The following is a presentation of TFNN The Tiger Technician Hour with your host Basil Chapman call now for free at 1-877-927-6648 Good morning everyone Basil Chapman on the 17th day Wednesday, April We're looking at the Dow at 94 at $37,891 all the rallies are just Unable to hold but we did make a higher high than yesterday. That's like a great leg in in the Chapman methodology Now I don't want to go through this again because I've done it quite a few times other than to say at this particular point It could change but I am calling the weekly chart a peak D Theoretically, it's only a C but you based on Chapman Chapman wave techniques that are formalized as techniques is not Form fitting or anything like that. There is a technique This is if you have almost parallel highs with a fractional difference between The left side high and the right side high to consecutive bars You can use it especially you have two in a row You can use it as a phantom peak and that says Using this particular technique the Dow has made a peak D using the futures which trades much more than the cash Index you have legitimately made a peak D and I've got a question mark above it because I have to wait It's a weekly chart. I have to wait for Friday to see if I can give it a designation of a cell signal If it if it also crosses the the green night period moving average right here Crosses negative that green goes under the black and changes to pink. That's going to be an immediate cell signal upgrade to cell mode I don't see that quite now. I see residual strength just kind of keeping the market on hold to break lower Not just yet. And if I'm looking at the S&P and I look this is the same thing S&P there's no other way. I can count this S&P is at a peak C. I there's no Phantom peak possibilities here. There's no you cannot Find something that's not there. It's just not there. And if I look at the RSP RSP, which is the 500 S&P 500 equal weight It's the same thing that actually has given me a peak F But That's too big a differential between a peak C and a peak F So I'm saying that I'm going to go to the cash, but look at this the E-mini Has gone to a legitimate Peak D Look at that top right there. Let me just give you the numbers right here. Look the week of That doji cattle the week of the 8th of March was five two five six point five Oh, the next week was five to five three point five. Oh, you can't see it But that was a slightly lower height that makes a peak That's what peaks are about and look at this daily chart in a cell mode So now I've got this the down in the cell mode daily There's to be in a cell mode daily the QQQ in a cell mode daily Look at that way below the Inside track pro actually I'm going to get rid of that because just a mess Right there. I don't need anymore. That was the inside track probe balance. Oh, now it's a repellent zone But it's so high up.  Oh Wasn't that interesting on Caesar? I don't know if anybody saw an NP on public TV station the Show on Caesar. Huh power, huh? All right, so let's just do this QQQ yep following following the SMP at to QQ Q All right, see D E so this is exactly where you can add a trough E With a doji canal, there's a chance that you could ever move up now I'm going to talk about this in a moment QQQ is have a legitimate peak D and they pulling back But that 90 so far over the 14 to get a negative you'd have to see 418 And here we are at 430 down 55 cents IWM So all the dailies so far or in a cell mode is the IWM Absolutely has been a cell mode for much longer. It's up 18 cents right now at 195 21 And now I can say there's a really good chance that I'm going to get a legitimate cell signal I haven't got it yet. I have to wait for Friday. I've got to wait for the candle to close a legitimate peak E Cell signal in the weekly chart whoo and look at the monthly back in the rectangle formation not good. Let's go to the Okay SMH is SMH I'm very close to giving it the designation of us. It's already in a cell signal You see the down arrow, but I'm going to give it the cell mode signal very soon this is just to me is a a Really major sign, but yes the SMH is Look at that for three sessions. It's been picked It hasn't been pink since the one two-day moments in January and since the start back around the 6th of November Look at that beautiful Tool this is the tool that I call indicator of last result because it's the one that I wait from wait for to confirm What I have in the other using other techniques. So this semiconductors is a serious step to the downside It's in a big breather formation if it closes under 210 By Monday or Tuesday, that's just a signal to say timeout. That's what we're looking at So I I've heard a lot of people talking about the upside upside in the general market when you get the semiconductors and the IAI the iShares broker dealer and security ETF in cell modes in the daily chart You've got to watch those week is very close to it could save the day by running sharpie But at this particular point everything's that daily charts are all in cell modes I respect that as being the tide is turned The daily tide is now about to interfere with the weekly time. Remember speedboat when I was talking to Teddy Kecksteig And when I was sitting in for Tommy O'Brien He showed the morning market kickoff and Teddy was talking about the different Currencies and how the shorter term can lead the the the longer term But the longer term is really the one that with the greatest input and I'm just concerned that a lot of people are missing The fact look the VIX index is telling us that it's not a single-day spike to the upside It's telling us that it was a concerted effort from around about the 23rd of March. Let me just check the date Not on my son's birthday. Was it? No, it wasn't it was on the 21st just after Tommy's birthday Right there the lowest at twelve point four nine four Oh on the 21st For the VIX index that's twelve point four. Let me put that in there twelve point Four oh on the three twenty one is 24 and Here we are at 17 having had a huge move up to there I didn't put that in but I should have there was a two bar reversal Right there and then I've got Iran Israel and bonds. I'm putting them all together. All right. I should even include the dollar Eight nineteen point fifty six. So all I can say is On a very short-term basis the VIX got a little bit overboard But that's not that's that's an emotional response to the market if at any point You continue with his higher highs and higher lows That says please be careful because the VIX has had a concerted effort the stairs that move That's not a single spike that fails in the scene where the Chapman a Roman candle right here on the 14th of February at 17.94. This is a concerted effort money going into the VIX. I'll be right back Basil Chapman Tiger technicians hour does up 62 If you're looking for potential trading setups in the stock market then rocket equities and options report is a newsletter You should try Tommy O'Brien delivers options and equity trades when the markets present them using a combination of fundamentals and Technicles sign up for rocket equities and options report today with a 30-day money-back guarantee So you have nothing to risk for all the details and to start your subscription today visit the front page of tfnn.com Tfnn educating investors in the world of trading only a few names stand out like Larry Pesavento a pros pro with over 50 years of experience Larry has seen it all a former Chicago mercantile exchange member Larry has authored 10 books and trained over 1,000 traders with his unmatched expertise Introducing Fibonacci 24-7 Larry Pesavento's daily trading service that turns the complexity of markets into opportunities published every Sunday Receive a comprehensive report packed with detailed commentary charts and videos that illuminate the patterns shaping the markets with updates throughout the week exclusively for subscribers Whether through charts or videos Larry's analysis is your roadmap to navigating the markets You can sign up now at tfnn.com for just $97 and with all tfnn newsletters backed by a 30-day money-back guarantee You have nothing to risk for all the details visit tfnn.com. You'll find Fibonacci 24-7 right under the newsletters tab the gold report as A precious metal gold is still king It continues to hold the most effective safe haven and hedging properties across the global major trading hubs of the London OTC market The US futures market and the Shanghai gold exchange the gold report Tom O'Brien publishes his weekly gold report every Monday morning for subscribers consisting of coverage of the XAU HUI GDX the dollar bonds the South African Rand as well as 25 different mining equities with specific buy-sell recommendations the gold report New subscribers get a 30-day money-back guarantee so you have nothing to risk Subscribe to Tom O'Brien's gold report newsletter now at tfnn.com Tfnn has launched the Tigers in hosted at discord Tfnn has been educating traders for more than 20 years with live programming hosted by a variety of professional traders during market hours The Tigers stand available to all Tigers and Tigris's for just one dollar for the year There's no catch or added costs when you join our community of traders sign up today and become a part of this educational community of traders just visit the front page of tfnn.com free at 1-877-927-6648 internationally at<PHONE_NUMBER> I have a question came in If I could talk about some of the screamers that are showed up on my screen. This is SCREAM for mother ERS not N So yeah, I have one Spartacus core a share special purpose acquisitions It's been there couple quite a number of times and I keep thinking I don't know what they really do Do I really want my subscribers going to something that I have not a clue about I certainly look at the technicals But sometimes you need to know something about Fundamental just about what so I've just left it alone But look at it. It's not only walking the 9-period moving average even at peak D It just pulled back momentarily for four sessions and then boop It makes a new recovery high This is a stock that was once in the in the 15s plummets down to under two and now is trading at 6.21 and it's made a new recovery high and look at the weekly chart This is a single leg a either a G or an A to the upside being tough, but it's holding so well Next one I have is out Lila L I L a And some of these have notations on because I follow them for ages. This one's holding well This is the one I didn't know anything about This is Liberty Latin America. Okay, maybe it's insurance or something like they're trading a 730 90s The stocks under 10 just hugging that 200-period moving average I just leave it as a CG a you that looks a you means and it must be a goal something or other CG a you is Centera goal Very nice move. Look, I put a peak B over there. It held the 200-period moving average and then it went CD EF and now it's consolidating and look at the weekly chart made a new low. So this is all leg Wow, is that a penny difference? No 2727 so that's a B leg B in the weekly chart looking really good really strong That's C G a you and a M BP a M BP See what we got there Yeah, that's just kind of sideways action. I wouldn't be bothering about that. That's a metal stock. I Can't make out the name our dog Metal something Wow It's there and it's just kind of sideways, right? So I just wanted to show you that Yeah, so that I said these change all the time the other day. I had 18 or 20 They showed up mid cap 2000s and I said, oh, that must be a top of sorts and they weren't all They were a lot of gold a lot of gold stocks and usually think you think oh, that's the end of the run No, no, no, but gold is in play because of other things gold is in play because it's really important as a geopolitical It's a your insurance. It's like an insurance policy to have gold More fact that into the food levels Okay, and now it's another oh a question came in about Tesla T. S. L. A Where would where would you start to at least think of putting in some kind of an entry point No, I think that's that was a question. Yeah So I'm just saying to you I would be careful right now the whole EV sector The whole automobile is to see what Ford's doing. Look at those Ford's really struggling You have beautiful move up to peak D in the Chapman wave That's where other things can happen and certainly did goes to the 1390s and now it's down at 1217 GM and These are the traditional companies But what did beautifully and I'm always surprised at the independence of this is to go to motors and a spectacular leg D in the monthly chart ran all the way to the 250s from the 195 area just two and a half months ago Now it's consolidating to peak D in the weekly chart TM is a symbol trading at 234 point zero zero minus 2.52 It's in this consolidation phase So the answer is that Tesla if you if you're going to have a position in Tesla Rather than having these arch formations that keep failing I have the one-to-one that worked beautifully before it worked three times in the weekly chart It's just looking at the top and a bottom and they're making it a thick blue line And then say parallel matching it to the previous and then using it using you this has a much lower Downside move and the weekly chart is even lower than that. It's talking about the the 90s I don't want to go that way. I'm just saying to you I can see Tesla at 154 The whole 151 to 147 area to me That's just an area that I'd be looking at and there's the reason being That I only only because I remember from this whole period back in November December of 2020 where it was at with the lowest 130 77 the high was actually 202 point 60 and then it had an inside bar of 155 126 And then a breakout to the upside and now what I'm looking at is that little cluster of two three months? Is probably the cluster that's gonna have to hold because if it doesn't you're going all the way back to you But Tesla's going all the way down to the one oh one point 81 low of January was a December January of 2012 this year of last year, so let's go one step at a time I The gap down and today not even Bay breaking to a higher high than yesterday's a gap down bar If it takes out today's yesterday's low of 150 3.75 Then that whole 140 is is going to be a game. I just be real careful I think it's a company that you need to keep on your radar Because of what they do. There's a good chance that they have a very secure expanding residual as Microsoft and many of the huge companies did when they went into a Subscription format So test is I'd probably and have something like that with all their EV stations And that to me is really important all the other things that they tend to do every once in a while They come up with something really innovative, so I think it's a as Apple did the same thing was an absolute innovator innovator and then for Couple of years now, especially the last year. They've been very much less of innovators I still think the Apple products design wise are just fabulous. Just look at them and they look beautiful I don't have many don't have any But my wife has so I look at them and I really like the look, but I'm just saying to you that Apple became a dividend type company I don't know if I can put that into the category for Tesla But it's that format that's going to change and then the whole thing that Tesla still has a chance to innovate if they can ever produce a much less expensive Family car or family vehicle. Let's say I think that's going to be a big deal for them. Most importantly I think they're now more and more people are saying and if I have a choice with with Elon Musk's mouth I Draw the notch Another not have a Tesla. I think that's kind of an attitude, but they are fabulous cars There's no question about and certainly very speedy. Okay. Now. Let's do this. We've got oh So that's the area that I've been looking at and I would do it only step by step I'd start a position and I'd actually have the patience to wait for higher highs and higher loads for the technicals to confirm I'd even wait for the weekly chart to give me a signal because The vulnerability to the downside with Tesla has been quite immense Right, so now we've got a nice move up in the reversal of the e-mini up 10 Let's see. I'll do a little work on this and tell you why I see resistance, etc I'll be right back puzzle chapter like the admissions hour and there are a couple of Dow stocks that are actually being very nicely today I'll be back in a moment If you spend any time online researching trading techniques on how to begin your trading journey You've no doubt come across many folks who push forex trading as a way to make big money quickly Unfortunately, there are equally as many stories of these so-called forex professionals Just looking to make a quick buck off aspiring traders without actually teaching the ins and outs of the forex market This is what sets Teddy Keck stacks the Tiger Forex report off the riffraff Every Monday former Chicago mercantile exchange member and author Teddy Keck stat releases his Tiger Forex report newsletter Where he dives into the complex world of Forex and takes time to actually teach you his methods that have made him so Successful in the fast-paced and rewarding world of Forex trading Furthermore, all subscribers receive access to archived live streams of teddies where he provides university level education to help you in Forex trading All first-time subscribers receive a 30-day money back guarantee. 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One simple answer the opening call newsletter Basil Chapman developer of the Chapman wave trading methodology has been trading the markets for longer than most trading influencers have been alive And over that time he has honed his methodology in order to accurately call movements in a wide range of equities From semiconductors to uranium to key indices and so much more Basil is old-school taking the time to educate the trader while also giving his insights into key indices Selective stocks and more opening call subscribers also receive access to dozens of educational live streams That can be accessed at any time for your edification All first-time subscribers receive a 30-day money back guarantee So ignore the pop trading influencers and start learning time-tested technical analysis Are you ready to take charge of your financial future? 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Yeah, I said that the 5107 is the 200 period exponential moving average 200-period moving average has been both support and resistance. That's the thing to break but more importantly You've got the 5101 pink 9-period moving average in the five-minute chart and you've got the 5104 black 14-period moving average and you've got the 200 periods of this whole conglomeration between 5103 and 5105 a lot of resistance. That's what it has to break out to even think of Piercing that whole 5107 level. So this is really tough. Okay, a couple of things a DK and G Questions, what are the support levels of DK and G DK and G's? Draft kings trading. Yeah, this is not acting all that well. Not bad. He would not all that well at 44 39 Most importantly what we're looking at is that it's gone pink the nine-period moving average has gone below The 14 so now you're looking at it has to try to overcome that by trying to get to the 46s So where's support? I would just say make it as simple as possible The close below means that making lower lows and lower highs if it closes below the 43 33 lower the 15 15th was three sessions ago and If it closes under that then you've got to think of that whole area of 42 is going to be tested at this particular point It's holding well, but it has made a peak yet 49 57 Roundabout the 25th of March and that's a peak D in the Weekly chart and it's a lake e but a chance of an instant restart is a possibility because this is a Stuck that goes in and out of favor. That's draftings and I forget to tell you what it is is draftings small spitting Trading yet as I say 44 41. We are long. We've been long for a little while And I'm looking at it as more if it's possible as an intermediate term play I Just don't know yet for the the stop will hold We're in lower down, but you never know with this type of thing. So okay with that said next question came in Where did it go? I wrote them down I did test that Oh Home Depot Home Depot is there an upside potential on Home Depot, and I'd say Excuse me. It's gone under the 200 period moving average HD trading at 334.05 down 78 cents 396.87 was the most recent high for 2061 was in December 2021 high and I promise down to the 260s and then ready strongly up to the 396 87 level Hmm. It's a peak D in the week, you know, it's a cell mode in the daily and it's It's a cell signal in the weekly chart. I'm absolutely sure That if it doesn't close above 346 by Friday afternoon at 2 or 4 p.m. I'm gonna be making this a cell Signal I have to put a down arrow in the weekly chart even though it's still only a cell signal The pink 9 p.m. Moving average is not there still green I have probably have to wait for that and the monthly chart has got a peak scene. It's pulling back sharpie Yeah, you got to be careful and if you look at so The combination question is what about toll you had mentioned you might go short toll I should have right there as I as I was talking about I should have just done it One of the reasons why is that we were concentrating on both longs and shorts at this particular time And I just kind of lost my just didn't I was thinking of even a push option I just couldn't spread myself too thin and at this particular point Total training 113 42 down 92 cents looks very much like if it doesn't hold 110 support It's going to take quite a dive for right now. It's one step at a time cell mode in the daily Not yet a cell signal, but it did make a peak D. Hi at that 1363 level in the weekly chart and a link E and this is an instant restart in the monthly chart Oh, this is something to make a note of bulls is the one that I spoke of over and over and over That's that's called bulls is first source ink building materials manufactured manufacturing on components It went from 214 70 with a round number low on I've got to put the date in that was March round about the 21st. I think March. Yeah, the 21st and Here it is at 180 tell me that round number business doesn't work. So, you know talking about round numbers We are long a particular stock that did have around a couple of round numbers And so far it's nicely over the round up. So round numbers can also work At lows, but there you got to look at the major tide Whatever the major tide is the tide is going to drag that particular issue down at some point I could I look at Oscar OSCR. Why is that so familiar to me? OSCR is if I can read it Oscar health ink training at 1564 Oh, I know why because it was in the single digits last year And now it's gone from the low in the fourth peak a Bcd in the weekly chart came back Let me talk about this. You see this nine-period moving average how strong it is And you see the black 14-period moving average underneath it, and you see that the price one two three four five six Even today went underneath the nine-period moving average So for seven weeks in a row and yet the price is moving up is down today down six cents at 1562 That's usually a positive. It says that You couldn't drag the price low enough to get that green nine-period moving average to go Pink by going under the black 40-period moving average. So I like this. So what's the question? Can I look at it? Yes, I'm looking at it. Ah, but do you want me to say something about it? Yeah, I'm sure you do So that's 14.07 was the low on the 22nd of March 14-20 1335 so 1335 is Above that. So that's your starting point Chapman methodology. Let's get one there and let's get one there And you've got a B C it's in leg D Doing very nicely Yeah, so let me just do this real quickly a B another a But this is not a B. This is a Interesting is that an overlapping wave that's very positive 1315 1320, yep, that's a B and a C. Okay. So here we go. So this is a C right here It's in leg D. I like it. So I don't know if you're in it You didn't tell me if you're in it, but I'm just going to say to you that it's acting really well Especially in this environment So very much like the stock that we have for subscribers of opening call was acting well from last Wednesday Thursday as the market was tanking. So that's the reason why we've gone in I don't know how high it'll go but it's holding very well right now. This is the same thing So I like it at 1559. This is what I'm going to suggest. No, I'm gonna suggest I got a break coming up I don't want to talk through the break but OSCR is looking quite positive. I'll be back Gold report as a precious metal gold is still king It continues to hold the most effective safe haven and hedging properties across the global major trading hubs of the London OTC market The US futures market and the Shanghai gold exchange the gold report Tom O'Brien publishes his weekly gold report every Monday morning for subscribers consisting of coverage of the XAU HUI GDX the dollar bonds the South African Rand as well as 25 different mining equities with specific buy-sell recommendations The gold report New subscribers get a 30-day money back guarantee. 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What I'm looking at here is So the question is looking for an entry So I would look at this look at this daily chart. You see this cup formation Now I one of the things that I've spent a lot of time on over the years because these these patterns are very frequent But you get a cup formation and then it makes a sudden spike spike up pulls back But that creates its own second cup. I tend to go to the first cup not the outside cup. That's my first level for the Cup formation so that the quarrel that's the first Quarter of a semicircle on the left here and then the right side Says that that that's really the first level that I'd look at is this level right here Which is the high of the 13th of March at 15? sort of 13 or 15 1542 that was taken out yesterday. So you want an entry. So I'm going to suggest since I know that you you have a question that has Two operating methodologies. One is where you're prepared to have a longer term outlook if you feel that it has upside potential and the other is that in the short term You are prepared to step in in Kind of a split position. So I'm going to say to you right here at 18 at 16 Just under 16s at 1564. I'd nibble And knowing that I really want a price, but you might not go there But I want the price of the 15 20 to 15 15 area. That's my first real entry So this is just kind of step step in 15 65 One of the reasons is the weekly charts really improving a lot In price with the 9 and 14 and 200 period moving average make these still weak and the stochastic is still weak as well It was the unbalanced volume. So either there's much much more upside potential because they they still have to get overboard or There's a divergence here. That's that's why I'm saying step in just a little nibble at 15 65 But really what you want is to get in the 9 period moving areas at 1498 I don't know if I would wait that long. I'd say if in the next two days it goes to 16 No 15 25 That's where you're first That's where I start my first split entry what you got now at 15 1564 it's just like it so I get a better feel for the stock and Then but the real first entry and it'll be a split entry would be in the 15 25 area, but let's have a look at it together. Give me a yell But that's really where you want to start your position. Why? Because it's going to take a lot more weakness for the 9 period moving average to go negative for the MACD to net go negative It's still good. So castings finally at 83 percent and flat. That's good on balance volume is a bit weak So that's what I'm saying step in here a Little bit just a kind of a feeler, but the real entry will be split entry with the first real entry being in the 14 25 Did I say 14? Keep missing these numbers here. Sorry 15 15. I'd say 15 30 to 15 20 area Okay, you could do that in a split second because it's a low-price stock But you can see how the week is starting to improve and the monthly chart has gone from a peak a Pullback months later it goes to a leg B pullback. It could be ready for the next move up We'll see. Okay. So I hope that helped you next question. That's I've got Let me just move this over here I've got it. There it is Can you please look at Amazon not in but curious as to the short term direction? So Amazon made it a high this is good this AMZ and Made not made the all-time high was at 188.65 back in July of 21 plummets down to 81 That's over a hundred points down But then it comes back in its only leg C and the other day just momentarily made an all-time high at 189 round about 189 34 training right now at 183 I'm going to suggest This is very tough why look at a weekly chart Every red candle has been met the very next week with a big strong green candle But you've got a doji candle at the high you've taken out the left side low You haven't closed under it of last week the magnies just about to turn down This the castics fabulous at 94 but also ready to turn down. It hasn't I'm balance volume in the week He's very good This is very tough. And that's the reason why I'm saying I just see like a 4 to 8 percent Correction unfolding here in the market. I don't see a major turn down and Amazon's saying oh, what are you talking about? I'm holding beauty. It's had a couple of round numbers They said 183 81 right now it had an 83 and 184 and 180 and it's holding very well Wow So Steve I'm going to say this I Like it very much. I have a stock that I I don't have it I've been looking at it for ages and ages. I wonder if it's going to tell me what I need to know Here it is It's in my screen on this that I've had for quite a while And I put down VTE X. Let's see where that is right now The VTE X Yeah, it's pulling back sharp the V-tex helps facilitate product sales on Amazon eBay Alibaba. I'll Know it's pulling back Hmm. All right. This is what I'm going to say You're looking for an entry in Amazon. If you're looking for an entry in Amazon I don't get the sense from the question that this is just a short-term trade You're looking for a real entrance in Amazon So I Let's see Okay, so I'm going to suggest At 183.98 Gosh It's acting so well I do see that the right side is starting to make low lows and lower highs and it hasn't done that for a while I did that back in March Before it took off to the upside I think the taking off to the upside is kind of done for now. This is my thinking could be completely wrong and the digest and Digestive phase and I'm going to put in a big rectangle right here. Okay. That makes it much clearer for me All right. So why did we do this? I You haven't given me any sense of long-term short-term if you want to position yourself for anything like that Well, what I'm going to say It's acting extremely well I think the upside is limited meaning that it could rally but it's getting as my eyes sees it I think it's gonna start making low highs and low lows just for a moment. Just a moment could be a week It could be two weeks weeks. I don't know so an ideal situation would be to see a drop into the 181 180 level With the 9-period moving average starting to go pink But if it holds well, it means that Amazon could hold very nice here. This is really tough because the easy thing for me to say is Start your position right here at 183 87, but that's the same as we were talking about with Oscar Just nibble on this. I don't know if that's really what you want to do I've never not seen you do that before Duncan speak Let me think about I just want to give you a plan because the ideal situation is In the 181 area, but if it goes to 179 it could actually start then to go quite quite a bit deeper I have to think this through because I want to give you a stop as well. I'll be back Tigers we have some exciting news Live trading Fridays are here join Larry Pesevento every second and fourth Friday of the month 9 a.m.. 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That's TFNN.com and hit watch Tiger TV Hi folks as we get to this final segment I'm just saying I've been saying this for about a week be careful out there So the Amazon I'm just saying I would not touch Amazon right now I was gonna say little but I didn't even see it. I think that we're in a consolidation phase I've got a cell signal a cell mode in the Dow. We are short the Dow I'm looking at this even the stock that we bought Just was it yesterday day before That did a beautiful test and is trying to rally did rally very well, but it's being dragged It's showing strength and yet still being dragged by the market So just be please be careful. Oh, I never even got to this. Look. Here's the XLF. This is the XLF is the S&P select financial spider fund 42 22 was the all-time high Just the end of March In January of 2022 it went to 41 70 down to 29 50 came back and so many of these in stocks and Sectors have gone right back to previous highs within pennies This is within 17 22 this is within 52 cents of the previous high made a new high I think this has got a cell mode in it and look. Here's the KRE. We were in it just briefly because I gave it a chance. This is the regionals. They're not doing well They made a lower low than the left side low Of earlier this year in an arch formation 45 67 yesterday went down to 45 30 45 46 This is not good news. So just please be careful You're looking for buys have a little bit of patience and then I would use them as stepping stones I'd probably have a three I'd have a nibble of what you like and then I'd have a sprit long position with lower At lower point and a lower point. That's the way I'd be thinking right now I just think the upside's limited. I've got the signals that have been Wonderful tools. You can even see it here. Look in the 120 minute in the 10 minute chart of the e-mini Look at this. Look for 10 minute went negative went pink at the 200 prem moving average at the 51 10 level and here we are 50 80 Uh, look at that 90 moving average. What a nice indicator. Have a wonderful day. Thank you for Steve Rose and all the great


So you don't understand auto landscape material painting, not a problem. Right click and make a new material. Call it something like auto material. Then right click that material and create a material instance. Now we need to create two material functions. To do that right click materials and textures and material function. Make one for stone and then make another one for grass. Then double click your functions and left click to drag the pen on the left into a make material attribute and plug everything in like normal. And just so we have some control over the tiling, right click landscape coordinate node, then right click again, add a multiply and drag everything together. Repeat this process for the other texture, then double click to open the master material. Drag your material functions in from your content browser, right click, break material attributes and duplicate it. Connect each break function to each break attribute, right click, linear interpolate and drag that into the base color of your main auto material. Now you will need a linear interpolate for each map that your materials are consistent of. We need one for base color, one for roughness, one for normal and ambient occlusion and drag base color from dirt into a and base color from grass into b. Right click, world aligned blend, right click, scalar parameter, name this one grass dirt sharp and duplicate it. Name it grass dirt bias and drag it into world sharpness, drag it into the world bias and drag the alpha from the world into the alpha of the lerp. Now you might notice that it's not gonna let you drag normal in without giving you an error. You don't drag it in directly. You have to drag it in from vertex normals. Then save, double click your instance, and check the bias and sharpness to make sure that they are active. Then click your landscape and drag the material instance into your landscape. If you drag your instance material into your landscape and you don't see any change, try just opening a new scene and creating a new landmass and that will usually fix it. If you go into sculpt mode and start messing around now, your material will automatically apply half the material to flat terrain and the other half to slanted. If it doesn't look like it's working, then try to double click the instance and adjusting the values of the sharp and the bias until you see a noticeable change. Hope that helps in as always. Hope you have a fantastic day and I'll see you around.


The U.S. Air Force Security Forces trainees, at the 343rd training squadron hone their skills, during the individual tactics and techniques basic course, at Joint Base San Antonio Camp Bullis. The exercise is designed to teach the trainees how to missile security shoot convoy actions capture and recovery of nuclear weapons law enforcement directing traffic non-lethal tactics such as using pepper spray and pressure points on a body and communicate through tactical environments the 37th training wing and 343rd training squadron provide the initial training for all Air Force Security Forces we are dropping rugs and kits see me I'm not like it's good right it's good


The lady is the tower of the Matthew Busbound Professor of Pediatrics, Medicine, Surgery, and in the College. She's also the Associate Director of the McClain Center, and she co-directs the Ethics Council of Children. Many of us have published two books on pediatric ethics, one on children's families and healthcare decisions, the other on children in medical research, both published by Oxford, just working on a third book on the genetic testing and screaming of infants and children. Lady is a creative philosopher as well as a practicing pediatrician, and she reminds the philosophical and clinical skills in her research work, often integrating a theory with a theoretical view. Her theoretical work often focuses on policy matters and she works to develop real-world solutions to this problem. She serves on the Committee of Biorepics of the American Academy of Pediatrics, and the book today is called Challenging the Professionalism Movement in New York. So the first caveat is that these thoughts are preliminary, marked in my presentation up by four months. I'm not arguing against professionalism, understood to be clinically competent positions to practice ethical medicine, nor am I objecting to teaching, clinical competency, and ethics. I am objecting to the professionalism movement in which we are one, proclaiming lofty ideals as professionalism. Teaching ethics is etiquette without a framework. And so that's what the focus of this talk is going to be. It's going to be talking about what professionalism really is or ought to be and where we've gone wrong. I do have to mention one conflict of interest, so we're after that. My conflict is I'm asking an author, not the lead author, on the American Academy of Pediatrics professionalism Station of the American Academy of Pediatrics. Despite my role, which I'll discuss, I'll actually criticize the document. So, I have three objectives for today's talk. The first is to analyze, So it was like that sounds like, you know, something like that. Good, so I'm representing myself. I'll make a long video today. So I'm going to analyze the professionalism document of the American Board of Internal Medicine and the American Academy of Pediatrics. I'm going to evaluate current pediatric residency educational curriculum regarding professionalism and ethics. And then I'm going to consider how current trends like social media challenge our understanding of that example, professionalism. So the Physician Charter in 2002 was actually a collaboration by the American Board of Internal Medicine Foundation, the American College of Physicians, the American Society of Internal Medicine Foundation, and the European Federation of Internal Medicine. And their goal was to write a document about medical professionalism in the new millennium of Physician Charter. And this Physician Charter set out three fundamental principles. The principle of primacy of patient's welfare, the principle of patient's autonomy, and the principle of social justice. I want to compare those three principles to the underlying principles of the Belmont Court, which are respect for person, beneficence, and justice. And so there are two changes from Belmont to the Physician Charter. Anybody notice them? I'll give you a hint. I'll put it back up there. What do you think has changed? Right. So we move from respect for persons to respect for economies, and we change the electrical order, both of which are a big mistake. So let me explain why. Let's see. What's the story about Belmont Court? Belmont Court in 1979 was written by the National Commission for Protection of Human Subjects and Biomedical and Biomedical Research, and is one of the best biomedical epic documents of the 20th century. And so I actually criticized this in a paper that I've already published. Why am I so upset about this shift from respect for persons to respect for economies? The first is, what do we mean when we use the phrase, or when Belmont used the phrase, respect for person? It actually had two components. The first is respect for the person's autonomy. But there was a second component integral to that, which is respect for the person's welfare, particularly for those who lack decisional capacity. So this notion of just having primacy of autonomy in a sense ignores all of those who lack decisional capacity. So those who are vulnerable because they're children or because they have development and disabilities of one sort or another. And language matters. The shift from respect for persons to respect for autonomy, I would argue, was actually a poverty-highly precation. I was at a conference this morning where I heard, the patient was found at a decisional capacity and refused treatment. And so we let her talk. I mean, that was how it was described this morning. That's the problem because it failed to acknowledge that there has to be also concern for his patients' welfare. So I'm going to actually argue that here's one mistake that the professional is removing, right? Sometimes we do them our professional responsibility and reinstate our obligations to respect our patients' persons and not just to respect their autonomy. So why the lexical shift? Notice that in Belmont it's respect for persons and then beneficence. And here we're putting welfare or beneficence above autonomy. And the reason for this shift is in part because of this shift in language. But it assumes then that patient welfare is some objective fact. And what we know is in an adoptive patient relationship, returning what is in a patient's welfare is actually a negotiation between the doctor and the patient. And so this professionalism chart, though, because it uses autonomy, has to put welfare first. But if you still had this notion of respect for persons, it would be respect for persons before you got to the issue of your patient's welfare. So again, two mistakes before we even get past the first three principles. And so again, now I want to look at these three principles and see how they're actually defined in the document. So I'm going to actually argue that two of these principles are two-demanded. So first I'm going to look at how they define patient welfare and social justice. And then I'll actually argue that they're two-linear on patient autonomy. So let's look at how they define patient welfare. And this is quoted right from the position charter. This principle is based on the dedication to serving the interests of the patient. Outdoorism is a tribute to the trust and essential to the position-tation relationship. Market forces and vital pressures and administrative emergencies must not compromise this principle. And then they go on to define altruism as putting the interests of others first involving self-sacrifice. So in a paper that I had written actually at around the same time, we asked the question to our doctors out there, and I wrote this to the college of Washington, Wyoming. And we actually argued that one of the most fundamental features of medical professionalism is actually a fiduciary responsibility based on trust to the patient. And it applies a duty or obligation to ask for the patient's best interest. And we use the language then of fiduciary and not of altruism. In fact, we argue very specifically that the problem is that altruism suggests that it's super-arrogatory for going beyond obligations and that you can be altruistic in a relationship in which there is no relationship. But in a doctorate relationship where you have a relationship, you actually have obligations. We don't want to be saying to doctors, be professional by being super-arrogatory. We want to see that professionalism is part of their duty. In fact, in this paper we did a bunch with, we actually argued that it was the patient for some kind of altruism. It's the patient who lets the medical student try the LP, even though the medical student admits it's their first time. It's the patient who agrees to be a living donor for another family member. It's not us for being the altruist. And we argued and concluded in our paper that if it is patients and not the doctors who are altruistic, then the patients are the gift barbers. To that extent, doctors owe them gratitude and respect for their many contributions to medicine. Recognizing this might help us better understand the morals of this kid of the doctorate relationship in modern medicine. So again, I mean basically my conclusion here is that altruism is too demanding and inappropriate in a fiduciary relationship. Now let's look at their second principle that I want to say is too demanding, which is the principles of social justice. And again, I'm quoting, although I've added some of the power. The medical profession must promote justice in the health care system, including the fair distribution of health care resources. Physicians should work actively to eliminate discrimination in health care, whether based on race, gender, social economic status, ethnicity, religion, or any other social category. We're not just supposed to be working actively to get rid of discrimination and social inequities. And then my first question is, does this apply locally, nationally, internationally, and is this a requirement for every physician or just for physicians as a group? And I'm sorry, it seems to have come off of me changing the computer. But basically my argument is going to be that I'm not convinced that each of us individually are actually working for that. But I'm going to talk about that. After they give the three principles, they then actually give another ten professional responsibilities. And one of them is commitment to improving access to care, which I would argue fits the law with the principle of social justice. And as the Charter explains, a commitment to equity entails the promotion of public health and preventive medicine, as well as public advocacy on the part of each physician and physician without concern for the self-interest of the physician or the profession. So who serves the underserved? The first question I would want to know, because if all of us have an obligation, the answer is we should see 100% on every single one of these, and we're not going to. So here was the study published in 2006, although the survey was done in 2001. And what you see is, I would say commendably, three-quarters of these physicians said, I personally want to be involved in providing care for the medically needed person in my medical career. But only 25 physicians said physicians should volunteer their time working in a free clinic. And then 87% disagreed with this statement, physicians should not be concerned about the problems of the medically needed. So we have about three-quarters of the physicians actually expressing an attitude about taking care of those who have left. In the look at behaviors, they say physicians provide charity care, you had 79.8%, and physicians had participation in national or international aid missions, you had less than 10%. So clearly, another study that was done looked at the percentage of physicians providing charity care. And the one thing that's really noticeable is the percentage of physicians who are providing charity care is decreasing over time. And part of that can be the economy. So if every physician is obligated to social justice and one-third of us who aren't providing any charity care are failing, and if the medical community is obligated to actively, remember it's not just providing, it's actively eliminating social inequities that we all fail. Which again is why I feel that this professionalism doctor is just lost the ideal. So now let's look back at these three principles. And now I want to focus on patient autonomy and say that the physicians are here may not be demanding enough. Because here's what they wrote. Physicians must have respect for patient autonomy. Physicians must be honest with their patients and empower them to make informed decisions about their treatment. Patients' decisions about their care must be power-mounted and their talents are mine. As long as those decisions are in keeping with ethical practice, they do not lead to demand for inappropriate care. And so why do I have this in a palette? My first is, decisions are in keeping with ethical practice. Does this mean that conscience clauses can or cannot override legitimate patient requests? Because that would be one way that they may have a, quote, legitimate request that's going to be overwritten or at least ignored. And then I have to ask the question, who defines what is inappropriate care? Is inappropriate defined by clinicians or utilization review committees? Or is inappropriate care based on evidence-based medicine? And are these boundaries decided by individual physicians or physicians as a group? And is there any negotiation or in a sense what reports that the patient has if they feel their care is appropriate and the physician deems it inappropriate? So in other words, I've now rejected all three of the principles. So let's move away, maybe just because it was written by the internal medicine people and I'm a pediatrician, so do the pediatricians do better or the answer is no? But here's what happens when the pediatricians decided to promote professionalism. I should say that the real process began with the American Board of Pediatrics. They wrote a book with the Association of Pediatric Program Directors called Teaching and Assessing Professionalism in 2008. And then the AAP came out with their own statement. And I was in transition on the committee. The one thing I did get out, in the one part, I'm only part of one of the two AAP statements, one of the statement and one of the technical reports. There's no use of the word altruism, for example, in the part that I'm involved in. And yet we did maintain the principles, the three principles, as decided by the American Board of Internal Medicine. So what do you have to know about the American Board of Pediatrics project? Basically, it's an interesting thing because it was done through the medical education. They said that since 1982, pediatric residency programs have been asked to evaluate training for ethical behavior. And in fact, in 2007, the ACGMA required document teaching and evaluation of professionalism. So they created this project in 2008, which was about teaching and assessing professionalism. There was a program director's guide who's written by eight highly respected medical educators and adopts most of the physician's charter. There were no ethicists on this project. And here's what the AAPP wrote. There are many definitions of professionalism. For our purpose, we will use Stern's definition as highlighted in his book, Measuring Medical Professionalism. And here's his definition. Professionalism is demonstrated through a foundation of clinical confidence, communication skills, and ethical understanding upon the field, the aspiration to a wide application of the principles of professionalism. Excellence, humanism, accountability, and absolutely. This definition emphasizes the fact that professionalism is a behavior that must be demonstrated. So remember, this was a group of pediatrician medical educators whose goal was how are we going to measure and evaluate professionalism. So they define professionalism as a behavior. So is professionalism a behavior? And the answer is yes. But professionalism can be understood as much more than that. It can be understood as an attitude, an identity. It's about values, norms, attributes, motives, or tendencies. I think it's really important to acknowledge that how we're going to conceptualize it is going to structure how we're going to teach it and how we're going to live it. So to have a more global, quote, identity conception of professionalism in medicine, we should say that teaching professionalism is not so much a particular segment of the medical curriculum as it defines it. Rather, it is a defining dimension of medical education as a whole. But we shouldn't have it sort of, hey, this is our professionalism education and we're now done. It needs to be throughout the curriculum. We have to deal with it because we have this whole hidden curriculum. So here's another problem I have is that once you make it a behavior that has to be taught and evaluated, you entrust it to the medical educators. But such an approach fails to provide the analytical framework with which to examine professionalism, which is in a sense coming from the foundations of philosophy and medical ethics. These case-based approaches, which is what both the ABIM and the American Academy of Pediatrics focus on, often use cases alone without theory. And it allows the students, but that fails to allow the students to then take these ideas and apply them to other cases. And there have only been a few articles that actually try to evaluate and they respond to this problem that because it's studied in a concrete way, it's not able to be abstracted beyond. Of course, we also have to acknowledge that one of the most important behavioral components is going to be this whole list of role modeling and the hidden curriculum and something we really haven't addressed so far. So the behavioral approach to professionalism, I just think again, is just a weak understanding of professionalism. When the A&P committee decided to look at the ethics underneath it, they also enumerated the same three principles and ten responsibilities. And one of the responsibilities they focused on, the social justice and advocacy, they went even further than the American Board of Internal Medicine, so I'm going to quote, pediatricians have a responsibility to use their knowledge, skills and influence to advocate for children and their interests in all domains of society, not just in healthcare. A child's health is broadly understood through emotional, educational, psychological, and spiritual well-being. I've left the clinic, I'm now responsible for all children in all aspects of their daily lives. So my first question is, if I'm really supposed to be advocating, how good are physicians about advocating? And I quote this article, although physicians seem to endorse the idea of civic engagement as a professional responsibility, there's less evidence that physicians actually engage in these activities. The limited evidence available shows that physicians are more likely to engage policy makers on issues affecting their own economic well-being and that on the most basic measure of civic involvement, that is voting, doctors vote less often than other professions or even the public at large. Others have observed that often discrepancy exists between the professional values physicians endorse and the behaviors they demonstrate. And here is the data that you showed in this article showing how poorly physicians have voted in all elections way below the average general public and even way below their lawyer colleagues. So, and that would be the simplest form of that. So what are pediatrics residencies doing about professionalism? We actually did a survey and Peter worked with me as well as Colleen Lang who's now at WashU. Again, I'll get my conflict with the Carson Funded by the American Academy of Pediatrics section on BioEpic and approved by the Association of Pediatric Program Directors who agreed to distribute the survey on their lists or within a sense their seal of approval probably helping us get the 60% response rate that we've got but neither the AAP nor the APTB have responsibility for content or data analysis. And so what did we find? The first thing is as I said we did get a 60% response rate. Programs were evenly divided on whether ethics was taught as an organized curriculum or integrated throughout. Professionalism was combined with the ethics curriculum in 27% of the program but independently in 38% of the program the 35% had no professional curriculum despite the fact that since 1982 it's been required as a Pediatric Residency Program. In almost half of the programs in which faculty could be identified, we asked them who teaches your ethics? Who teaches your professionalism? There was no overlap between those who taught. So these are really viewed as one is in the realm of mental education and one is viewed in the range of the ethicists and the two are rarely actually communicated. More than one-third of the respondents were not able to answer questions about content and structure. So we were asking the program directors tell us who teaches and what format and they had always the option I don't know and for every single question over one-third was I don't know. So taking a real vested interest in what's being taught in their programs in this area. In fact the two-thirds of those who responded they did that program dedicated 10 hours per year to ethics and professionalism respectively. The only three-quarters of the program identified crowding of the curriculum and one-third of it by lack of faculty expertise as their curriculum strengths. So that is what we were able to show why do you only give that many hours and the main reason was for both ethics and professionalism is crowding of the curriculum. Scarily over one-third saying they lack the expertise in their medical schools. So our conclusion was that despite requirements to train and evaluate residents and ethics and professionalism there's a lack of structured curriculum faculty expertise and evaluation methodology. The effectiveness of training curriculum and evaluation tools need to be assessed if the ACGMA requirements are going to be meaningfully realized. So while we as a community need to do professionalism to behave it to be measured other movements in the last decade are further eroding professionalism and I learned that my notion of professionalism isn't called dinosaurism it's called nostalgic professionalism. And this was complexity theory meets medical professionalism and in nostalgic we have the most important value are patient autonomy again number one rather than respect for person altruism, interpersonal confidence and personal morality is the least important thing between things like lifestyle and communication. What was fascinating was that these authors then told me that there's a concept called an equally badly concept called lifestyle professionalism where autonomy lifestyle and personal morality are on top and the least important are altruism, social contract social justice, professional dominance even better is that we have something called unrelected professionalism where we get autonomy interpersonal confidence personal morality but on the bottom we get to have social justice and social contract and basically this article tells us that all of these are competing notions of professionalism I'll just start with the complexity theories are wrong decision is a privilege, not a right if you're not willing to put social justice and other issues higher up and you're only focused on your own needs we have a problem the matter of the professions is not defined professionalism, society does by delegating powers and responsibilities to the profession so again we have it this wrong way we think we get to define it and in the sense it's really society who's giving us the privilege and we should acknowledge it as such so unrelected professionalism is not professionalism nor is lifestyle professionalism so as I've said, I'm a dinosaur that's not to say that there have always been challenges to ethics and professionalism but here's a famous quote the most common criticism made at present by older practitioners is that young graduates have been taught a great deal about the methodism of disease but very little about the practice of medicine if you put it more bluntly they are too scientific and do not know how to take care of patients who said it and when that could keep out of you 19.7 you're in the right century in the last half of the century of course the most famous part of that paper being the last line one of the essential qualities of the clinician is interest in humanity for the secret of the care of the patient is in caring for the patient for professionalism but there are some interesting real challenges to professionalism today and I want to talk about two of them one of them being duty hours I figure if I'm going to give this box I'm going to make sure that I insult every single person so now we'll look at duty hours and social media here is a study which looked at the faculty views of the implication of the new duty hours and the one thing you'll see is this one is professionalism and what they felt was so how does it affect a little over 40% felt that it had no decreased patient care 40% thought no change they thought over 70% thought it decreased medical knowledge but here is what they thought about professionalism 60% really felt that it was going to decrease what I would assume they meant nostalgic professionalism the real issue is social media and we're going to have lots of issues with this for example the question of behavior by healthcare professionals there's resident blogging about a physical patient which the patients and the family may access there have been cases where the Mayo Clinic surgical house officer who photographed a patient's tattoo and texted it to friends from the OR anybody know what body part and what it said what? yes it was it was a bar owner who had chewed on his penis the word red top he actually was thrown out of the residency program there have been unprofessional behavior by medical students engaging in drug use documented on a social media site but the social media concerns is actually bi-directional right because the privacy concerns go both ways and by that I mean that patients learn lots of personal facts about their positions unless you don't have people here who don't have a Facebook account okay it's a minority right and LinkedIn and when I say Facebook I mean all of those accounts so can physicians one of the issues that has come up in the medical literature is whether physicians can reach patients blogs so imagine a patient has a blog and then as you may even talk about compliance or alternative therapy secondary goals can you go and try to find out about it now if it's the transplant team it could actually exclude the person from getting a transplant of course it can get even more complicated if the person is reviewing the psychiatrist right we reveal what we want to reveal but now in the sense the whole web is there so physicians can actually have to ask permission and say hey by the way you know I'm just going to scan the web and see if anything you're writing is of relevance to our doctorate relationship so we're going to have issues like this that I think that really haven't been understood by many of us I quote the nostalgic professionalism and Parkinson's don't really take part in this in this era of social media so but how big is the problem they did a couple of surveys recently confident out of the university of bars study Facebook found that only about half of the medical students had about 12.8 percent of their residents and they said a majority of the accounts were not private in some cases that were inappropriately run professional content posted right in 2010 they did focus on medical students from Washington University School of Medicine the vast majority used Facebook the majority were identified online by name and institution and it was disreviewed of what is inappropriate to post online all of these type of violations were wrong and illegal activities were inappropriate but there was disagreement for example about commenting on attending and classmates either professional skills or attitudes so the AMA actually did come out with a very interesting report looking at professionalism in the use of social media it was published in 2011 in the Journal of Clinical Ethics the boundary that exists in the patient's additional relationship is something that we consider when physicians take part in social networks and post online these boundaries is defining characteristic of the professional relationship and respect, trust in the patient's well-being or power amount at least the word respect has finally gotten back in and here were their recommendations physicians should be consistent of standards of patient privacy and confidentiality that must be maintained in all environments including online when using the internet for social networking physicians should use privacy settings to save personal information and content to extend possible which it realized that privacy settings are not absolute and that once on the internet content is likely to be there permanently if physicians enter applications on the internet physicians must maintain appropriate boundaries maybe you should have a recommended separate personal and professional online persona professional responsibility to address unprofessional behavior of colleagues seen online their recommendations first contact your colleagues say hey you're not supposed to post things about your peers if no response then actually they are going to be an issue that should actually go to higher authority the decision must recognize that actions online and content posted may negatively affect their reputation on patients and colleagues and may have consequences for their careers so let me end where I began challenging the professional movement as currently interpreted ethics and professionalism are integral to medicine the three fundamental principles are respect for persons, beneficence and justice medicine is a social contract between physicians, patients and the public at large it's a fiduciary relationship not an altruistic one and that while changing social, technological and political events impact on how we behave or ought to behave as professionals the fundamental component of the social contract in Georgia so I'll end there and take questions we respect others one level because they are human being we respect a person because a person is human we also respect a person for their character we have owl for certain people respect them because of their accomplishment and sometimes we respect people because we are afraid of them you respect someone with a gun in the hunt so the respect can be vague but we respect patient for their autonomy and for their individuality but we may not even respect a person who for example was in a process of putting a bomb someplace or was going to kill someone and then somebody shot him and now this is our patient so we may not even respect this person but we respect the person's autonomy and being a human being so why would be bad to replace respect with autonomy so with everyone able to hear so Javad's point very fairly is that respect has many different connotations so I was using respect in a technical sense I was using it in the phrase respect for person which is clearly articulated what it's defined as in the Belmont report and the first is about respect for patient autonomy but it's also about respecting the patient's welfare particularly for those who lack autonomy and even for those who have autonomy but may be in a vulnerable situation being sick is a vulnerable time for all of us and so that's why it's not just about autonomy or the person said no I'm done the person said no is the beginning of a conversation and that's the difference so Lanny you mentioned that this talk actually came four months before it was supposed to be given so a work in progress which were pretty definitive for example if the enemy talked about social media you had a very clear statement about boundaries between professional and personal persona but there were other parts social justice part where I think in some ways both what was presented in terms of the societies regarding social justice issues and then your discussion of it was less clear so let me give you an example you mentioned for example that the society talked about well active physician advocacy and a variety of areas for social justice but it really wasn't defined in terms of the professional charters so in some ways some of your critiques I think were potentially unfair in terms of being vague and you started putting words in people's mouths so for example you mentioned for example the uncompensative care slide where you then defined the same well if one fourth of the people weren't giving uncompensative care well maybe they're being hypocrites or the issue about well pediatricians getting involved in schools and poverty and a variety of non health issues if they weren't very strong advocates then you know they were hypocrites in some ways with the implication the last SHIM meeting the theme was advocacy and it was a very impressive speaker who was basically Gandhi in terms of her life career but she had one slide where she had like a ladder of ten different ways to become involved ranging from feeling minimal to being like her in terms of being Gandhi at the point that well you know we don't all have to be Gandhi that we have to figure out given our interests our strengths and talents what do we fit in the continuum but everyone has to do something in terms of social justice so I guess in terms of that particular topic of social justice it's going to spin a little bit more in terms of I guess a little more specific in terms of where you think we should be then because in some ways it took a straw man in terms of the existing I use the voting example as the minimal amount of social advocacy and we don't do a very good job there so you know I'm not asking for Gandhi I was asking for something that minimal but you said I was unfair I'm using their definition which was the decision to work actively to eliminate discrimination in healthcare whether based on race, gender, socio-economic status, ethnicity, religion or other and the other social categories and I think that it's demanding too much to ask that everyone do it actively so I agree with the speaker who said it's all on a continuum and that different people should do different things but my point is if we really require that then we're failing because we can't even get us to vote let alone get us to actively try to change the system try to you know try to work for the Obamacare and trying to get all those people without health insurance meaning more positions are against it than are for it right so I think we're failing and I don't think I'm being too harsh I guess my concern was I know you had this slide I thought you were implying that well we shouldn't be actively whatever actively means be trying to eliminate discrimination along these different lines I think that if we're going I think this is too lofty and ideal for all of us to be at that level of activism I'll settle for having all of us vote and take an active interest right we can't even get more than 40% of us to vote in any election when you talk about then what should be done you know if you were the charter writers what I'm hearing is that you're thinking that everyone should play their part you know some people it's going to be a public policy others it's going to be how we treat individuals in our institution well the policies we create in our institution or the role modeling we set and all so I think we're on the same page but the message that I heard though was that it's either all or nothing that you know you either sort of you're doing the public policy or else if you're not doing what you interpret it to be what the charter meant then well you know but that's what the charter is demanding not demanding that it's a team effort and that we as the profession move forward it's demanding individuals each one of us have a personal responsibility and it's conflating the person on the professional I just want to follow up on Marshall's question when the WHO defined health as not just the elimination of disease but a positive state of social of physical and economic well-being and I didn't quite get it right it was pretty much understood that that definition did not describe the situation on the ground that was not the way things were but it was a kind of aspirational vision of how things ought to be in some future time and place in a similar way I'm wondering if this discussion between you and Marshall doesn't turn on what the charter means I mean whether it actually lays down a code of expectations and responsibilities to each and every doc today and forever or whether it does have some of this aspirational quality to it that in the right sort of medical world of the future where health is social, economic and physical well-being these would be the kinds of aspirations that doctors ought to have and ought to work towards so it's a real difference so there are two issues about it one is that remember that this is being developed for medical education purposes so lofty ideal we'll get back to but we're supposed to be evaluating and measuring whether they're achieving this and we have it, let's talk about the World Health Organization definition have we gotten any closer to that definition in the 25 years of anything we probably made three steps back so we're not moving towards there so lofty ideals are great but when you have to quote measure it and infuse it into your medical students we're not doing a great job if it's just a behavior and I don't think it is but if it's just a behavior that's one way of responding that they're talking about behaviors so if we ignore it as a behavior and then say well maybe it's lofty ideals I still think that they're demanding too much of individual physicians if it's about lofty ideals it should be about the commitment of the healthcare profession it shouldn't be about each one of us having these responsibilities Laney one of the observations you made that I think was very important was the sort of rupture if you will between ethics and professionalism or the way in which they are often conceived of in parallel and I wonder sometimes I've wondered whether or not the modern professionalism movement as currently conceived came in some ways as a reaction against medical ethics either conceiving it as saying these are rules of people telling me what to do and I don't want that or a bunch of people abstractly reasoning about cases and went off in its own direction so the first question is do you agree that there is anything to that theory of how it happened and secondly regardless of how it happened do you have any suggestions for bringing ethics and professionalism back together so I don't think that's actually how it happened I really think this was sort of a decision was made that we need to incorporate this and the educators who are very clinically competent and ethical people felt they could do this and didn't really think about it in the notion of I mean I think this wasn't a malicious intent I think it was just sort of obliviousness about the fact that in a sense the three principles they are never cited as where they came from they came like mushrooms out of the ground rather than that there's a whole history of medical ethics in which these principles come from so I think that's the issue and I think it's a failure on the ethicist part for not sort of engaging as this movement started to take place and saying we can help with this as well so from what I've heard today it isn't that hard to figure out what is an professional behavior at least once it's been committed but since justice potter but you teased me having four months with a very brief suggestion of the other side of the so called super professional when you said we're going to have to deal with professionalism and conscience clauses what is it that it is professional to ignore orthodox medical treatment because of conscience I don't think it is and I've written that so well you got some argument in this room I know I do I have a theoretic question can you define and contrast ethics and professionalism as terms and concepts you know I actually thought about that a lot the other day trying to do it so in a sense I would actually argue that professionalism is in a sense one component of ethics that ethics is sort of the theory of what is right and what is wrong and what is good and right and things of that sort and professionalism is just looking at it in the particular area of healthcare it's not adequate but I've been thinking about but I do think they're totally overlapping the principles we're using are the same now professionalism also has another component which is about clinical excellence but I would actually argue you could sort of assume that in ethics as well I think that's an important point because from seeing in educating groups ethics is seen as a subset of professionalism not professionalism as a subset of ethics and I think that paradigm shift is part of what I think you're pointing out join me in thanking ladies for wonderful


In this video we provide the solution to question number six from the practice exam number one for math 1050. We are given the graph of a piecewise function f as illustrated right here. And we're supposed to find the algebraic formula that determines this piecewise function. Now be cautious on this one. None of the above is a possibility. And probably our best approach is to do this by the process of elimination. Now when we look at this function I can see there are three line segments that seem to build this function together. Therefore I can fairly safely eliminate any piecewise function that doesn't have three components to it. Alright so you'll notice like choice a this is a linear function this is a linear function but there's only one switch. It goes from negative one to two and then two to eight. I need three different pieces thus I need two switches for it so it can't be choice a there's not enough pieces. Same argument with choice C right here there's only two pieces.  So that's not going to work for choice C as well and I also can rule out choice E as a possibility. Notice this is one and negative one there's only two pieces to it. We need at least three pieces. Choice B is somewhat satisfactory because there are three pieces there. Same thing with choice D though so how do we eliminate between them? Well there's two approaches one could take at this at this perspective. You'll notice that each of these expressions for choice B look like a linear function some mx plus b. When you look at choice D you'll notice that there's a linear function linear function great but there's also this quadratic expression right here. This would suggest the graph would have some type of parabola inside of it. Now maybe you're not quite familiar with the shape of a graph based upon these formulas lines and square roots and parabolas. Maybe we're not familiar with that enough and that's okay look at the domains look at the switching numbers. The one line switches at negative one and it switches at the other positive one right. And so we have to look for a function which is using those switching numbers. You'll notice that for B it switches at negative one it switches at one right. There's one and negative one there it switches at those values that's pretty good. When you look at choice D it does switch at one but the other switching numbers at three. So just considering the domain of these functions even if you don't understand how to interpret the formulas yet that's okay. We can rule out choice D as a possibility. Now like I said this none of the above is somewhat of a dangerous thing on this question. It's understandable. If you continue to look at the domain of choice B right we end at negative three over here that's included and then two over here. X equals two. So the domain is spot on on this thing and so the only concern might be the functions for which we can use some test points to help us out here. Like if I plug in let's say negative one into this expression just get negative one. That's this point. If I plug one into this expression I get one right here like so. If I plug one into this thing you're going to get two minus one which is one. Again that point they're touched no big deal. If you plug in two you'll get four minus one which is three that gives you this point right here. And then lastly if you plug in negative three into this one you'll get negative nine halves plus one half which is negative eight halves which is negative four. Which is this point right here. So you can see that all of these points seem to match up here. And so even if you have a little bit you're a little bit shaky on how to graph linear or quadratic functions. We can actually with very strong confidence suppose that B is the correct answer. Now of course if you are if you do not a graph a linear function you can see that that's exactly what these things are you can look at the slope. What have you but it's not actually necessary to rule this one out. B is in fact the correct response for question number six.