So, hi guys, I'm Krishanu here and a little bit of background of mine, I have been working as a mechanical engineer for 11 years, more than 11 years now and most of my work has been across in the medical industry, although I have worked in other sectors also quite a bit but majority of my work has been in the medical devices sector and in the amount of time I spent in the medical devices sector I spent a majority of it working on ventilators and that's that's why I'm here today just to take every one of you through through the basics of ventilator and understanding the nitty gritties of it and why it is a difficult very difficult engineering challenge to have right so so to begin with let's let's start from the agenda here on so so we are basically gonna look at the types of ventilators that are there in the market so this is gonna be a very broad perspective of ventilators we're not looking at ambulatory or transport ventilators here just just the kind of ventilators you would find in a regular hospital and after that we're gonna look at the ventilators that would be needed in the current COVID situation and and what are what are the problems that you you face and then how you could be treated for that right and then we'll take a deeper drive into the working of the ICU ventilators very we are gonna take you through how each module works and why is it needed and stuff like that and then we will go through the different mechanical ventilation modes in which you will have the kind of modes that a ventilator needs to run on and the kind of sensors that are needed for it and how an electronic control needs to be in to handle all these modes and most importantly last but not the least the lung trauma that is caused by ventilators so this is gonna be a very basic overview of the kind of damage a ventilator can do to the lungs and anybody who's even thinking of making a ventilator should have this as one of their you know most prior you know highest priority information and they need to be very wary of how a ventilator can damage lungs so going on from here so the if you go back in history ventilation started from something known as a mapleson circuit a lot of you guys find the Ambu bag or the Gamma bag everybody talks about right now and this mapleson circuit is nothing but a just an elaborate balloon with a couple of NRVs and you have a fresh gas inlet if you can see here so fresh gas is nothing but a combination of oxygen, air and a little bit of anesthetic agents if needed so this circuit is primarily used when a patient is you know fully in coma and cannot breathe at all or anesthesia induced coma is there so he cannot at all breathe so you they pump fresh gas in to ensure that the coma state is always there and the Ambu bag is expressed by the respiratory therapist or whom I was doing it and this is the state where a patient cannot breathe at all so from here the ventilators basically graduated to the anesthesia ventilators that you can see in the right side so so most of these anesthesia ventilators are a better version of the mapleson circuit and they basically are used to ventilate patients who are you know under anesthesia so as as the word says right that the anesthesia ventilators will use will be used on patients who are completely on in coma or undergoing surgery and they they have no breath of their own at all and they have all pressure monitoring volume monitoring and all the other essential monitoring systems that an OT needs to have and it ensures that the right percentage of anesthesia keeps going into the patient during surgery and the anesthetist home seller is there can sit on on the table that you can see there and have a look at all the parameters and keep the patient alive during during the surgery so that's that's basically the job of this ventilator it's it's to ensure that the patient is always you know in coma during the surgery and also to ensure that the patient is alive by checking all the vitals and with everything is fine or not right and the most advanced version of it the broad spectrum of the most advanced version of it is the right most you let you see they're called ICU ventilators and these ventilators are used on in your regular ICU where you see either a patient can breathe completely or they're there they basically give assist to breathe to a lot of patients so these these ventilators basically even detect and understand how a patient is breathing and try to mimic their breath and I try to ensure that a patient can be weaned out of a ventilator so basically a lot of patients would be in coma and they would take time to to first they will take ventilator support and slowly slowly slowly they have to be removed removed from the ventilator so the it's it's only this ICU ventilator that is capable of that kind of a functionality in ventilators so coming to the next topic what kind of ventilator is needed for this current COVID situation right so a lot of patients whom you see are tested for COVID positive and need ventilation nowadays COVID usually induces something called as ARDS which is acute respiratory distress syndrome and that can be mostly tackled with an ICU ventilator and the other the Mapleson circuit and anesthesia ventilators can only be used in case of these patients being sedated under anesthesia and you induce coma and then you give them that ventilator but however if you if you have to get them out which is a like which is the most amount of time so when you say date a patient and give them anesthesia ventilator or the Mapleson circuit after you get you take him out of sedation you have to slowly bring him to full consciousness and he should be able to breathe 100% on his own so so when this phasing out of the ventilator comes you need to always ensure that the ICU ventilator is the one that can do it because that will be the one that will be tracking and monitoring the breath and changing its mode as per as per what the patient needs so I think I pretty much covered the assisted ventilation here in my previous discussion over here and weaning patients of the ventilators is just what I'm saying so ICU ventilator is something that is needed to ensure that you can you know you can take patients off off of a ventilator after that the next very important requirement from patients for patients suffering from ARDS is a requirement of peep so peep stands for positive and expiratory pressure so this is the amount of pressure that is always kept inside the lung when you're doing when you're getting mechanical ventilation this is this is very important for ARDS patients so that the lung walls and the alveoli walls do not shut in on themselves and if they do it becomes very difficult to to reopen them because the lungs and the the lung walls and the alveoli walls also will have some percentage of edema some amount of edema and that edema is usually sticky and the moment both walls of the lung and the alveoli come together what happens is it is very difficult to reopen them again and you need a very high requirement of peep in case of ARDS subsequent slides will give you more of an understanding of the alveoli and why peep is needed especially for ARDS the next point over here is this ventilator ICU ventilator needs to have some amount of intelligence and some amount of sensing sensing the reaction of the patient and when a patient gives gives breathing effort right so whenever the patient gives breathing effort this day this ventilator should be able to sense it and also try to synchronize his breath with with the breaths given by the ventilator if you don't do that you you you induce a lot of other kind of problems in the lung majorly barotrauma and volutrauma that you're gonna again I'll explain this in one of the next slides so we need to be very very careful and these with these ventilators are are designed to be very sensitive to what patient is doing and only then they can respond and not only that this whole ventilation circuit that goes goes into a lung it needs to be completely leak proof that's that's why you see those who are those who need ventilation of this level usually they need something known as an invasive ventilation where they have an ET tube and they basically put a tube down your trachea and then and then there's a balloon that blows up close to your lung and what what that ensures is there's whatever amount of gas exchange is happening this gas exchange happens in a completely leak leakage freeway leakage is the enemy of any ventilator and it it always throws off calculations by by a long time by by really far and it causes a lot of damage in in the patient's lungs so we need to be very careful and there are a lot of standards to ensure that that whatever circuits that are there and the internal circuits that are there they are completely leak proof so that the ventilator sensors work in a very in a way that is reliable and then last but not the least this the particular standard for critical care ventilators is ISO 8061 dash 2 dash 12 and this is a particular standard for the ventilator and you need you need to follow this standard to get to get into to get Europe you marking a CE marking and even FD Clare certification also right now in the Indian market if you look at ventilators are not a regulated product and this standard right now is not needed to call out to make a ventilator but it is in the works and ventilators in India which will become regulated and if they put this standard as a minimum requirement then it would make a lot it would make ventilators a lot more complicated and it would need a lot more safety safety precautions to ensure that whatever ventilation happens happens safely so if you can see on the right top of the slide over here you can look at lung capacity and tidal volume inspirators volume expiratory residual volume so before we go on to our next slides just to give you a little background these these are terms that you will use you will see me or hear me use pretty regularly so the total lung capacity is pretty straightforward you know the total volume that a lung can carry during normal operation right and a part of that total lung capacity would be residual volume that will be when the lung completely collapses and completely excels there'll be some amount of volume of air still in the lungs so that is what is called as residual volume and then you have expiratory volume so from the residual volume to the amount of volume that you need to inside to keep hold of peep that you can see your positive end expiratory pressure is called the expiratory reserve volume and on top of it you have the inspiratory reserve volume where you say the amount of buffer of ventilation keeps ventilator keeps knowing that your knowing that your inspiratory reserve volume starts you know buffer that a ventilator keeps so basically then we go on to the tidal volume right so this is something that you listen to a lot of ventilator manufacturers and designers always talk about so tidal volume is the volume per breath that a ventilator can give to a patient and this tidal volume necessarily is never the complete lung capacity or it's not even the total lung capacity minus minus the residual volume this this is always less than the reserve lung capacity just to ensure and reduce the chances of volume trauma on the patient and the tidal volume is always prescribed by a respiratory therapist or a pulmonologist or whosoever is the expert in that field so let's get into one of the workings of the ventilator over here you can see the ventilator predominantly has two inlet lines one is air and another is oxygen and both of them get filtered before they enter the ventilator and both of them need to be hundred percent dry so the major this is the major requirement for any ICU ventilator and I think why it needs to be clean is very you know understandable to anyone but why they need to be dry is because any amount of humidity is gonna hamper the working of any of the electronic sensors that you see along the line and these sensors mind you need to be very very very very sensitive so the air and oxygen enters through the filter and knee they usually enter at a pressure pressure of 60 psi and they need to be dropped down to a pressure of around 50 to 60 centimeter of H2O now from 60 psi to 50 to 60 centimeter of H2O is less than one psi so it's a huge drop in pressure and from industrial standpoint from sensing standpoint sensing anything less than one psi is very difficult and getting very very accurate sensors is very very difficult in that range so the you can also see there would be an electronic pressure sensor before the regulation happens so that that basically connects to your to your micro to your microcontroller or your electronic circuits to ensure that if the pressure inlet pressure drops below a certain amount of limit it shuts down the ventilator and ventilator throws up an alarm that a there's no enough pressure not enough pressure in the line and you know we cannot ventilate the patient with the amount of pressure you're giving so once the pressure regulator brings it down to 50 to 60 centimeter of water usually there's no regulator that can accurately bring that can accurately bring down the pressure from 60 psi to 50 centimeter of H2O sub one psi in one stage so you usually have to two pressure regulators working in tandem so one of them brings it from 60 to 2 psi and another one brings it from two to sub one psi so the usually the later regulator is more expensive since those those pressure ratings are not seen in the market and you do not have enough demand and also they're bigger and clunkier and more difficult to manufacture there those regulators would be more expensive after that once you've regulated the pressure to a certain level you need to get into flow control where you've basically control the amount of flow that is going into into the patient so in both of these cases you need very high fidelity valves and these valves also can you know can control the flow in in millilitres per second in less than millilitres like or some of them will have very low resolutions like of 0.5 ml per second or something like that so when when you have such high resolutions that are needed for these valves these valves also can can get incredibly expensive and impossible to manufacture in in in many setups so they would need clean rooms and they would need very high finishing to be to get that kind of a fidelity after that you get a flow sensor a flow sensor here is nothing but to all mechanical engineers out there they would know it's just a venturi and it measures differential pressure it have got pressure sensors in two different places and it and it detects minute change in pressure and then based on Bernoulli's theorem it can calculate the amount of flow that is happening through the ventilator after that this comes into something known as a both oxygen and air comes comes into something known as a mixing block this mixing block is where the mixing of course happens between air and oxygen and there is some amount of challenges involved over here as well so this here basically the problem is the specific weight of ventilator of air and oxygen are very different and the specific gravity sorry the specific gravity of air and oxygen are very different and they do not want to mix that easily so when you put although you put air and oxygen it it doesn't form a homogeneous mixture it forms a heterogeneous mixture and the danger of this being that there may be times when the first I mean if you get if you give the patient 10 breaths maybe three of them would be 50 60% oxygen and three and remaining seven of them would be like very low less than oxygen so both cases are not good I think sending less less oxygen will ensure that the parent the patient you know I mean he doesn't get enough oxygen and he gasps and if you have more oxygen going to the patient that also leads to a lot of medical complications and they end up you know burning your trachea or the bronchi and they they cause a lot excess amount of oxygen also cause a lot of damage to the human body so once you have ensured that in the mixing block that both air and oxygen are mixed homogeneously you send it through a pressure oxygen cell and the oxygen cell is also known as an FiO2 cell and the FiO2 cell essentially measures the percentage of oxygen that is there and ensures that the flow control happens in such a way that the amount of oxygen that the that the doctor suggests is the amount of oxygen that's going to the patient so this is one and then the final piece is the emergency pressure relief so this is a mechanically set valve which is which has no you cannot set that valve this is preset by the manufacturer and left so this is there always to ensure that if there's any problem in in the whole ventilator and it's if any of the electronics fail there you should never have more pressure getting into the patient lung which would you know lead to a lot of lung damage and even death so this pressure relief always ensures that you know if there's a software as a bug or the electronics have malfunctioned any of the valves are malfunctioned that whatever it basically releases all the pressure and gives only what is acceptable to the patient and no surgeon or no doctor can can even get access to this valve on it's neither settable by them so from here it goes to the patient and when the patient inhales and then he exhales out these gases so when this when the gases get exhaled you come to the orange side so you have it comes to the exhalation valve and and from the exhalation valve this exhalation valve is majorly responsible for ensuring peep as what I told in your preview in the previous slide so this inch this exhalation valve allows how much ever pressure above the set peep to go out and the gas to go out but as soon as the peep is reached by the patient the pressure that is supposed to be there within the lungs this exhalation valve basically stops the breath and doesn't let the patient exhale fully and the flow sensor here musically measures the amount of air that goes out and the exhalation pressure sensor also measures the amount the pressure at which the patient is breathing out and based on that you can see there's some amount of small amount of air that is taken from the input airline and this is controlled with the right right valves to ensure that whatever peep is set by the doctor is executed on the patient so you would have a you'd have a diaphragm and you just have a diaphragm and one side of it you have patient pressure and another side of it you have the pressure given and set by the doctor so as soon as the lung can overcome the pressure set by the doctor this valve basically just leaks out and then also starts blocking once the pressure set by the doctor and the pressure and the patient lungs are same you basically stop the breath so after this we get on to the breathing modes here there we go so there are predominantly four modes here so you so you can see there is volume assist and control mode so in volume assist mode you you have a preset tidal volume and only that is what is an input taken from the doctor and other pressure curves and pressure in pressures are not controlled by the doctor the ventilator sets the pressure to ensure that at what respiratory rate if you can see that sir what what what I mean by respiratory rate is the number of breaths per minute and what breath for minute is maintained is maintained to give that amount of volume to the lungs of the patient and also complete the breath so it basically only controls the volume that goes into the patient and does not it just monitors the pressure and checks for safety against excessive pressure but it does not control the pressure at all the second mode here is called the pressure assist control mode so this is basically inverse of the volume assist control mode so what happens here is you basically control the pressure and only pressure is controlled here and volumes are not controlled here so as soon as the lung reaches some amount of pressure your you know the ventilator switches to an exhalation mode and let's let's the patient exhale the air so the next mode that we come across over here is called pressure support mode and pressure support mode is large is largely also done by ICU ventilators and also there are machines in the market called bipap or CPAP that can do this kind of ventilation so this basically just supports whatever breath you're doing that it basically only gives you some pressure that when a patient can breathe so this this basically just eases the method of breathing that he the patient doesn't need to do too much effort to have a breath last but not the least I think synchronized intermittent mandatory ventilation along with pressure support so that this is usually called SIMV along with PS in the medical fraternity and why this mode is very very important is this is the mode where the ICU ventilator basically synchronizes synchronizes with the breath of the patient and then it it lets the it it lets the patient breathe breathe and gives mandatory breaths to the patient as decided by the doctor so a doctor can basically say okay that I would give five mandatory breaths in a minute through the ventilator and the other breaths will be taken by the patient itself and the patient would be taking and this this mode over here will be basically monitoring all the breathing characteristics of the patient and synchronize the breath as given by the ventilator to the patient so in all of these ventilation modes let's let's get get into each of these in a little bit of detail over here the next slides so if you can see the first mode over here is controlled ventilation and this control ventilation can be both pressure control and volume control like I'd said in the last slide and this is something that you would seek very commonly in an anesthesia ventilator as well so you would see that in volume control mode you you would have a preset flow and the flow would keep increasing inside a ventilator till it reads reaches some amount of peak and then and then the flow direction basically reverses that flow starts dropping here and then the flow comes comes back to normal when the breath is completed and similarly if you look at the pressure here if you see volume control ventilation you can see that both the pressure curves are different so the pressure here is not monitored at all you can see the first pressure would read some amount beyond which the safety would cut it off and the next breath the same pressure is not reached but in volume control mode you can see that the volumes are always maintained and the tidal volume given to the patient is always always the same across two to three breaths and once one tidal volume is met it allows the patient to exhale out and again the tidal volume goes up and then again it allows the patient to exhale out in pressure control ventilation as well you can see the same thing happens but here you can see your pressure is always constant whatever the doctor has said but the volume keeps changing the tidal volume that goes into the patient keeps keeps changing and before I go on to the next slide I would just want to say that this these slides are you know pretty much into the medical medical domain and electronic domain and I'm not an expert in that domain so I have basically referred to Dr. Lokesh Tiwari here whom you can see on LinkedIn and taken these slides from one of his presentations and then we can get on to assist control ventilation so the problem with the control ventilation before I go on to the assist is is that it is only time driven you can see that you know here the breaths that are given that is just given to a particular time duration that is set by the doctors with the number of breath per minute so if the doctor is said set it to like 20 breaths per minute well the ventilator will give the patient 20 breaths per minute so this control ventilation is always used when the patient is completely sedated and or in coma and cannot breathe at all however when you come to the next stage of ventilation it is called assist control ventilation some anesthesia anesthesia ventilators have it but most I but it is this this this feature is mostly there for ICU ventilators and you can see here in assist control ventilation here the here the ventilator keeps monitoring the breathing mechanics of the lung and once it keeps monitoring the breathing and realizes that when a patient needs a breath and only gives a breath when the patient needs it so the doctor cannot you know set number of breath per minute or something like that here the patient will only be the ventilator will only you know respond to the effort of a patient so if you can see here on the assist control ventilation pressure you can see PT triggered so you basically have a trigger you have a breath trigger so the more amount the moment the sensor of the lungs in that that is sensing the pressure in the lungs detect that there's a drop in lung pressure beyond a certain limit which is maybe 25 percent of the P it basically decides that okay this is not the amount of breath that a patient needs to have and it starts giving a breath to the patient as against a time triggered one which basically doesn't take that any any input from the lungs so here also I would say that this this is not used regularly on a patient who is fully conscious this is used on a patient who's basically serrated or coma are in coma and or is trying to get out of coma so this this is used in this mode is used in those cases more often than not after that let's come on to pressure support ventilation so when you come to pressure support ventilation it is pretty evident that this if you can see the name itself says this is just support so this ensures that your patient is just breathing breathing normally and this just aids it so if you can see here on this pressure support ventilation slide slide you can see that whenever the patient exhales and then inhales this pressure support ventilation just enhances the amount of inhalation that a patient does and then the patient doesn't breathe even the pressure even the pressure support doesn't do any work and then patient exhales again and then when again he inhales he he he inhales a lot more than what what he would do normally with his own effort so this this happened this is used when a patient is not having enough energy or as long as not functioning enough to take in the amount of breath that is needed for him to complete breathing cycle and ensure that his body is oxygenated enough and although he can take breaths but the breaths is taking a lot of effort and he's not able to you know oxygenate his body enough so that is where this pressure support ventilation is is used and they are typically they are even given to homes these kind of machines they are called three paps and my paps as i told you earlier if you can go if you can see the first uh first image that i have over here i don't know if you can see it properly but if you can see here during during the pressure breaths given by the ventilator you can see small breaths being taken by the patients over here so here if you can see uh the patient is trying to take a breath but the ventilator is not helping and you can see a condition here where the ventilator is forced him to give a breath whereas the patient was trying to take a breath as well so these are conditions where you basically end up damaging a patient's lungs because either he's trying to breathe differently that leads to barotrauma and also it leads to a lot of distress in the muscles around around the lungs of the patient and because the patient is forced to breathe despite all efforts of the muscles around his lungs so this is where a need for synchronous ventilation comes in that when a patient is trying to breathe you only basically give a breath then and you do not give a breath otherwise that is what synchronous ventilation means and coming to the next slide you have something called as simv so synchronous intermediate mandatory ventilation so here you can see where a doctor can do a trade-off right with pressure support so when a patient is breathing you you just aid his breath with pressure support but during one of his breaths maybe whatever the patient says doctor says you know you need five breath a minute or eight breath a minute the ventilator synchronizes with the breath of the patient and gives a major breath with the help of the ventilator and then he and then the ventilator keeps quiet and keeps monitoring the breath of the patient again for the next couple of breaths and again it it goes only when a patient is trying to breathe so this mode doesn't come into you know picture otherwise this mode is also used with patients who have asthma and diseases like that where they have a lot of effort to breathe they have to give a lot of effort to breathe and they keep breathing and this ventilation just helps them with the effort so coming to the trauma caused by the ventilators on the lungs so you have first of all ARDS right so if you go back this is the same condition of the lungs that that is caused by even COVID and even a ventilator can introduce ARDS as well the next one is volume trauma if you can borrow sorry barrel trauma so if you can see the right two images the top and bottom images on the right you can see that if the alveoli over here is closed completely and you're you're just giving him too much pressure giving it too much pressure you would see that the bronchi of the lungs would would start breaking in different it would bulge and just pop out or it would just you know share out in this case and this this amount of damage on the bronchi would also would ensure that there'd be more edema in the lung because the body will try to repair this by giving it some blood and energy to heal quickly so that is what happens and on the left side over here you can see how an alveoli works basically so you can see air comes in and the alveoli is is the sac around here and then you can see impure blood coming in and as soon as the air comes in there is a osmosis happening here and the air basically goes sorry not osmosis diffusion diffusion happening here so air which has higher concentration of oxygen the oxygen gets into your blood cells impure blood cells and they get oxygenated and the impure blood cells let out CO2 which get into the alveoli and it's sent out to the during exhalation so it's it's it's in this alveoli where basically oxygen exchange happens and whenever you're maintaining you're giving mechanical ventilation it is of primal importance that this alveoli is always you know is all is is not damaged because these these cell walls are very thin and these walls that causes diffusion are very very thin there you can see and because of that if you give excessive pressure or excessive volume they would rupture within no time so coming to volume trauma over here volume trauma is something that that happens over here if you can see right so if you if you give this alveoli too much of volume so you basically it's like a balloon and it you give it too much volume it it expands it expands it expands after sometime it just pops open and this pretty much affects the membrane of the of the alveoli and also it gives a lot of stress to the lungs and the lungs have many alveoli and I think a few of them get I mean if not taken care all of them can get damaged with volume trauma and also there's atlect trauma which is if you if you let the alveoli wall stick like in this case and then you force it open multiple times even then this wall gets this wall gets damaged and that is where the requirement of peep comes into the picture that I discussed earlier and to ensure that that that doesn't happen you need to have some amount of peep and in ARDS the amount of peep is usually higher and you ensure that your alveoli walls do not you know collapse onto themselves completely like like what is shown in this image and they always have some amount of air inside them and lastly that the amount the ventilator can also cause pneumonia in patients and the primary response the primary thing that happens over here is because the internal circuits of the ventilator are out of you know patient or sterilization requirements you put filter in front of them to ensure that that circuit doesn't get infected or or germs don't live there but however no matter how many filters you put there are something that escapes and because of this it is very difficult to clean the inlet airway pressure but however the exhalation ports that deal with more patient output are can be sterilized separately that you know detachable and they can be sterilized separately but however in ventilator you have to be very very careful just to avoid cross infection I think that's that's it from my side if you if anyone has any questions you can ask before I guess we compile any questions from people okay to me this is like space tech right like literally too many complexities involved too many sensors and this is a complex setup that's out there and as you said that things can fail in any place and you have the safety wall at the end which just ensures in case of failure it just stops so like I see it's complex and how even to make one how long does it actually take to make one of these and how how much of money is usually does it cost so if you if you're looking at development of a ventilator it it'll easily go into years right if you're trying to start from scratch if you're if you're reverse engineering something or you have the design already it will take you less amount of time to make it but the cost involved will be very high you will you will have to source valves and you'll have to make valves and manifolds and the amount of you need to have proper industry machines and proper setup and also have good source of these valves because these valves are traditionally very difficult to make and they because primarily because of most of these valves are made by hand right so the most critical valves here are basically finished by hand and then sent out so even the companies that are manufacturing them have a manufacturing limit to the amount of valves they can make and then when they send it out to to the companies and then they need to assemble it properly in a manifold and have a very good clean room setup where these valves get manufactured and the setup cost and and the the manufacturing cost of these will be will be very high it it would go into crawls even you know if you're trying to develop this okay uh what do you think about this whole open source ventilators that people are trying to develop with right so most of alternative centers yeah so most of these open source ventilators if i come back here they would work on any one of these control ventilation kind of setup right and they can work very well if the patient is sedated completely or is in coma and you have to keep him alive and there is no lung function at all and you just keep him alive so you have either lung volume control or you have pressure control so most of these low cost ventilators would do would essentially stop in this mode over here and if if you want to go beyond anything beyond this mode like you know maybe an simv mode or a assist mode you would need like we are talking about pressure sensors over here that that uh that typically sense around one centimeter of h2o kind of pressure and in engineering we know right that if you're trying to measure something it needs to be one tenth its least count needs to be around one tenth to one fifth of what you're measuring otherwise what will happen is if your least count is more than one centimeter of water you would never get accurate and reliable values because your error is more than what you're trying to measure so you would never get good values so you need to get that those particular sensors with around 0.1 to 0.2 centimeter of water accuracy to be able to measure these kind of values and getting those sensors would be would would be tremendously cost expensive and also time consuming most importantly okay so some of these ventilators that people are trying to build will only be helpful in specific scenarios but COVID in itself may not be not no no in it it i would just say it would not help in ARDS okay in fact if not careful these ventilators will cause ARDS essentially damage to the lung yes yeah interesting uh i guess there are not many questions out there maybe we'll redirect people to the comments if anybody has questions post the event you can actually post in the comment section of the page and we will redirect them to Prashanu okay i guess we'll end it here it was a really interesting talk i i guess i'm not sure how many people in India are actually developing this but i do come across people trying to post images saying we're trying to do it like right so i i see a lot of efforts around the world even in India i see a lot i hear a lot of people even contacting me but i just want to say this right so if if you're planning to make a ventilator i will not discourage you it's you know the more manufacturers of ventilator the better it is for humanity but it is you need to be be into it in the net for the long you know it's it's not something that you can turn around in a couple of months yeah so i mean we have this startup space in Telangana called t-hub so there's some it's kind of a maker space i guess they have this hardware division called t works uh so there are a bunch of folks who were developing one and they developed a prototype i guess they're testing it with the doctors but so yeah i guess how do you test these i mean right so when you test one of these ventilators you need the first thing you need to do is you need to buy a lung simulator so any of the high-end like any of the ventilator manufacturers have a lung simulator and if i if i can get back to the slide right there's this iso standard over here right the iso standard calls for you to test it on that simulator and when you buy that simulator and test all your modes on that lung simulator and ensure that all lung compliances and all lung conditions are uh the ventilators behaving to is proper and acceptable only then you can sell this ventilator in the market right so without a lung simulator i uh even if you say a doctor is you know testing this untested ventilator on a patient it is basically unethical you should not be doing it uh i mean do we usually have lung simulators and like educational hospitals i don't think so because it's a very expensive uh piece of equipment most of them most people think test lungs are lung simulators but it's not uh a lung simulator is a machine that can easily cost upwards of 10 lakh rupees and then it's very difficult to maintain because you have to send it out every year to calibrate uh to the us or to whomsever is a manufacturer of the simulator and then it goes to them and then they calibrate it and then they send it back every year year on year and uh it's very expensive to keep and it's very expensive to maintain as well so that's that's that's how you've got to test a ventilator and it's very difficult like uh designing a ventilator can take you between you know a couple of years or three years and then you when you figure out the testing that will take another year or so okay quite time so i have one question from the audience he was like uh there are these new uh ventilators splitters like mask oh yeah yes yes where they're providing one ventilator for multiple patients uh how how does that work so same synchronized breathing so long and short short of it is in most cases it does not work right so let me let me be very clear here but however there are few cases under which they work so if i can come come down here uh if you go to volume control and pressure control in these cases also they will work provided one of these splitters have some kind of a valve which which controls the amount of volume that gets into difference see basically when you put two different patients you've got two different lung compliances and uh if you're trying to do synchronized intermittent breathe breath on them it is impossible because a ventilator would not know which lung is behaving in which way at which lung is trying to breathe so it will become very difficult to do simv on them uh pressure support is possible is one of few things that's possible pressure control is possible but pressure assist is not and volume assistant control is also out of the picture but pressure assistant pressure control is possible with the condition that both of these lungs have the same pressure and both and compliance and then whatever the splitter is can give two different volumes to the size of the lungs otherwise you will need to look for lungs that will need same tidal volumes and when it needs the same tidal volume if you if you have a like if you have 10-15 patients you will not even get a single patient who has a who need who needs the same amount of pressure and who needs the same amount of tidal volume it's statistically very low so they would not help you in any way so these are very few conditions where you can use these splitters okay so it's it will help provided you have have these kind of ventilators and where you're also you you are controlling the flows yeah which means me to the question like how train should a medical professional be to actually operate this right so respiratory therapy is a field of paramedical in itself you you need a BSE or MSC to do it and even the pulmonologist and all they have to do your mbbs and have to do your complete you know masters and other things to be trained enough to understand enough to be able to handle a ventilator so even nowadays in hospitals right the people those are nurses and all do not set a ventilators these doctors those who do they come and set it and then these ventilators I need to bring up one more point over here most of these ventilator handles patients for weeks and weeks and months even years we've always heard of patients who are there in the ICU for a year or two years or three years in coma and then you know the payoff family you know cannot pay for the ventilator anymore and stuff like that but this ventilator is supposed to be doing that so can you imagine the amount of reliability that a machine needs to have to ensure that you know in a year you can imagine this gives 20 breath in in one minute in one one and a half years how many breaths this machine gives and all these breaths should be reliable all the time even if one breath goes wrong it kills the patient right so that much amount of reliability needs to be built into these ventilators and that's that's what's very important for us over here it's it's it brings out that most of this is like a very complex problem both in terms from a health care perspective and even from a tech perspective whether it's mechanical engineering perspective rather i don't want to call it tech per se in terms of both mechanical and electrical so i would want to bring you know one more thing into consideration over here making the low-cost ventilators is not something new right if if people are thinking right now oh covid has come and we have to make low-cost ventilators no it's it's not something that is new engineers have been trying for tens of tens of years to try to make something low-cost and something more uh accessible but it's not possible many of the african countries few of them don't even have a single ventilator and they have dealt with pandemics like ebola and like for example nigeria nigeria has one ventilator right and it's it's people are trying to make it for a long long time now and this is where you hit a roadblock where you say oh okay this this is what the laws of physics allows me to do this is what laws of physics doesn't allow you to do you know it's you cannot go more than the speed of light right i mean that's that's what it is it's it's a physical boundary that you are fighting against over here okay on that note uh thank you so much krishanu for explaining these basics of how ventilators work i hope people understand what they are trying to do when they are attempting to build some of these and hope uh more than be more people also learn about this and more medical doctors are also trained on these and we'll end it here if you have any more questions please comment on our page and we will ensure that they reach krishanu and we'll see we can get it applied for you okay thank you thank you


Welcome back to Orlando, Florida, 2018-21 convention. This is the e-ticket for the entire show. I have to confess, I have been seeing the movie trailer for this speech for the last year. Matter of fact, it's been a little over a year. This speech had its origin probably about two, two and a half years ago.  I am terribly pleased to introduce the founder, CEO of 21 University, 21 Studios, and 21 Convention, presenting the future is still masculine, Anthony Dream Johnson. Thank you gentlemen, let's dig right into it. As he said, the title of my talk this year, sequel to last year's keynote, the future is still masculine. As he said, my name is Anthony Dream Johnson. Soon that will be legally true. My middle name currently is Paul. With that said, while I'm known as the dream, I have a dream. That dream is to create positive media for men and destroy feminism. Recapping on last year's keynote that was mentioned by Socrates and now myself, I opened last year's address with feminism as the ultimate hate and supremacist movement. That's the biggest image of the talk.  Super important and we'll dig more into this concept as we go throughout the talk. What I'm doing with that image, with that idea, with that speech, and with this speech is igniting a cultural revolution, a peaceful revolution, a revolution that destroys feminism and replaces it with something positive. So last year I spoke during the talk and it was actually joined between Socrates and myself. I spoke, he spoke. He's actually a professional architect. You guys know him as a speaker of this convention on relationships, relationship management, masculinity, things of that nature. But his day job is an architect, he's one of the best. He wins awards, he gets in magazines, he's a complete badass, surprise, right? That was his component and this is a big unveiling that we've been working on for years. We're hosting this convention right now in hotel. We've done that for many years. We've done it in schools, conference centers, things like that. But eventually the day will come, I think we are not allowed in venues like this. As of yet, we've been able to avoid that problem free. I maintain really strong relationships with venues, but I'm not counting on that. Many others have been deep platformed from Alex Jones to Rouge V and that's just the beginning. That's gonna get worse. So we're gonna avoid that as long as we can, but long term I am not counting on a digital or physical venue platform for this convention. We're fine now, but eventually we have to build it.  That is in motion and we'll dig more into that later in this talk. Continuing on a recap of last year's presentation, the future is masculine.  It spreads and spreads and spreads and it gets worse over time. Whatever it started as, there's controversy and debate for that. What we see today is obscene and disgusting and gross. It's horrible. It's a hate movement against men. And it's a premises movement for women. It has infected everything we see in Western life, everything we value, every institution. From the governments, we see from state, federal, local government, schools, universities, on and on down the line, right down to business and even the family in your home. It's all around us all the time. Even right down to churches, entertainment, schools, everything. Feminism as a woman's rights movement is a myth. I do not believe that's true. And if it was ever true, it hasn't been true in a long, long time. Long before any of us were alive at this point, especially in this room. Feminism today is hatred of men, boys, masculinity, family and fatherhood. It is absolutely opposed to that in every medium we see it. And it's getting more explicit, more open and more aggressive by the day. One of the most important points of slides from last year's presentation I brought into this one is the debate between being anti-feminist, opposing feminism, criticizing it, ridiculing it, making fun of it, opposing it, versus being all about positive masculinity and pro-masculinity. My ideas that both are very, very important, perhaps equally important, dead on, I think either one is naive. They are either ignoring an aggressive movement against men or you're focusing entirely on yourself without opposing it or without realizing, without appreciating the environment and culture and context that you exist in. So even if you're all about self-improvement, you want nothing to do with opposing feminism, well, feminists don't care.  And they don't care what you look like. Feminists do not discriminate.  That's your crime for being born that way. Outside of that, they don't care what you look like.   So both are important, and this is really important to keep in mind. For many years of this convention, I did not focus enough, not nearly enough, on being opposed to feminism and appreciating the environment that this company that it was evolving in, as well as myself, maturing over time. The older I get, the more apparent this gets and the more aggressive it gets. As we've seen in the culture, we're gonna discuss in this presentation. So both elements are important and the complementary. They work together very well. You guys have seen that at this event. Let's discuss what feminism is a little bit. So when people bring up feminism, one of the first things they say, it's all about equality, right? Equality, equality, equality. It's very vague, very poorly defined, very, feminists are almost opposed to defining it. We try to define it, they want it, they say no. They keep this vague and nebulous momentum going forward. But if it's about equality, they then jump right to equal rights. What's different? Equality is not equal rights. Equal rights is more specific. So if feminism isn't about equality, equal rights, what about women's rights? They jump to that. Then they jump to women's empowerment. Suddenly you have this feminism is all about equality and then it jumps into 47 different things all at once. The silvery slope. They do that so they can goal post shift over time. They can keep it mutating and shifting over time so that you can't pin it down and be precise. In fact, I think Roland Tomasi is one of my favorite speakers here and I think one of the most important contributions he makes to the manosphere and the red pill is his precision, it's surgical.  His precision is needed. Now that doesn't mean short form content's bad, it means both are important. And the way he writes out his essays, it gets really detailed is very important.  So feminism has never been about equality. We'll discuss that more later. But I think it's quadrant of ideas. They tend to jump between. It's important to keep this in mind and look at this whenever they bitch to complain about something. It's always shifting, it's always moving around. It's never this tightly defined thing. And that's on purpose. Feminists say that women getting the vote was this major victory for equality. I think it's not, I think it was not at all. I think it was the death of equality in this country. It was the death of equality between rights and responsibilities. Women getting the vote was not the problem. It's women getting the vote in the way they did, the manner they did, that's the problem. There are many thousands of feminists that were opposed to getting the vote because they thought they're gonna get drafted into the military, what we call today a selective service. They dodged that, they got out of that. I think this death of equality between rights and responsibilities is horrible. Obviously, there are racial elements that were fixed later in this country, but in terms of men and women, this is when equality died, 1920. It's horrible. We need to fix this someday. I'm not proposing a solution at this time. I'm pointing out a problem. Let's dive a little bit into the manosphere understanding of feminism.  I think it's more along the lines of what we see in the manosphere.   So they're flipping, it's a power reversal. In some ways, revenge and supremacism and hatred of men. I also wanna make a point that very few women today identify in the West as feminist. Maybe 20, 30% from different studies I've seen. As big of a problem as they are and as annoying as they can be, they're not really the problem.  The mainstream, the other 80% of the population don't identify as that.  That's what we're concerned with. For them, for women and for men. For men, we call blue pill lies. I think these are feminist lies, the blue pill. This is a control system for men and it fucks men up, it gets men killed. We've talked about that at this conference. So with women today in the West, I think feminism has become basically their religion, their philosophy for life. It's no longer a, whether or not they have a particular religion they follow, Christianity, Judaism or whatever. Feminism dominates the majority of how they operate over time in their life in major ways, decisions, choices. From becoming a mother to schooling to career, things of that nature. Feminism is the dominant force and how they think, how they act over time. It's replaced God, it's replaced patriotism, everything like that. Every other important pillar of life for them. And the infection rate is incredibly high.  They've been brainwashed more or less, like many men. The difference of course is that men have a positive counter movement. We have the manosphere, we have the pickup community, we have the red pill and more. Women don't have that. They have feminism and then nothing. That's a problem. Let's talk a little bit more about feminism versus masculinity. Right now in America, the political tensions are really high. In my lifetime, I'm only 30, but I've never seen anything like what we see today. I've talked to men of the 50s and the 60s to say that you did the same thing. They have never seen things this tense in this country, not even close.  And the ways displayed or portrayed by the mainstream is left versus right, Democrats versus Republicans, liberals versus conservatives. I think that's all nonsense. I think that male-female relationships are the cornerstone bedrock of human life, not just for thousands of years for the entire span of our species. The red pill in particular focuses in on that, hones in on it as truth, the very raw understanding of it. So male-female relationships proceed language and fire. And I think that getting screwed up by feminism is in large part over the past 100 years is why we're seeing tensions rise so high in politics, left versus right, and the philosophies and groups, the parties of each one. That's not a problem as much as it is a symptom.  I mean, think about it this way. We've talked about Black Dragon, other speaker of this conference, Caleb Jones and Socrates. They talked about the sexual marketplace, the dating marketplace and other speakers. Gender relations today have basically collapsed. What are the rules of dating? Nobody knows. It's a complete chaos at this point. You can read about it all day long, study it, try to appreciate, study the laws, you know, understand game, the red pill.   Feminism has driven that in large part. So I think what we're seeing today with the tensions, left versus right, Democrats, Republicans, liberals, conservatives, that's real, but again, it's more of a symptom than a direct problem. The war we're seeing play out before our eyes is toxic femininity versus positive masculinity. And it's my belief that the future of America and Western civilization hinges on destroying feminism. America will not survive this century in the West without feminism ending. One way or another, all these different mechanisms, birth rates, demographics, family formation, the institution of marriage itself, these things are going to die. They're not going to last if feminism lives as a movement and is a dominant force in the culture. I'd ask to end and be minimized and put in the history books. I wanted to go through this a little here too, get more specific with masculinity and feminism. So this isn't going to get really specific and we're going to hammer through it and I think you guys are going to get it pretty quick. So team masculinity versus team feminism. Team masculinity, we have individual rights versus women's rights, right? Group rights. We have the quality of opportunity versus the quality of outcome. We have patriotism versus globalism. We have the rule of law versus the rule of women. I think displayed perfectly in the recent confirmation of the Supreme Court Justice Brett Kavanaugh. We have innocent to proven guilty versus guilty until proven innocent. We have believed evidence versus believed women. Personal responsibility for all evade all responsibility. Men and women are different.  So we have men and women are different versus female supremacism, which we're going to focus on in just a minute. We have a love of women. By the way, an attendee here nailed that. Just, I believe it was yesterday. During a Q and A session with one of the speakers, he came up and said, I don't think he was 99% right, almost 100%. He said, I love women, but I hate feminism with a passion. I want to one up that.  It's not a but, it's an end.  It is disgusting, nasty, and it destroys women. It destroys families and it hurts men. It drives men to suicide, left and right. With masculinity, we have an objective consent standard. No means no. I grew up in the nineties, that's what I heard. That made a lot of sense. It's very obvious and that worked really well for a long time. With team feminism, we have subjective consent standards, which we now see as enthusiastic consent.   Objective standards matter for the rule of law and that is exactly what feminism hates and what they don't want. Team masculinity is pro-family. Team feminism is anti-family and pro-broken family. Look at the statistics on single motherhood from anyone whether it's Roland Tomasi writing an essay or Ann Coulter or anyone else. Single motherhood and broken families are horrible for the United States and every Western nation, any nation for that matter. Team masculinity is pro-fatherhood, pro-motherhood. Team feminism is anti-fatherhood, anti-motherhood. Unless it's single motherhood, apparently. Team masculinity is pro-West and light-man values, the country or the values that built the United States and all the West. Team feminism is anti-Western values. Team masculinity, teamwork and cooperation versus divide and conquer, identity politics, getting everyone amped up. Team masculinity, racism is evil. Team feminism, white men are evil. Team masculinity, boys will be boys.  Rational patriarchy, radical matriarchy. Father knows best, kill all the men. Sarah Jiang is her name, New York Times editorial board said this on our Twitter account before being hired by the New York Times and they were fully aware of it when they hired her.  This is sick. This is extreme racism, kill all white people and extreme sexism and this is becoming normal. This is no, 20 years ago this had been radical. Today, that's mainstream.  They're fully aware of this, they don't care. They probably could ask her if she had any friends who wanted to work there. Team masculinity, genocide is evil and crazy. Team feminism, reduced men to 10% of the population. There's an asterisk there, you can read that. The founder of gender studies in 1973, woman, her name's Sarah I believe. In 1973 she gave a lecture advocating to reduce men to 10% of the population.   She actually said this, there's documentation of this. Reduce men to 10% of the population.   This is the true face of feminism. We have Kathy Griffin up here chopping the head off of President Trump by the way a father and grandfather.   Normalize violence against men.  Even better, you'll never see Anderson Cooper chop off Sarah Palin's head. This level of violence, decapitating somebody is normalized violence against men. You'll never see it in reverse regardless of political parties. You have Madonna up here, right?   This is a meme we have made up by Buddy of Mine believe in something even if it means sacrificing everyone. This is the face, I know right? This is the face of feminism. This is what it's become.  This is getting really extreme really fast. It gets worse. There's Sarah Jung from the New York Times, like I said earlier. This is her tweet from 2015. Anyway, as my point is that we should kill all the men prior to removing the state for marriage and institution.  She got hired, she should be permanently unemployable for saying this.  It probably is one of the reasons she got the job.   Christine Fair, professor at the University of Georgetown, the oldest Catholic university in the United States. Look at, she just tweeted this. She did get banned eventually from Twitter. I was surprised, right? Look at the course of entitled white men justifying a serial rapist, irrigated entitlement. All of them deserve miserable deaths while feminists laugh as they take their last gas. Bonus, we castrate their corpses and feed them to the swine, pigs. This woman has a verified account, tens of thousands of followers.   This is sick. This is torture and violence. Open, right out in the open. And then you have a Scotzi or Cortezov here. A thousand cocks there, crazed bug eyes.  And then this, this is a Mormon Christian, mother of six, comes out recently. This got over 80,000 retweets, more retweets than a sitting US president gets on an average tweet. She's advocating for castration of all men for I quote, irresponsible ejaculations, knocking a girl up, an accident. She then advocates for forced sterilizations, vasectomies for all boys who have puberty. This is a mother of six, a Christian woman.  And New York Times bestselling author, openly advocating for castration as punishment.  And then forced sterilization of all men when they puberty. This is no longer out, this is extreme, but it's no longer unusual. This is becoming normal. This gets retweeted 80,000 times. I think I just saw it today. It's got over 250,000 likes on Twitter.  This is the new normal for feminism, 2018. Where do you think it'll be in 2028, 2038? Where do you think this goes? You'll say, oh, this didn't ever happen. They're pushing for it. They're talking about it. Talk leads to action. Talk precedes action. More on justice, Brad Kavanaugh. I mean, this guy, you know, Boy Scout, as far as we can tell, lived a perfect Christian Catholic life. Mr. Clean impeccable character. One through seven FBI background checks. Absolute witch hunt for this guy. Exactly like Justice Clarence Thomas in 1991. He was a black man in 1991 who was accused of very similar circumstances by Anita Hill. He got up in 1991 being confirmed to the Supreme Court. He said it was a digital lynching. It was. And now it continues. Now it doesn't even matter where your skin color is.  It's a witch hunt. Me too is a witch hunt and it's a hatred. It's a little witch hunt is against men. It's the best way to put it.   This is a witch hunt.   Like these are gang rape.  But hey, we got them. Actually, let's pause here. He was just confirmed to the Supreme Court. Great. He was confirmed 50 to 48.  That was upheld. The presumption of innocence was innocent or proven guilty. Was upheld by a razor-thin margin by vote. That's where this country's at politically. That's what feminism has done to men and women in gender relations, as you see expressed in politics. Barely got it. Just scraped by. Shifting gears a little bit. I believe that speech is the most dangerous thing in the world. There's a reason that the United States, on our constitution, it's a First Amendment, not the Second. This is a drawing from the 1848 Seneca Falls Convention for Women. About 300 women got together in 1848, and it led to the feminism we see today, regardless of what happened along the way. People meeting, anyone, male or female, is powerful. People talking is powerful, because talking leads to action. Here's another convention that we're familiar with. This is a drawing or a painting from the signing of the Declaration of Independence. People don't like this convention market. They say, what are you gonna do?  No. I'm gonna build events. I'm gonna organize. We're gonna talk. Rollo was talking about his speech. He did a great job with it. Women hate men getting together and talking in a male space. Because you know what happens? Action happens. Things happen. Things change. Very much like it did for them in 1848. We're barely 100 people behind what they had in 1848. As this convention grows, it's gonna be attacked more so than it already is. The point here though is that speech is very, very powerful. Talking, talking, talking, no. It leads to action.  One of the most epic moments in human history. Masculinity at the forefront, defeating tyranny, defeating a king, found in the greatest country ever created. It's a masculine future is what we're creating this convention. The West lacks right now a replacement for feminism. And we need to destroy it while it has to be replaced with something. If we just destroy it and get rid of it, that doesn't solve anything. That just creates a gap. It creates a vacuum and ain't gonna last. It will be replaced by something. I believe that the manosphere, the red pill in this convention are building that future. It's taking time. It takes years. It takes speeches. It takes conventions. It takes videos. The publication of that information. But over time, that's exactly what's being built right here on the stage, right here in Orlando, Florida. I do wanna take a moment here and recognize Richard Nicolai, one of our alumni speakers from last year and a couple years previous as well. The effects of feminism.  Now I say American in particular, but not just Western. Because women in America enjoy a level of wealth and prosperity and physical security through the military that women have never seen in history. And I think we see that expressed on social media platforms today. You see a never an extreme of narcissism.   More on feminism today. Like we discussed, feminism is the ultimate hate supremacist movement. It's a hate movement against 3.8 billion men. It's a supremacist movement for women. No other movement in history has gotten, has scaled to that level. Usually it's racial or religious or political or geographic or something. This is gender, this is sex. I know we hear there's 97 genders, I don't think so, I was going to, of course. But feminism as morph has mutated and morphed and shaped it into that. That's sick. Hating the opposite sex. They always of course say, they'll claim anybody in the hemisphere that has any controversial ideas.  No, I don't.    Very few men in the hemisphere, just as like normal discourse, they don't lash out at women instantaneously and say, you must hate men. Maybe you should. But most men don't do that. This is a distinctly feminist thing that they do. This is a distinctly feminist projection. And they even, we'll get into it more in a second, but it's supremacism. They march in the streets now. The future is female. I say the future is masculine for a reason. I don't say the future is men. I don't say the future is male. I say the future is masculine. Masculinity is a set of characteristics that guide and lead. It revolves around one half of the population, sure. But it's inclusive. We love women. Women love masculinity too. Most of them. Going more into it. Feminism is a toxic culture where men, masculinity, boys, fathers, and family. Toxic masculinity, of course, as Rola pointed out, quickly became all masculinity is toxic. That narrative of toxic masculinity lasted for what a year or two. Now all masculinity is toxic.  A little bit, a lot of it, all of it.  They are seen as, it's like feminism is driving women off a cliff.  Crazy. It's a rebellion against nature. It's a rebellion against fact that men and women are different. They hate this fact. I think this is one of the cornerstones of what feminists hate and what they're war with.  Whether you go that far, I don't think it's important. This is a fact. Men and women are different. Our difference is polarizes and they make us get along and cooperate and be compatible. They make the, I mean they make, for example, sex and make it beautiful. We're attracted to things that we don't have. Very few men wake up and say, oh, I want a strong independent woman in my life. Why would we want that? We bring strength at the table. They want strength. They're attracted, of course, to strong, confident men. Not to the way around. I gotta drink some feminist tears, hang on. It's a rebellion against nature. I believe feminists and feminism in particular is a toxic ideology independent of the individuals involved. It's a hatred of nature and of masculinity. We're the placeholders of that. We're like in the moment that. So that's why they hate men as well. But really it's against nature and it's against masculinity and even themselves. I think it's the disease of civilization. Psychologically equivalent to something like heart disease, diabetes, obesity, things that we see exploding today because of the way people choose to live. Feminism is a philosophy. It's a core set of beliefs that is infected the West but it's psychological instead of physical. At the end of the day though, it's very similar. A disease of civilization. Feminism is extreme and radicalizing a young woman.  You see Christian mothers of six talking about open castration or castration of men for irresponsible ejaculations.  Left and right. It's getting worse every day, every month, every year. 10 years ago it wasn't really as bad when I started this company 12 years ago. Now it's just out of control. I also believe, we'll talk more about this soon, that we've lost a generation of women, millennial women. Not all of them, but a lot of them, many of them. That's the first time that's happened. You've seen feminism, you've seen that with men as well and I think we've responded more positively. Feminism has compounded for the first time across multiple generations. Men have responded with the suction community which spawned into the man's sphere, the red pill and so on. Women don't have that.  Most of them will not self-repair in my opinion. Men are, we are responding positively in a healthy manner with the man's sphere itself, especially the red pill and my personal judgment. But I have plenty of love for the pickup community as well where I got my start, many of you as well. I believe that we're nearing total collapse of gender relations in this country. It's severely dysfunctional and the future of America is uncertain at this point because of this fact. For more information on feminism and how toxic to become at this scale, you can see our speakers like Roland Tomasi and Socrates as well as Stefan Molyneux and Black Pigeon Speaks on YouTube. Both big YouTube channels with great videos on feminism, criticizing it in very rational, slowly constructed ways that are easy to understand. It's a lot of information. Highly recommend looking those up in addition to our speakers. Stefan Molyneux with feminism and Black Pigeon Speaks with feminism as well. Let's talk about this. Let's talk about pink pussy hats, right? So we see women now marching in the streets by the millions, or around the world, yeah, by the millions, but in America especially, right? They put on these pink pussy hats and they march around saying the future is female. The future is still female.  Heads would explode. But you change the color hat to pink and you change white to female. Oh, you're so brave.  That's disgusting.  That has become normalized for American women today.      Sicker than this.  But fucking, this is right now, man. This is gone. So pink KKK. So you'll see me on Twitter if you guys follow me at Beach Muscles. Oh, the triggering name, right? If I don't dream I have beach muscles. This is what, this is right now, all the time. The pink KKK. That's what feminisms become.  Feminism destroys women. As I discussed, we've lost a generation of women, in my opinion. These women will fail to successfully pair bond. They will fail a family formation. I would estimate maybe 10% are intact and avoided the worst of feminism. Another 10 to 20% will self-repair somehow. That's time-sensitive. Women are on a tight biological reproductive timeline. Men are not. The other 80% are varying degrees of severely damaged and brainwashed by feminism. I don't believe they're gonna make it out. You can be more optimistic than me about that. I'm not.  Gen Z is next. Gen X is not quite as bad, in my opinion. So feminism took down an entire generation of women and nearly the men, too. No positive counter-movement exists right now for women. To my knowledge, there's nothing. And that's a shame. We're gonna talk about this image here. So this was some blogger, a female blogger on the internet, right? The transform wife. This went viral a few months ago. She put out an image of a young woman smiling and said that men preferred debt-free virgins without tattoos. This today, whether or not you like tattoos on girls is irrelevant, right? Debt-free virgins that don't have a PhD in gender studies or some bullshit without tattoos, this is rebellion today.  This is the rebel today. I think we need a positive counter-movement. We need something positive for women. Destroying feminism is the key to doing that. But in the meantime, we need something along with it as well. We need to make women great again. Now, I'll say this too. I'll say this too. Regardless of how you voted in 2016, I don't actually care that much. Because with this stuff and with this, you need to take all politics and policy stuff, put it to the side. This is about gender relations, this is about men, this is about women, this is about femininity and masculinity. This is a good starting point. This should not be a rebel. This should be like fairly normal.  So let's make women great again. Shifting gears a little bit, back to 21studios update. Last year, Socrates and I unveiled the plans to construct 21studios, right here in Orlando, Florida, Central Florida. That's going to be a multimillion dollar production facility, very similar to this that enables year-round filming and year-round events. Not once a year or twice a year or three times a year. Every month, maybe more. We are cleaning up the legal framework of the company to take on major investors at this time. That's gotten significant progress and Socrates and I have been talking a lot more about doing this or progressing along this path. In 2019 and 2020, I believe we're gonna start getting that funding in place. And we're moving along in that direction. It's gonna take time though. This will not be built next year, not in 2020. It will be in the 2020s. So progress has been made in removing the right positive direction on that. In particular, I wanted to go over this. This is something that Roland encouraged me to include in this talk very, very much. I'm glad he did. 21studios is so basically, you know, we're bashing feminism, looking at a lot of the negatives. The future is uncertain at best in a lot of ways. Like where is this country gonna be a year from now? I don't think anybody knows with complete certainty. Nevertheless, the Manisphere is at some major positive developments over the past year. In particular, my company, 21studios, we've seen revenue jump over 250% approximately. This is part of it. We've seen from 2017 to 2018, 250% revenue growth. This event itself physically has doubled.  For a 12 year old company, this kind of growth is astounding. Our subscribers on YouTube and all social media, but particularly YouTube, we gained 63,000, lost like 14,000 or whatever. So we've gained over 50,000 subscribers in one year. Not bad. Richard Cooper and I are racing for 200,000. I think I'm gonna win. Yeah. Where's he at? Over there. But he might beat me. He's doing really good to him.  We could be deleted any day. Just like that. I don't think we will. We've been fine for 11 years now. Zero problems on YouTube, but we'll see. In particular as well though, the Redman Group. So in my talk last year, I advocated for in the Manisphere and particularly the Red Pill, more media, more podcasts, more blogs, more books, everything like that they could produce, right? Rola got together with me and Richard Cooper. We started the Redman Group. This has been beyond my wildest expectations.  So this exceeded what I had in mind. And there's other stuff too. It's not just the Redman Group. Lots of podcasts, events, Hunter Drew is a really good example too. Lots of positive developments, growth in the Manisphere and the Red Pill. This is in large part how we win the culture war over time. We have to drown feminism and content, positive ideas and positive media. For men in particular, women follow men lead. We keep making men stronger, more powerful, more healthy, more game aware, more Red Pill aware. We can win this war. It's gonna take time. That Seneca Falls Convention was in 1848. Women got the vote in 1920. Whatever shitty elements went along with that in the manner they did it, took a long time. Is it gonna take us this long to win the war of feminism? I don't believe so, but it'll take a long time. Media and content and ideas and overproducing that stuff as much as we can, as fast as we can and high quality as we can is in large part how we do that. And the Redman Group is a fantastic example of that. That seriously exceeded my expectations.  And kudos to Rollover thinking that showed up. Where's he over there?  Some content with feminism in particular or anti-feminism. These are the two books I found. This one, The Rolo, the other one, maybe two. Broken, The Rise of Radical Feminism. This is a great book. Very short, we have it on sale outside after this talk. You also get on Amazon for like 10 bucks. Really good book, very short, very powerful. Also, The Feminist Lie is another one as well. Right here. Highly recommend checking this book out. Educating yourself on feminism, building the knowledge up. So a lot of people say, a lot of men in the monastery, they say that feminism is one. We're fucked. There's no way out. Let it all collapse.  I don't believe we need to do that. I don't think you're never beaten until you admit it. The fact that we're here speaking on the stage, organizing by the hundreds, we're collecting millions of views across the internet. 20 of the studios does, we do anywhere from one to two million views a month. We'll do over 10 million views a year easily all the content. So reaching millions of men. The fact that we're doing that, we're having this event, that we're still free to do that, speak freely and defend our rights. It's a very good sign. We are not beaten. We can win this. It's gonna take time. It'll take years and decades to undo the damage that feminism has done. But it can be done and we can't win. The buck has to stop here.  There's something really screwy going on. But regardless, feminism has existed until now. It's worse it's ever been. It has to stop. If it's not us, it's the next generation. I don't have kids yet. I don't have any sons or daughters. I do not want to see this continue and perpetuate itself in the future. Socrates said that feminism belongs in history books. I believe that as well. We have to destroy it, get rid of it. The buck has to stop here.  Enough has been dumped on future generations.  That's a stop. In particular, I believe that the key to destroying feminism of a few probably the most important is the red pill. Men's rights activists have been fiercely opposed to feminism for a long time, right? They criticize it. They're trying to improve rights for men. All these things, right? They have consistently failed to do that really harshly. I sympathize with the issues 100%. But their effectiveness is near zero. Why is that? I believe it's because they don't understand women. Now, feminism includes beta-vishi males as well.  But mostly it's women. Men's rights activists have fundamentally, they're knee-capped. They don't have the teeth to take on feminism in ways that matter over time. So they consistently get very little to nothing done. The red pill is understanding women. Men's rights activists routinely reject that. And until they accept it, they will not take on feminism and win. They will keep failing. As hard as much as their cause is legit, it doesn't matter. I also believe this is why the red pill is such a threat. The red pill recently on Reddit, the community of men about almost 300,000, it was quarantined, basically censored on the road to being banned. I believe that's because the red pill is very dangerous. Men are being educated on a conscious level to understand women. Feminists do not want this in particular.  The red pill is the antithesis to that. Much more so than the pickup community ever was, much more so than men's rights activists in that community they've ever been. And we say too, that I agree, that the red pill is prexology. It's the car manual to fix your car, not why you should maintain it, not what you should buy, not why you should drive it and enjoy it, to how to fix it. That is what the red pill is as a concept. But it's also a community and I don't hear that talked about enough. Whether or not it was intended, the red pill is almost 300,000 men strong, plus all the auxiliary stuff rounded like 20-minute studios and other YouTube channels and movements and causes and blogs. It's a couple hundred thousand men easily. Unintentionals that may have been, that is a political entity. That is men organizing and talking and swapping notes as we call it and thinking about their interests, thinking about their futures, short-term, long-term, all the way through. That is dangerous. They recognize that and they want to shut it down. They may or may not end up banning it. I think it's on the road to being banned. There's a reason for that. It's very, very dangerous. And a very healthy way for us.  Some MRAs have failed. Milano's also are the hero generation, in my opinion, from what I've read on this.  Well, hey, you know what?  Let's also look, though, for a second at what MRAs have done. They're consistently doing things that on a micro level repel women, right? They compromise the appease, they're trying to negotiate. Desire, of course, between men and women cannot be negotiated. These are all strategies that fail at a micro and macro level with women. MRAs do this consistently and they keep failing. Red pill, of course, does not. I think to destroy feminism, of course, first of all, no surrender, ever. We need to stop apologizing for a masculinity.  No compromise, no negotiation, no appeasement, no mercy. That does not mean anything violent. This is a peaceful, lawful, culture revolution that I want to ignite. Nevertheless, this is what it's gonna take. It's gonna take red pill-style masculinity, old-school masculinity, positive masculinity. That means aggression, that means anger, that means power.    Second of all, well, it was born. Second of all, angry?  I'm watching my country being stolen from me. Not just America, Canada, the West, all of it. You think I'm gonna take my country and my future?  Angry?  You should be too.  What has done to this country? What has done to men? What has done to women? What has done to gender relations? It's destroyed dating and it's nearly destroyed relationships in family and marriage.  And be angry. You're angry in anger, there is truth and there's power. Do not apologize for it. In 2019, the war on feminism goes global. We're going back to Europe, like this image. We're going back to Europe. Feminities have overrun Europe. Per usual, the Americans and Canadians are coming. We're a bit late, it happens. We'll come, yeah, we'll come. Better late than never, right? Feminism is, of course, infected in Europe as well. We'll be going to Poland, Eastern Europe, Central Europe. We used to go to Sweden and London back in the day. We've had the Swiss, it'll be our fourth European event coming up in 2019 in the spring. Sweden, of course, this point is impossible. They proclaimed that they were the first feminist government in the world. Zero chance of going back there. London, the United Kingdom is now banning speakers, public speakers like Roush V. He's not a speaker of this event, but he could be. If we had an event there and invited him, he literally could not go. If I try to put on an event there, we could have half a dozen speakers and it would be banned from entering the country.  So we cannot even have a third UK convention for the 21 convention. So we have to go elsewhere, we'll be going to Poland. We'll also be doing an event, of course, in Orlando again, right here, not this venue, but down the road. And beyond that, we'll keep expanding. More events, more content, more videos, more speakers. So the war on feminism goes global. The culture war. Even considering it though being a peaceful culture war, you have to remember that a culture war is a war. How do we know that? A gender war, even. How do we know that a gender war and a culture war is a war? Well, it's in the name. Whether it's peaceful or violent, it needs to be peaceful. Regardless, a war is a war.  We need to fight back, we need to defend ourselves. With that said, the future is still masculine, the future is masculine, and it will become hell or high water. That depends on me, that depends on you, that depends on you, that depends on our speakers, that depends on all of us. If we don't do it, it's dumped on kids in the next generation or even less prepared to deal with it than we are. That's my speech, thank you very much. Appreciate it, Tom. I do have one more thing. I do have one more comment. So this is Roller's third book, Positive Masculinity, the Rational Mail. With fighting feminism, you guys need to really amp it up. He has a fourth book coming out. A lot of you are probably gonna buy it. That's fantastic. When this fourth book comes out of his series, you don't buy one, you buy 10. If you can, you buy 50.  It's very bitter candy, a little sour, but it's good for you. It's good for your friends too. Socrates has a book coming out. When that book comes out, you don't buy one, you buy 10, you buy 50. You seriously pass them out to your friends at your house who you think would benefit from it. Feminism is like Roller talked about infected and invaded churches. Well, if you go to church and you have a few in your pocket, maybe they fall out on the way out. Accidents happen, you know? That should happen to all the time. So be aggressive with the media, with buying books and distributing them. If you have the funds to do it, become as powerful as you can in your life.  Not me, not this event.   They are opposed to it and they're threatened by it. They should be. Becoming more powerful, more healthy, more wealthy, more game aware enables you to protect yourself, protect your loved ones, and exert force out on the culture. Whether it's through political campaigns, politicians, contributions, or just buying something like a bunch of books and passing them out to your friends. I've bought over 200 copies of his books since I've known him. And I think I've sold thousands at this point. Who knows how many more thousands will be on that? And many other speakers as well. I don't expect you to sell thousands, but if you can buy 30, 40 of these books, pass them out to your friends all day long. Never mind the fact that these are published on Amazon. Roush just got banned.  Don't risk that. These are hard to print. These are self-published. Buy as many of these as you can because you can't ban them without burning them. With that said, that's my speech. I'll take questions off camera for you guys. Tonight, now, tonight, all night at the party in Socrates, all day tomorrow, and Monday if you're there as well. For everyone else, I'll answer questions maybe in the comments if they're polite on YouTube and 21U. 21U, there will be. YouTube, probably not.  All right, let's give it up for Anthony. Dream Johnson.


What's going on everybody? My name is Alex Feebrandt and today we're going to be talking about aliasing. Now all aliasing really is is temporarily changing the colon name or the tail name in your script and it's not really going to impact your output at all. Aliasing is really used for the readability of your script so that if you hand this off to somebody or somebody comes behind you and starts working on this, they can more easily understand it and it may not sound super useful, especially for small scripts like what we have on the screen. But when you start getting to larger scripts where you have six, seven or eight joins and you're selecting 10 different column names, it actually is very useful and very important. So let's get into how that actually works and then I'll have an example later of how we can use aliasing with a little bit of a larger query. So in this table, let's select first name and execute. What we want to do is just write as and let's do fname and all that's going to do is it's going to rename this column from first name which was originally named to fname. Now you can use as but you can also just get rid of that and do it exactly how I have it and it's still going to work perfectly. You can either use the as or you can not use it. I typically don't. I just put a space between the actual column and the alias. Let's look at an example of how this might actually be useful. So we have a first name and a last name in this column so what we're going to do is actually combine those. So let's do plus and let's add a space in there and let's do a plus and let's do last name. So this is going to take the first name add a space and then do the last name and we're going to do that as and let's do full name and let's execute this. So now we have a column called full name which is our alias. So we've combined the first name and the last name column into one single column and we've renamed it full name. If we had not used this alias at all it would have just said this which is no column name at all. We don't typically want that when we have an output. We want to give this column a name so that somebody who is actually looking at the script or who's looking at the output of the script actually understands what is contained within this column. So for that we're just going to keep it as full name. Now another time that you're often going to use aliasing in the select statement is when you're using aggregate functions. So in this table we have age so let's pull that up really quick. So we have age right here and let's actually just do the average age and when we execute this we're going to get no column name at 31. So we want to do is give it average age and when we do that we now have a column name and again you want to have a column name in case someone comes up behind you and is reading the scripts that they understand what this column is being used for. Now that we've looked at aliasing column names let's look at aliasing table names. It basically is the exact same thing. We're just going to write as and let's do demo for demographics and let's do demo dot and it's going to give us all of our options and we'll do employee ID. So when you alias in a table name when you are selecting in the select statement you actually need to preface your column name with a table name or the table alias dot and then employee ID and this is extremely important to do especially when you have a lot of joins that you're doing or you're selecting a lot of columns when you have several joins because it can get very very messy quick. So let's actually join this to employee salary and let's do that on demo dot employee ID is equal to sal dot employee ID. So now let's do demo dot employee ID comma sal dot and let's do salary. So looking at the script now is very clean is very easy to understand and that is what's so important with aliasing. If for example we took this off every time we wanted to reference this table we would have to put the entire table name and putting the entire table name is correct it just is very cumbersome and does not look clean at all and so using something like demo as an alias makes it a lot more easily readable and a lot more manageable when you're looking at it when you have a very long script. Let's look at this query where we're joining together three separate tables and after each table we have an alias for employee demographics we have a employee salary we have b and warehouse employee demographics we have c. Now unfortunately I have seen a lot of scripts that look exactly like this and this is what you do not want to do you do not want to use your aliasing to just write an a a b or a c that is very frowned upon when writing queries because it really doesn't give any context to what the table that you're referencing is and it gets really confusing as this query continues to grow and as you add more columns to your select statement it makes it more difficult to understand where those columns are coming from and so when I'm reading that I say select a dot employee ID okay what's a a is employee demographics so you really do not want to do that now let's look at an example of what it should look like so for employee demographics instead of having an alias of a I used demo for demographics for employee salary I use sal and for warehouse employee demographics I used where now this is not perfect by any means but in the select statement if you're just glancing at it you can easily understand which columns are coming from which tables so when I look at employee ID I know that's coming from employee demographics because I have a demo as the alias so it's a lot easier to understand and when you hand this query off to somebody it is going to be a lot easier for them to read through it and understand where those columns and those table names are coming from and so they will appreciate that in the long run so that is all I got that is aliasing again not a super tough subject but a really important one to understand especially as you start working in teams and as you start creating more and more complex queries you want to have it more organized and more easily readable and so it may not come into play with those really simple queries but again as you build out those more complex queries this becomes very useful I really hope you enjoyed this video if you did be sure to comment and subscribe below thank you so much for watching and I'll see you in the next video


That's undefeated team in the NFL. They go into week four. Sunday is the only undefeated team in the NFL. They come out continuing be the only undefeated team in the NFL. Jalen Hurts, absolute dog it seems like. This team is awesome to watch. This team has a coach that used to be with Indianapolis Colts. Takes a big shot there. Knows that he gets in in the middle of a rainstorm. Helmet to helmet collision, scores a tug, lets the ball come out late, gets up flexes on air everybody. Jalen's a guy and there was a lot of pressure going into the season. So I'm like incredibly proud of him and I'm pumped for this Eagles fan base.