres, health centres, amenities and so on take account of the need for access without reliance on the car. Secondly, there were actions to improve access to alternatives to the private car through the availability of better public transport links and routes that are cycle and walking friendly. Smarter travel in particular committed to intensive action to make cycling a popular travel mode publishing Ireland's first ever national cycling policy which laid out actions to achieve by 2020 a five fold increase in cycling's modal share and I should acknowledge the attendance here this afternoon of Ciaran Cofu in his time as Minister of State at the Department of Transport was particularly active in pushing the sustainable transport agenda and in particular the cycling agenda. Actions to improve pedestrians experiences of streets and public spaces were also part of the policy. The third heading encompassed actions aimed at improving the fuel efficiency and environmental performance of motorised transport through improved fleet structures, energy efficient driving and alternative technologies and I'm going to come back to that one in a bit of detail in a moment. Finally, the strategy recognised that a lot of the things it wanted to do could not have been delivered under the existing institution arrangements at the time so the fourth broad action heading related to improving governance arrangements. But then of course we had a blip, a rather large one. The strategy was published in 2009 just as the full horror of what was about to befall the economy and the public finances was beginning to emerge. And since then we have of course had a massive contraction in the public finances. The new government's medium term expenditure framework which was published last autumn has provided greater clarity about the spending profile that transport now has for the next five years and investment in sustainable travel has inevitably been less than was originally envisaged when the smarter travel policy was published. However the government has still prioritised investment in this area and over the period from this year to 2016 close to one and a half billion will be invested in sustainable travel including public transport. Now to put that in some context when the document was published in 2009 it was estimated that some four and a half billion euro would be required if the policy was to be implemented in full by 2020 and that didn't count the cost of investment in major new public transport infrastructures such as Metro North or the Dart Interconnector which were going to be largely delivered by the private sector under PPP arrangements. About two billion of the projected smarter travel budget was for implementation of the national cycle policy framework with the bulk of the remainder to go on improvements to bus transport. So the funding now available to us both for public transport investment and other sustainable travel policies is hugely reduced from what was initially planned. However within those reduced resources funding has been prioritised to ensure the maintenance of existing infrastructure and to advance a small number of projects which can add value to the existing network. Now as everybody knows the larger big ticket items such as Metro North and the Dart Interconnector have been postponed for consideration in advance of the next capital programme which will be drawn up in 2015. Sadly there is no PPP market at the moment. There is no possibility of large PPP projects being funded by the private sector in Ireland and as both of those projects were reliant on the PPP markets as well as some extra expenditure there was no possibility of there going ahead until the overall confidence in the Irish economy improves. So funding is now focused on delivering improvements to the existing public transport network through maintaining existing infrastructure, removing bottlenecks and pinch points and providing better passenger information and some limited and targeted improvements to the network are possible. Two recent examples of this new targeted funding are the integrated ticketing project in the Greater Dublin area, long promised and long in development but now here and the expansion of real-time passenger information. If I had a penny for every person who has told me over the last three or six months the difference that the real-time passenger information has made to their inclination to possibly put their hand out and get a bus I would have quite a few pennies. Not enough to pay for Metro North or Dart Underground but I would certainly be quite comfortable. A national web-based journey planner is also being developed by the NTA. Any new public transport infrastructure investment is going towards the integration of the system that we already have and of course the remaining big ticket or medium ticket item in that is the Lewis BXD which is going to join up the two Lewis lines and extend it out to connect with the Manuth rail line at Broomebridge. That subject to planning of course should commence in late 2014 or early 2015 if and are possibly earlier. Progress is still being made although slower than originally anticipated on the remainder of smarter travel. In 2009 the Department of Transport established the National Sustainable Travel Office and stronger working arrangements with the local authorities were also established through the launch of the local authorities sustainable travel officer network. In 2010 the national transport authority came into effect and among other things was given responsibility to improve the linkages between transport and planning and to develop a transport strategy for the greater Dublin area. This represents the first step in delivering a key commitment of smarter travel which is to integrate land use and transport planning seeking to establish the GDA transport networks services and the supporting transport policies that will support the regional planning guidelines for the area. However planning improvements though hugely important to how we manage transport policy are unlikely to have a huge effect on transport and travel trends in the very short term and will only have medium term impacts on transport emissions so they are not likely to have a huge impact on our 2020 emission reduction targets. We have also made progress on other smarter travel initiatives including cycle lanes and pedestrianisation projects. Just to take one example that some of you may be familiar with the Grand Canal premium cycle route in Dublin is an example of how high quality provision can still be made for sustainable travel modes despite a reduced budget. A smarter travel demonstration projects fund invested three million nationally on sustainable travel projects. We are looking at models to assess how the very successful Dublin bike scheme could be extended to some of the regional cities. The smarter travel areas programme which was originally budgeted for 50 million euro has been launched this year albeit in a reduced manner and that's providing 23 million euro for three local authorities who are selected from a competition, Limerick Dungarven and Westport over the next five years and the idea is that this investment in each of those areas will transform the local transport systems to support sustainable travel patterns and serve as demonstrations for the other towns and cities in terms of what's possible. A full evaluation of the lessons that are learned from these areas will ensure that key policy information on what works in Irish sustainable travel can be rolled out on a more systematic basis once the fiscal conditions improve. Funding calls have also recently gone out to the local authorities for national cycle network projects which will connect the main towns in Ireland through high quality off-road cycleways and for active travel towns focusing on promoting walking and cycling regional towns in Ireland. The National Transport Authority is also providing funding for sustainable travel for all of the authorities in the GDA at a rate of three million per year per authority and also in the regional cities. So there is a lot going on to a certain extent under the radar but it is going on and a key element of all of this funding and of all current and future funding will be proper monitoring and evaluation of the investment so that knowledge is gained and improved on value for money so that we can better target the more limited resources that we're now working with. I promise I'd come back to technology and as I will make clear, this in my view is how the game is going to be won. I mentioned earlier that we have seen a significant reduction in transport emissions in the last three, four years. Not all of that is due to the recession. Actually apart from construction freight, vehicle kilometres elsewhere are pretty consistent with what they were in the boom time. This gives us an indication that a society's travel patterns are relatively difficult to change and they're not that responsive to changes in personal financial circumstances. Travel behaviour tends to be relatively ingrained and it takes a lot of effort in policy terms to shift. What has made a significant contribution to transport emissions is the impact of the CO2-based VRT and motor tax regime, encouraging the purchase of more fuel-efficient vehicles in conjunction with the CO2 from cars directive which was negotiated and agreed at EU level. The objective of that directive is to reduce vehicle fleet emissions to an average of 130 grams per kilometre by 2012 and 95 grams by 2020. We have seen in Ireland a dramatic reduction in CO2 emissions across all car models. I gather that there is a particular model. It's a Ford Mondeo 1.6 litres, I'm told. The current version on sale is available with emission levels of 114 grams per kilometre. The exact same model in 2008 had over 170 grams per kilometre. So that's a reduction of around, if my arithmetic is right, almost exactly one third in the same model over three years as a response to what the punter wants essentially and the punter wants it because the tax system encourages the punter to get the lower emissions car. People don't necessarily want to drive very small cars, they do want to drive cars that have low emissions and as you know there are one or two brands which will be regarded I suppose as premium brands have actually exploited that extremely successfully over the last couple of years. The range of cars coming on the market at sub 100 grams per kilometre is increasing dramatically. The average specific emissions from new cars purchased in Ireland in 2007 was 164 grams per kilometre. Three years later in 2010, 133. I'm not now talking about pulling out the best example, I'm talking about the average across all new cars purchased. Very very dramatic reduction, which of course feeds immediately into transport emissions. With each successive year the average emission level of the national fleet is reducing substantially and of course as older vehicles get scrapped and replaced by much lower emission vehicles that are now being bought, this is a continual process so it's having and will continue to have a huge impact on national transport emissions. The potential contribution of electric vehicles shouldn't be discounted and we we heard Sarah being extremely upbeat about it this morning and I look forward to hearing Paul Mulvaney's update on how that project is progressing. Similarly the biofuels obligation of 4% biofuel mix has directly reduced emissions from transport by this equivalent and of course the increasing price of fuel including the carbon tax element will also have an impact. The big impacts on our emissions come from tax measures and technological improvements. For everything that I have said about all of the things that we are trying to do under smarter travel in terms of changing behaviour, there is nothing other than tax and technological improvement that will have a huge impact on transport carbon emissions. Taken together all of the items have a not insignificant potential but once the emissions from the vehicle, once those reductions are locked in the remaining potential lies across a range of policy measures that will all deliver small amounts rather than any big ticket items that can solve our problem and those abatement options in many cases are costly and difficult to lever because changing ingrain travel behaviour across the population does not happen quickly and that of course is where we need to weigh up the marginal costs of the potential reductions and compare them with the marginal cost of policy interventions across other sectors and that's where I part company with a view that's often expressed although actually I haven't heard it expressed here today that that transport or any other sector should simply be given an overall sectoral target for emission reductions. I have a strong belief that as an economy we need to find the overall mix of reduction measures that will enable us to meet our national target at the least overall cost. Just coming towards the end now I just want to finish by putting the question of transport policy into a wider context. Long term one of the most important elements of delivering a sustainable transport system in Ireland will be ensuring that proper planning processes are repelled. In the short to medium term smarter travel is a broad range of policy instruments. There is a range of reasons for pursuing those policies and emission reductions is only one of the reasons. Benefits through reducing congestion, through improving the health of the nation, particularly the health of our children, through improving quality of life, improving productivity, making public spaces more attractive, all of those are outcomes of smarter travel policies as well as emission benefits. Smarter travel policies on increasing walking and cycling and public transport are not likely to give huge benefits in reducing emissions in Ireland given our dispersed population and our associated travel patterns. Particularly if we're talking about regular journeys such as commutes because generally it's shorter journeys where the greatest potential exists to switch modes but short journeys in general are not the problem for Irish transport emissions. Just to give some examples, a significant public transport investment such as delivering metro north would be likely only to deliver a reduction of about 40,000 tonnes per annum and this would equate only to about 0.2% of transport emissions. So emission benefits alone don't justify public transport investment in city regions. The benefits are to be seen in all the other things, the reduced congestion, the value of time savings with emission reductions aside benefit. Similarly you can't justify investment in cycling solely on the basis of emission reductions. Again emission reductions are a co-benefit rather than the main objective and an example of this would be that if an additional 5% of all journeys per annum switched to cycling with an average distance of five kilometres the equivalent reduction in car emissions will be in the region of 100,000 tonnes per annum and that's only about 0.5% of emissions. So the point that I'm making and I want to be very very clear about what I'm not saying by the way, I'm not saying that because all of these things will not deliver huge reductions in emissions we shouldn't do them and I hope nobody in the room has taken that interpretation because I mean quite the reverse. I'm saying that all of these things should be done because they give us a better future by all sorts of different measures but they won't solve our climate problem on their own. Further cuts in emissions can and will be delivered in the transport sector through implementing a whole range of policies that will deliver small reductions together aggregating to a significant level of abatement and giving us all of these other benefits as well and for those reasons we'll continue to deliver as much of smarter travel as we possibly can in current circumstances and when the economy and the public finances improve we'll be making the strongest possible case for the resources needed so we can start making serious investment in in those areas once again but it will be technological change on which we are a taker because we don't make cars in Ireland but we're fortunate to be members of the EU where there is a very very strong set of of EU legislation focused on driving down car emissions. All that's left for us to do is to make sure that we continue to maintain the fiscal structure that we have at the moment which supports the choice of people buying low emission vehicles and if we continue on all of those tracks we will achieve over time the reductions in transport emissions that we need to. Thanks very much.


Thank you very much. Our next speaker is Dan Browner, Associate Professor of Medicine here at the University of Chicago, who went to medical school at SUNY Syracuse and did his residency at Cook County, where he was Chief Resident, and he's interested in developing better ways to communicate and evaluate the decision-making capacity of persons with dementia using linguistics and discourse analysis. And his research interests include the historical study of resuscitation, cardiac arrest, and DNR, about which we're going to hear. Now, thank you. Thanks, Dan. Everyone hear me? Can you hear me? Yeah, good. I want to thank Mark and the Colleen Center for being a real intellectual home for me for the last almost 20 years. Now on to my talk. How many of us have been exasperated by the family who wants us to do everything for their loved one, despite the fact that there's not much we can actually do that will help? I hope to show today that this exasperation is misplaced because it is us who created this option and we who continue to routinely offer it. To understand where the scripts that drive current performances of the negotiation of care for the very old and gravely ill, my methodology is historical analysis, which involves a close reading of the mostly medical literature as well as articles from lay press from the past. In order to appreciate how everything came to be presents a long and interesting history and way beyond my 15 minutes. So I will zoom into what I consider to be the most compelling pieces of this history and distill that. We need to go back in time to a time when before resuscitation was the default for everyone whose heart stopped. When cardiac arrest, a condition contingent on its treatment could only occur in the operating room right before resuscitation became the first and quintessential embodiment of everything. This takes us to the 1950s, which I consider to be a really neglected decade historically. Because it was during this time that our current indications for resuscitations were developed. We are currently operating under a framework that was developed in the 1950s at a time when resuscitation meant ripping open the chest and directly massaging the heart. And this is really the moment of the ascendancy of resuscitation, illuminating the fact that it was really never about the efficacy of specific techniques, but about the potential for success. It was during this time that the idea of universal default resuscitation was born and the campaign to adopt it conceived. So it's essential to look at the circumstances that led to the broadening of the indications, asking what were these forces, medical, social, political, economic, which will hopefully inform us now in the future at our present time to look at the possibilities for improving the current situation. So we're talking about a procedure that was developed in the actually in the 1880s, but really the first successful cases were done in the turn of the last century. This is a New York Times article describing how life apparently extinct has been renewed, or shall we say the dead themselves have been brought back to life. And this is a description of open resuscitation done in the operating room at the turn of the last century. So this was a procedure that was fairly uncommon for some time. You see here I picked just three papers here. In 1906 there were 40 cases in the literature. This is a paper that reviewed all the cases. In 1945 another paper looking at the history of resuscitation reviewed all the cases that had been reported in the literature and this numbered 148 at that time. Of course this is a slight underestimation because everybody's not reporting all their attempts, but this gives you sort of an idea. In 1953 a paper was published from a paper that was presented in 1952 that described 1200 cases which you can see as a marked increase in the number of people undergoing resuscitation. In the 50s really see a marked increase in this number. We see the initiation of courses in resuscitation and a group of advocates who were very, very excited about resuscitation because it worked. And their goal in reporting their results from my review of the literature was not so much to determine whether the procedure worked or not. They were convinced that it worked. They had seen it work in their own hands. If not to bring the patient back to life, at least to restart the heart, which was the beginning. And so their real intent was not to prove that it worked but to convince other physicians and the public that it worked and that there was a vast potential for it to work better. One of the interesting things in which I don't really have time to go into specifically here is that the ways we talk about science and what was happening at the time have vastly changed since that time in the 50s when they were reporting their results. And what we really see here is an evolution from case reports to outcome studies. The initial reports talking about cardiac resuscitation were reports usually of success because most people don't want to report their failures about how it worked in the operating room starting in the early 1900s. But slowly this changed into studies which were actually looking at outcomes and percentages. And what was really interesting about looking at these papers is what information do these authors choose to include and not to include because the standards of the time are really different. And this becomes really critical in the 1950s when resuscitation, the decision is made to move resuscitation out of the operating room. This is really a really important decision that I don't think people really appreciate the import of it because it really led to a development of indications for resuscitation to the indications that we have today. So this is a picture of a crash cart that was used at Bellevue by Stevenson, the author of the paper that reported the 1200 cases in 1953. And this is a crash cart that he developed. And what they did, he developed a course and they taught the residents at Bellevue in the early 50s how to resuscitate patients on the wards. And they let them loose. And they basically started resuscitating pretty much everybody who died on the wards. And he did report the results of the study as part of this paper. Now, again, the 1200 cases here is actually a worldwide registry that he got from a lot of physicians and it includes the Bellevue experience. And the Bellevue experience is mostly in the operating room, but 13% were outside the operating room. And interestingly, what he talks about in this paper and in subsequent books on cardiac resuscitation, it's not so much what the patients had, what their conditions were, but where the resuscitation occurred. Because location really is the key here. The first place is the operating room and then once we get out of the operating, where does it happen? And so he breaks it down by location. And they actually have a pretty good success rate, so 24% success rate for resuscitation outside of the operating room, this 13% of the cases here. But he never really breaks it down as to which locations were better or what the conditions were the patients have. And interestingly, there comes a critique, which I think is a really important paper that most people, I dare say have not read. This is a paper that was written by someone who was clearly inspired by Stevenson's work. And he tried to replicate his work of resuscitating people outside of the operating room using this technique. And what he found was a pretty abysmal. He was able to resuscitate one person out of 24. And what he found, and that person was someone who was in the actually radiographic suite, who had undergone a bronchography, which was basically they would blow oil impregnated with iodine into people's lungs to take pictures of their lungs so they could visualize their bronchogram before the age of CAT scans, obviously. And that was the patient that resuscitated. And when he delved into what the other physicians were doing, a critique of the other reports, he found that in the vast majority and just about all the patients who were successfully resuscitated, he found that a physician had usually performed the study which precipitated the arrest. So this technique works. It definitely works. The only problem with it is that it only works if the doctors have killed you first, which is not something that is not something that's really made clear in any of these papers. So despite the abysmal results of most of these studies in terms of resuscitating patients who had other illnesses who were not undergoing niatrogenic deaths, there was a sense that the indications needed to be very broad. In part because of the necessity of getting in there quickly, time being an important factor, the analogy of the fire drill is almost used, is often used. And Claude Beck, who's one of the real fathers of resuscitation, I think probably the most responsible for how resuscitation looks today, made this statement, which I think was pretty prescient. The possibility for successful resuscitation are greatest in patients who do not have primary diseases of the respiratory or circulatory systems. And previously he had advocated that those people should not be resuscitated. But he sort of changes his mind beginning in the 1950s and goes on to say, however, successful resuscitation is possible even in the presence of disease. And this is a major trope we see in lots of resuscitation literature is that this notion of uncertainty. And so it should be attempted even though one anticipates that it will be futile. At the worst, the surgeon may gain valuable experience from the attempt. And so we see here sort of an early rationalization, I think, for the start of what would become universal default CPR. So by the time the 1960s come, and this paper is published in July, when closed chest compressions were rediscovered, and the first 20 patients reported, we see here a 70% success rate. Again, because they're using the same patients that the surgeons had been attempting to resuscitate before. These are patients who were either in the operating room, who were getting cardiac casts. The vast majority of them had diagrogenic complications. And that was why they had, you know, a 70% success rate, which is obviously never been replicated. Now, the same group that started using closed chest compressions realized that as you broaden the definition, the indications for resuscitation, you need to therefore change the actual definition of what constitutes cardiac arrest. And they actually say it specifically, the term one supply only to sudden death associated with anesthesia and surgery. But now, cardiac arrest is now the sudden and unexpected sensation from whatever cause of circulation, from the unexpected sensation from whatever cause of circulation producing cardiac activity. Of course, people have talked the notion of what's unexpected. You know, that's a very obviously dependent on the person, somebody else's expectations. And that's been one of the controversial things about that was initially discussed about cardiac arrest. But now, we don't really even use the unexpected. You know, your heart stops, you have cardiac arrest by definition. I would say the third factor, the final, the force in the development of what I see as universal default resuscitation, was happened in the 60s. And with the outlay of large amounts of government dollars into the infusion of large amounts of government dollars into the health care industry. And I would suspect, and I'm looking forward to studying this further, that a lot of the health care dollars that were put into medicine in the mid 60s were used to treat cardiac arrest. That this was a very sort of expensive condition that required very high tech and very expensive medical care. And that a lot of the money that came in at this moment would go into that pursuit. That's making that treatment of cardiac arrest very much a part of health care. And I would say at this point then, with the establishment of a default CPR, that resuscitation really became everything. Everything being a treatment without really an expectation that it would actually help this particular patient. And I think starting in the late 50s with the development of sort of the universal notion of resuscitation that we see a conceptual shift in the locus of interest in the doctor-patient relationship. That's very deep. And I think it's a very important shift. And the shift is from the patient, the embodied individual whom you are caring for at that moment. And the question, what is the best for this patient at this moment? And it shifts to this sort of broader concept of patients. And that's the group of all patients and potential patients. And it's more of a theoretical construct based on a belief in the awesome power of resuscitation to help them. And so it's sort of this belief that resuscitation is a good thing in general that really changes how we interact with the patient that we're taking care of at that moment. Of course, DNR comes along in the 70s. And I see that as an attempt to fix this paradigm. And I think what it was was a really well-intentioned effort to transfer focus back to the patient in front of us. What's best for this patient at this moment? However, that's the positive part of it. I think there are several problematic aspects of it as well. It supports the current paradigm in which we have these defaults. It tends to limit the focus to a future response to a procedure that in the vast majority of our patients won't help. And what I think it really gets in the way of is diverting attention from care in the present. This notion of care, of advanced care. And people tend to act and to think in very binary ways. So the opposite of everything becomes nothing. And so very often people will shift that, will see the definition and it makes sense that DNR would then go on to mean that. Even though everybody knows it shouldn't mean that. Very often, even though we know it doesn't, there's a lot of empirical evidence that shows that people do get less care when they are DNR sometimes inappropriately. I'd like to use the analogy of selling protection, which I'm not going to get into. And what I would call for at this juncture after making this sort of hysterical analysis, is that, is a refocus on care in the present for patients. And this, this requires a sort of a radical, alteration in sort of the way we talk about the potentials for treatment and truth telling with our patients. And I think DNR needs to be sort of the last question that we bring up with our patients.


Animals, for beings of higher consciousness, it's essentially the same thing only reversed. In this scenario, we are like the animal and we are communicating with beings who know and understand far more than we do. There are a plethora of channelings on the web that you can find. Some are really helpful, enlightening and perceptive, and others are, well, not. It's important that when you're listening to or reading channelings, that you use discernment with what you're listening to. For the most part, you have no idea who or what is being channeled, and the only way you can really truly tell is through listening to what they are saying and finding truth in their words. If what is being said feels right, then go with that flow. If it does not, then you don't have to subject yourself to it. The final decision will have to come from you, though. Everyone channels differently as well. Sometimes channelings are quite boring, as the channeler will just lay down and connect internally and just let the information fly. Other times, the connection between the beings is stronger, and they'll walk around the room and talk and be quite lively. Then there's people like this. It has been often said you are shifting your frequencies from one reality level to another, and this is so.