with this or a show human human architecture on thing take away. And this happens to be our 310 show you are our accumulated viewer which you see down there. And that's all story Michael and Jay without promotion so with shameful non promotion just promoting itself. And so we're going to go back to the 9th time talking about Lahaina. And it is us. Membring Lahaina on top of what you to Soto Brown in when you are not with us during your Bishop Museum up there as a historian so welcome back to Soto. And we have you Martin Ancelini back with us here for this. So this this is us going back and you just Soto had been we said it was four times. Remembering Lahaina and both from the archives and also from you having been going there and now we're in multiple times looking at what could one do and starting out on this slide. I just want to put into perspective so you the audience when you want to see the whole narrative you got to go back to the recent shows. And here we basically show you what we are not talking about which also one could do maybe one should do. I put this from the Web site that funded can this the con had put together this exhibit of traffic hearing which the Web site Web site features two approaches that could have been done. One is using two by four is the all American system version of the pre contact six of your ancestors to Soto. But he says the mindset is the same the new indigenous you just go with what you have. And then you have one wrench and one connection and you put this together.  So these are all suggestions and more many more that are based on using what you have from scratch. And please get us right. We appreciate the intention of what we see at the very bottom right there which is people who mean well, but they don't any and any different as to import things from. After all the world where I am from from Hungary and they import these you know folding out boxes that bring shelter yet yes which is good but they bring too much and they also bring back what was not good which is the missionary and I compared it with the image of a winter cold you bring a winter cold here which people in the Ukraine need now again is season wise but we don't need here. We just need an umbrella. And so also bunded has kindly given me trying to keep me hydrated this son Pellegrino bottle which are also you know I drank and I brought it with me which is really nice. But I have to reuse this now all the time because you know this is this is a lot of embodied carbon in it to make glasses melting sand. Now I have to reuse it. So this comes from Italy if you haven't known and also the solo at the bottom left you reported on that quite excessively recently this is the new rail system, which again the train comes where this comes from from Italy. And I just drove there and I want to throw up this picture here of the rail in the back as an all her medic invasive thing that also already started to break down it isn't quite perfect it right. We keep going back to my to our pying mobile, which is more exotic right is also from at the other end of the world from Germany and old Mercedes, but it is a convertible so it's easy breezy. You know, makes no sense to even have that car over there for the few months in the summer, not worth it because I have to have the heart up on all the time. Right. And so that is just just just the points we try to, we try to make about about things this can also be the Arbor day week show because Arbor day is around Arbor day comes from my home away from home, Nebraska. This is where the Morton family that we know from the assault more from later generations has started this thing to to basically plant trees in the world. And the former supposedly former owner of this car, which is former first lady Jean Arioshi has, you know, just like Jimmy Carter has done a lot. You know, during and past her reign, which is having a million trees planted and I just watched you know this. I think this is a show quote of a quote of of public radio having interviewed here where she said well we had a million people at that time now have more. And I suggested to plant a million trees, which they basically did. Right. So we just want you the audience to join us, you know, and thinking beyond what you see but actually, you know, you look at what you see and make up your mind about it and take a critical position, getting us to the next slide because this is what we did when we first met Martin right and you want to stay a little bit what that was and what we looked at. So this is a we should absolutely talk about you the easy breathing know we see it in this image. No, the, the Hawaiian weather in general, don't requires a to be enclosed. We now know that most of the of the casualties that happened in the high now we're because of and what that happened normally with fires are not for the fire itself but but for the smoke and the smoke is dangerous when it is enclosed. You know, even vernacular construction, tropical constructions, when they were closed with palm or or or or straw or different vegetable materials that that were breathing. Now we cannot make this hermetic architecture as the the something you know, and the metro wagons, because this is what is dangerous. So if we leave the air passing, of course we are saving tons and tons of of carbon produced in this in this local context, but also we are generating safer architectures. Yeah, and we, the very the large picture picture at the bottom right is in our favorite mid century modern master mid and late century modern master run Lindgren late partner of Edward killingsworth. And this is the Holly Colani and next slide. This total share with us the update on Ron. Well, Ron is our friend Ron is a retired architect and we've been friends with him for some years now and he is responsible for the entire refurbishment and redevelopment of the Holly Colani hotel right in the middle of wiki key. He worked for the company that created the Kahala Hilton hotel and in both cases of what what they ended up with was this beautiful free open space classical types of attitudes and how they did it but still a lot of openness a lot of live ability and and some things that we really admire. Of course that's not all that he did. Well, our friend Ron is now retired. He's getting elderly. He is working on his finances, and he is living in a wonderful house that's in Long Beach, California, that is just perfect for him architecturally. And again is historic to coming from the 1960s. And he's working on that and we're hoping to help him out in a variety of ways as he gets older and we're hoping to, I won't go into the specifics because that's his business but still, we want to be helping him to live a better life and not only an architecturally nice places but also financially secure as well. And yeah, this is Ron's runs. We've got a lot still to learn from Ron. Let's put it that way. Yeah. And, and again, when you now watch the show and you have been, you know, hit hard by lost everything.  You might say, hey, you behemians.  We want to, I want to make sure and I will allow myself, hopefully it's okay for you, Ron, watching us as one of our most loyal viewers to talk about because what your, your life has a lot to do with Hawaii with its architecture and with what to do and what not to do. And what you actually did, Ron, is for me the utmost, you know, hero because you have never done anything that other, other howlies have been doing ever since Cook came and they wanted to steal pieces of the Soda, your islands because that's not what one should do. Steal other people's land, right? And so Ron has not done that versus most other architects, even the ones that we admire that we like. They have that shop here and they bought even Pete Wimberley built himself a house, a beautiful house, a lovely house. But maybe it's, you know, this is your land, the Soda of your people and there was no land ownership. So there is no such thing. Ron always went back home to Long Beach, California and the house he bought that you mentioned that we did many shows about is not what he even designed is the best compliment. It was inspired. It's a track home. It's a developer's house that was inspired by his work. Best compliment you can ever get. If you inspire the mainstream with your avant garde, that's the best you can do. And he never, he just took, you know, as profit what he needed to shelter himself, not make, not making anything more, which puts him in the place that he can't even come back and visit the lovely places he designed as a Hali Kalani, because he can afford it. In fact, he can't even afford a flight here. And that's why he's personally taking care of himself. We're proud of you, Ron, because you talk the neighbor into of your duplex into you selling your half to him. And then he allows you to stay there for lifetime. Thank you, new owner. And that gives you more cash liquidity. But hopefully he use it, Ron, to come back to us because we need you here. There's an article in the star appetizer that we all read it's called called home sharing Hawaii. So one of the problems of the terror of both tropical and temperate territorialization as we call it that it isolates people, right. So Ron, we want you about next to us as the good times we had with you at the docomomos symposium where you were a keynote speaker, but more importantly about all the good times we had before and after because we need you around. Like, like, like rich, you know, is has been taking around just yesterday the soto and the days before, and him playing piano at an art event. That's the way to involve people evolve people who are the wisest, rather than shoving them away locking them away, enslaving them in the golden cages and best case of real estate as we call it. And this gets us to the commune the communal idea that we've been talking about and that you are revitalizing Martin that you are giving a renaissance. And, you know, next slide because we have to talk about touchy things also on our side because there might actually be a problem in Maui that has to do with embracing things with the best intention, not just like the people shipping in these affordable metal boxes, but actually then also not just having the best intention, but also doing the best. And this is here, Ron's masterpiece of the Kapa Lua Bay Hotel that was built in the late 70s. I have to correct myself on previous show. We said it was in 78 and they tore it down in 2006. And you might say, well, because it wasn't, you know, cool enough anymore. Well, this lady in the New York Times as just one example wrote how cool it was and it could have should have easily been kept. And recently we recognizing how great Akashi Anbi was a similar thing. Next slide. This is the Maui Prince Hotel. In fact, what it was from the 80s. And is this shame on us? It got torn down when I was already here and I was the founding board member of Doko Momo and I didn't do nothing to prevent this. They tore this down a few years ago. I think it was 2018. And I leave it up to you guys to judge it. How does this come across to you? And this gets hold into the whole issue of, you know, hotel rooms and should you have people staying there and living there. Does it keep the way the, but I mean, pairing something like everyone talks about, you know, great energy talks about circular economy and ecology. Sorry, something both things, both places, hotels that have, you know, not even been, you know, 30 years or around it. Pairing these down. I want to have, I don't want to quiz your, I'm getting very emotional about that as you can tell. So share your emotions about it please now. Well, the Maui Prince was somewhat controversial when it was first built because it was kind of out in the middle of nowhere. And in fact, the road to get to it was very undeveloped. So there were a lot of people who complained about, you know, you're going into pristine landscape and building this, this huge concrete structure. I actually visited it at first a few times. I don't believe I stayed there, but I gave a presentation to the guests at some point. And again, what you see, which we all admire is the openness and the fact that the air flows through this. And yes, it is concrete. But at the same time, it is not a monolithic concrete monster that's entirely enclosed and uses nothing but tremendous amount of energy to keep it cool inside. So that is part of its, that's part of the appeal. But the other thing that of course we must mention too is that architecture and buildings do not exist in a vacuum. They exist for people with people, people live in them, work in them. And there are economic factors. And unfortunately, and Martin, you and I have discussed this a great deal. Economic factors will be used against buildings sometimes to justify their destruction, even if they are architecturally distinguished. And even if the whole process of demolition and rebuilding is going to consume a great deal of energy. And let's go to the next slide for that because it looks pretty good. Here's the picture that we're going to see of that, of demolition. So there are lots of reasons to preserve things. And there are lots of reasons to build things that are environmentally conscious and that also, as Martin just said, that are open to the elements that are not only safer but better and easier to live in, more pleasant to live in. And again are, and economical too. It's economically wiser to do that rather than to go through the entire process of destruction. And Martin, you and I have discussed this before, the whole, the whole concept of, well it is no longer economically viable so we must destroy it is not necessarily really the truth. There are times people have other motivations and they'll claim that money is the root of it. Well, okay, that's enough for me.  Sorry, give us a break because so was the Kahala Hilton. It totally flopped when it was built. And I'm now basically retraining myself into a business person teaching a class of resort architecture with your support, your guys support and Ron's support and Don's support. So again, the people we're teaching then are the upcoming new leaders in hospitality design and we got to let them know that Kahala Hilton was saved by them by a clever manager who turned the dilemma into a virtue in reaching out to the people who love remoteness which is all the celebrities, all the royals in the world and all the movie stars who didn't want to be paparazzi in the center of Waikiki.  So that's how killings were started out and with Ron they ended with Larry Stricker as the design architect who shows are out there by us about it. The Ihi Lani which is now the four seasons to really give us a break. I mean they are all talking by rebranding if there's a will as a way, but there was no there was no will here. Obviously and and how does this resonate with you. I find it Martin ironic that you see this is green architecture as people like to call it. Because what you run always did the beautiful planter trough Bella straight integrated. There is actually nature living in architecture here. So again coming back to this. This is only green on the surface and not in its substance.  I can either that I should write. So what we see on these lanais is also real green. So I stop here and give it to you Martin. Not just just to compliment is the fact of belonging that we're also talking this in this following shows is probably a hotel where people of course there is people that have an appropriation to these hotels because they work there or because they go often every summer every every winter. Every year. But going back to the high now what is keeping the high now life is the the the people that still makes the high and the high and the the remembering and the big old belonging of a site. No, if sites really generate belonging on a community level also in an individual level. Spaces will survive. No, doesn't matter if they are made out of wood or even spaces that as a tree. No, this bunion tree that it is not a build space. It is a space it is a place that will generate a meaning for that generates meaning that implies meaning for some people. And this is what will line up the keep alive. Yeah, go to the next slide here. This is actually then.  We are out killing, you know, elderly and women and children currently in the Ukraine out there in the in in the Middle East. Right. We're unfortunately doing that. And it's often driven by greediness. And this is here again. We, you know, on when we try to keep our spirits up this total we say okay if you tear something down that is already really good. You've got to replace it with something even better which is really hard, but show quote at the bottom right has not happened at all with replacing Ron's beautiful Kapalua Bay. In fact, the opposite.  And so that's what's there now.  My picture is too small that something with in front of Kapalua Bay the montage montage what kind of a montage what does this wants to say, well the montage is that it's not that the Kapalua Bay was a budget hotel six hotel which you don't even have here on the island right something cheap budget. No it was already a pretty high end hotel. But of course that was not enough. One is never satisfied greediness means I want more I want more I want more so what I found here now is what is now is actually the fifth law in the fifth most expensive hotels flesh resort in the world right. That's what it's all about. And it has big rooms like sweets and it has kitchens in there right so well that's what these rich people have a 1500 per night that's what people have already where they are. Why do you want that where you go right this is really absurd and obscene horrible besides all the like the great energy loss and carbon footprint you know wasting all this stuff. I think that's one of the cultural ways because again run brought tropical exotic player here. He acted like we said many times the Soto as your ancestors were thinking, and he did this as a howly that never robbed your land. I mean that that's why Ron you're I can't repeat this more often you know you are on all levels the most responsible as you So now instead of Takashi on be which you know it probably you know killed him because he died too early at the young age of 60 around that time. They actually build you know he built the the prince Maui and he probably now turns around in his grave if he sees And you know this is again architecturally there's this DeRuse architect I don't know if that pronounces the right way and he's actually you know doing architecturally versus what they did instead of you there bottom right again. He does well and he says you know if you do research he's trained as a carpenter and he does pretty you know nice crisp and and sexy things also tropical exotic. Again on the expense of tearing down things and in there also were part of the team of renovating. Larry Strikker is he he Lonnie into the four seasons now on at Corlea up there out out west right, and they, they recognize what the killings worth was so they know, but you know then they stay outdated. And that's why I think this account as an excuse because there is no such thing you got to educate the visitors first and foremost and say you know you might think this is outdated what you're staying in but instead it is vintage. And that's what we have complimented the management of the Holly Colani because that is actually the last one of the killings worth and your prime piece run where the management is smart enough to understand what vintage is, and that they can justify to the customers that it doesn't need to be renovated but just touched up to keep it fresh right. Yeah, and I was going to just say that the photographs that you showed of your field trip to Waikiki. You also show the Royal Hawaiian hotel and and that the Royal Hawaiian and Holly Colani both from the 1920s 1930s were built before air conditioning and they are both meant to be trade wind cooled and they both survived like that. Unfortunately, those those buildings have survived, which again are easy breezy. Yeah, and do we just wanted to have this show next week we're going to wrap up and we let me mainly you talk Martin but we thought we needed to make clear what we're not doing. What also one maybe should do as traffic hearing but also what some you know unfortunate legacy and some of the psyche of there in Maui might might actually be some fear being afraid of tropical exotic which again one does not have to be if the mindset is right, as Ron you have proven so well and you Takashi, not with us anymore physically but spiritually also have proven well. And I think one could have beautifully, you know, a retrofitted and maybe repurposed these these hotels, and maybe building some of their, you know greedy lust for high end luxury somewhere else for better not if you ask me but that I think this qualifies me for the course I'm supposed to teach, because I'm believing in a more cultivated capitalism and that I won't give up because again you're on. You are the hero you showed us how to do that. And we have to figure out with the emerging generation both architecturally as thanks to you Martin and then from the business side, the Tim people how to continue to do that in the future. And that we will go back to that next week in wrapping up this here and showing your fantastic proposal, Martin that I believe is that's why I threw this in in the tradition of these two projects, but differently they're still based upon a sort of a contemporary, you know mainstream paradigm of hotel rooms and stuff like that but they at least did that fairly well. I'm showing above and beyond that in a in a in a fantastic way so let's wrap this up and conclude that with your additional many thoughts on that. Sorry we didn't get you to talk about it that much today but next week it's all yours. We promise I promise because I talked the most, because I get so emotional about things alright so wrapping this up. See you next week for the final fireworks of you Martin and until then please stay exotically tropical tropical exotic as you Ron keep teaching us in the best way. Bye Ron and everyone else.


Today, Sunday, October 18, 2020, the Ministry of Health received confirmation of three new cases of COVID-19. Case 34, 35 and 36. Case 34 is a 21-year-old male who is the son of COVID-19 case number 31, the 47-year-old male from Castries who was diagnosed in October 14, 2020. The second case, case number 35, is a 23-year-old female who is a close contact of the cases 30, 31, 32 and 34. These two newly diagnosed cases were identified during the contact tracing process being undertaken by the health team in response to the cases which were diagnosed during this past week. The third case, case number 36, is a 21-year-old male who participated in one of the COVID-19 community testing drives which was recently conducted. This individual is linked to case number 33. In all three of these cases, there was no travel history into St. Lucia. Upon receiving their confirmed COVID-19 test results, they were each transferred to the respiratory hospital for care. Though the Ministry of Health has been able to establish a link amongst cases number 29 to 36, it is important that we all bear in mind the likelihood of community transmission. It is this likelihood that made necessary the recent COVID-19 testing activities which were held in some communities and institutions of concern. This testing will assist in the timely identification of any additional cases which may exist in communities. The public is therefore being appealed to to take all of the necessary measures to keep each and everyone safe and reduce the risk of transmitting COVID-19. It is important that every citizen every day ensures we play our part to protect our health and that of our family and those most vulnerable amongst us including the elderly and people living with medical conditions. This can be done by following the guidelines for preventing the spread of infection which include consistently using face masks in public places, keeping a safe physical distance from others, washing or sanitizing hands frequently particularly throughout the day and to promptly seek care at the closest respiratory clinic if experiencing respiratory signs and symptoms. The Ministry of Health and Wellness will continue providing updates as new information is received.


as always it is a pleasure being with you each and every Thursday a very good morning to you thank you very much for keeping it Y254 this is power talk my name is Ram Maguco we are coming to you live from the broadcasting house here in Nairobi Kenya we are also live on our website at www.kbc.co.ke 4th slash Y254 it is a very fine Thursday today the 23rd of September 2021 hoping that you're well this particular day we have a lot in store for you in our conversation it's all about mental health and campus life for those who are about to join campus it is September intake they are those who are about to join campus you have no clue how you're going to go through that whole process are you a parent are you concerned about how your child is going to fair on during this particular season campus life has a lot it has a lot mental health is an issue people get into drugs when they're in campus it is in campus when we've seen making headlines people even killing each other a boyfriend killing the girlfriend a girlfriend killing the boyfriend it is happening right under a parent's nose what do we need to do to maintain our mental health drug abuse has been an issue for campus students have you seen or heard about campus students getting into drug addiction this conversation is for you you don't want to miss this particular discussion joining me to help us understand more about this as always i'm having fantastic guests learn in my letter what do we learn about how they go about talk show it's their first time ever and i tell you there are people that you would not want to miss hearing what they have to say i'm joined next to me and to my extreme right yes i'm joined by none other than anthony njanga yes he is a counseling psychologist thank you so much i'm so happy because isn't if he's gonna happen and this conversation you see one thing that you need to understand about this is mental health and drug abuse is one particular conversation that is important especially this time yes both of my guests are you know fighting helping us to the fight against drug abuse especially among the youth when you mute man yeah yes yes yes yeah edutainment yes catch him or also edutainment on on his social media platforms instagram at official anthony njanga a n t h o n y n j e n g n facebook anthony njanga youtube anthony njanga magnificent yes this is a conversation that you do not want to miss ladies and gentlemen remember this conversation also will have a repeat of this show at 10 p.m welcome and this as always as i say is power talk now compass i remember when i was in campus it was like so id as in in campus It's because the house is full of fruit and our fruits are picked, not picked It's not picked, it's only picked but it's picked at the campus I don't know if I'm saying it's because of the BD but at least for the A and B+, there are grades up with the campus so that you don't have to do a bridging course and stuff So, okay I don't know if it's the same I don't want to go to the campus I don't want to go to the pub I don't want to go to the pub There's always a place like ASEE where you can have campus and you have one year pre-university Okay, okay, bridging But life is the same Is your life the same? It depends on the job market Maybe when you have a job you need to have standards if maybe staff will talk to the university and do better to come and say you have campus at school you are the university because of the recommendations Do you think it is the same campus and the same place? Definitely it is the same because the university has two MSM A and B plus I went to the rest of the colleges and there are others But I think some of the issues that happened in the college I remember that it didn't happen Because there were drugs that didn't happen It didn't influence but it was the same place I was saying I remember my time Now I am afraid of saying campus It is the same It is the same Let's say tertiary issue Yes But this time I went to the university I remember there was a time when There are those days that we came in and sang And in my school we came in and sang Thursday We were in the same class We were in the same school But if you go to the university You can go to the school You can go to the place You can go to the school You can go to the university I am too much I am too much Some of you are from Agari Some of you are from Agari And you are from Mangoma I am packing a lot Oh Share it Let's get it from the get go Your opening remarks When it comes to mental health For campus students I am a college student What do you mean by that? Mentor stability Especially in the campus What do you mean by that? As I said Before the first thing Before the first day The first thing is What is your Where are the campus What is the main goal When you study your career After that you can achieve whatever you want So number one thing When you are a student You join campus The first thing before Before you admit it Mindset is number one When you have mental health In the campus You have positivity You have mindset And you achieve your career Once you have that mindset You can come through But in our days The issues we have today When you go to high school When you go to campus When you go to school When you go to school When you go to school When you go to school When you go to high school When you go to school When you go to high school Life at the campus Life at the campus There is no job So the mentality When you go to campus When you have freedom You are a long-standing parents In order And if you want to go With a negative way That is the main purpose Because there is no sacrifice But when you go to the campus, the mindset is very strong. The mindset is very strong. If you concentrate on something, you can achieve your career.  Number one, what is taking you there is studying and achieving your career. But if you go to the campus, the mindset is very strong. If you go to the campus, the mindset is very strong. Every time you go there, it is very tricky for you to achieve what you have gone there to achieve. For me, it is very difficult for me to go to the campus from four leavers. So I am not going to go there. The thing is, just finish high school. The rest is not going to be there. So I am not going to go to the campus from KCC. Because I am going to the campus, I am going to school there. If I go there, it is very difficult for me to go to the campus. So when I go to the campus, I am going to be so shocked. I am going to be so shocked. I am not going to be so shocked after one year, then just finish high school. These things are serious. Ma? I am sorry. I will tell you one more thing. If you are going to go to school, when you go to the campus, you or you have life thrown at you. I will not respond because at first, I went to the campus set here, because it's important to prioritize, not just in campus, even in life. Like, when you're in a camp, you have to do it. Because, for me, because I was in middle school, maybe I was in class and everything, but I came to colleges, badai and everything, I did graphic design after, I took a break from music and everything. So, when I got from school, I was in primary school, when I was in primary school, high school was easier. It was actually harder. Because primary school was prepared for basic, secondary, secondary, tertiary, and so on. So, it was a job that I was interested in. Because I imagined, I was an employee, I was a boss. Because boss has the pressure of being an employee. Yes. So, at the same level as before, it was a challenge. Yes. So, like in campus, there are people who want to be free. So, for me, to be free, there are people who want to be prepared for it. Yes. Like, there are people who want to be like me, and there are people who want to be like me, anyway. So, I think there are people who want to be like me, my target is like, in this semester, but in grade, because it's different. So, there are people who want to be free at long-term goals, and they want to participate in first-class owners, when they want to be free. So, that's the system of owners, because they want to be owners. Sir, I was in the American system of education. So, I wanted to be a GPA. Okay. So, I wanted to be a GPA. Grade point something. Yeah, grade point average. Okay. So, I wanted to be an owner, first-class owners, second-class owners. Yeah. So, I wanted to be a GPA, first-class owners, third-class owners, then I wanted to be a court lady. And thenulares were Translate Google Translate for me. Sir, so, in this case, because you've gone through a infrastructure education, I don't know your area of expertise. For me, These days, there are free shelters, Do you know what? He just said Mr. Zakwaza nearly failed Why? Because he had many kids He was very relaxed I was the one who was the most worried Man was at 2.4 No one failed in university Yes I was the most worried I will buy that teacher over there No one failed in university Shock on me How did you get into college?  I didn't go to school but I did bounce in Furai, so I would go to school at Zako, the best one I could do. I would go to the Bamba, the Tei, and I would do everything that I wanted to do. So that was the hit. Later on, at the time, I was at school, I was on media, I was in Thika, I lived in Thika, and I was in Thika, It's a good place. It's a very, very nice place. And why was it pointed at? I think it's because of the mindset that you have. Trust you me. You can do whatever you want. You can do whatever you want. I'm a student. You can perform. I think it's the Institute of Technology. TTI. TTI. What do you perform? I perform shows. So you can do whatever you want. You can do whatever you want. You can do whatever you want. I think it's an event. It's a mechanical, it's a week or something. You can do whatever you want. Because one thing I learned after I had fun was that I was rewarded after I achieved. Like, I was told that I was going to go to high school or a campus. A campus. So I was told that I was going to go to a university. I was told that I was going to go to a campus and I was going to work. Like at least function weekday. Like Monday to Friday I was going to have a break. I was going to focus on the fun. On weekends I was going to get a treat. I was just going to have fun throughout. I was told that I was going to enjoy myself. But after I was going to go to school and I was going to go to school I didn't want to enjoy. I was going to get a job. I was going to get a job. I was going to get a job. So I didn't want to enjoy. But at the time I was going to focus on the mystery and study below. So like, when you have been at the same level you have struggled. You have struggled. You have struggled. Because I always appreciate success and reward. It's a struggle. If you want to do it, you can do it. If you want to do it, you can have fun. But if you want to enjoy the fun, you can do it. You deserve it. So, do you change after things are not going well? Yes, yes, yes. I have a lot of pressure. Every single person in the campus has to manifest their pressure. But with time, it's not immediately. You can do it with your phone, you can do it with the campus. The lesson is more important. You have influence, I have influence. When you are the one who has a good mind, when you are the one who is good, when you are the one who is good, but you have to get hit, because you are spoiling your life. I have a couple of friends who have come to the campus, who have come to the campus, who have achieved their dreams, It's a trick you can do because it's like a youth man when you want to build a future generation. It's a trick you can spoil. Jumot, I'm here. It's your experience when you were in school. That whole aspect of your mental health when you were in school during that whole period. What was it like? I was a fan of Sanna. Because I was the first one to write quotas. My mum used to work there. She was the matron there. So I was at home. So Primo was a fan. Yeah. High school was a big challenge. When I was in the middle of school, there were only two of us. There were only two of us. High school, I was the one who insisted. It was a challenge because Primo was a chopper. I was in high school then. Primo was the first one. Primo was the first one. Because I was in the provincial at that time. So Primo was in high school. He was in high school. He was chosen as an average. Because the provincial was a national. So I was in the provincial. So he was relaxed. Primo was in number 15, number 20. But he was in the country. He was in 30, 40. He was in school at that time. He was in school at that time. So he was at school. He was in high school at that time.  But there is a challenge in high school that as in... Let's say it's a boy's school. Because it's not just a school, it's a barack. It's like you're in a jiffanier and everything. And you have to prepare for life. Corresponsible. At first I didn't know that I was in school. When I was in school, I was equipped to face ease of it all from the school of life. That's why I moved to the gym for edutainment. Because most of my life I was in school. I learned a new thing. So most of the time I was in school and a new thing, I was in school. Because I didn't know what to do. I didn't know what to do to improve my life. So I didn't know how to improve. I was still in school. I learned a new thing. But the change is important. The foundation is there. So at that time, I was in school. I had a lot of mental perspective. But at that time, I didn't know what to do. And during that period, I had a lot of impact in my future. So at that time, when you were in campus, at that time when you began to lose it, for most people, or for some. So you pressure yourself. Studies pressure you. Exactly, exactly. Because mental health is important. There is a pressure for studies. There is a pressure for research. To convert it into... To pressure. To pressure. To pressure. To pressure. To pressure. To pressure. Now apart from that, someone's mental health is challenged. You get into drugs. You get into bad company. You get into stealing. You get into stealing. You get into stealing. You get into stealing. Mostly, I am the one who is from drug abuse. For example, I researched drug abuse. And everything. There are drugs that are related to drugs. Like what are the policies? They are illegal. That's why I am telling you, because it's illegal to do drugs. Because if it's illegal, it's illegal to steal. By the time, there is an age plan to graduate. If it's illegal, it stimulates the effect. That's why I am upgrading it. If it's illegal, it's illegal to drink a brown bottle of alcohol. With spirits and vodka. So, okay, some people say that if it's illegal, it's illegal to steal. How much do you think it's illegal? I think it's risky. It's risky. Because some people say that it's illegal. It's risky. Yes. It's stigmatized. But at least it's not illegal to steal. I think it's illegal to steal. Exactly. I wish it was reckless. Yes. But I want to be disciplined. Because through that, you are training them mentally. Yes. To accept certain things. It's acceptable. Especially, if you know it's illegal to steal. And if you know it's illegal, it's illegal to steal. You can't compare it with those people. I think it's more like age-converting, it's like 2018, and you can try things for it. I might be wrong. So, if it's illegal, you can steal it. But if it's illegal, it's illegal. And they are light as a key. They are feeling it. And from then, if you are going to be a part of it, you will say, The same thing, people are trying to do something about it, they're not upgrading from something, they're not knowing what's going on. But Ram is at the campus today, he's mentally depressed, he has a lot of social media, he has a lot of influence, he's coming back to the campus and we'll take care of him. He has a growing background in the future. Exactly. not like to to to Kujapu will come there yes but first to all these triggers these things that push people towards there because come on how well if you don't understand these things there is a reason why things happen yes well apart from Zaya and Kujapu, apart from Tota Apu, apart from Afanya, Kerala from Chapa how do you come in here? You don't know what led to that so I want to get about those triggers because I remember those time I was in primary come to it those triggers that you know push people But in your experience, when you interact with my youth up until now, what kind of videos did you use to push out? Because what are your stories? Mostly I think challenges, I have expectations. Yes. Maybe, for example, when I was in the 1st grade, when I was in the 1st grade, when I was in the 1st grade, I was killed. Yes. Like, some of the people in my neighborhood, some of them were in the background. But when I was in high school, I was in the middle of school, in Europe, I was in high school, I was in the coast, I was in the western, you know, I went to different places. So, it was like, some of them I was in an area, some of them I grew with, with different, yes. Some of them were in the house, some of them were at home, some of them were in the house, in the corridor, yes. So, I was out-deem, I think. But I think it is in the past, when you have challenges at home, it is the past. You know, when I was at age, I would not deal with them. So I think, the ground and the virtue of growing up, Because most people say that they grow from normal homes and that they are at a place where they come and say this is right, this is wrong They come to the Sunday school and say be polite, don't indulge in negative things Like, even if you are in a society where you don't want to be stuck at home but you want to stay at home and have fun So, what do you expect to end up with? My background is different because I know You know what I mean, right? You have to go home, you have to go to school, you have to go to school You have to go to school, you have to go to school How did you end up with 18?  So, I am a psychologist I am a psychologist I am also a social media person Most people get confused They don't understand anything They want to be noticed I am a journalist So, my life is ODI My life is ODI My life is ODI Let's not shake it, let's not fall off No shaking it Hey, we have a few people from the US that beat us You might be M or Ferris, you might be Odi I'm an ordinary I'm too ordinary I'm so familiar with the music So Odi dance But Odi dance comes from? From ordinary I'm like someone that got Odi So, the money is whatever you have. I'm in debt mostly. But, I have to return the money to my brother and my brother-in-law. So, what happened to society? I don't have money, but I have to return it to my brother-in-law. So, I have to return the money. So, I asked my brother-in-law and he said, when I returned the money, he had a drinks class. He had a Nezafordi. I'm not a student, I'm a teacher. I'm not taking any...   So I told him, I have two companies. You can share this. So you have this design. If you want to buy it, maybe it's cheap. If you want to buy it, if you have a club, you can buy it. But if you want to buy it, if you want to buy it, you can buy it. But if you want to buy it, you can buy it. Because drugs affect our society. They also handle stress. I think you will be dependent on drug abuse. For you in your story, it started because of peer pressure. How did it start for you? I think I had a vision. I did have a vision. I told him, I have two companies. So when I went to the studio and went to the studio, I had a TV and a performance. I had some money. I had a famous handle. But I had a fame and fortune. I was a bit tricky. So I had to interact with him. It was easy. I was like, I'm so busy. I was like, I'm so busy. I was like, I'm so busy. I was like, I'm so busy. I was like, I'm so busy. I was like, I'm so busy. When I was gone, I saw politicians they were targeted. When you say about addiction, when I break down addiction, it's A Habit. A Habit is like a disease. These are the science. The� Habits is a disease. I thought I came here so I did it in a good way. It was OK. Someously it was like going out on weekends, weekend it a graduate weekday or a weekday it a graduate daily so you get a point that you might miss you might miss your breakfast so you take a look at it with time you can see it you can see it in your phone you can see it in your phone you can see it in your phone you can see it in your phone you can see it in your phone because it has a withdrawal effect it's stable you can see it in your phone you can see it in your phone it's stable so you can see it in your phone before you go to school you have to watch you can see it in your phone you can moderate you can have fun because when you go to school you have to watch it once you can watch it daily there are times when you are in class in science, in maths, in geography but you have to relax you have to be unwind so you have to be happy when you hear the word so for you the trigger was money it was money and lack of a vision and structure and it's stress because you are famous and you aren't prepared for it so when you go somewhere like when you come to school you have to watch it but when you come to a place public you have to watch it so you have to watch it now so you can see it in your phone wow it's interesting everyone has their own triggers in your experience when it wasn't a trigger to get into drug and drug abuse because a lot of people challenge mental health because I believe if someone is well-oreated people say there is a vision there is a structure there is a vision when I learn to watch motivational speakers you can either suffer two things the pain of discipline so discipline it affects you later on in life regret exactly that's very true I agree with what you said and if you have a vision because it's true if you lack vision number one if you don't have a vision and strong principles if you are a person if you are a person you are swayed in by the people so when you learn to watch it everyday there is a structure people influence you but if you want if you have a strong principle if you have a vision oriented and you look to the future you have a great future ahead you are feeling so positive that one day you are going to achieve whatever you want to achieve trust you may have a trigger and you will be supported by drugs and get into mental health and you will get depression which is called suicide you will get peer influence you will get social influence but when you are in high school when you are in campus if you have a student who is working because you don't have a job or if you are working but in campus if you have the latest phone Let's say Ram is going to go to Suti Mojapolite and Pamba Mojapolite, Kiatu, Nethulia, place Ako is going to go to Pujanandae, Mojapolite is going to go to Mekubali. So if you feel maybe you go to campus and you want to achieve, you want to get what Ramas get, but one thing you should understand is that these things don't come easily. How do you influence social media? If you are going to be stressed, you can say Mekubali is going to be stressed as a course one, people to get into drug and substance abuse. So there is a connection between drug abuse, drug and substance abuse and mental health? Yes, drug and substance abuse is a mental health illness. Drug and substance abuse is a mental health illness. Maybe Nili learned the hard way. Yeah, she learned the hard way. I like to destigmatize people. It's like a disease, addiction is a disease. disease per se because I'm going to go to jail later. But I'm going to go and accept everything that's going to happen. Everything that's going to happen is going to help people, help people lose jobs, give them their stuff and then they're going to be disrespected for their parents and everything. So I'm going to go and go and do it.  It's something that I appreciate. Come and reach out, you need a step forward. You need help. Because there's an indenial thing. Defends me. It's an issue. In the word indenial, it's always a progress. Because there are people who postpone it. And this is a good exercise, I think that if I go and I told him, if he doesn't like me, maybe next week I will postpone. But you are not in a bad way. Ok, but you are not forced. You are not forced. So you are not forced. I am getting this conversation. In the moment you like the feeling. In the moment, you feel like you know, at that moment, but it's a long-term effect. In fact, you know, the effects are different. Yes. The problem is, everything is different. There are genes and everything. Yes. So, always it's true, come in and there, you don't want to be handled. You will come out, right? Yes. You don't want to be handled. There is a small difference, like a barrier. Like, you have to deal with it. Because there are some people, I tell them, if you reach out to a family, they will say, hey, I'm going, you know, I'm not going, you know, I'm not going. You're going to say to me, I'm not going, I'm going to say to me, I'm not going. I'm going, I'm not going. I'm not going. I'm not going. I'm not going. I'm not going. I'm not going. Sometimes you have to think real though. Yes. And that's real talk is what people don't get. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes. Yes, yes. Yes, yes. So, you know, some people outside here, the people get forced into it. I actually know people who have gotten forced, but I want to change. So, when you're in a situation where you're sober, you have to be careful. You have to have withdrawal symptoms. You have to have addiction, you have to have it. You have to have it, you have to make it. So there are some auto-functioning and alcoholics.  But, as a mimicry, the reason I'm doing this and I'm doing it, is to limit the spirituality, for example, being able to drink, And get tipsy, like getting a nosebleed. Some people can't do that. Some people can't do that, some are like that. Some people can't do that, some are like that. Some people can't do that, some people are like that. I thought you're using something different. Some people don't do that. So when you're getting out, it's not an overnight thing when you're being rehabilitated in the process. I want us to look at different scenarios, Sir. Now, let me start with one scenario. In campus, the part I would say one has a good date. Who you say are on a date? Who are you? And in that whole process, if you ask me to marry, I would be shocked. And I would say, those guys that you've had getting killed, they're campus girls.  People who are still in school, you were in the institute when you were in Wana. How is it that they get to that position? When you say you're a middle-aged girl, you're at a cardio level. You're in school, you're in campus, you're in college. I would say young, young, you're in so much life.  You're in high school, you're in high school. When you say you're to graduation, you say to her, Antoine, you graduate. The next thing you do is you post your graduation, you post it. The sad sad, that's why I'm like, the platform comes like this. Yes.   Fiction, yeah. You say you're on the ground, you say you're in the real. Real, yeah, in real. Is it real? Because there is a time where you're like, when I'm working with my business, it's like I'm under stress. So there are news that I'm depressing, because I'm sad. Because you're, you're in a relationship, you're at age, you're in a relationship, you're in a relationship, you're like 20 somethings. I think it is stress, it is stress and circumstances, it is also anger. And that is the thing that we are going to talk about after this break. Different case scenarios, relationships, after this break suicide, after this break depression, what is it that we can do to have that mental stability that we need when we are in college, when we are in campus, and appear after this break as a parent, what is your role, Kamamuzazi, who said in this conversation. Let's take a short break, we'll be back in a bit. This is Power Talk. Y254 Imagine. Keep tweeting, keep texting the hashtag Power Talk Show at Ramaguko, at Y254 channel, and check that you also tag our team members here, you know, when you meet them down. Jim Wat, Edutainment. Jim Wat, Edutainment. For Power Talk to Nagee Tokia Power. Tokia Power. Ah! Yes, sir. To let that rumble out for. Impression, impression. Official, at official Anto Ninjanga, for Instagram. Yes. And make sure that you also use the hashtag Power Talk Show. Head over to Facebook, we've posted a question on our Facebook page. I shall be sampling a few of your comments as you continue with this conversation in a bit.  How do we have mental stability for our children? As youths, to traffic, we need to have mental stability because we need peace in here. At the end of the day, we all need to make it. How can we make it? Because if anything, if anything, our parents, our guardians, they are those who are looking up to us, we are going to have expectations of it, we care. Now, before we took that break, we were talking about drug and drug addiction. Now, I want us to take different scenarios. Why? To go take it to Apevi. Relationships to Mesema. Jamah and Awam say Mingi. Relationships to Agani Topic, Moja. Nasha. Hathari, Saena. Uko Kampo. Onajakun, I'm telling you advice. But when you're in campus, don't date anyone. In that campus, I'm just... Because who do you want to see in campus? Maybe out there, to Kondani, though you'll let her issues. Because everybody knows your story. Yes. So in Kiyachana. In Ajuli Kana? In Ajuli Kana, I didn't avoid her in my class, Moja. See, I'm telling you, when you're in school, you don't want to go to a hostel or a hostel. So in Kiyachana, you don't want to go to a hostel or a hostel? No. And a takeover? You're kidding me. Oh, by each other. You want to go to a hostel? Yes. How should you handle the campus relationships? What do you think about that? What do you think? I think in college, I have low expectations. Because what happens, like when I was in college, I was in school with Lisa because of her music. So I had some priorities. But it was really bad after rehab and everything. So at this time, I was mostly a mature student because my daughter had already been born and everything. So I was a mature student. So even if it was a single and our students who were there, I noticed that there was a place, let me say, where I was born. I was raised in Assam, and so on. Now you're in a class? Yes. I'm a level Moja.  So we have lower expectations, like priority, we say that the focus is on the grade, because if you go to the camp, you have to attend Kiwi Ake. What's your date camp? It's a few. Very few. Very few. You know, when you go out to work, you say, ah, they started when they were in campus, they assisted you. 25% actually, 25% is the end of the year. Yes, 25% is the end of the year, because if you go out to work, you have to attend Kiwi Ake. It depends on who you are.  It's the wrong thing. There's a reason for it. There's a reason for it. But what has made you go into this relationship? Actually, I want to mention that I have an aunt. Yes. She's married. She used to go to campus because I used to go and visit them. But I think it actually happened. What happened was focused. And what happened was jobs. Exactly. You see, there's no such thing as a date. There's no such thing as a level. So, actually, it's not a given, but yeah. So, I think for any grades poor, there's no competition. There's no such thing as a close-up. You see, there's no such thing as a date. There's no such thing as a vibe. There's no such thing as a vibe. There's no such thing as an intellectual level.  Yes. Do your best. Yes. Yes.  Yes. Yes. Because relationships affect the mental health of somebody. Yes. Because, you know what I'm saying? It's very tricky. When you're dating on campus, if you have a problem, if you have a problem, it's a big issue. One thing is that you have to go to campus, you have to go to school, you have to date someone. Don't put much focus, don't put much attention on this relationship. But if you're not paying, focus on what you're doing. You know what I'm saying? At least try to make it work hard to a point where you're almost on the same level. At the end of the day, I'm only focusing on where we're going to work to end up out, to live life here, to come up with couples and stuff like that. You won't be able to concentrate on what you've achieved. To come up with a distraction. Distraction, yes. What are you able to achieve? If you're going to go to school, you need to have a couple goals.  I don't know, I don't know, I don't know the term for hashtag will scare you up. Of course, I'm going to go to school with a couple goals for my education. Education? It's going to scare you up. It's going to scare you up. It's going to scare you up. It's going to scare you up. That's a joke! Then your weerity of science doesn't suit your ком? I'm going to throw a couple goals. Couple goals goes up Some cases go up in social media. Some is something that's a different generation. There's that modern society. And when you have a silly Instagram I was vegetable gardeners who were interested in cutting the vegetables of the fields, and iném they were able to sustain the life of them. It's true that if life is social media, I'm a bit fake. I can filter words, but some people don't even Instagram them. I don't know what that is. You're not involved. I think I'm saying you're fake. Even though he's in industry, in a studio he would always be on a Qarlife. Even if she's in a match, you know that. Like all these. He would always be on a Qarlife. It was a humble beginning. Actually, it wasn't easy to keep grounded, you know. Even though it was hard, I would say it was a loss. Yes. I think my fans would say it was a loss. It was a loss. See, the door would change, you know. It would change, yes. I appreciate the art. But social media in effect has mental health, you know. Because expectations are fake. We take the same steps, we take the same steps. Post, we post people, so it was a joy to be able to play such a role. It was a joy to be able to play such a role also. So it was a joy to be able to play such a role. Yes, it is.  Yes, a fake role. I see what you mean by fake.


What is going on guys welcome back to the channel and I appreciate you being here today. I am back with another Destiny 2 video and today we're going to cover another part of the weekly updates because it was full of useful information but because there are so many individual subjects to talk about which were big points I'll break it down into a few videos which I believe are definitely worth covering. Today we're going to talk about exotic masterworks and I'm going to try and explain everything you need to know. Okay so here is what Bungie said about exotic masterworks. How do you make an exotic feel more exotic? It's a two-part question including how it feels to acquire and upgrade the weapon and how it feels to use the weapon. To answer the first question scenery investment designer Mark you will can't pronounce that second name I apologize is here to walk us through the process. Quoting Mark right here are goals in extending masterwork perks and mechanics to exotic weapons are primarily to create new in-game goals for hobbyist players and read for specific activities with these long tail pursuits. There were a few problem spaces that we wanted to address when creating the exotic masterwork pursuit. First up exotics in Destiny 2 are very very easy to acquire many players have most if not all of the non-quest exotics as we don't want to make players re-earn every exotic weapon. Exotic masterwork acquisition and progression needed to take place after acquisition. Additionally we needed to figure out a player friendly way of representing the process of obtaining and applying an exotic masterwork. The milestone trade doesn't provide a good flow for every exotic masterwork and bounties are planned for summer as noted on our recently updated development roadmap. With these goals and restrictions re-landed on the following player experience there will be one exotic masterwork per exotic weapon that exists so far in Destiny 2 in order to begin the masterwork process players will have to find an exotic masterwork catalyst when inspecting the exotic there will be a hint at why activities can grant the catalyst for that weapon not all exotic masterworks have the same drop rates some exotic masterwork weapons are guaranteed after a certain amount of engagement while others are earned at random we see an example unscrewed now with the cold heart we see here with this exotic weapon catalyst this is found via defeating the most challenging enemies in strikes and this won't be a guaranteed drop it will be an rng drop obviously a part of the loophole from certain enemies within strikes i would say maybe strike bosses but i'm sure that would be mentioned here quoting bungee game right here once acquired the catalyst can be applied to immediately enable orb generation and double kills for the weapon exotic weapons with catalysts applied will also start tracking enemies defeated like their legendary masterwork weapon counterparts after applying the catalyst there will be bounty-like objectives available that need to be completed in order to upgrade to the final masterwork state which will apply stat perk bonuses to the weapon again we see an example with the cold heart once that catalyst is obtained the next step is making this exotic a masterwork and gaining that extra stat and perk to do this with the cold heart you have to defeat enemies using this weapon so this one i'm guessing can be relatively easy compared to others quoting bungee game right here a few masterworks will require you to do single things while others will have multiple steps these objectives will vary in difficulty and length but will not be determined by rng the goal for these objectives is to push the player to engage with the weapon that they wish to make into a full masterwork when it comes to difficulty there are a few exotic masterworks paired with difficult activities or accomplishments in game we're expecting that they may be one or two exotic masterwork weapons that give players the opportunity to set goals in mastering specific activities in order to earn their most desired masterwork to get ahead of a few questions we're expecting here's a quick roundup of more specific notes exotic weapon masterwork pursuits only need to be done once per account you don't have to chase your white whale on each character through the masterwork process duplicate drops of an exotic weapon via engrams milestones or even the exotic collection will be initialized at your current masterwork upgrade state the exotic masterwork process takes place fully in the weapon detail screen there won't be any objectives that take up your character in virtually space not all exotic masterworks will be available immediately when the season three begins if you inspect an exotic weapon and a masterwork socket is not visible the catalyst is not yet available we won't be publishing guides on how to acquire specific exotic masterworks this is in your hands as with all things in Destiny 2 these new features are subject to evolution we'll be monitoring acquisition rates and community reactions once these are in the world and adjusting as needed and guys that's all she wants so to quickly summarize these exotic masterworks come season three exotics will be upgradeable to exotic masterworks not every exotic will be available at the start of season three the ones that are upgradeable will take two steps to become a true masterwork the first step is obtaining a catalyst there is a hint at how this is obtained when inspecting that said weapon once you have done that said activity or challenge and got that catalyst the weapon will now generate orbs and double kills but it doesn't end there there will be a bounty like challenge for you to do to unlock the full exotic masterwork and get that additional stat and perk bonuses which come with these masterworks so it sounds super fun and super cool and guys that is all there is to know really so come may 8th we will see which exotics will be upgradeable i truly hope won't you don't try and pull it fast one and limit us to one per week to make content last that would be a complete joke i'm not guys i am out thanks as always for stopping by if you enjoyed the video leaving a like really helps me out feel new around here and enjoy daily destiny videos be sure to subscribe and hopefully people i will see you on that next one


So our next speaker is Dr. Sarah Nicarvan. She's an anesthesiologist and intensivist from the University of Washington. She trained in anesthesiology at Washington University in St. Louis and completed a fellowship in critical care medicine and cardiothoracic anesthesiology at Stanford University where she subsequently served as faculty and directed the critical care ultrasound training program. She's the director of point of care ultrasound and associate program director of the residency program in the department of anesthesiology and pay medicine at the University of Washington. Dr. Nicarvan is a past president and chairperson for the Society of Critical Care Medicine ultrasound committee and critical care ultrasound course. She's a member of the national board of ecocardiography's exam writing committee and has lectured extensively both nationally and internationally over the last decade. Hi, my name is Dr. Sarah Nicarvan and I'm really, really excited to be sharing lung ultrasound in the ICU with you here today. I'm so sorry I can't be there kind of more live virtually but this is a really big, passionate area of mind and I hope that you'll walk away from this talk with a lot of information on how to apply lung ultrasound to your critically ill patients. Now, I have no disclosures to share with you and I'm hoping that we can talk a little bit about how lung ultrasound came to be. I'll try to introduce lung ultrasound to you and share an algorithm that I use in my practice and then we'll apply that algorithm to a number of different cases. Now, you know, it's been many years since lung ultrasound kind of was born in a way there was a consensus document that came out back in 2012, it was an international evidence-based kind of guideline and recommendations for the application of lung ultrasound for a certain pathologies in particular and then along the way other studies were done looking at, you know, how to apply lung ultrasound to patients with alveolar interstitial syndrome. This is another really nice piece to review lung ultrasound in the critically ill. If you get a chance, I would really recommend reading this by kind of the godfather of lung ultrasound, Dr. Daniel Lichtenstein and another really great review on lung ultrasound as primary survey for the acutely dysentic patient. So there are lots of studies that have been done and we're gonna share them along the way, but really what pathologies have, or which pathologies have been validated for the application of lung ultrasound assessments have been to kind of really rule out pneumothoracies, evaluations of consolidation, interstitial syndrome and pleural effusion. And so we're gonna try to focus on these things. This is a very broad category, which I'm trying to cover in 25 minutes. So just bear with me here as we move through it. You can use any probe to do lung ultrasound imaging. I will say that if I was stranded on a desert island and there was only one probe I could take with me to do lung ultrasound, it would be this curvilinear transducer because it provides enough axial resolution for visualization of the pleural line but also gives the appropriate amount of penetration for evaluations of consolidations and pleural effusions. The linear transducer is really great for seeing the pleural line, but unfortunately oftentimes it doesn't allow enough depth to catch those other pathologies that I just mentioned. Now anytime you scan, you have to have a scanning protocol. I predominantly practice in a cardiothoracic ICU and so my patients are usually plugged up and plugged into devices and different things and using this protocol that was validated back in 2005 in this bedside lung ultrasound in the assessment of alveolar interstitial syndrome paper is the one, this is the one that I use. So I take the chest and divide it into four quadrants using the parasternal line, the anterior axillary line and the posterior axillary line. I'll draw a line along about T5 or the nipple line and this will divide each section of the chest into four quadrants, this will be the right and then of course the left. Now make sure that when you're doing your imaging, you label your image because unlike cardiac imaging, lung ultrasound looks the same on both sides. So if you go back to look at it, you won't know whether you were on the right side or the left unless you labeled it appropriately. Now what is lung ultrasound? It's really an assessment of artifacts and I mentioned this because for cardiac imaging, oftentimes we have harmonics on to really kind of in a way diffuse out those artifacts and allow for better cavity imaging. But if you did that for lung ultrasound imaging, you'd get rid of the artifacts and wouldn't be able actually to do your evaluation.  We're looking at the difference in acoustic impedance between air and water because that generates ultrasound artifact and when there is underlying lung disease, that changes the pattern of those artifacts and that's what we're looking for. You can see the bright plural line is really about typically half a millimeter below the ribs. You can see the chest wall here and I try to get this image with my orientation marker pointed towards the patient's head so that I can get some ribs in my field and get a sense of where I am. So you can see here that about half a millimeter below the ribs, you're seeing this bright plural line and it's sliding kind of to and fro. This is what we call lung sliding and you can see it almost like ants marching up and down as the visceral and parietal pleural slide against each other. Now, you can evaluate this with M mode by putting M mode across the pleural line and when you do as the visceral and parietal pleural rub against each other, they cause almost this smudge or this motion artifact which makes this image look like what we call a sandy beach sign. So you're standing on the sand here and you're looking at the water. This is static chest, chest wall. It's not moving really and that's why you see kind of almost like stasis or no motion but then once the pleura kind of slide against each other, you're able to see this motion artifact. This is a normal finding in normal lung sliding. Now, notice here how this patient has once again, normal lung sliding. You see these B lines which are reverberation artifacts that start from the pleural line and they go all the way down to the base of the image and you can see this to and fro motion but in this patient, you can see, here's that bright pleural line, half a millimeter below the rib and there's really no sliding and you don't really see any B lines and if you were to put M mode over this image which you would end up seeing is that stasis that you saw in the chest wall, you would see below the pleural line and this is what we call a barcode sign or stratosphere sign. So this is really pretty significant for a lack of lung sliding and something that you should do anytime that you're worried that there is not lung sliding. Now, if I say a lack of lung sliding, automatically people think of enuma thorax but I will say that lung ultrasound is not very specific when used for the evaluation of enuma thorax. It's very sensitive, you can easily rule it out. So if you put the probe on the chest and there's lung sliding the patient does not have enuma thorax but if there is no lung sliding then you have to employ a enuma thorax algorithm and look for other things. So if there is no lung sliding you then need to look to see if there are B lines. If a patient has intact visceral and pleural contact there will be B lines and this will not be a case of enuma thorax but if there are no B lines and that's once again concerning and you're now gonna move to look for a lung point which we're gonna talk about now. A lung point is really that inflection point where the visceral and pleural separate from each other. This is the margin of enuma thorax and it can be very specific if it's seen in the anterior lung fields in the presence of A lines but please be cautious in patients who have pulmonary blebs because they have been known to mimic enuma thorax by causing a lung point. So you need to know a little bit about the history of your patient. Now, this is a ultrasonic graphic finding of a lung point. You can see the pleural line here is gonna come up and slide makes contact and then it falls back as the patient kind of exhales. So you see lung sliding and then that lung sliding goes away. Here it is, there's the lung sliding here and then it's gonna fall back and then you won't see lung sliding here. Here's another really example, a good example with arrow markers to kind of delineate where that inflection point occurs. This is called a lung point and when it's seen in the anterior lung fields in the absence of pulmonary blebs it is really pathic mnemonic for a enuma thorax. Now, let's say you do your evaluation and you don't see a lung point. So you can't say that it's a mnemothorax. You don't see a lung point. So now you're gonna look for this thing called a lung pulse. And basically a lung pulse is the rhythmic motion of the pleura as it's adjacent to the heart. This typically is seen in patients who have poor aeration of their lung. So maybe the lung is consolidated or you're evaluating the left chest in a patient who has a right main stem intubation. So basically the visceral and parietal pleural have contact with each other but the lung is just not being ventilated well. It's not being aerated well. And so every time the heart beats it causes a small little pulsation of the pleural lines against each other, which you're seeing here. This is absent in a mnemothorax. So if you don't see clear lung sliding but you see a lung pulse this cannot be mnemothorax. Once again, notice how there are these almost like rhythmic motion of the pleural line with the cardiac beat. There is a lot of risk for false positives when using lung ultrasound for evaluation mnemothorax. So you can see an absent lung sliding in patients who have bad ARDS or bullish lung disease like we just mentioned. Pneumonia with poor lung aeration, fibrosis or patients who have had pleuro-DCs in the past. If the patient has an acute asthma exacerbations and the lungs are just over-inflated that can cause poor lung sliding. The patients have chest tubes or if you're evaluating the apices in particular in patients on mechanical ventilation with high mechanical ventilatory support, high peeps where you know the apices just stay inflated throughout the respiratory cycle. Now, if you wanna use lung ultrasound for the evaluation of consolidation what you're basically looking for is a tissue-like quality to the lung. We call this hepatization. So the lung will look almost instead of that gray kind of very ambiguous appearance. It'll look like a solid organ. Oftentimes these patients have lung pulse because the lung is not well aerated like we just mentioned. Sometimes you can see air bronchograms both static and dynamic which we'll cover. And you see this non-homogenous distribution of B-lines. This can be visualized in anyone who has a consolidated process so maybe it's adolescences, pulmonary infarction, lung contusion and pneumonia, cancer, you name it. So here's a patient of mine in the ICU. This looks a little funny because I use the curvilinear probe. This is directed towards the patient's head but this patient was actually prone which is why this looks so bizarre. Here is a big, poorly fusion which is a hypoechoic area of fluid surrounding this consolidated lung that looks really kind of squished down and has what we call this starry sky appearance that looks like all these little bright points. So these are static air bronchograms often seen in consolidated lung but if you look really carefully here in just a second you're gonna see these bubbles kind of come up and down in the airway and this is what we call a dynamic air bronchogram. Think of it like mucus bubbling up in the bronchi. This is a common finding in patients who have a consolidation secondary to pneumonia. Let me show you a better example of that here. Now here's the liver. Notice how the right lower lobe of the lung looks really kind of hepatized. It looks like the liver and consolidated. And if you look here you see these bubbles kind of moving up and down the airways. This is a dynamic air bronchogram in a patient with a pneumonia. So really interesting finding. Now interstitial syndrome is an umbrella and this umbrella really encompasses anything that can cause interstitial pathology in the lung. So this could be pulmonary edema, this could be interstitial pneumonia or pneumonitis, diffuse Prink-Mole lung disease like pulmonary fibrosis or ARDS. This topic is a giant topic and we could spend like an hour just on this topic alone. So we're gonna just be very superficial about this and I'm always happy to get messages from you later if you have more questions. Now, this is an example of B-lines. You see these comet tail rocket-like artifacts, reverberation artifacts. They start from the pleural line, they go from the pleural line all the way to the bottom of the screen, usually at least 12 centimeters in depth. They're laser-like and they obliterate A-lines which are reverberation artifacts of the actual pleural line that are typically seen equidistant from the pleural line. You don't really see them here because there are so many B-lines that they obliterate the A-lines. And you see that they're moving with the lung sliding. When you see more than two of this in a field and a field is between two rib spaces, then this is an abnormal finding and very commonly seen in patients with pulmonary edema. Now, how did we even get to do this? Well, B-lines were first seen to correlate with extravascular lung water and dialysis patients. So basically they used ultrasound to have assessed the lungs of patients who had insadrenal disease and they did the scans before the patients were dialized and noticed a higher amount of B-lines. And then they did the scans again after fluid was removed or the patients got diuretics and they saw that the number of B-lines reduced in both of these patient populations. So this is how kind of our understanding of using B-lines for the assessment of pulmonary edema kind of came to be. Now, here's an example of like diffuse B-line. So you have this relatively crisp looking pleural line. You see these bright comet tail artifacts and they're kind of everywhere. There's their homogenous in appearance. There's no area of the lung that really looks spared. This is very classic for pulmonary edema. But patients who have perincomal lung disease can also have B-lines but their distribution is different. So, there was this study that was done correlating B-lines to CT findings of fibrosis. And what they found was that patients who have fibrosis end up having pleural line abnormalities oftentimes have sub-pleural abnormalities and have this very non-homogenous distribution of their B-lines. And if you can look here, you can see these anterior sub-pleural consolidation. The pleural line does not look normal. It looks very kind of chewed up and irregular. And the patients have oftentimes these spared areas of normal lung. So, you know, there's these patchy disease process where this lung area looks pretty whiteed out. This white lung appearance is really a more consistent with a patient who has some sort of underlying interstitial lung disease. And then they have these spared areas. This were findings that they saw in a patient with acute respiratory distress syndrome. Now, what about these studies that were done looking at lung ultrasound and CT and chest x-ray imaging? So, this is an example. You see a relatively crisp pleural line, pretty diffused homogenous B-lines everywhere, chest x-ray that correlates with pulmonary edema. So, this is a patient with pulmonary edema but what about this one? You can see that the lung is diseased. There is interstitial process going on. The pleural line does not look normal. There are areas of spared kind of lung here with a non-homogenous distribution of B-line. So, this was a patient with diffused interstitial pneumonia. What about this patient here who's some chest disease clearly abnormal, very abnormal looking pleural line here. You have these areas of spared lung very non-homogenous distribution of B-lines. This was a patient with idiopathic pulmonary fibrosis. Now, pleural effusions are very well assessed with lung ultrasound. Actually, lung ultrasound is exquisitely sensitive and specific for diagnosing pleural effusions much more so than even chest x-ray imaging. So, here you have a patient with an interposition of fluid, this hypo-coic fluid between the parietal pleura and the lung. And oftentimes you see the lung kind of consolidated flopping around like a jellyfish in air quotes within that pleural effusion. And you may be able to see this thing called a spine sign which means that there's some pathologic process going on in the chest which allows the ultrasound beam to get propagated forward so that you can actually see posteriorly and see the spine. In a normal chest and thorax that's filled with a lung that's filled with air, that doesn't allow the ultrasound beam to propagate. And oftentimes you cannot see the spine in a patient who has normal lung aeration that only really pops up once they have a pleural effusion or if they have a really bad consolidated lung that is hepatized and allows for the ultrasound beam to propagate forward.  This isn't validated. This is an algorithm that I use but I take care of patients in the CVIC or the CTICU. So when they're coming in hypoxic and dysphonic the first question I ask myself is, is their echo normal or not? If it is normal, then that's when I really move to evaluate the lung to see if there's lung sliding and what are the characteristics of the B-lines? Is are they patchy? Are they homogenous? Is there a pleural effusion? Can I see consolidation with static and dynamic air bronchograms or not? So let's apply this to a number of cases. So here I had a case. This was in the high time of COVID. I'm in Seattle. We had a lot of patients who were very sick. I had a patient who was 35 year old male. He was on VV FMO for COVID pneumonia and he had been on it for months. He was now tolerating intermittent sweep weins, and physical therapy. And he suddenly overnight at 2 a.m. has an acute drop in his circuit flows, becomes hypotensive, increased work of breathing despite the support of the VV FMO circuit. Fluids are initiated and baser pressures are started and we're attempting to increase the circuit flow but it's not working. And the circuit is alarming. We can't flow. So this causes a very broad differential diagnosis, right? This patient has pulmonary support to a certain extent but of course is young and has a high demand but he doesn't have cardiac support. And I'll tell you that I did an echo and that echo was normal as the first portion of that algorithm. So then I moved to evaluate the plural line. And you can see here R2 means I was in the right two zone. You can see his plural line on the right side has a subplural consolidations. This was very classic of patients with COVID. The plural line is not normal. He's got some V lines that you see here but the lung is moving and sliding. Now compare that over here. So here's a rib we're about half a millimeter below the rib. Here's the plural line. And not only do I not see lung sliding, I see A lines which tells me that my imaging plane is appropriate. I don't see any B lines that are coming down to obliterate these A lines. So if we think about this, do I see lung sliding? No, I don't. Do I see B lines? No, I don't. And I'll tell you that I scanned his whole left chest up and down and I did not find a lung point. And if you look at this, does this look like a lung pulse where it's rhythmic with the heartbeat? A patient who's tachycardic here, does he have a rhythmic motion? No, we do not see lung pulse here either. So I was convinced that this was a pneumothorax. I was getting ready to needle decompress the chest when they rolled in with the X-ray tech rolled in. And I said, well, what the heck? You might as well get the X-ray because no one's gonna believe me anyway. And look at what we found on chest X-ray imaging. So now to make my point, I needle decompress the chest. His hemodynamics did get better. Remember what this looked like, that it was a poor kind of no lung sliding, no B lines were visible. There was no lung pulse. I couldn't find a lung point. Then we decompress the chest here. This is in the left two zone. And now suddenly you see plural irregularity, plural sliding and visceral and parietal, plural contact here. So this was kind of a very interesting case. And the next case I have is that of a 32 year old woman. She was 32 weeks pregnant. She'd presented with premature rupture of membrane and contractions, had early fetal decelerations and we were called by the OB team because she was really hypoxic. And she was hypoxic. She was on five liters face mask. She was setting 91%. She was relatively hypotensive. She was definitely tachycardic and she was febrile. So they had already started her on antibiotics and started giving her fluids. So as part of this algorithm, the first question I had was, what's her heart doing? What's her heart look like? So we did an echo. And as you can see here, her cardiac function is definitely not normal. She's got five in tricular, severe cardiac dysfunction. And if you think about these patients, you know, who are in heart failure, you're very familiar with the Frank Starling curve and how once they're kind of on the upper edge of the curve, increasing their preload really doesn't do much to increase their cardiac output. Now, if we can put the Merrick Lemson curve on top of the Frank Starling curve, you'll also see that in patients who are septic, their extravascular lung water kind of curve shifts upward. And for that same area of this Frank Starling curve where maybe they may have had some improvement in their cardiac output, maybe not a lot. They have a lot of extravascular lung water that causes a large increase in extravascular lung water. And when they're septic, that goes up even higher. So now we're looking at a point here. So whenever I have patients who are septic and then have cardiac dysfunction, I'm really concerned, we also have information, you know, from echocardiography that's longstanding that you can use diastolic assessments to kind of get a sense of what the cardiac filling pressures are. And we have patients who if they're E to E prime is really greater than 14, we see a very nice correlation between that relationship and pulmonary capillary wedge pressure. But, you know, oftentimes we have patients in this kind of gray zone that we don't really know what to do with. And this is when lung ultrasound imaging becomes really helpful. So in this patient, you can see her mitral inflow pattern is that a restrictive diastolic dysfunction. But her E to E prime doesn't necessarily fit into the bill of, you know, being greater than 14 elevated left ventricular and diastolic pressure or left atrial pressure. So, huh, so what do we do in this patient? So now we're looking at her and we know that her echo is abnormal and that clues you in to really start looking to see, does she have B lines and could this be pulmonary edema? So then I did a lung ultrasound on her and you can see a very crisp looking pleural line diffuse B lines everywhere. There's no area of sparing. They're almost homogenous and really kind of coalesced. So she had significant pulmonary edema. And after this, we really kind of knew that we needed to get aggressive about supporting her cardiac function. So really know what pathologies are best for evaluating lung ultrasound. Plural effusions, this is what lung ultrasound was made for, super sensitive, super specific for catching pleural effusions. For pneumothorax lung ultrasound is very sensitive so we can rule it out easily, but it's harder to rule it in if you don't see lung sliding, make sure you go through the entire pneumothorax algorithm. For interstitial syndrome, it's relatively sensitive. You really have to compare the B line morphologies to understand what might be the disease process. And for consolidation, it's kind of sometimes can be a little bit hit or miss because the consolidated process really has to reach the pleura in order for it to be visible but it can be helpful when it is visible. Always have a scanning protocol and use an algorithm to help work through your differential diagnosis. At the end of the day, ultrasound is just a supplement to your clinical judgment. We're all still doctors and practice providers so please use your clinical judgment, that is key. I wanna thank you so much for your time. Here's a patient who had COVID pneumonia. Look at how terribly jagged the pleural line is, these sub pleural consolidations diffuse B lines everywhere with some areas of sparing but really kind of a white lung. This is pathologic interstitial disease, not just pulmonary edema but underlying interstitial pathology. So thank you so much for your time. Feel free to reach out to me with any questions you might have and I hope you have a great rest of your conference. That's excellent, thanks Dr. Nick Revan. So I think many of you use lung ultrasound in order to assess issues with oxygenation both in ICU, maybe emergency cases in the OR. It's very interesting to see some of the correlation across modalities though. So I'm looking forward to hearing more in the Q and A.


The same damage that stimulated vasoconstriction, the same damage, the same stimulus that caused vasoconstriction also causes the formation of a platelet plug. So let's make a little note that now we're talking about this platelet plug. And platelet plugs only happen when platelets are activated. And platelets get activated when exposed to damaged tissue. So think about this. In fact, one of the things, one of the molecules found in a blood vessel wall that's normally not exposed and is only exposed when damaged is collagen. Collagen fibers are found in connective tissues and there's connective tissues surrounding your blood vessels to make them stronger. And that connective tissue layering that you might be exposed to if there's damage to that vessel activates platelets. Now, here's the deal. Activated platelets, they grow, so they become bigger. They get irregularly sized. Okay, let's just say they have irregular shapes.  Like they have little twangers twanging off into twangy land. They get super sticky. Dude, these guys, all of a sudden an activated platelet is going to stick to other activated platelets or stick to other platelets in general. And this is crazy. They get sticky and they produce chemicals that activate more platelets. One of those chemicals is thromboxane A2. Interesting, the platelets, when they become activated, they produce this thromboxane A2, which causes vasoconstriction and causes more platelets to activate. More platelets become activated and produce more thromboxane A2, which causes more vasoconstriction and causes more platelets to activate. Now, go back. Think about our sticky platelets. They're sticky, they're irregularly shaped. They're literally going to form a mass over the top of the damage. You can imagine that it's kind of a puffy, sticky, weird mass, but it's going to slow down the blood flow. That's not a clot. Clotting is the next thing that we're going to talk about. So the platelet plug is another whole process entirely. There, this is a little gift from Ashton, my favorite dog pound of a feather.  You can see that they're all sticking together. And look, they're like, dude, this is awesome. Let's have a platelet party. And some of them are getting stuck on there. Like, look at that little guy. Oh, he got stuck on there. He's like, how did I get here? And they all are kind of differently shaped, but they, as they form this clot or plug of madness, they're stoked, they're having a party, but they're also doing a really important job slowing the bleeding.  The platelet plug is going to take care of business.  Like, our platelet plug will do the job. You can imagine that if our platelet plug got out of control, can you see how, I mean, it's a positive feedback cycle. And that, like they literally would clot all or platelet plug, activate all those platelets through your whole body. And then that's going to be a bad situation.  You do not need to have any more parties. Quit sticking to each other, like, come on, be grown-ups for a change and then encourage those little platelets to not activate. So normal, healthy endothelium is saying, relax you guys, there's no need to activate. Damage endothelium produces that positive feedback that causes lots and lots of them to activate. Are you happy? Shall we find out what happens with clotting? Clotting is another whole ball of wax. Go find out how that works.


The probability of a research finding being true depends on several factors such as study size, study design, and the ratio of true-to-no relationships among the relationships probed in a given field. When effect sizes are small, when there are more studies conducted in a field, when there is greater flexibility in designs, definitions, outcomes, and analytical methods, and when there is greater financial and other interest in prejudice, the likelihood of a research finding being true decreases. Furthermore, simulation suggests that for most study designs and settings, it is more likely for a research claim to be false than true. Additionally, for many current scientific fields, claimed research findings may often be simply accurate measures of the prevailing bias. These issues have significant implications for the conduct and interpretation of research. This article was authored by John P. A. Ionidis.