Welcome to NTN Nightly, I am regional novel, this edition's top stories. St. Lucia receives donations of AstraZeneca vaccine from regional counterparts. St. Lucia announces cushioning quarantine of fees for returning nationals. And the Ministry of Health and Wellness introduces the rapid antigen test. The regional security system RSS Fairchild Metro 3 touched down at the George Charles Airport about four p.m. yesterday afternoon with Precious Cargo. In its hall were 2,000 doses of the Oxford AstraZeneca vaccine from the government of Dominica. On hand to receive the shipment will Prime Minister the Honourable Alan Chastney and Minister for Health and Wellness, Senator Honourable Mary Isaac. Boxes of the vaccine were handed over to Prime Minister Alan Chastney and Health Minister Mary Isaac as the aircraft sat on the tarmac at VG. This donation will bolster the national COVID-19 vaccination campaign which will be launched soon by the Ministry of Health and Wellness. On Wednesday, February 10, 2021, St. Lucia also received 1,000 doses of the vaccine from the government of Barbados. These vaccines which have been received from regional counterparts will be used in the rollout of the first phase of vaccinations for 1,500 frontline workers including medical personnel, state security, including the police, fire service, correctional officers and paramedics. The government of St. Lucia has extended sincere gratitude to the government of Barbados and the Commonwealth of Dominica for their acts of generosity. Prime Minister the Honourable Alan Chastney announced Tuesday at the House of Parliament that 74,000 doses of the vaccine will arrive on Island before the end of February. St. Lucia will also purchase a further batch of the AstraZeneca vaccine from India as well as receive a donation. There are also ongoing discussions for vaccines from the African Union. In keeping with the Ministry of Health and Wellness's updated National COVID-19 Response Policy effective February 11, 2021, the government of St. Lucia is absorbing a greater part of the cost of state quarantine for returning nationals. Subsequent to routine reviews of the quarantine policy, noting infringements in the process, home quarantine has been reduced to special circumstances only and will now transition to state-based quarantine facilities as much needed vigilance is required in the management of all incoming nationals. Please note that the government of St. Lucia continues to cover the cost of locals and residents on Island who are placed in state quarantine and isolation. The daily fees announced in August by the government of St. Lucia indicated that single occupancy would have been 95 US per day, double occupancy 160 and triple occupancy 240 dollars and double and triple occupancy applies to families within the same unit. These fees have now been reduced to $25, $45 and $65 US respectively. The government in acknowledging the nature of the COVID-19 pandemic will continue to honor applications for financial exemptions and that includes students who have completed their studies within three months and are returning home and to persons who have traveled for medical care. The government is also considering dire socio-economic needs including the forced repatriation of nationals. Now during the quarantine period the policy still stands that returning nationals will be swapped on the seventh day and those receiving a negative PCR result and meet the criteria to thereafter quarantine at home will be given the permission to do so of course with the wearing of the amber solution watch and the biointellicent sticker. The biointellicent sticker is for one-time use and will also monitor vital signs. Being mindful that the state regulated quarantine period is 14 days those who do not meet the requirements to leave state quarantine will need to ensure that their payment for accommodation is made for the full 14 days. Anyone testing positive for COVID-19 will be immediately transferred into care at the cost of the state. Permission for home quarantine will be granted after application through the portal www.saintlusha.org and applies strictly to minors, persons with health conditions and those with specific conditions after careful review of all applications including site visits. Returning nationals from all international jurisdictions must note the following Check with the airlines for flight schedules Secure your reservation and facilitate payment for accommodation at a government operated public health facility by accessing the booking portal located on www.saintlusha.org slash COVID-19. All fees must be paid directly to the quarantine facility. If you have applied for a quarantine payment exemption please await confirmation of approval. A 7-day wait period is necessary to facilitate applications. Once the quarantine arrangements have been confirmed pre-fill the travel registration form located on www.saintlusha.org slash COVID-19. You must do so no less than 7 days prior to travel. Print and travel with the authorized travel registration. Obtain and upload a PCR negative COVID-19 test within 5 days of travel into St. Lucia. Please ensure that the result indicates PCR. You must travel with a copy of your result. On arrival in St. Lucia the wearing of a mask is mandatory. All arriving persons will be screened at the port of entry and assessed for any signs and symptoms of COVID-19. After advancing to immigration and customs you will be guided to the designated government operated transportation for the transfer to the state operated quarantine facility. At the public health facility you will be screened daily by healthcare professionals. Individuals are permitted to receive items from friends and family. However, they are not permitted to deliver items to anyone until the full 14-day quarantine period has come to an end. The government of St. Lucia wishes to remind nationals and residents that only essential travel is encouraged at this time. For more information about St. Lucia's COVID-19 response entry protocols and travel registration forms can be accessed at www.saintlusha.org slash COVID-19. In an effort to scale up national testing for COVID-19 the Ministry of Health and Wellness has introduced the rapid antigen test at specific points of care. The testing option will commence through a two-faced approach. The first phase will focus on the validation of the test which is a standard activity prior to the full-scale introduction of any diagnostic test. In this validation phase individuals who come in for COVID-19 testing at the Victoria Hospital or when King European Union Hospital the St. Jude Hospital and the VG Sports Complex testing outpost will be offered antigen tests. Dr. Dana Dacosta Gomez is the active national epidemiologist. The validation phase covers a one-week period and is expected to be completed by February 13, 2021. Due to the high prevalence of COVID-19 in St. Lucia any individual with symptoms suggestive of COVID-19 who tests positive on an antigen test is considered a confirmed COVID-19 case. However, while the validation phase is being undertaken anyone presenting for testing at the clinics which were previously mentioned receives both an antigen and a COVID-19 PCR test. It is important to note that a negative antigen result does not necessarily mean the absence of COVID-19 infection particularly as it is possible to get a negative test result despite having symptoms suggestive of COVID-19 or being a contact of a confirmed case. In such instances the antigen test must be confirmed with the DNA PCR test. Individuals who receive a negative result on an antigen test should confirm that diagnosis with a PCR test and continue to quarantine at home until receipt of the DNA PCR results. The antigen test detects the presence of a specific protein of the COVID-19 virus. A positive test in someone with symptoms indicates that they presently have the virus. Like the sampling procedure for the COVID-19 PCR test the antigen test requires a swab sample to be taken from the nose. Antigen tests offer some advantages for both the individual and the healthcare system. They are fairly inexpensive. The tests can be used within non-health settings as well as within clinical settings where individuals seek care such as respiratory clinics or hospital emergency rooms. They provide results in approximately 20 minutes. There is no need for highly technical staff to perform the antigen test. The antigen test allows for rapid detection and isolation of cases particularly those people presenting with symptoms. The quick turnaround time of test results allow for faster identification of high-risk contacts of confirmed cases. The validation phase is required to ensure the reliability of the antigen test as a diagnostic tool. On completion of this validation and the confirmation of its reliability the second phase will be implemented. During this phase select respiratory clinics will become dedicated antigen testing sites on Ireland. In the lead-up to this second phase of point-of-care antigen testing the public will be provided with more information. Saint Lucia has amended its arrival protocols. All arrivals must now obtain a negative COVID-19 PCR test five days before arrival. The COVID-19 prevention and control amendment bill which was passed in Parliament at the last sitting amended the COVID-19 prevention and control act number 9 of 2020 which was enacted on the 2nd of October 2020. The act regulates the containment of the spread of COVID-19 in the interest of public safety, public order and public health. Prime Minister Saint Lucia the Honourable Alan Chastney highlighted the significance of the amendments. There are pre-travel requirements under section 36 of the act and one of the requirements is for taking of a test for COVID-19 about seven days or less before a person arrives in Saint Lucia. A person is also required under section 36 of the act to upload the negative result of the test for COVID-19 and keeping with the act of polymers chain reaction PCR test is the test approved for COVID-19 and therefore the bill amends the pre-travel requirements to stipulate that a negative result of PCR test for COVID-19 must be taken five days before a person arrives in Saint Lucia. Speaker, this five days is the standard now in the industry and has a lot to do with the access of the test. Prime Minister Honourable Chastney explained that it is not possible at this time to implement any timeframe less than five days. If we were going to go to 72 hours, Mr. Speaker, it wouldn't require us to accept a rapid test and sadly the CMO is advised not to accept a rapid test at this point and therefore we are amending it to now reduce it to five days as part of the new protocols that we're putting in place. But I want to say Mr. Speaker that we have been very satisfied so far as to how this protocol has worked for Saint Lucia and we think that reducing it to five days will significantly strengthen the existing protocols and the bubble that we currently have that went through all its stages and was passed. Support systems remain in place for the business community on island impacted by the pandemic. The Ministry of Commerce, Industry, Enterprise Development and Consumer Affairs has been engaging such private sector agencies who are experiencing difficulty with their operations. Permanent Secretary Sofia Henry says the Ministry's wrap call with the business community has been further strengthened as they have been exploring solutions to stay afloat. Finance is available through the Saint Lucia Development Bank. Again, it's a matter of having the collateral to take advantage and also persons to guarantee these loans. So they are coming to us and we are trying. We are sitting there and we are putting together the business plans and that is essential. So a lot of our support is by way of helping them with their financial statements, helping them with their business plans together, contacting the financial institutions, connecting them, letting them know what is available and that is key because sometimes you have the measures available that support and maybe they are not aware. So we have been having sessions with the business associations and with even those that are registered with us and that are not part of the association to let them know what is available. Ms Henry explains the process for businesses to access its support services from the ministry. Chetan has a lot of big businesses but they also have small businesses. But we have other small associations so quite a few of our businesses are members of the smaller associations. We have for example the Central Coalition of Services and we have the Biggers Association and that's a newly formed association. We have the Fashion Council we have the Southern Business Association. There are quite a few associations that then support these small businesses and that are very much connected to the ministry. But even some of the other small businesses are not members of the association. Once they come to the ministry for support, we register them and we have their details and we assign a business development officer to every business and that business development officer will contact them and keep in touch with them and then the businesses support to them. Businesses interested in accessing support from the ministry of commerce, industry, enterprise development and consumer affairs can call 468-4223 to register. Saint Vincent and the Grenadines also received a shipment of the vaccine from Dominica on Thursday afternoon. The minister of health, Honorable Saint Clair Jimmy Prince and the Permanent Secretary, Cuthbert Knight received 5,000 doses. Officials say the doses are enough. The Government of India will be providing to Saint Vincent and the Grenadines about 40,000 doses of the vaccine. Prime Minister Ralph Gonzalez on Thursday said that priority would go to frontline workers in the first instance. And 5,000 doses of the Oxford AstraZeneca coronavirus vaccines also arrived in Antigua and Barbuda on a regional security system aircraft. The vials of the vaccine were donated by Dominica who received 70,000 doses from the Government of India. Prime Minister Gastor Brown's office said that the doses will be given to 2,500 frontline workers. Antigua and Barbuda is expected to receive another 40,000 doses from the Indian Government shortly and Brown has written to Prime Minister Narendra Modi seeking to purchase a further 5,000 doses. Let's take a look now at how fellow regional countries are coping with the impact of COVID-19. The Barbados economy is expected to be hit by more than $50 million in losses during the two-week COVID-19 lockdown announced by Prime Minister Honourable Mia Mortley in giving an overview of the economic impact of the lockdown last year and the potential fallout from the current shutdown in an interview with Barbados today. Minister in the Ministry of Finance Ryan Strong said his forecast is based on the average spend per week across the economy which he hopes does not decline any further. However, Strong expressed some fears that the economic impact could turn out to be even worse when one considers that unlike in the earlier lockdown supermarkets are closed on weekends and public markets are also out of business during the national pause. He said it is estimated that the Barbados economy lost just under $1.5 billion in 2020 which he linked to the shutdown in tourism business with its obvious effect on the economy. Strong issued a plea to Barbados to comply with the health protocols so that whatever economic activity the country could muster would help to keep it afloat through the end of the year. The Government of Montserrat has announced that during the current lockdown measures following the confirmation of a 5th COVID-19 case a student at the Montserrat Secondary School. The Ministry also disclosed that 30 persons have been tested since the first new case was confirmed on February 6, 2021. In an effort to curtail the spread of COVID-19 and to allow for the testing of 40 primary contacts of active cases the list of essential government and private services has been reduced. The list of businesses that must remain closed has increased and now includes supermarkets. The list of mandatory closures also includes bars and night clubs restaurants to include takeaway or delivery service, barbershops hair salons, spas, jeans retail stores, churches and other religious establishments banks, gas stations, bakeries a business connected with farming fisheries and all utility providers. This is NTN Nightly up next Primers Hutchinson with the NTN Nobel of Loyal. Do you know we can limit the spread of the COVID-19 virus? The Ministry of Health is your partner in achieving this solution. Introducing the AMBER wristwatch. The AMBER wristwatch is designed for monitoring daily movements while in quarantine. It provides an accurate location and a precise heart rate. The device is also waterproof and can be worn during all daily functions like washing the dishes or taking a shower. It's worn like a typical timepiece. The Ministry of Health can now better monitor people in home quarantine and receive alerts of those who do not stay in the confines of their home. A 14 day rental of the AMBER wristwatch is just 75 US dollars. Let us stop the breaches of home quarantine. Welcome back. We join Primers Hutchinson for the NTN Nobel of Loyal. Monsieur Ta jeanelle, Monsieur Madame, Department of State and University of Switzerland to inform the Government of the National magazine of NTN to present the Declare qu'il s'agit de ses netteurs, mais d'il y en s'agit de ses nettes, c'est même pas s'il y a, qui a fait un monde caporté attaque, attoué, appuisant, bordelé, sans permission, les autorités prisonaires, c'est une qui compte l'agislation et les autorités qui a adressé situation à la très sérieuse. Ministre Francis Dickey, les autorités très concernées pour savoir qui, les prisonnaires qui n'aient téléphone mobile et que l'autre attaque pour servir, sans permission. Ministre Théa Vettiquy, les officiers prisonaires bordelés, qui a commencé pour un bon démarche, mais fort démarche, une action qui toussoie que ce n'est situation à la. Wezoki Ministre l'a adressé situation à la démonstration ses nettes-là. C'est parce qu'il y a une décie même qu'il y a des prisonnaires bordelés qui n'aient téléphone mobile, qu'a servi media social pour faire pleins de maladies coronaires prisonaires. Ministre Théa, ma vraie situation, c'est la vie normale, c'est avec affaire à calmer. Les autorités, j'apprends démarche pour protiver les prisonnaires et puis, c'est nécessité regarder maladies coronaires, en particulier sanitiser et massuprofidiaire. Ministre Théa fait comprendre que même quand tout l'autre secteur a trouvé affecté par corona, c'est même pas ce qui s'actuel, j'ai trouvé affecté aussi. On a humongous dit qu'il y a un bordel trois prisonnaires qui a saut remand, j'ai trouvé séquestion. Mais malheureusement, il pourquoi possible pour y opéer et présenter ce qu'il nécessit pour sortir barrimane. Mais Ministre Francis n'y espère qu'en gouvernement, j'ai apporté des juges en place pour aider à adresser ces cas-là, ça c'est qu'à isoler et coéglir les opérations de l'audience à payer-là. Ministre Francis déclare qu'il y a chef-juges-là, j'ai apporté 11 juges pour adresser ces sessions de l'audience par Zoom, ça veut dire qu'à sa vie media-social et que ce sont ces cas des affaires criminales-là qu'il a aussi trouvé adressés tout de suite. Selon Ministre Francis, demain j'ai en place un comité qui a mis plusieurs officiers qui a engagé des affaires à payer-là et qui a trouvé établis. J'ai trouvé établis pour discuter et conseiller premier ministre-là et qu'il a conseillé Asoumaire Wood pour adresser à Félogias avec toutes ces cas qui pourront paraître devant M. J. Jacques Magestrois.   M. De Santé a continué pour mettre un pile d'efforts qui ont construit et qui ont abattu des guets maladeux corona, mais qu'à s'y manger et qu'assez aux autorités qui a menagé ainsi que les ces. Par conséquence, M. Aja a organisé une façon pour menager ces cas-là dans ces cas-corona qui par guave ainsi comme il n'a même ça qui a fait par un groupe médical qu'à ce que ce soit. Qu'a-tu fait pour sa moune qui a trouvé maladeux à panier et des guets qui tuaient sérieux. Et ça a gongatité ainsi qu'à y rester, qu'à y poursuivre treatment. Mais, les officiers ministères à poursuivre qui a pile moune qui a qu'à y poursuivre treatment l'immua qui a augmenté et qui a l'intention de panier assez la à dans ces cas-corona. Et aussi, à dans moune par cas-corona. Alors pour risquer ça, pour placer moune à d'ailleurs facilité à pas. En résultat de ça, c'est car qu'il n'a pas de guave qu'à y rester à d'ailleurs facilité aux hôtels et que c'est ça qui plus guave qu'à l'hôpital victoire. Initiative-là c'est pour protéger principalement pour protéger principalement pour protéger principalement pour protéger principalement pour protéger principalement pour protéger principalement pour protéger principalement pour protéger principalement plus facilement. wishes-you-wé treatment multi-fac chcembla There's a lot of inflammation that is very bad. During the exercise, a person who visited the clinic received a lot of tests. This means that the test results are very good. The Ministry of Health said that the test results will be good for the antigen, and it will be a good advantage for anyone who has a point. There's also an ex-officer who doesn't share his life so that he doesn't have to go to the clinic. He doesn't have to go to the clinic. The Ministry of Health said that it will continue to play with the people, to continue to cooperate with them, so that all of us together, will be able to move forward with the example that will affect the patient. Everyone needs to work together to make this possible. This is a very good news for everyone. I would like to thank you for your time. I would like to invite you to join us. When you live, you can get a lot of good news. I wish you all a good financial week, and I hope that the Ministry of Health will be able to understand that everything has to do with the coronavirus, to protect our health, to sanitize and protect the group and to assist the people who are waiting for the vaccine. Thank you very much. It's been a very nice time. Thank you. Thank you very much. Thank you. Thank you very much. Thank you. Thank you very much. Thank you. book page or YouTube channel. I am Channel Nobel.


Welcome everyone, we are going to be talking today about the Transesophageal Echo Equipment Infection, Control and Safety. This is part of the lectures for the Toronto General Hospital Fellows, the Cardiac and Stasis Fellowship as part of the preparation for the National Board of Echo from June the 19th, 2019. So, you know, I don't have any disclosure to discuss with you guys, so we are going to go direct to the index. We are going to talk a little bit about the equipment, indications, contraindications, how to manipulate the probe, how to maintain the probe. We are going to talk about infection control, we are going to talk about safety, probe insertion, complications, biological effects and the safety of ultrasound. Ok, so equipment. So, Transesophageal Echo has several indications. The last review from the American Heart Association guideline updated for the clinical applications of echocardiography was published in circulation in 2003. And they state that as a class 1 indication for TE is the repair of a complex, repair or complex valve replacement, history of hypertrophic obstructive cardiomyopathy, dissection with thyroid valve involvement. As a class 2A, which means weight of evidence and opinion is in favour of the use and effectiveness, is any surgical procedure which has like risk of myocardial ischemia, MI or hemodynamic disturbances. And the big debate came up with the class 2B indication, which means usefulness and efficacy is less well established. So, this is the situation that we are going to find in an off-pump, or the coronary bypass for evaluation of regional myocardial function, something is going to happen with evaluation of coronary anatomy or graft patency. So, those two indications are related to standard on-pump ACVs or even like long transplantation is a class 2B for checking of the graft patency or the anastomosis on the pulmonary veins. And then it's when the risk and benefits needs to actually be pondered and make a formal decision if you can or can't do TE. So, in 2013, from the American Society of Echo, there was an update and basically what they described is that interoperative TE is required always when it's an all open heart for valvular replacement, as we were mentioning, or valvular repair, or if you have a thoracic-artic surgical procedures, anything involving the ascending aorta, thoracoatominal repairs, and then they recommend in some coronary artery bypass graft surgeries, what we normally do at our center is whenever there is an impairment in the systolic function, which is more than mild, then we suggest and we recommend to actually go ahead and do it. And then you can actually, the third statement is non-cardiac surgery, but patients that have known or suspected cardiovascular pathology which may impact outcomes. It's important to, like in critical ill patients, is any patients where the trans thoracic images are not able to be obtained. So, contraindications. So, the first report that we got is from 1999, from the American Society of the Efeco and the SEA guidelines, which states that the absolute contraindications is known as esophagus, a previous esophagectomy or esophageal gastrectomy, an esophageal structure, an esophageal tumor or diverticulum, or an esophageal trauma whenever you have a perforation or a laceration, otherwise it's a relative contraindication. So, the fact of having a recent esophageal gastric surgery is again a relative contraindication, the same thing that an atrial tracheoesophageal phase 2. So, that's from 1999. So, in May 2010, there was like a practice guidelines from the SEA, the Board Update, in conjunction with the American Society of Anesthesia, which states that the T might be used for patients with oral esophageal or gastric disease if the spectra benefit avoids the potential risk, provided appropriate precautions are applied. So, at the end it's a balance and you guys need to decide. The last update from the American Society of Efeco from 2013, it keeps saying exactly the same statement. Absolute is going to be a perforated viscose, an esophageal structure, tumor diverticulum, or an esophageal perforation or laceration, but they include a new thing, which is the, as you can see here, the active upper GI bleed. So, before it wasn't included, and then since 2013, an active upper GI bleed is an absolute contraindication. And then on the right-hand side, you can actually see the relative contraindications and one of the things that we were always discussing when we are actually doing TE is if the patients with Yata learning are an absolute contraindication for transesophageal echo and they only mention it here as a relative contraindication. So, now we have talked about the contraindications and indications of TE. We are going to follow up with instrument controls. So, basically what we want with those controls is to adjust the image based on the anatomical structures that are displayed. So, you need to optimize your image for the structures that you are assessing. So, each structure is examined in multiple imaging planes, and from there we have more than one transducer position. So, basically the possibilities that we have in transesophageal echo and that's what we'll describe in the comprehensive TE examination from the American Society of Echo Guidelines in 2013, you can advance, withdraw your probe, turn left, turn right, and the flex, retoflex, flex to the right and flex to the left. And on top of that, you can rotate your omniplane from 0 degrees to 180 degrees. Okay? So, the way of actually mentioning all that is we call superior when you go towards the head, inferior when you go towards the feet. So, superior and inferior, and then you advance and you withdraw. Anterior and posterior, you can actually achieve it with antiflexion and retoflexion, which is anterior towards the sternum, posterior retoflexion towards the spine. You have the advanced drawing that we previously mentioned and then you can rotate towards the right clockwise, towards the left, counterclockwise, and you can rotate the omniplane from 0 to 180 degrees. Okay? So, when we rotate our angle, so when we start at 0 degrees, you basically are cutting the heart in half, showing the four chamber view where you have on the right side of the screen your left ventricle and on the left side of the screen your right ventricle. Okay? So, when you go to 90 degrees, if you are focusing on the LV, what you're going to have on the right side of the screen is going to be your anterior part and on the left side your inferior. And again, if you incremented it to 180, what you are actually obtaining is a flip image from your fourth chamber. Okay? You are very familiar with the angle manipulation. We are not going to comment anything else on that. Okay? So, instrument manipulation. So, those are the classical probes. This specifically is an X7 Phillips probe. Same thing for the G-image beam. Basically, same thing for the CMNs. Okay? So, you have two knobs. The first knob, like the small handle, is the one that is the one on top. It's the smaller and it's the one that is going to give you the right to left axis movement of the probe. The second handle or the biggest handle, which is underneath the small one, is the one that is going to allow you to do anti-flexion or retroflexion. And then you have the possibility of lock or unlock the movements of the probe. The G-machine has an extra knob. Here we have a lateral two knobs for increasing and decreasing your angle. And the G has an extra knob in the middle that can actually make you jump from 0 to 90 degrees in your angle. So, probe maintenance. It is recommended to use protective covers as we use for the electrical connector and for the tip of the probe. We need to check before we put the probe in for brakes, fissures or stroding wires because there is a risk of electrical safety. We need to avoid exaggerate flexion of the tip of the probe because we can actually do damage to the stomach and then we will show you some examples of that afterwards. You need to use infection control after the use and we will go through all the phases. And you need to do an electrical safety if you see any fissure or any brakes or stroding wires. It is recommended to keep a mountaineer in slow book for each TE probe. So, what are the most common things that we can find when there is a rupture of the equipment? So, those are examples. So, as you can see here, there are some brakes, there are some fissures, there are some not stroding wires but cracks and all these needs to be checked before introducing the probe into the patient. And if we exaggerate the flexion, the tip of the probe. So, this is the most usual thing that we can see and those are safety issues because with time this cover will actually get damaged and erosion and then you can actually have an electrical issue here. So, we are going to talk about infection control now. So, once the probe is used, you need to sterilize the probe. So, how are we going to do that? So, we are going to talk a little bit about different options like at TGH, what we do is we drop our probe at the CPD drop-in station. Once it's there, what we use is hydroxyl peroxide 0.5% wipes and we use it for the electrical connection. One wipe and a second wipe for the handle and the tip. And we leave it for three minutes to dry. An alternative option to do like a mechanical cleaning of the probe as we did with hydroxyl peroxide is to use 70% isopropyl alcohol like that's what they use at the Royal Heart Institute. Actually, that's from one of the chapters published at the Content and No Multimedia Manual and they specifically clarified that you cannot use the alcohol for the connection between the electrical connector and the handles and neither into the tip of the probe because then the isopropyl alcohol at 70% can actually damage those. So the only parts where we can actually use these kind of solutions is the connector hosing and the control hosing but they don't recommend it to use it in the other parts. So that's why at TGH we actually use hydroxyl peroxide we use a different agent to do the mechanical cleaning. Once the mechanical cleaning is done we put the probe in what we call an automated TGH probe cleaning machine. So what we are going to use for that is a 2.65% glutaral day solution bath and the recommendation is to put the probe there do it during 20 minutes and after 20 minutes is done you need to let it dry and recommend it to put a plastic cap on the distal and put it in the dropping cart ready to be used again. One of the recommendations is to use the earth tank to dry the electrical connector so you are very sure that there is no residual liquid so when you connect the probe you don't have a problem with the probe but the same thing for the knob handle you need to dry it with the electrical with the earth tank so you are sure that there is no residual glutaral day after the automated cleaning. So another option if you don't have a machine for an automated TGH probe cleaning so it's what they use for example the Morvell Harden Institute the hose and the tip of the TGH probe and they leave it at 2% glutaral day solution bath for 20 to 30 minutes so what's the importance of doing those 20 minutes and can we cut it if we are in an emergency and we need the probe so the recommendation again is when you actually put the probe under a glutaral day disposition so the pathogen destruction is going to happen as follows like in the first minute all the bacteria are gone in two minutes you have a 100% sterile solution in two minutes you will kill HIV and enteroviruses and you need up to 5 minutes to kill your HIV virus and you need a maximum of 10 minutes to get like a very lower type of mycoactamint tuberculosis so that's why it's so important to actually keep it for 20 minutes so you are sure that you have a complete sterile probe so we have talked about indications contraindications and infection control after the probe would use but then we need to talk about the safety so safety how do we insert a probe how should we use like a TGH probe so we don't damage the patient so the recommendations and again this is well well well described in the 2013 American Society of Eccles guidelines for a comprehensive TGH study which they recommend to insert the probe in the unlock position so you need to be sure that the probe is in the unlock position the bite block is actually you pass it through the hose but you don't put it in the mouth only after the insertion why because if you put it in the mouth you can put it in the back of the throat and then you can make damage to the tongue or make the probe to be more difficult to insert so the recommendation is one the probe has actually passed and it's in the suffagus then you actually put the bite block into the mouth to prevent biting from the patient ok always advance the probe in an neutral position with a little with a slight underflection of the probe when you are actually passing the test ok, prevent this large amount of endotracheal tube when the patient is intubated obviously and the recommendation is doing this maneuver which consists in lifting anteriorly and causally demandable in case that that's difficult the laryngoscope can actually facilitate the insertion and in many centers what they recommend is at the same time that you the laryngoscopy you put the endotracheal tube and immediately later when you check the endotracheal tube the solution you just put the T probe in ok so what are the risk of complications when we actually use TE so the global, the average risk is 0.2% which is extremely low and it's something that we need to consider so what is the most important part and I think the major morbidity it comes from the suffageal perforation and we are talking of TE of 0 up to 0.3% ok, you have major morbidity and major bleeding and we are talking for interpretive echo for a major morbidity between 0 to 1.2 and mortality is actually 0% in interpretive echo which I think there are excellent safety numbers for our studies so what can happen, what can go wrong so we talk about the complications that's what can go wrong you can have a buckling during the TE insertion and there are many ways of actually doing damage to the suffageal so if that happens you have trouble to pull up the TE probe and you are not able to do what they recommend to advance the probe with the retroflexion back to the straight position don't try to come back when you are still retroflexing or anti-flexing the probe because then you can damage, so you advance it forward to the stomach in the straight position and then you pull it back and normally you have a higher success of actually removing the probe without causing any damage perfect, so let's talk now about the biological effects of the ultrasound on the human body so the biological effects are divided into thermal which is going to be dependent on your intensity of the ultrasound and non-thermal we should have a mechanical or direct effect which is called a radiation force and cavitation cavitation and intensity are the three main things that are going to cause problems in the body so we are going to start talking about the thermal bio effects so with ultrasound the increasing temperature is absorbed and converted into heat by the body an excessive temperature increase creates toxic stress in mammalian systems so that is going to be completely dependent into the direction of the exposure, the type of tissue that is exposed the cellular proliferation rate on the mucosa that is exposed and the potential for regeneration in this area so as per today the probability of an adverse biological effect increases both with saturation and magnitude of the temperature and we are going to explain that in a second so the thermal bio effect is the most important in terms of the effects much more than the non-thermal so there have never been any health related problems associated with it but I think it is important to understand how that works so TC is the duration of exposure in two minutes and it is also considered the critical time so to calculate the critical time that may happen between 39 and 43 degrees the formula is 4 to the 43 minus T which is the thermal elevation to make an example of that the temperature of the probe is 39 degrees we have 43 minus 39 so that will give you like 4 elevators to the 456 minutes that will be affecting the tissues on the opposite side is your probe is at 43 degrees so that will give you only 4 to the 0 which is 1 will give you 1 single minute so that is when your probe gets too warm and it goes to 43 you will see a message in the screen saying the probe is going to go to automatic auto cooling which is the temperature by itself and the recommendation is to stop to do the ultrasound until the probe actually cools down so the rate of increasing temperature it comes from that formula where the T is going to be the thermal elevation that we have already discussed previously where alpha is the absorption coefficient of the tissue for a given frequency and I will show you the numerator as in the intensity of the ultrasound exposure and that is what is important from that formula you don't need to remember the formula itself but you need to know that the intensity of an ultrasound exposure is normally measured like in millivolts per centimeter to the square or volts per centimeter to the square and it is going to be placed in the screen of your T machine when you are using pulse width opener or continuous width opener the recommendation is as per the FDA to limit the pulse width opener to 720 millivolts per centimeter to the square, the CV is the specific heat capacity of the tissue so the important part that you need to remember here is the intensity of the ultrasound exposure should be limited to 720 and anything above 200 is why it can start to actually create a thermal wire effect so how do we measure that so there is something called the thermal index or the thermal index or TI and this is the indicator of probability of cavitation so this thermal effect is going to condition a non-termal effect which is the cavitation which we will talk in the future in the presentation so it is the predictor of maximum temperature increase and it is the potential for the ultrasound heating related to an average intensity and it is going to be indicated during the Doppler if you are just input with Doppler, color for Doppler or continuous width Doppler the normal value is less than 1.9 the formula is Wp divided by Wdeg so Wp is the relevant acoustic power at the depth of interest and Wdeg is the estimated power necessary to rise the tissue equilibrium temperature one single degree so this thermal index is divided into soft tissue, bone and cranial bone so intensity is important to actually talk a little bit more about the ultrasound intensity as we were mentioning before it can be measured in watts per centimeter to the square or milliwatts per centimeter to the square the intensity can be measured in average or peak intensity and there are three different kinds of intensity where the intensity is going to be different which is the spatial, the temporal and the pulse so when we talk about spatial intensity that means that the intensity in an ultrasound being is going to be different in a certain part of the space or in a certain distance the temporal and it can be measured as spatial intensity, it can be average or it can be peak and it's during the whole time and it's during the pulse duration while we are transmitting and when we are receiving the ultrasound and it can be average or it can be peak and the pulse intensity is the one that is measured only during the transmitting time which is the pulse time and it can be average and peak to understand those concepts better spatial considerations when we talk about spatial intensity we have that the ultrasound beam have different intensities at different depths as you can see here there might start a lot of intensity as soon as it goes deeper it actually fades away, it depends on the type of ultrasound beam the ultrasound beam have a different intensity from side to side locations too and in particular depth the center of the ultrasound beam is more intense than the Hs so those are the spatial considerations but we are actually measuring spatial intensity and this can be average or peak we are talking about temporal intensity what you need to remember is that temporal peak or TP intensity is the maximum intensity and you see here IM is the most intense half cycle in the pulse ok when you are measuring temporal average or TA intensity is measured both during the transmitting time and the receiving time when for the TP it is just at the maximum and the pulse intensity or PA intensity which is only measured during the transmitting time ok so after those explanations how do we quantify intensity which one is bigger, which one is lower so I think the most important part that you need to understand here is that the peak intensity is always going to be above the average intensity the spatial intensity is always going to be the spatial intensity is always going to be above your your temporal ok so what we have here is spatial peak, temporal peak, both of them are peak they are going to be they are going to be always higher than your spatial average and your temporal average ok so the second thing that you need to know is your temporal intensity is always going to be above your pulse intensity ok because it's during the both times as we were mentioning before so when we are doing that the only important thing to remember is when you are using continuous with Doppler your temporal average is going to equal to your pulse average because during continuous with Doppler you have a continuous with Doppler as the word it says it's not a pulse, it goes up and down it goes up and down and the continuous is constantly the same the spatial peak intensity temporal average intensity is going to equal your spatial peak intensity to your pulse average intensity ok so that's the only thing so your temporal average is going to equal to your peak average ok the most relevant intensity with respect to the tissue heating which the FDA is limited at 720 millivolts per centimeter to the square something that they know to ask in the exam is the spatial peak temporal average and why they are going to catch you here because the highest intensity is the spatial peak temporal peak but the most relevant intensity is the spatial peak temporal average I like to put that in a to compare with a ventilatory issue so which pressure is more important in a ventilator your peak airway pressures or your plateau airway pressures sustained during time so that's exactly the same so spatial peak temporal average is the highest exposure average of a period of exposure and it's the most relevant intensity and it's limited by the FDA to 720 millivolts per centimeter to the square ok then I think it's important to mention too that the spatial peak pulse average is the average pulse intensity at an spatial location of maximum intensity ok I think those are the most important things that we need to remember there is another concept that normally they can actually ask is frequent but sometimes there are some questions that have been asked about that it's what's the duty factor which is the relationship between intensities with time it's unit less and it goes from 0 to 1 choose the relationship of the intensities with respect to time that's the duty factor ok so remember spatial peak temporal peak is the highest intensities of all spatial average temporal average is the smallest intensity of all and spatial peak temporal average is the most relevant intensity with respect to tissue heating so ok we talk about thermal bio-effects now we are going to talk about the first one of the non-termal bio-effects which is called radiation force which is a mechanical effect or a direct effect so this is exerted by the sun beam on the tissues the particles are pushed away from the transducer and when the particles are pushed away from the transducer there is an acoustic extreme that is generated on the fluids ok so this will produce stresses and an extreme of the fluids distorting the biological structures that's what is called radiation force it's non-termal and it's a bio-effect the second non-termal bio-effect is cavitation they love to ask about that ok so what is cavitation? cavitation is an oscillation of vibration of gas filled bodies when exposed to the ultrason beam there is a huge wave of the ultrason beam so you have a rudder fraction and compression of the bubbles also they can refer to the bubbles as gaseous nuclei ok so the micro bubbles resonate and when they resonate they resonate at a frequency so this frequency is f0 which is calculated at 3260 divided by r0 which is the micro bubbles radius in micro means ok the gas bubbles form with the oscillating or vibration and then they grow until they reach a critical size and then they collapse that's what cavitation is about so how are we going to measure cavitation? remember that we talked about thermal index to measure thermal bio-effect so the thermal index because it's a non-termal is going to be the cavitation effect related to the peak pressure and you will see that on your screen when you are doing 2D echo we will see your thermal index when you are using continuous width Doppler push width of the colorful Doppler when you are just using your 2D images you will see the higher fraction pressure divided by the square root of the frequency ok which means the higher the frequency the lower is going to be your mechanical index which makes sense because the higher the frequency the less that the ultrason is going to penetrate the tissue the lower the frequency the more that is going to penetrate the same thing for the peak by the fraction pressure the higher the fraction pressure so the mechanical index is going to be higher so the mechanical index increase with lower frequency and a stronger sound waves lower frequency so the lower the frequency is in the denominator the higher the mechanical index the peak by the fraction pressure is higher which means stronger sound waves so you can get more mechanical index the mechanical index reflects the amount of contrast harmonics that are produced you have low mechanical index higher mechanical index and highest mechanical index point is below 0.1 which is almost minimal you have no harmonics you have packet scatter you have a linear behavior of the bubbles and normally is associated with higher frequency sounds so this is going to be a surface probe the one that we use for doing central lines when you have a higher mechanical index it's up to 1 you have some harmonic effects you have some resonance you start to have non-linear behavior and it's related with lower frequency probes we are talking about probes that are between 5 and 3 MHz when you have the highest mechanical index you have below 3 or 2 MHz you create a mechanical index of more than 1 you have the strongest harmonic you start to have bubble disruption and you have an extreme non-linear behavior of the bubbles and they are related to the lowest frequency probes so when we are talking about cavitation we have two forms of cavitation we have stable and we have trenching cavitation it's important to differentiate the nomenclature here because when you say transient is inertial or normal when they say normal cavitation that doesn't mean stable that means transient or inertial ok that's important because it's easy to get actually confused with that when we talk about the stable cavitation stable cavitation is at lower mechanical index levels so the bubbles expand and contract but don't abreast the bubbles oscillates with the sound bin they can be related to this stable cavitation some mechanical damage, they can be membrane rupture and cell lysis at in vitro levels ok when we talk about transient or normal, inertial so it's when you have higher levels of mechanical index which produces as you can remember it's non-linear behavior of the bubbles rapid expansion and collapse the bubbles start to burst and they can lead to colosal temperature and shock waves it's not clinically significant ok so cavitation, what can cavitation do it has been described long emeralds in adults and it has a special important effect into fetus so when we are doing the ultrasound for the fetus it's something that doesn't apply to TE but you need to remember that ok just to remember a little bit when do we have increased mechanical index or increased thermal index when you are using your Doppler modes more than when you are using 2D when you have low frequency flow when you have a reduced scan area so you are concentrating more your energy when you use a deep focus because then you need to reduce a lot your frequency to be able to penetrate the tissues ok so when you go down down down to the screen with the focus that is going to concentrate in that area your mechanical index and thermal index when the power that you are using from the ultrasound is higher and when the big fraction is high when the ultrasound beam the power of the ultrasound beam is higher ok so we have talked about biological effects thermal and non-termal we are going to talk about electrical safety ok so you need to remember that the electrical energy converts into thermal energy but not sonic energy ok what happened with that is whenever we have like a rupture of the membrane of the transducer so the electrical energy instead of converting into sonic energy is going to be converted into thermal energy and this electrical harm of thermal injury with ultrasound can happen but the risk of happening is very low so that's why it's so important to look for erosion, perforation or any cracks ok before introducing the probe as an example when we are doing radiofrequency for atrial fibrillation there has been report of esophageal burns during the radiofrequency and fistula or perforation so that's why during those procedures the tea should be removed during the ablation I hope you have enjoyed the lecture and we will see you with the multi-choice questions the next week, thank you


Hello people of the internet. My name is Johnny. Welcome back to yet another FNAF news video and we have a packed news video for you all today. We got Funko news. We got U2's news, Sanchi news, a whole bunch of merchandise, Ruin news, the FNAF movie news. We just got a whole bunch of stuff to take a look at in today's video. So quite frankly, let's not waste any more time. If you're brand new to the channel, consider scrolling down, giving that sub button a little tickle. So without further ado, let's go ahead hop right into the first topic, which is a brand new t-shirt from Spencer's. Definitely not one of the most appealing t-shirts we've had, but it's here nonetheless. We got Glamrock Freddy front and center, Five Nights at Freddy's. Written below him, he's in front of a red circle, I guess the saturation on him is booming. Yeah, not entirely sure what is up with the exposure on this t-shirt, but it's out there in the wild if you wanna go take a look for it. Moving on to some other merchandise. We got Sanchi back at it again because they're actually releasing some brand new pins. This was a photo taken at a recent convention that Sanchi was a part of. And as you can see, you can notice some brand new pins. They appear to be simple stills from the FNAF One cameras. They even have the UI still on the screen. So I'd assume each camera's gonna get one pin and we can also see another box with some tickets across it. And thanks to a listing on Makari, we can actually get a closer look at these brand new pins based on tickets. And these things look absolutely fantastic. The art on them is just phenomenal. So as you can see, this is series one of Sanchi's brand new prize ticket pins. They come in a blind box and each box has a chance of getting either Freddy, Bonnie, Chica, Foxy, Mr. Cupcake, which is a rare one and also a mystery character, which is super rare. Not entirely sure when these products are gonna be releasing, but since they were at a convention, hopefully they do come out pretty soon. And speaking of stuff that's coming out pretty soon, we actually got a brand new Funko FNAF AR plushie this time of Firework Freddy. This guy is once again, another Walmart exclusive Funko product. Seems like they just love giving their FNAF AR products to Walmart. This guy is no different. Honestly, he looks pretty good. I like the Firework. I like the sunglasses atop his head. The colors on his fur and also the clothes are really good. And also he has a look at his tag. So if you're interested in this brand new Firework Freddy Funko plushie, maybe stay on the lookout for Walmart's. Now what's interesting about this guy is that we had no clue he was coming out. He wasn't leaked prior, which nowadays is pretty common with Funko products. Traditionally though, it seems like nowadays when Funko makes a plushie or figure based on FNAF AR, seems like they're gonna get a figure and a plushie. So hopefully pretty soon, we can get a figure of Firework Freddy too. Moving on now to U2s. And speaking of U2s, look what came in the mail the other day. Oh, it's my Vanny headband. It's actually pretty comfy. I don't look too bad. Anyways, moving on to U2s news though, they released this photo over on their Tuzi's Twitter account. With the caption, all this talk about the FNAF movie got me hungry. And in the image, you can see what appears to be some sour gummies based on Glamrock Freddy and Vanny. Tuzi's, if you don't know, is kind of a side company. It seems of U2s where they make previously, they've made drinks. Seems like now they're gonna make their way into candies. So pretty soon, it seems like we can get some sour candies based on some security breach characters, which is gonna be very interesting. So if the mouse that's very interesting and something I'm looking forward to very, very much are the brand new Pop Goes pins. Kane Carter announced on Twitter yesterday, the official Pop Goes X U2s pin set will be available to pre-order for 14 days only, starting on the 21st of April at 3 p.m. Eastern Standard Time. And attached is an image of all the pins within the set. You got Pop Goes, Blake, Sarah, Safra and Stone the Crow, as well as Minora. These pins look absolutely adorable. I cannot wait to get my hands on them once again. The 21st of April is when these guys release. And yesterday, these guys also released a TikTok showing off a whole bunch of brand new upcoming products. First off, the main focus, their brand new upcoming Ennard plushie. Seems like he's taken on the Chibi form. He looks absolutely adorable. I don't know how they made a giant messy monster of wires like Ennard into an adorable plushie, but they did it. And in the background, you can also make out some other upcoming U2s FNAF products. First up, you've got the upcoming Dreadbear figure releasing alongside the other Help Wanted figures later this year. It's just a better look at his box. We've taken a closer look at the box in a previous FNAF news video, but as for other plushies you can spot in this video, first up, we have a Glitchtrap plushie who looks adorable as well. A lot of detail on this guy, the whiskers, the bow tie, the vest as well. The color looks spot on. Overall, this is probably gonna be one of U2's best plushies for FNAF. He just looks absolutely incredible. And finally, they also showed off a Helpy plushie who looks to be laying down a bit. He looks very, very adorable as well. No release date for any of these products just yet, but hopefully they come up pretty soon. Especially that Glitchtrap one because I gotta get my hands on him. He looks perfect. Moving on now to Clickteam news, they released a brand new update for the mobile port of Ultimate Custom Night. The changes include revamped and improved user interface. Player defined AI is now saved. Subtitles for 11 different languages. Resampled graphics at a higher resolution. Improved audio support, revamped vibrations and various fixes and improvements. Something else you may have noticed in that trailer at the very start, we could see a very strange looking room. It's simply used as a background image but it still looks really, really interesting. It appears to be a party room with art to the FNAF one characters on posters. You can see a door and happy birthday banner off to the right side, the checkered pattern around the walls. Like this looks like an official location. So a lot of people were confused like what the heck is even this? Is Clickteam leaking a brand new upcoming FNAF game? Well, luckily Clickteam explained it a little bit saying to be clear, we worked with VIJ who cooked up the following mock-up sketch. Then our new shiny in-house graphic group turned it into a 3D scene. The scene itself is a mock-up for an idea we had. And rather than waste the work, it is being repurposed for the trailer. Based on this tweet, it seems unnecessary to try and guess what they were working on because based on the wording, it seems like it was scrapped and now they're just gonna repurpose some of it for a trailer. But it's still pretty interesting because this looks damn good. I really hope in the future, Clickteam reveals a bit more about the scrap project because I'd love to know what it was gonna be. Moving on now to some real news. We've got some very interesting news, but you may have noticed April 6th and the 13th came and went with no news. And if you don't know what I'm talking about, well, not too long ago, I made a video talking about a leaked teaser that got uploaded to Security Breach TV. A lot of people were assuming it was gonna be for ruin the upcoming DLC for Security Breach and the site was gonna be updated on the 6th and 13th of this month because those dates could be found in the source code of the website, but those dates came and went with zero news. Why we didn't get that teaser or any news for the website on those dates, I'm not entirely sure when or even if we're gonna see it in the future. I'm also not sure. Maybe they're still testing out the site and those dates were just placeholders, but I really have no clue. I'll let you know if there are any updates, but overall seems like we're just gonna have to wait a bit longer.  But Ray McCaffrey, the executive producer of Stewell Studios, made a tweet with two takeaways. Number one, ruin development is still allegedly going pretty well, saying on top of Ruin Dev, which has been going very well. Point number two, we've been super busy hiring sauce. Please welcome the newest member of the Stewell Studios team. Wait until y'all see what he's cooking up. If you don't know who Duralr Sauce is, you've probably seen some of his cosplays. He's an absolute frickin' legend and apparently now according to his Twitter bio, he's also now the creature fabricator and designer at Stewell Studios. Now what exactly is cooking over there with Stewell? We're not entirely sure. We're just gonna have to wait and see. But once again, huge congrats to Sauce. You really deserve it, bro. Finally, for Ruin News, we've got a brand new branch added to the Depots of Security Breaches DLC called FNAF 9 Beta Shipping, seemingly confirming that the alpha stages of the DLC are now complete and they've moved on to beta. Now what's exciting about this is that the beta stage of game development is honestly very, very close to a finished state. Usually beta entails almost the complete entirety of a game is done. The functionality is there. There's still quite a few bugs. So usually this is the stage where you test all the functionalities of the game. Go through, make sure you get rid of all those bugs, which hopefully Stewell takes quite a bit of time to do that. I'm hoping this time around they'll be more conscious about that, but one can only hope. Yeah, the beta stage is honestly very, very close to a release candidate state. So hopefully pretty soon we can get some official news. But that is actually gonna do it for this FNAF news video. Originally I wanted to cover some FNAF movie topics, but we honestly got way too many that I think I'm just gonna turn it into its own FNAF news video for tomorrow. So I'm sorry to leave you hanging like that, but honestly we got a lot of very interesting things to talk about. It really does deserve its own video. We got a leak of the Pizzeria set, some brand new characters coming into the movie that I don't think anyone was expecting. Some ad-rating info as well as some plot details that I don't think anyone has caught on to yet. So thank you so much for watching this video. If you're excited, don't forget to subscribe so don't miss out on that movie news coming pretty soon. And I'll see you all on the flip side. Goodbye.


Hi, everyone. Welcome. I guess I have to put this on something. Oh, this is the biggest crowd that's attended a systems meeting. So it's a pleasure to have you all here. It's a nice topic. So I think that's probably why that we've got a larger crowd. It is an exciting time for systems, as we'll see in a moment when we look at the plans for systems 3.0. But I'd like to take the first bit of this and introduce you to some of the things that we've done in this last year. And in the years before, sort of a look back. And Greg will come up as the incoming director and tell you about systems 3.0. So for those of you who have not been here before, can I have a show of hands who this is their first meeting? OK, good. So this slide's for you. So I have dozens of different slides that talk about the various things that underpin our science. But I chose this one because it provides a pretty overview, but it also engages in some of the systems 1.0 and 2.0 goals. And as Michael just alluded to, we're moving into more coupling into the human domain. But I think everyone should understand at least that these are the goals that form systems 1.0 and 2.0, such as talking about the different transport processes and their interactions with their environment. And of these processes, which of them are self-organizing and what are the pattern formation? It talks about material fluxes and surface evolution and deposits. So there's a geological side that has driven some of our activities. And then there's this really big coupling that has always been with us, but we're now taking it to the new level, which is coupling between the physical, the ecological, and the human processes. And even the outside domains that influence all of that, which are the Earth's interior and Earth's atmospheric dynamics. We covered last year was climate. So that was to try to get a handle on those kind of interactions. For many of you, you obviously haven't seen this, but this is how systems 2.0 has been functioning. We have a number of things that we need to get done and we need to maintain, such as making sure our community is active, engaged, and all of these other activities. So let me just quickly walk you through a few and point out what I consider the salient point for each. So this is our governance structure. We're basically a community of communities and we have working groups, we have focused research groups. And they're quite large in size in hundreds of people who are a part of each of them. But then there are these individual projects and that's what I want to concentrate on. So for every dollar that we get at the integration facility to buy NSF to sort of manage this whole thing and develop some of the middleware and software. NSF has handed out $13 for every dollar to individuals and teams for their affiliated systems projects. So that's a force multiplier of 13.1. And when you add the other agencies, systems has served a large community. Its impact is much larger than the initial grant cooperative agreement with CSDMS. So this is a slide that I've also not shown before because I never knew this. So this is the population by country. And we knew we had 69 countries. I knew what our growth rate was about 150 persons a year. And I've been showing where the people are choosing to populate themselves in these various working groups. But the country side of things is sort of new for me and I'd like to share it with you. So two thirds of our membership comes from the US. And this is both government agency, scientists, as well as academic people and those from industry. And then there are the countries and I don't think the countries that are next highest up are should be of any surprise. If I was surprised at any of this, I have some German colleagues in the audience is that there weren't a lot of Germans who choose to be members of CSDMS. So we have to change that somehow given their population. So I'd like to welcome four new co-chairs. The first one is Kim DeMutzert who's co-chairing the ecosystem dynamics focus research group. Where's Kim? There we go. And Myra Zellner, the human dimensions focus research group. Hi Myra and Mary Hill who can't be here right today but she's coming a little later on in another day or two shows.  And then Scott Peckham. Scott here. Scott's not here either. Who's co-chairing with Tom, the Cyber Numerics Working Group. And since this last year, we've had a number of models that have come into the system. And when I'm listening here in the domains is these are sort of the basic domains. Some of these are both terrestrial and coastal. Some of them are coastal and marine, et cetera. Some of them are hydrological and terrestrial. Those are the models that we have entered into our repository. And we have not quite as large, but we have a lot of heavy code tools that are associated with some of these models or can help other models. And then we have this compliant side of things. And the compliance side is for those models that have been refactored, altered, wrapped, whatever way you wanna word it so that they can be in a plug and play modeling world that we've been putting together. So I wanna thank all the new contributions. These are the models that came in this last year.  Some of them are Lagrangian. Some of them are direct American simulations. Some of them are social or local or time marching, et cetera. So systems has always been a community of communities. And in this community, there is a wide variety of models and languages that they offer. For each model that's submitted to our repository, the integration facility does a few things on behalf of that submission. We can start and usually start for all of our models, we've done this citation indices for both model overview papers and model application publications. So you can get credit for writing models. This is something that I've been pushing academic community to recognize. So it's not just scientific papers but it's actually the models themselves that should be credited. Our model metadata with its digital object identifier for each stable model, we now provide this. And by doing this, this has really helped. And we've been working with the various publishers to make sure that when people publish a paper with a model in it, people can reproduce that model. You can reproduce it in such a way that we can get back to what is called normal science because in the past, without the code, you would have a model paper that could never be reproduced. So we thought that was a mistake and we've worked hard to try to sort that out. So obviously all the code that comes into repository is open source and our version control we use is given. Quick word on our soon to be retiring supercomputers. Janice has already retired but we brought in these supercomputers in three stages. First there was beach, that was the largest on our university for a short time and then there was Janice and then now there's Summit.  So that'll be the next one that we replace. We replaced Janice with Summit. But if you look over this last 10 years of supercomputers, you'll notice that not only are the teraflops, computational speeds that we can attain increased over time, but the entire architecture has really changed. This is always a challenge for modelers because modelers like a stable hardware platform from which they can write code towards. So if the hardware keeps changing, we have to adopt and that's why we put on these clinics for helping people use HPCCs. And now you can see your interconnect bandwidth is so large in our new systems. It's not just clock speed. It's not just number of cores. In fact, you can see the number of cores have gone down yet the teraflops isn't coming. We put on a number of in our educational repositories. We work with the community to take what you have developed and what we developed internally and make sure that we can sort of spread the word, the domains, whether it be creating new student labs that you can download and run on your behalf and in your classes or short courses or lectures or whatever the method is. We have our own YouTube channel. So please, if you've not experienced our educational EKT side of our web domain, please go there, have a look around and use it. We put on a number of special issues. I think this one that we're attending right now deserves a special issue. So you may want to talk amongst yourselves and whether you think that the social surface dynamics community can get together and put a special issue out in an appropriate journey. In our EKT that Irina Overeem is trying to develop this quantitative toolbox, she wants to tag the concepts that come in that you may submit in terms of concepts, discipline, domains, level and model difficulty progression because you need to know that when you're giving us first year student course and they have a lab and you're using one of our things, you know that this is something that you can use or it may be more appropriate for graduate students. So please work with us on trying to make this system happen. It'll help all of us in our academic teaching pursuits. So one of the things that we've done is we've looked at how models have been written and how model coupling systems have sort of combined allowed one model to talk to another model. And there is this thing that's been around for a long time called IRF. IRF has initialized, run or advance, finalize. But a couple of the systems have that get values, set values. When you do that, you can have your models wrapped in such a way that they can enter the plug and play world. And I've shown this slide many times and there's this blue arrow that basically indicates that once you've done one, you've done another, you can then all all these models where there's an appropriateness of either subject matter or need to couple them. But I never tell you about the blue arrow. The blue arrow is actually quite a complicated arrow. And so I thought on my last time up here, I would tell you a little bit about the blue arrow. The blue arrow is quite complicated. It is really the guts of the middle aware that has been developed over the last 10 years by CSDMS.  So when we get a model written in any of our open source languages, C, C++, Python, Java, Fortran, any of the Fortran. This model needs to be BMI. It needs to be put into this IRF get set system. So we've developed ways to help all of you do that. If you're a model developer, we've put a builder in place, we put templates in place, and we have a tester that allows us to test whether it really meets the standards. And then you end up with a BMI model. So once you have a BMI model in our system, then it needs to be babelized. So a systems babelizer allows a BMI model to speak Python. And it does that through some pretty heavy sophisticated code. It's babel, the language neutral compiler that spits it out in one model into any of the other languages. And in our case, we've chosen one language. So no matter what the languages are coming in, we spit out one language called Python. And we make that BMI model a Python component. And together with the BMI metadata, we can allow it to get into the Python modeling tool called PyMT. And then that will allow it to get into the web modeling tool. And if you're just a user, not a model developer, the only thing you may see is this last box called WMT Client, which is your browser code. But there's a lot of magic that goes on here. In fact, there are these are new concepts, as Eric will show you tomorrow, and when he provides his, with Greg, the keynote on BMI, you can actually take a model and in PyMT, change the model and its whole structure without actually touching any of the code. So you actually don't need a couple with another model, you just need to get it into this PyMT to make things happen, and you'll show you a little bit about that. So it's a whole new concept. And we have a bakery repository that allows you to get access to our recipes, pre-built binaries for all of your components, tools, and models. And of course, again, something we can do and of course, again, something we don't often talk about, you can't have one model talk to another model if they actually can't agree on what discharges or what units discharge, or even what discharge means and there is called. So we have standard names and these standard names have a method that's being picked up now by other groups. And it's really important that this becomes part of how the semantics and the whole one model can talk to another. We've also worked on, and there's a clinic on this, on getting Dakota, our DOE uncertainty tool, to get it to be much more useful. And so we've been PMIing various portions of Dakota so that they can be used in this plug-and-play world. And we've been pushing ahead on the benchmarking and our first off is supporting this island, this benchmarking tool that we've been developing for permafrost exercises and work. So some of the history back in 2002, 15 years ago, there was about 60 people that had came to a meeting here and you can see some of the young faces that were there then. I still had an old face back then. And the core concepts that we moved forward with was developed from this first meeting and elected from that meeting was a bunch of representatives to go to the agencies in DC, NSF, NOAA, USGS, O&R, all these various agencies. And they were to sell the contents of that first meeting. They sent the agency people sent us back to then write the implementation plan and a few years later we were funded. So if you look carefully up in a tree, you will see Brad Murray, who's gonna become our new chair, freshly elected. You also see Pat Weiberg and Brad as one of these leaders. This group has been giving their blessed wit and tears to systems for a very long time. So I would like to thank Pat for her great contributions and I would like to welcome Brad for the task of keeping this organization on track. So I'm not gonna walk you through this history but this is a history where you can see we developed the integration facilities, our first HPCC, the plans, the repositories, the various tools started coming out, new HPCCs came online and we walked our way through these various developments to get us to where we are today. And hopefully this will lead us to a submission in the near future for systems 3.0 and new visions and goals for various working groups and focus research groups. And since this is my last time, I have to say the following. This group that you're looking at here is some of the most talented, kind and generous people that I've had the pleasure to work with around the world and I owe them everything and so please join me in thanking them for their contributions to where we are today. And if you need to see any of them or you have any needs, please see one to support you. Okay, so welcome everybody, it's great to see you all. I wanna tell you a little bit about plans for the next phase of CSDMS, CSDMS 3.0. Before I launch into what that's about, let me make a couple of observations. One is that CSDMS is still growing. This is sort of remarkable to me. Jai mentioned that the membership has grown by about 150 people per year. That's shown in this chart here extending back to 2008 and if you had asked me 10 years ago to predict, I would have said, well, after a few years, this will level off. We've found our community, people are those who are interested have joined and yet it's a straight line pointing upward. Then it says something about the level of excitement and enthusiasm among you, the community. A second point has to do with the diversity of this community. So if you look at a distribution of membership in our various working groups and focus groups, right away you recognize that just from the titles of the groups that this is a remarkably diverse community in terms of its interests. So, for instance, among you all are people interested in long-term tectonics and geodynamics, the building of mountain ranges. There are people interested in ecosystems, fisheries, vegetation. There are people interested, of course, in human dynamics and human systems. Now, the National Science Foundation is very interested in the concept that they call convergence, which they define as the merging of ideas, approaches and technologies from widely diverse fields of knowledge to stimulate innovation and discovery. This is one of the sort of 10 big ideas that NSF has recently put out. And I think that this community actually has a credible claim to be achieving convergence in its diversity and its eagerness to work together and share ideas. Okay, so a year ago today at this meeting last year, we asked you all those who were in attendance then to get together in a group of a series of breakout group discussions and to help shape a vision for what systems 3.0 might look like. And in the years since then, the integration facility has sat down, collected the notes from those conversations, worked with the working and focus group chairs to try to craft those ideas into a vision of systems 3.0. And that has now been translated into a draft proposal that we hope will be submitted to NSF sometime in the coming months to support the integration facility for a systems 3.0. So I wanna tell you a little bit about what the outcome of those conversations has been. First of all, if we try to sort of synthesize a high level view of the science that comes out of this, we've tried to encapsulate it in the phrase you see here with the white arrow, model data synthesis in Earth surface science and applications. So it's a little bit of a mouthful, but those words are carefully chosen. First, model data synthesis. This reflects a view that came out of those discussions last year and that one of the key opportunities before us lies in bringing our computational models together with the rapidly expanding number, quality and resolution of data sets that pertain to the Earth's surface and its dynamics. I'll say more about that in a minute. The second part here, science and applications reflects the view that emerged from these groups that we can and should be doing more as a community to embrace applications, to bring systems models and systems expertise to bear in the applied world where the state of the art models are not always state of the art. So those two things together gives us our theme. Another way of casting this is that we're seeking to move toward a more predictive science of the Earth's surface where predictive here means not just forecasting the sort of sedimentary weather tomorrow, but it means prediction in the broadest sense of a good scientific theory is one that predicts the observations. So let me say a few words about model data synthesis and data opportunities. Last year at this meeting, there was a poster presentation that talked about a project called Arctic DEM. So this is one of a few examples I wanna share with you. Arctic DEM is an audacious project designed to create high resolution digital elevation models of the Arctic. High resolution meaning a few meters per grid cell, the Arctic meaning literally the entire Arctic landscape. That's what makes this an audacious project and they're doing it with satellite photogrammetry. Now this is an example of a dataset that means that we are now on the verge of having for this part of the world high resolution images of the landscape that can be repeated. They can be regenerated as long as the satellites keep flying. That means that we can do change detection. And this is a place where change is happening fast as we know. So whether your interest is in coastline retreat, or thawing permafrost, or shifting river networks, we're on the cusp of being able to measure those changes in a way that we never could before. Another example comes from LiDAR. So LiDAR has been with us for, I guess two decades or so now as a technology, but of course as you know, its applications are rapidly growing. Its coverage is expanding fast. Some states in the US have LiDAR coverages. A lot of countries now are acquiring LiDAR for things like coastlines and river quarters. So the coverage is increasing fast. And it too is repeatable. And it too raises interesting opportunities and change detection. So you're looking at images now from some of Marielle Perignon's work. If you look at the sort of bluish figure, that's showing an image, a difference image between two LiDAR data sets collected five years and one big flood apart from one another. This is an image showing in detail the patterns of sedimentation along a flood plain that resulted from a large flood. You know, when I was a grad student, we never had a prayer of having anything like this. To collect a data set like this would have been a major investment in time and money. So this too is an opportunity in change detection and it means increasingly as modelers, we're not gonna have the excuse to say, well, my model looks a little bit like a river, right? It's gonna have to be how much like this particular river and its dynamics over this period of time does your model capture?  Another example from the coastal realm, this comes from Chris Sherwood. Chris showed some of these data last year. And you're looking at a digital elevation model of a stretch of the Cape Cod National Seashore that was obtained using drones and cameras on poles with structure from motion photogrammetry. I'm sure some of you are interested in using structure from motion now. It's a relatively new technology that makes high resolution surveying of topography fast and cheap, much faster and much cheaper than it used to be. Again, change detection becomes a real and affordable possibility. Again, pushing our models to say, not my model looks like a coastline, but my model resembles this change in this stretch of coastline in these ways and it fails in these other ways. The world of asymmetry is also part of this data revolution whether it's from submersible drones and improving quality of sonar technology. We're getting better and better images of the submarine world as well. Here's an image of the Baltimore Canyon trough at a resolution of five or 10 meters per grid cell. So all of this makes change detection and modeling of change detection and testing of models much more feasible and powerful than it was just five years ago. Now, not all of us deal with, many of us deal with processes that happen in scales of our lifetime and some of us extrapolate them into the geological record, right? The geological time scales. We think about mountain building, we think about sedimentary archives and things like that. But there too, we have a data revolution, not so much in our ability to live for 10 million years and measure things over that time. That would be cool. But in the form of experiments. So we have with us today at this meeting, representatives from the sediment experimentalist network. So welcome to you all. These are some of the experiments that the SEND group has produced. And what's interesting here is not so much that experiments are happening. Experiments in sedimentology and geomorphology and related fields have been undertaken for a long time. But what's new is that we can now actually measure their dynamics very precisely. So in sort of visualizing and teasing our visual imagination, it's also captured digitally. We can capture stratigraphy evolving, landscapes evolving in a controlled laboratory setting. And we have no excuse not to be testing our models in these controlled environments. So a wealth of data that we didn't have when systems was first launched and that's a huge opportunity. So in a way, the challenge moving forward then is to embrace this and other opportunities while also sustaining the good things that the integration facility has created and that are valued to the community. And doing that in uncertain budgetary times, right? So doing it if we're lucky on a flat budget. So that's the challenge that the integration facility is gonna be grappling with over these next months. Now, talking about some of the ideas that we have on track for systems 3.0 that again, came out of your vision last year, it's useful to think about the CSDMS integration facility activities in terms of three pillars, right? These are sort of three core areas that systems works on. And they reflect three things that many of us do in our science, scholarship, engineering, and so on. First of all, we collaborate with one another that's partly why we're here. We share resources, whether it's model codes or data sets or whatnot, and that's the community piece. Those of us who work with computational models, we do models, we run models, we write models, we debug models, and we need computers to run them on. That's the computing piece. And then finally, many of us are educators and all of us are learners. And that's true whether we're just starting out, we're just learning how to do basic programming, we're learning numerical computing and so on, or whether we're interested in learning a new specialized technique, whether that's the latest advances in computational fluid mechanics or it's agent-based modeling of human systems. We're all learners. That's the education piece. So I wanna talk about some ideas for systems 3.0 in each of those three pillars and I'll start in reverse order with education. I won't go through each of these items in detail. The key is that the light text is things that systems is doing now and will continue doing. The heavy text is sort of new ideas. One of the messages that came out loud and clear from last year's breakout group discussions was that clinics at these meetings are great, but there's only so much you can learn in two hours. So there is an appetite for more in-depth training opportunities and one idea that emerged from at least one breakout group was the concept of summer schools, some kind of fairly intensive training opportunity to bring people up to speed with best practices in scientific computing and applications. So we hope to launch that in systems 3.0. These will be probably something like 10 day summer courses. Let me say a few words about computing resources. There's a lot to say about computing more than we really have time for now, but let me highlight three things. First of all, the data challenges mean that we need better ways to bring models and data together, whether it's ingesting data set into a model or it's comparing model outputs with data to try and figure out how well a model did. That calls for tools to help that process along and so we hope to be able to create something like a basic model interface for data sets and to enhance GIS capability. So if you need to project a data set or project a model output, so you can compare them with one another. Let me say a word about beach. So Jay talked a little bit about super computing resources. What's unique about beach, of course, is that it is dedicated to this community. It's specifically for CSDMS users and it has a sort of a low barrier to entry. It's a starter system. As Jay mentioned, the beach facility is aging and it needs to be replaced. And so we hope to partner with research computing here at CU Boulder to create essentially a chunk of a modular system that they maintain that will probably have fewer cores, at least initially than beach does, but those cores will be a lot faster. Connections will be a lot faster and the memory will be a lot bigger. So we hope to see improved performance with that. And then finally, let me mention the Python modeling tool that Jay also mentioned. This now exists as a beta product and Eric is gonna show you a demo of that tomorrow morning. We hope to turn it into a full-featured product that you can use in doing your science and we'll talk about why it's, we'll show you some examples of what makes this such a cool and useful tool tomorrow morning. Finally, the community end of things. Again, lots of ideas came out of last year's discussions and we've tried to synthesize them. One thing that became clear is that many people in our community are interested in cold regions, whether it's glaciology or it's thawing permafrost or it's Arctic coastal retreat. And CSDMS has never sort of formally recognized that area of activity. So we hope to do so by forming a cryosphere focus group to complement our existing suite of focus groups. Let me also say a few words on the idea of science teams. As Jay mentioned, the working in focus groups are big. The smallest group has something like 70 odd members in it. Now the biggest has over 700, right? So that's a big job for the group chairs to manage. And yet we want to provide, we're hearing from many of you that you want to become more closely involved. You want to contribute in some fashion. So one of the ideas that came directly out of one of the breakout groups last year was look, what about the idea of forming teams within the groups? These are people who volunteer their time to engage in one or more projects on behalf of the broader community each project year. And those projects could be anything from wrapping a model to writing a group proposal to doing a multi-authored review paper and many other kinds of things. Proof of concept study and what have you. So that provides a venue to sort of recognize your contributions and provide a way for broader participation while honoring that formally and also providing a mechanism by which we the community can do projects that directly benefit both your science and the broader base of infrastructure that CSTMS supports. So stay tuned in the coming months for more information about the process for applying to join a group or nominating your colleagues to join. So that's a quick sneak preview of some of the things that we have on tap again. That's a direct outgrowth of the discussions that were held last year. If you have further thoughts, we would greatly welcome them. Just pull an integration facility person aside during this meeting or send us an email at systems at colorado.edu. So back to Jay. So I won't even put this on, maybe I should, I don't know. So here we are at this meeting. It's called the dynamic duo. And I think it's gonna be an exciting time, but let me tell you a little bit about how we got here in the first place.  It was the linking earth system dynamics and social system that both work. It was also co-sponsored that, I guess we're having some mic problems. Anyways, this small group forged some very interesting ways forward. And they came up with a list of ideas that I think are worth pursuing by our community, you know, from the natural hazard side of things to migration to how various, we deal with various low-frequency high energy events. And that white paper went around. And so I think all of you will have seen some copy of that as members. There was a follow-up meeting just months later in Kyoto that broadened that group, which was sort of less of an international group of folks. And this Kyoto meeting was part of the a future earth initiative and that future earth initiative under the auspice of the analysis integration modeling of the earth system aims project. And so that's that a group of people you see there in that met in Kyoto. And they really pushed, you know, what are the barriers for that the social scientists are facing when they are developing their models. Right now they're locked into many of them agent-based models or integrated assessment models. And they really have a hard time interacting with the kind of modeling that we all are doing. So that meeting really brought out some of the finer points. And then there was a follow-up meeting at Potsdam as Michael said, integrated modeling of the social environmental systems. This was a real blueprint forward way of trying to get that community to make advances. And now there's this meeting. So we will have an opportunity to meet later today. In fact, after a few more keynote speakers to really finally get sort of the service dynamics community with populated with social scientists who are gonna be leading this effort in reporting to try to get your thoughts into these developing white papers. Now the developing white papers, I don't know for many of you folks if you've all experienced writing them, they almost always lead to some agency turning on money. And so whether this money is at NSF or whether it's in the international community, I think it's really important that you get the opportunity to put your thoughts down. And no matter how young you are in your career, your thoughts matter. So please attend this breakout session and to get your thoughts recorded. You will notice that we have clinics every day. And if you forgot which ones you've signed up for, you can look at the back of your tag and see which ones you signed up for. We have limitations on some of our room sizes. So please try to attend the clinics you suggested you were going to attend. We have plenary keynote speakers. Every year that we have these plenary keynote speakers, they've been given advice on how to make their presentation so that together there is a coherent way forward. And you can find all of these presentations online. So I really urge you to attend these keynote talks that will include some award-winning student talks. And then we have poster sessions on today and tomorrow. And we will vote, you will all vote, as my father used to say, vote early, vote often. Vote for the best poster so we can hand out the award at our banquet. And so the groups that we'll meet, the focus research groups and breakout groups, they each have their own individual attendance structure and again, we hope you attend them and make sure that they can start developing the visions for systems 3.0. And finally, my last slide is to let you know that we have three outstanding winners today for this meeting. Mike Ellis are winning the program director award for 2017, Julia Moriarty winning the student model award and outstanding thesis and the competition this last year was fierce with the numbers of people that we've had to go through the various publications and theses and Julia won. So I'll hand it off to her for her achievements. And then finally, our lifetime achievement award, Bob Anderson, I don't think there could be a better winner of our lifetime achievement award than Bob. And I'm so pleased that he's winning this award while I'm still director. So thank you, Bob, for this achievement. So what you see in all of this will be celebrated at the banquet and please congratulate them when you see them. And now I will introduce 30 seconds left. Our next speaker is going to be Marko Janssen who's going to be talking about two modeling cultures. So please welcome Marko Janssen.